By: Mindy Yochelson

  •  Health plans praise passage
  • Traditional Medicare, managed care, ACOs affected

(BNA) — Legislation intended to improve care for chronically ill Medicare beneficiaries through a potpourri of provisions was approved May 18 in a show of bipartisan support by the Senate Finance Committee.

Some will have a hard time believing that the committee was able to pass “major transformational Medicare reform” in the current political climate, Sen. Ron Wyden (D-Ore.), the committee’s ranking Democrat, said during the markup of S. 870.

But because “more than 90 percent of the Medicare dollar goes toward seniors who have two or more chronic conditions,” members realized the importance of the legislation, Wyden said.

Similarly, Finance Chairman Orrin Hatch (R-Utah) said it was remarkable that the committee passed the bill unanimously despite the “contentious nature of our nation’s current health-care debate.”

There is no immediate schedule to bring the measure to the Senate floor as a solo bill, committee aides told Bloomberg BNA. They said initial contacts have been made with House committees and that some of the provisions in S. 870 have been included in individual House bills.


The legislation would be paid for between 2018-2022 mostly through $370 million from the Medicare Improvement Fund, which is intended to make improvements for beneficiaries, according to a preliminary committee estimate from the Congressional Budget Office. Another $5 million would come from the Medicaid Improvement Fund.

The bill would cut direct spending by $217 million during that period, the estimate said.

The bill, a product of a committee working group, takes a broad approach to tackling high spending for chronic conditions. Changes are spread across fee-for-service Medicare, Medicare Advantage, and accountable care organizations.The provisions include extending and expanding an Affordable Care Act home care program, called Independence at Home, and would allow beneficiaries receiving home dialysis to get assessments through telehealth services.

MA Changes

It would permanently reauthorize MA special needs plans if certain policy requirements are met. The three types of SNPs are aimed at beneficiaries dually eligible for Medicare and Medicaid, those with chronic conditions, and those who are institutionalized.

Additionally, MA plans would be allowed to offer supplemental benefits to meet the needs of chronically ill enrollees.

The bill would expand the ability of MA plans and some ACOs to use telehealth services. ACOs would also have expanded ability to enroll beneficiaries through prospective assignment.


The committee approved an amendment that would allow Part D drug plan sponsors to obtain claims data under Medicare Parts A and B. The data could be used to optimize health-care outcomes through better medication use and improved care coordination.

Other amendments, including one by Sen. Benjamin Cardin (D-Md.) that would have repealed the therapy cap requirement, were put aside. The controversial caps impose a limit for beneficiaries on physical therapy, speech-language pathology, and occupational therapy. Congress has repeatedly extended an exception process that allows beneficiaries to receive an unlimited amount of rehabilitation services if medically necessary.

Health Plan Support

Health plan groups issued statements lauding the bill’s passage.

The Alliance of Community Health Plans said it was particularly supportive of the enhanced telehealth services and provisions on MA plans.

The National Association of ACOs said it appreciated “greater flexibility” accorded ACOs.

The Association for Community Affiliated Plans said permanently authorizing SNPs would help to lessen uncertainty by states that want to invest in integrated models for dual eligibles.

Source: Health Care Daily Report, Bloomberg BNA