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AMDA Fact Sheet on S.1340 and H.R. 2244
Geriatric Assessment and Chronic Care Coordination Act
AMDA Fact Sheet on S.1340 and H.R. 2244
Geriatric Assessment and Chronic Care Coordination Act
Geriatric Assessment and Chronic Care Coordination Act of 2007
S. 1340 Introduced on May 9, 2007 by Senator Blanche Lincoln (D-AR)
H.R. 2244 Introduced on May 9, 2007 by Representative Gene Green (D-TX)
Issue
The Geriatric Assessment and Chronic Care Coordination Act was introduced in the 110th Congress by Senator Blanche Lincoln of Arkansas and by Representative Gene Green of Texas. Prior versions of the bill failed to pass in the 108th and 109th Congress. AMDA supported prior versions of this bill
The current bill has been updated to include the following changes:
- Change in the title of the bill and language on “chronic care management” to “chronic care coordination”. The reasoning is that the word management may have been misconstrued as applying to disease management. The new wording reflects the coordination of care for multiple disease and multiple functions.
- Removal of settings from the list of settings that an individual can reside in to be eligible for the benefit. Hospice, SNFs, and NFs are removed. It was felt that there already are regulations in place for these settings on this topic. In addition, generally, there was a need to limit the number of settings for the benefit to cut down on the scoring of the bill.
Legislative Summary from Senator Lincoln’s Office
The Geriatric Assessment and Chronic Care Coordination Act extends Medicare coverage to include geriatric assessment and chronic care coordination.
The geriatric assessment will include a comprehensive history and physical examination as well as the individual’s clinical and functional status, social and environmental functioning, and need for care giving. Also, it will require the use of standardized clinical tools to measure cognition, environmental needs, and functional status. The geriatric assessment will only be conducted by a physician, a practitioner under the supervision of a physician or another provider that meets conditions by the Secretary. The assessment will result in the development of a written care plan that identifies problems, outlines therapies, assigns responsibility for actions, and indicates whether the individual will benefit from chronic care coordination. It also serves a basis for the chronic care coordination plan. Annual assessments may be performed more frequently if deemed medically necessary due to a significant change in condition.
Eligibility for the geriatric assessments are those identified by the Secretary as eligible for the assessment. Eligible individuals must have at least one chronic condition, multiple chronic conditions or dementia, or those with medical costs in the top 10% of Medicare beneficiaries. The bill excludes individuals who are receiving hospice care, residents in a skilled nursing facility, nursing facility, and patients with end stage renal diseases.
The term chronic care coordination means services that are furnished to each eligible individual by a chronic care manager chosen by the individual. The manager will prescribe a plan of care to coordinate the chronic care needs of the individual.
Services include the following:
- Development of a care plan;
- Management of and referral to medical and other health services, including inter-disciplinary team conferences;
- Management with principal nonprofessional caregiver in the home;
- Medication management;
- Patient and family caregiver education and counseling;
- Self-management services;
- Telephone consultations, including 24-hour telephone availability;
- Management and facilitating transitions across settings, including advance directive; and
- Information about and referral to hospice care and community services.
The chronic care manager must be a physician, physician assistant, nurse practitioner, clinical nurse specialist, and/or a clinical social worker. If care is provided by any provider other than a physician, the provider must work under the supervision of a physician. The care manager will advocate for the individual by providing ongoing support. They will also use evidence based medicine to guide decisions and monitor the status of patients using health information technology. In addition they will be there to encourage the patients and guide the implementation of the plan of care.
An individual that meets the requirements for the geriatric assessment and the provider performing the assessment determine if the individual is likely to benefit from care coordination at that point they may elect to participate in the services.
Physicians providing the assessments will have to comply with practice guidelines put forth by the Department of Information Technology. These include maintaining a team of professionals and allowing for appropriate communication with patients via telephone and email. These guidelines also contain special provisions for rural providers.
The proposed legislationdirects the Secretary of Health and Human Services to study and report to Congress on how effective different payment methodologies are with respect to the chronic care coordination services developed and implemented under this legislation. Report the effectiveness of pay-for-performance programs toward serving Medicare beneficiaries with multiple chronic conditions and the process measures and outcomes for evaluating Medicare beneficiary quality of care.
Providers of either the geriatric assessment or care coordination may submit for payment as they would for any other Medicare benefit.
Various conditions and trends lead to the introduction of this proposed bill. The Congressional Budget Office estimates that 43% of Medicare costs are induced by 5% of Medicare’s beneficiaries. The Geriatric Assessment and Chronic Care Coordination Act was introduced in an effort to improve the cost-effectiveness and overall delivery of health care to these high-risk elderly individuals by specifically paying for certain physician services, and encouraging health care professionals to integrate and coordinate their services.
Supporting Organizations:
The impetus behind the Geriatric Assessment and Chronic Care Coordination Act is the American Geriatrics Society. The following organizations support the current version of this bill:
- AGS Foundation for Health in Aging
- American Academy of Physical Medicine and Rehabilitation
- Alliance for Aging Research
- Alzheimer’s Association
- American Association of Critical-Care Nurses
- American Association of Home Care Physicians
- American Academy of Family Physicians
- American College of Nurse Practitioners
- American College of Physicians
- American Geriatrics Society
- American Heart Association
- American Medical Directors Association
- American Nurses Association
- American Public Health Association
- American Society on Aging
- Association for Gerontology & Human Development in Historically Black Colleges & Universities
- Association for Jewish Aging Services
- Association of Directors of Geriatric Academic Programs
- Catholic Health Association of the United States
- Center for Medicare Advocacy, Inc.
- International Longevity Center USA
- National Academy of Elder Law Attorneys
- National Association of Nutrition and Aging Services Programs
- National Association of RSVP Directors
- National Committee to Preserve Social Security and Medicare
- National Council on the Aging
- National Health Policy Group
- National PACE Association
- National Rural Health Association
- Rosalynn Carter Institute for Caregiving
- Society for the Advancement of Geriatric Anesthesia
- The Society of Geriatric Cardiology
Status:
S. 1340—Referred to Committee on Finance.
H.R. 2244—Referred to Committee on Energy and Commerce and to the Committee on Ways and Means.
Co-Sponsors:
S. 1340—8 Co-sponsors
H.R. 2244—1 Co-sponsor
Last Updated: May 24, 2007
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