In December 2015, the Senate Finance Committee’s Bipartisan Chronic Care Working Group released a Policy Options Document. The Policy Options Document was issued as part of a process begun in May 2015 to develop legislation to address challenges facing Medicare beneficiaries with chronic conditions. According to a press release issued by the Committee, the Options Document “outlin[es] policies being considered as a part of the committee’s effort to improve how Medicare treats beneficiaries with multiple, complex chronic illnesses.
The paper organizes policies into several key areas under consideration:
- Providing high-quality health care in the home;
- Improving access to interdisciplinary, team-based health care;
- Expanding innovation in benefit design and access to technology;
- Identifying ways to improve payments and quality for the chronically ill population;
- Empowering patients and caregivers in care delivery.
The Center’s comments, drafted in conjunction with a number of other advocacy organizations, underscored the need to address significant barriers that exist within the Medicare program in order to truly address current gaps in coverage for individuals with chronic conditions. Building on comments previously submitted to the Committee in June 2015, the Center argued for, among other things, full implementation of the Jimmo v. Sebelius settlement, elimination of outpatient therapy caps, and the inclusion of oral health coverage in Medicare.
Since a number of the policy proposals in the Document focus on expanding access to care for individuals with chronic conditions who are enrolled in Medicare Advantage (MA) plans, the Center urged the Committee to focus on a level playing field between traditional Medicare and MA plans by ensuring that new policy proposals also apply in traditional Medicare. Further, the Center highlighted current challenges in accessing care by some individuals with chronic conditions within MA plans, including ongoing problems with appeals, and studies that continue to show that individuals who are poorer and sicker tend to disenroll from MA plans at a disproportionately high rate.
Specific Policy Proposals
Among comments that the Center provided concerning specific policy proposals, the Center expressed support for expanding the Independence at Home Model of Care, improving care management services, and addressing the needs for behavioral health among chronically ill beneficiaries.
Among the proposals about which the Center expressed concern is an effort to fold the hospice benefit into the Medicare Advantage (MA) program.
On one hand, doing so:
- could address problems for some MA enrollees who currently elect hospice but face full cost-sharing for services received in traditional Medicare; and
- such integration could provide an opportunity to create appeal rights where they don’t currently exist for beneficiaries and their families when they are denied care by a hospice agency.
On the other hand, incorporating the hospice benefit into the MA program:
- raises significant concerns about beneficiary autonomy with respect to making the decision to elect hospice services; and
- since most MA plans provide services through a limited network of providers, could compromise freedom of choice of provider for those who elect the hospice benefit.