Washington health policy watchers are obsessing now about who might run Donald Trump’s U.S. Department of Health and Human Services, who might really run the process for choosing his HHS secretary, and who else might whisper in his ear about health policy issues.
Meanwhile, outside Washington, baby boomers are still getting older, and sicker.
During the primary season, Trump himself talked briefly about Alzheimer’s disease and the need for more spending to find a cure.
Mike Pence, the vice president-elect, said during a vice presidential candidate debate in October that, “A society can be judged by how it deals with its most vulnerable. The aged, the infirm, the disabled and the unborn.”
A bipartisan team at the Senate Finance Committee has produced a discussion draft that the Trump administration could use to start conversations about how to help people with problems such as Alzheimer’s, diabetes and heart disease.
The draft of the “Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2016″ bill, includes a number of ideas for improving how Medicare handles enrollees who are living with chronic health conditions. Because Medicare is such a big, influential program, any new laws that affect Medicare could also shape how ordinary commercial insured plans and other non-Medicare plans handle chronic care issues.
The origins of the draft may provide some clues for health policy watchers wondering who the Trump administration will work with to get deals through Congress. Senate Finance Committee Chairman Orrin Hatch, R-Utah, released the draft together with Sen. Ron Wyden, D-Oregon, Sen. Johnny Isakson, R-Georgia, and Sen. Mark Warner, D-Virginia.
Isakson, a traditional Republican who fought off tea party challengers in the primary, won re-election with 55 percent of the vote last week. Warner was not up for re-election, but he represents a state that gave Hillary Clinton a narrow victory on a night that was difficult for Democrats.
Trump has expressed impatience with the Washington policymaking process. His administration could find, or create, unexpected shortcuts. But Republicans will start with only 52 seats in the Senate in the next Congress. They can get budget measures through the Senate with a simple majority vote, but, under current Senate rules, they would need at least 60 votes to get nominations and ordinary bills to the floor.
That means if the Trump administration operates within the current Senate rules, his team will have to attract the support of at least eight Democrats to get ordinary bills to the Senate floor.
For the Trump administration, backing a Senate Finance proposal that comes into the world with several Democratic sponsors might be a simple way to show it’s fighting congressional gridlock.
Here’s a look at some highlights from the CHRONIC bill draft:
The proposed CHRONIC Care Act of 2016 bill favors home health care. (Photo: iStock)
1. Home care
The Affordable Care Act promoted a shift toward home-based health care services, and away from heavy use of nursing home care.
The official Republican Party platform calls for efforts to support increased use of home care.
The CHRONIC bill reflects that broad interest in helping people with health problems stay in their own homes: It would extend the Medicare Independence Home Demonstration Program, and it would also expand the level of access that people with severe kidney disease have to dialysis therapy in the home.
The Medicare home care pilot program is now set to end Sept. 30, 2017.
The CHRONIC draft would keep the program going until Sept. 30, 2019, and it would increase the number of Medicare enrollees who could participate to 12,000, from 10,000 today.
Medicare requires enrollees getting dialysis services in the home to receive monthly clinical assessments. The CHRONIC draft would make meeting that monthly assessment requirement easier, by letting enrollees get the assessments through telehealth systems, without any geographic restrictions.
CHRONIC bill drafters are pushing the use of telehealth services. (Photo: iStock)
The CHRONIC draft includes many provisions that could increase Medicare enrollees’ access to telehealth services.
The draft would let the HHS secretary expand the list of telehealth services a Medicare Advantage plan can include in its bid proposal; let accountable care organizations get paid for providing telehealth services; and require Medicare to pay for telehealth consultation services, without geographic restrictions, for enrollees suffering from acute stroke symptoms.
3. Medicare enrollees’ risk scores
Medicare Advantage plans assign enrollees health risk scores. The Centers for Medicare & Medicaid Services (CMS), an arm of HHS, uses the risk scores when administering the Medicare risk-adjustment program, which affects how much cash an issuer gets from the federal government.
The CHRONIC draft would require CMS to use more years of medical history when calculating a Medicare Advantage plan enrollee’s health risk score. The draft would also have the HHS secretary look into the idea of adding other diagnosis codes to the scores. One suggestion is to consider adding mental health and substance use disorder codes to the risk scores of people with kidney disease.
CHRONIC bill drafters included an incentive for wellness initiatives. (Photo: iStock)
4. Care planning
The CHRONIC draft calls for the U.S. Government Accountability Office, a research arm of Congress, to look into the idea of having Medicare pay for a one-time care planning physician visit for an enrollee diagnosed with a serious health condition, such as Alzheimer’s, cancer or multiple sclerosis.
Lawmakers want the GAO to tell Congress whether a care planning benefit would duplicate any other benefit; what barriers to care planning now exist; and how feasible it would be to make a patient stick with the care plan developed.
The GAO would also look at developing ways to measure the quality of the care planning provided.
5. Wellness incentives
The CHRONIC draft would let a Medicare accountable care organization offer $20 incentive payments to accountable care organization enrollees who get high-value primary care services.
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