AHA, Others, Endorse the Chronic Care Management Improvement Act of 2023

April 25, 2023

We, the undersigned organizations, strongly endorse the Chronic Care Management Improvement Act of 2023 to ensure that more chronically ill Medicare patients receive access to high-quality care. By removing the patient cost-sharing obligations from the Chronic Care Management (CCM) code, millions of chronically ill Medicare beneficiaries stand to benefit from the care coordination and care management services the code supports.

Because CCM is a critical part of coordinated care, Medicare began reimbursing clinicians for primarily non-face-to-face chronic care management under a separate code in the 2015 Medicare Physician Fee Schedule. We continue to support this initiative to effectively manage chronic conditions and improve patients' health. Providers and care managers report many positive outcomes for beneficiaries who receive CCM services, including improved patient satisfaction and adherence to recommended therapies, improved clinician efficiency, and decreased hospitalizations and emergency department visits.

However, creating a separate billable code created a beneficiary cost-sharing obligation for care management services. Under current policy, Medicare beneficiaries are subject to a 20% coinsurance requirement to receive the service. This cost-sharing requirement creates a barrier to care, as beneficiaries are not accustomed to cost-sharing for care management services. The latest data reveals that only 4% of Medicare beneficiaries potentially eligible for CCM received these services. That amounts to 882,000 out of a potential pool of 22.5 million eligible CCM beneficiaries.ⁱ

We support your legislation to waive the beneficiary coinsurance to manage chronic care conditions and improve patients’ health more effectively and appreciate your leadership on this issue. Please let us know how we can be a resource to ensure that the coinsurance requirement is repealed so that more Medicare beneficiaries can benefit from coordinated care.

Sincerely,

__________

ⁱ https://aspe.hhs.gov/sites/default/files/documents/31b7d0eeb7decf52f95d569ada0733b4/CCM-TCM-Descriptive-Analysis.pdf