GENERATIONS – Journal of the American Society on Aging

The CHRONIC Care Act: Expanding Access, Extending Medicare’s Focus By G. Lawrence Atkins and Andrew L. MacPherson

The Act begins a shift toward building home- and community-based support for people with chronic conditions.

M edicare beneficiaries who live with multiple chronic conditions present the most com- plex array of care needs and rely heavily on medi- cal care, behavioral healthcare, and long-term services and supports (LTSS). Medicare beneficia- ries with four or more chronic conditions account for 90 percent of Medicare hospital readmissions, and 74 percent of overall Medicare spending (Bipartisan Policy Center, 2018). Despite the impact that chronic conditions have on health- care spending, there have been few major legisla- tive initiatives that have focused on improving outcomes and lowering costs for people living with chronic conditions. Recognizing this, a bipartisan group of law- makers worked to develop legislation to support better management of chronic diseases in pub- lic programs. Following a multi-year process with two-rounds of stakeholder input led by Senators Johnny Isakson (R-GA) andMarkWarner (D-VA), the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care

Act of 2018 was developed, introduced, and ulti- mately passed by the Congress. On February 9, 2018, the president signed the Bipartisan Budget Act of 2018 (Public Law 115-123) into law, which included as Title III the CHRONIC Care Act. Provisions of the CHRONIC Care Act The CHRONIC Care Act makes changes in the Medicare program in several areas; these changes are aimed at expanding access to high- quality care at home for beneficiaries living with one or more severe chronic conditions. The Act has two major areas of focus: improving access to primary care, and expanding opportunities for in-home supports and services. As stated above, one major focus of the Act is to encourage greater reliance on primary care, thus reducing unnecessary and avoidable medi- cal care and hospitalization. It does this by: √ Providing an opportunity for beneficiaries in traditional Medicare to choose to enroll in an Accountable Care Organization (ACO) and select

abstract The CHRONIC Care Act expands access to primary care and homecare for Medicare beneficiaries with multiple chronic conditions, and extends Medicare’s focus beyond medical treatment toward home support for people with chronic conditions. The Act includes a targeted, non-medical Medicare Advantage supplemental benefit option that is a test case for offering long-term services and supports–type benefits in Medicare. More needs to be done to build on the opportunities created by the Act to address unmet needs, especially functional assistance needs, of people with chronic conditions. | key words : CHRONIC Care Act, Medicare, Medicare Advantage, chronic conditions

28 | Spring 2019

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