Introduction Of The Medicare Chronic Care Improvement Act
Mr. Speaker, today I join with several colleagues to introduce the Medicare Chronic Care Improvement Act of 2003. This legislation would strengthen Medicare in the truest sense, by improving the quality of care delivered to Medicare…
Mr. Speaker, today I join with several colleagues to introduce the Medicare Chronic Care Improvement Act of 2003. This legislation would strengthen Medicare in the truest sense, by improving the quality of care delivered to Medicare beneficiaries. The bill would make these improvements without forcing beneficiaries to leave the traditional Medicare program and join private insurance plans, and without restricting beneficiaries' choice of doctor, hospital, or other health care provider.
Medicare beneficiaries have significant chronic care needs. Nearly 90 percent of those aged 65 and older have one chronic condition and two thirds have two or more chronic conditions. Beneficiaries with five or more chronic conditions comprise 20 percent of the Medicare population, but they account for an astonishing 66 percent of program spending. On average, Medicare beneficiaries with chronic conditions see eight different physicians regularly.
Unfortunately, Medicare--like the rest of our health care system--is designed around acute care needs. We generally do not adequately compensate providers for on-going care such as the time spent communicating with each other around complex patient needs, monitoring for harmful drug interactions, or teaching patients and caregivers how to better manage their conditions. As a result, these crucial care coordination services are rarely provided.
President Bush and some of my Republican colleagues would have us believe that we can solve this problem by forcing seniors into private insurance plans. Simply put, that claim is ridiculous. The need for chronic care improvements is just as pervasive among private insurers and the rest of the health care system as it is in Medicare. That is why the National Academy of Social Insurance (NASI) Study Panel on Medicare and Chronic Care in the 21st Century concluded earlier this year that, ``Medicare has the potential to refocus its Medicare program--as well as the nation's health care system--and should take a leading role in improving chronic care.''
The Medicare Chronic Care Improvement Act would follow through on that expert recommendation. This bill provides the Medicare improvements that seniors and people with disabilities need by: Improving access to preventive and wellness services; expanding coverage for care coordination and assessment services for Medicare beneficiaries with chronic conditions; implementing a chronic care Quality Improvement Program; providing federal matching grants for clinical information technology systems that improve the coordination and quality of chronic care; ensuring that Medicare beneficiaries are not inappropriately denied coverage for services that are necessary to maintain health or functional status; commissioning an Institute of Medicine study and report on additional ways to ensure effective chronic care.
For more detail, I am entering a section-by-section bill summary into the Congressional Record following this statement.
The Medicare Chronic Care Improvement Act is supported by a variety of health organizations representing consumers and providers, including the Alzheimer's Association, the American Geriatrics Society, the Center for Medicare Advocacy, Families USA, the Medicare Rights Center, and the National Chronic Care Consortium.
The Medicare Chronic Care Improvement Act enjoys wide support because it strengthens Medicare for all beneficiaries, whether they are in traditional Medicare or private plans that contract with Medicare. Unlike the President's Medicare ``reform'' plan or plans being developing by Congressional Republicans, the Medicare Chronic Care Improve Act would never force elderly and disabled Americans to give up traditional Medicare in order to get crucial benefits. They will never be forced to choose between the doctors they know and trust and the coverage they need. Those are not real choices and will not improve the quality of care beneficiaries receive.
I urge my colleagues to support real Medicare reform by cosponsoring the Medicare Chronic Care Improvement Act.
Medicare Chronic Care Improvement Act of 2003
Representative Stark and Senator Rockefeller
title I--benefits to prevent, delay, and minimize the progression of
chronic conditions
Improve Access to Preventive Services: Eliminate all cost-
sharing (deductibles and co-insurance) for preventive
services that Medicare covers today; Direct the Secretary of
Health and Human Services (HHS) to contract with the
Institute of Medicine (IOM) to investigate and recommend new
Medicare preventive benefits every three years; Streamline
Medicare benefit improvements by granting the Secretary the
authority to expand Medicare coverage of preventive benefits
in accordance with IOM recommendations; Provide coverage for
a ``Welcome to Medicare'' initial preventive exam, in which
beneficiaries would receive initial preventive screening
tests, a physical exam, and discuss prevention and health
promotion with their doctors.
Expand Coverage for Care Coordination and Assessment
Services: Create a new care coordination benefit for Medicare
beneficiaries with chronic conditions; Examples of items and
services to be covered include: initial and periodic health
assessments; management and referral for medical and other
health services; medication management; patient and family
caregiver education and counseling; 24-hour access to care
coordinators; management of transitions across care settings;
information and referral to community-based services and
hospice care; other services and benefits specified by the
Secretary; Beneficiaries eligible for these benefits include
those with either a serious and disabling chronic condition
or four or more chronic conditions; Care coordinators
(including physicians, physician group practices, or other
health care professionals or entities) must be periodically
certified and must agree to participate in a quality
improvement program.
Implement Chronic Care Quality Improvement Program: Direct
the Secretary of HHS to establish a program to monitor and
improve clinical outcomes for beneficiaries with chronic
conditions. Under this program, the Secretary will establish
performance measures, collect data, and provide performance
reports to care coordinators and beneficiaries.
Improve Medicare+Choice for Beneficiaries with Chronic
Conditions: Require Medicare+Choice plans to provide care
coordination services and implement chronic care quality
improvement programs.
Improve Chronic Care Coordination through Information
Technology: Establish federal matching grants to support
clinical information technology systems development,
implementation, and training among Medicare-participating
care coordinators.
Ensure Proper Medicare Coverage Standards: Direct the
Secretary of HHS to review all Medicare coverage policies.
The Secretary must ensure that Medicare contractors properly
apply the Medicare statute and not demand a showing of
improvement to find that items or services are reasonable and
necessary.
title II--institute of medicine study on effective chronic condition
care
Recommend Medicare Improvements to Ensure Effective Care
for Beneficiaries with Chronic Conditions: Direct the
Secretary to contract with the IOM to investigate and
identify barriers and facilitators to effective care for
Medicare beneficiaries with chronic conditions, including
inconsistent clinical, financial, or administrative
requirements across care settings. The IOM report must
include recommendations to improve the provision of effective
care, including seamless transitions across health care
settings.
Definitions: ``Chronic condition'' means an illness,
functional limitation, or cognitive impairment that is
expected to last at least one year, limits what a person can
do, and requires on-going medical care; ``Serious and
disabling chronic condition(s)'' means the individual has at
least one chronic condition and has been certified by a
licensed health care practitioner within the preceding 12
months as having a level of disability such that the
individual, for at least 90 days, is unable to perform at
least 2 ADLs or a number of IADLs or other measure indicating
an equivalent level of disability or requiring substantial
supervision due to severe cognitive impairment.