Expanding Home Dialysis Among Options in Draft Senate Bill

xpanding access to home dialysis therapy and a Medicare Advantage model that tests benefit designs are among the recommendations in a draft Senate committee bill to improve treatment for beneficiaries with chronic illness released Oct. 27.

The Finance Committee Chronic Care Working Group, headed by committee Chairman Orrin Hatch (R-Utah) and ranking member Ron Wyden (D-Ore.), has been working since May 2015 on ideas to improve care for beneficiaries with chronic conditions and save money.

Treatment for chronically ill beneficiaries with diseases like heart disease, diabetes and Alzheimer’s accounts for 93 percent of Medicare spending, the committee said.

The goal is to develop policies to manage disease, improve care coordination and reduce Medicare costs, Hatch said in a statement.

Bill Introduction

The bill is expected to be introduced when Congress reconvenes for a lame-duck session after the election. The Congressional Budget Office hasn’t estimated the cost of the legislation. It was released as a draft to allow other members to consider it before introduction.

The draft has about 15 recommendations including:

• extending the Independence at Home Model of Care that uses physicians and nurse practitioners for home-based primary care;

• expanding home dialysis by increasing the sites from which beneficiaries can get an assessment of their condition via telehealth;

• broadening the Medicare Advantage value-based insurance design model (known as V-bid) to MA plans across the county instead of specific states; and

• expanding the ability of MA plans and accountable care organizations to use telehealth.

Most physician groups contacted by Bloomberg BNA were still analyzing the draft.

Positive Reaction

AMGA, a national trade association for multispecialty medical groups based in Alexandria, Va., told Bloomberg BNA it appreciates the bipartisan efforts and the working group’s “very open door policy.”

Kidney Care Partners, a Washington-based coalition of patient advocates and kidney disease professionals, said the draft policies “will measurably improve access to quality care and expand treatment choice.”

Some of the working group’s ideas were in the Centers for Medicare & Medicaid Services proposed 2017 physician fee schedule rule. These included expansion of a diabetes prevention model and creation of a payment code for a visit to discuss a serious illness with a provider.

Hatch and the other working group leaders urged Health and Human Services Secretary Sylvia Burwell and acting CMS Administrator Andy Slavitt in an Oct. 27 letter to keep these provisions in the final rule, which may be out Oct. 28.

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