Senate Passes CHRONIC Care Act of 2017

In October, the U.S. Senate passed the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017, which aims to improve care for seniors with chronic conditions. The Act would extend the Affordable Care Actenacted Independence at Home (IAH) demonstration for two years and increase the number of beneficiaries that can be included in the program from 10,000 to 15,000. The IAH demonstration, which was slated to expire on Sept. 30, provides shared savings incentive payments to medical teams providing high-quality home-based care to Medicare beneficiaries with multiple chronic conditions and functional limitations.

A key provision of the Act would make the Medicare Advantage (MA) Special Needs Plan (SNP) program permanent. SNPs, which are the only type of MA plans that can limit enrollment based on patient characteristics, include plans for beneficiaries eligible for both Medicare and Medicaid (known as dual eligibles, or duals — D-SNPs), those residing in medical institutions and those with chronic illnesses (C-SNPs). This provision would require enhanced coordination between states and the federal government for D-SNPs, especially for appeal and grievance protocols, while requiring all plans to have direct contracts with the states in which they operate. And, starting in 2020, care management strategies employed by C-SNPs would be subject to heightened standards, with the Centers for Medicare and Medicaid Services required to update the list of qualifying chronic conditions every five years. In addition, the Act would expand the array of extra benefits MA plans may offer to chronically ill beneficiaries, and allow plans to use rebates to add coverage for health-related services beyond the traditional, mandatory Medicare package when premiums are below the benchmark for the region.