The Atlanta Journal-Constitution
Medicare adds benefits for chronically ill
Home wheelchair ramps, hot meals among services.
WASHINGTON — Congress and the Trump administration are revamping Medicare to provide extra benefits to people with multiple chronic illnesses, a significant departure from the program’s traditional focus that aims to create a new model of care for millions of older Americans.
The changes — reflected in a new law and in official guidance from the Department of Health and Human Services — tackle a vexing and costly problem in American health care: how to deal with long-term illnesses that can build on one another, and the social factors outside the reach of traditional medicine that can contribute to them, like nutrition, transportation and housing.
To that end, the additional benefits can include social and medical services, home improvements such as wheelchair ramps, transportation to doctor’s offices and home delivery of hot meals.
The new law is a rare instance of bipartisan cooperation on a major policy initiative, embraced by members of Congress from both parties.
The changes are also supported by Medicare officials and insurance companies that operate the fast-growing Medicare Advantage plans serving one-third of the 60 million Medicare beneficiaries.
“This is a way to update and strengthen Medicare,” said Sen. Ron Wyden, D-Ore., an architect of the law, the Chronic Care Act, which was included in budget legislation signed recently by President Donald Trump. “It begins
a transformational change in the way Medicare works for seniors who suffer from chronic conditions. More of them will be able to receive care at home, so they can stay independent and out of the hospital.”
Half of Medicare patients are treated for five or more chronic conditions each year, and they account for threefourths of Medicare spending, according to Kenneth Thorpe, chairman of the health policy department at Emory University.
Under the new law and Trump administration policy, most of the new benefits will be reserved for Medicare Advantage plans, which will be able to offer additional benefits tailored to the needs of people with conditions such as diabetes, Alzheimer’s, Parkinson’s disease, heart failure, rheumatoid arthritis and some types of cancer.
“This is a big win for patients,” said Seema Verma, administrator of the Centers for Medicare and Medicaid Services.
Officials hope that combining social and medical services will produce better outcomes for patients and save money for Medicare.
“An inexpensive railing in the bath can avoid a fall that can cause a hip fracture and potential complications,” said David Sayen, who worked at the Medicare agency for 37 years.
Medicare Advantage plans must cover all the services the original Medicare program covers except hospice care, and many offer extra benefits as well. Until now, the government has generally required each Medicare plan to offer the same benefits with the same cost-sharing to all beneficiaries.
The Trump administration has reinterpreted the “uniformity requirement” to allow different supplemental benefits for people with different medical needs. Congress went further and allowed Medicare officials to waive those requirements for patients with chronic illnesses.
Moreover, Congress allowed Medicare plans to offer a wider array of supplemental benefits to the chronically ill, eliminating the current requirement that the extra benefits must be “primarily health-related.”
John Lovelace, president of government programs at UPMC Health Plan in Pittsburgh, said the extra benefits could include visits by a personal assistant to help with bathing and dressing; visits by a nurse or a pharmacist to make sure a Medicare beneficiary with a dozen prescriptions is taking the right medicines; and special supervised housing for a person with dementia who cannot be left alone.
John Gorman, a former Medicare official who is a consultant to many insurers, predicted rapid growth in the use of high-tech pill dispensing machines, remote monitoring of homebound people and tele-health services to connect patients with doctors hundreds of miles away.
The Chronic Care Act provides new financial incentives for the use of tele-health services, including coverage for stroke patients in traditional Medicare as well as Medicare Advantage.
David Certner, the legislative policy director of AARP, the lobby for older Americans, said his group supports the idea of allowing greater coverage for supplemental benefits, including non-medical services that can improve care. “We believe such coverage should be available under both Medicare Advantage and traditional Medicare,” he said.
Sarah Szanton, a professor at Johns Hopkins University, developed an experimental program that provided 1,000 low-income Medicare beneficiaries with extra services, including several visits from a nurse, an occupational therapist and a handyman who did minor home repairs and modifications. These services, she said, saved Medicare an average of $22,000 a year for each beneficiary, keeping people safe at home and avoiding hospital and nursing home admissions.