AMGA Supports Newly Introduced Legislation on Eliminating Cost-Sharing Requirements for Chronic Care Management Services

June 26, 2019
On Tuesday, the American Medical Group Association expressed public support for the introduction of legislation in the House of Representatives intended to end cost-sharing requirements for chronic care management services

In a press release published on June 25, the Alexandria, Va.-based American Medical Group Association (AMGA), which represents more than 175,000 U.S. physicians, through their medical group organizations, expressed support for legislation introduced on Tuesday that would eliminate co-pay requirements for Medicare patients receiving chronic care management services.

“AMGA encourages Congress to swiftly pass legislation introduced yesterday to eliminate beneficiary cost-sharing requirements for chronic care management (CCM) services,” the press release began. “AMGA applauds the work of Rep. Suzan DelBene (D-WA), who drafted the legislation to improve a tool which our members can use to support the care management services that are a key aspect of treating chronic illnesses.”

The press release quoted AMGA president and CEO Jerry Penso, M.D., as saying that “Medicare beneficiaries with chronic diseases face so many challenges. While it may not seem like much, removing the cost-sharing requirements for these services will allow patients to focus on their treatments and care without worrying about their out-of-pocket expenses,” Dr. Penso said.

The press release noted that, “In 2015, the Centers for Medicare & Medicaid Services began paying for CCM under a separate code to reimburse providers for non-face-to-face care management in the Medicare Physician Fee Schedule. AMGA strongly supported the creation of the CCM code, which reimburses providers for services outside of an office visit to help individuals with two or more chronic conditions follow their medical care plan, practice preventive health care, and more effectively manage their health. The code covers services such as care management, medication management, and preventive health counseling, among others. AMGA members provided such care before the creation of the code, which was developed in recognition of the need to support the ability of providers to deliver such treatment.”

The press release went on to note that, “Creating a separately billable code, however, resulted in new beneficiary cost-sharing obligations, which contribute to low utilization of the code. For example, only about 648,000 Medicare beneficiaries received CCM services during the first two years of the code’s availability. AMGA has recommended that Congress eliminate the cost-sharing requirement to help fulfil the code’s potential and remove an unintended barrier to its use. AMGA appreciates that Rep. DelBene recognized the need for reform and strongly endorses her legislation. Congress should enact this legislation as quickly as possible.”

“AMGA would like to thank Rep. Suzan DelBene for her leadership on this issue,” Penso added in his statement. “Her efforts to further this legislation demonstrate a commitment not only to patients with chronic disease, but the providers who are working to deliver the best possible care to them.” The association had sent a letter to Rep. DelBene (D-Wash.) on Monday, thanking her for her sponsorship of the legislation.