CHRONIC Bill moves through Finance Committee

Senate Finance Committee recently passed the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017. This legislation is the product of several years of work by the committee to improve care for Medicare beneficiaries with chronic illness, whether they are served by traditional fee-for-service, Medicare Advantage plans, or Accountable Care Organizations.

What is most notable for the hospice community is not what’s in the bill, but what is not. Early drafts of this legislative package included a proposal to carve hospice in under the Medicare Advantage program. Thanks to the advocacy efforts of the hospice community, the committee opted not to include a hospice MA carve-in in this legislation.

The bill does, however, include a range of policies aimed at increasing home based care, advancing team based care, expanding innovation and technology, better identifying the chronically ill population, and empowering individuals and caregivers in care delivery. Many provisions in the bill are relevant to distinct provider groups and patient populations, such as ESRD patients or telehealth providers. Others, however, may be of particular interest to hospice and palliative care providers, including provisions that:

  • Extend the Independence at Home program, a physician and nurse-based model that allows seniors with multiple, complex, chronic conditions to receive specialized care at home from a team of providers. Some hospice and palliative care programs have developed relationships with IAH programs.
  • Allow an MA plan to offer a wider array of supplemental benefits to chronically ill enrollees. These supplemental benefits would be required to have a reasonable expectation of improving or maintaining the health or overall function of the chronically-ill enrollee and would not be limited to primarily health related services. This could be an opportunity for providers to work with MA plans to offer community based palliative care services.
  • Require the Government Accountability Office (GAO) to submit a report to Congress to facilitate a comprehensive plan of longitudinal care for a Medicare beneficiary diagnosed with a serious or life-threatening illness. GAO would study the extent to which such services are currently provided to beneficiaries, whether there would be any duplication with existing benefits, and any barriers to hospitals, skilled nursing facilities, hospice programs, home health agencies and other providers working with a Medicare beneficiary to engage in the care planning process. NHPCO would be sure to work with GAO on this important report.

While the Finance Committee passed the bill with unanimous approval, it is unclear whether the bill will find its way to the Senate floor in the near term. Senator Hatch has made clear his intent to keep the bill separate from other bills to repeal and replace the Affordable Care Act. As such, it could take some time for this bill to move through the process. NHPCO and HAN will be sure to carefully monitor and keep our members apprised about the progress of this legislation.

Questions? Comments? Contact the HAN team at