By: Michelle M. Stein

The Senate Finance Committee on Thursday (May 18) unanimously passed bipartisan Medicare chronic care legislation that is the culmination of years of work on the issue, though lawmakers suggested the committee still needs to focus on some issues including ways to make the Independence at Home demonstration permanent. The bill as passed included a few tweaks, including new language giving practices more time to show savings through the Independence at Home demonstration, changing the definition of conditions a beneficiary can have to participate in a chronic condition special needs plan, and requiring additional studies from the Government Accountability Office and the Medicare actuary.

The bill includes a two-year extension of the Independence at Home demonstration, and changes in the chairman’s mark make it easier for practices to participate in the demonstration by giving them three years to demonstrate savings without a requirement that the practice also receives an incentive payment, rather than two as required by current law, according to a summary of tweaks to the legislation. As passed, the chairman’s mark also adds a requirement that the evaluation of the demonstration look at participating practices’ use of electronic health information systems, including remote monitoring, to the extent that information is available.

Sen. Rob Portman (R-OH) lamented the fact that the demonstration could not be made permanent, and blamed that on the Congressional Budget Office’s score.

“I wanted it to be permanent,” Portman said, adding that the committee settled on a two-year extension because of CBO — though he thinks the CBO score for making the demonstration permanent is misleading. Portman expressed hope that having the program in place for another two years will bring in data showing the initiative saves money. “My hope is we can get CBO to recognize the cost savings that come from this home-based program and this data will be helpful,” Portman said.

Finance Committee ranking Democrat Ron Wyden (OR) said he shares Portman’s views that lawmakers need to relentlessly focus on making the demonstration permanent, and said the program is on the “right side of history.”

The chairman’s mark also tweaked the definition of a chronic condition that would allow a beneficiary to participate in a C-SNP. The bill, as passed by the committee, calls for the C-SNP condition clinical advisory panel to include as conditions that make a beneficiary eligible to participate in a C-SNP those that require prescription drugs, providers and models of care that are “unique to a specific population of enrollees of a C-SNP” and where a C-SNP could help slow or halt the progression of a disease, improve outcomes or decrease beneficiary costs compared to other options. A condition that would allow for C-SNP participation could also be shared by those participating in the plan but uncommon in the general Medicare population, or one with a disproportionately high per-beneficiary cost.

The chairman’s mark also would modify the feedback HHS solicits on what telehealth procedures should be available through Medicare Advantage, and says MA plans must provide access to those services in person, as well, so that beneficiaries have a choice of how to receive their care.

The chairman’s mark also includes an amendment submitted by Sens. Bob Casey (D-PA) and Portman calling for HHS to consider the impact of looking at SNPs’ quality data reporting at a plan level on those that serve a disproportionate number of dually eligible beneficiaries.

The bill also calls for a GAO study, part of an amendment submitted by Sen. Maria Cantwell (D-WA), on state Medicaid programs’ work to rebalance duals’ long-term care from institutions to home and community-based settings, and the effect of those efforts on Medicare spending.

Also included in the chairman’s mark is an amendment by Sens. Tom Carper (D-DE) and Bill Cassidy (R-LA) requiring the Medicare actuary study long-term risk factors for the prevalence of chronic conditions in the Medicare population.

The committee also passed an amendment from Carper and Sen. Pat Roberts (R-KS) that would allow Part D plans to request Medicare Parts A and B claims data.

Lawmakers at the committee’s Tuesday (May 16) hearing on the bill praised its bipartisan nature, and many at the markup Thursday reiterated that praise. Wyden again touted the committee’s ability to pass what he called a major Medicare bill in this partisan environment. Committee Chair Orrin Hatch (R-UT) commended his colleagues, particularly Wyden and Sens. Mark Warner (D-VA) and Johnny Isakson (R-GA) who led the working group on the issue. However, he cautioned that “now is not the time to celebrate anything. We’ve got work to do.”