Health Organizations Support Removing Cost-sharing from Chronic Care Management

June 25, 2019

The Honorable Suzan DelBene
2330 Rayburn House Office Building
Washington, DC 20515

Dear Representative DelBene,

We the undersigned organizations are writing to offer our strong endorsement of your legislation to ensure that more chronically ill Medicare patients receive access to the best care. By removing the costsharing obligations from the Chronic Care Management (CCM) code, more chronically ill Medicare beneficiaries will benefit from the care coordination and case management services the code supports.

CCM is a critical part of coordinated care, and as a result, Medicare began reimbursing physicians for CCM under a separate code in the Medicare Physician Fee Schedule. This code is designed to reimburse providers for non-face-to-face care management. We support this initiative to further manage chronic care conditions to improve the health of patients.

The creation of a separately billable code, however, 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. Consequently, only 684,000 patients out of 35 million Medicare beneficiaries with two or more chronic conditions benefitted from CCM services over the first two years of the payment policy.

We support your legislation to waive the beneficiary co-insurance amount to facilitate further managing chronic care conditions to improve the health of patients. Providers and care managers report several 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.

We appreciate your leadership on this issue. Please let us know how we can be a resource to ensure that this co-insurance requirement is repealed so that more Medicare beneficiaries gain access to providers who prioritize and coordinate care of the chronically ill.

Sincerely,

American Academy of Family Physicians
American College of Physicians
American Diabetes Association
American Medical Association
AMGA
American Osteopathic Association
America’s Physician Groups
Association of American Medical Colleges
Health Care Transformation Task Force
Healthcare Leadership Council
Medical Group Management Association
National Association of ACOs
Patient-Centered Primary Care Collaborative
Premier healthcare alliance