Recent Law Expands Coverage of Chronic Care Through Medicare

Q. My wife and I are considering moving to a home in a more rural part of the area, with more land and less traffic. It has been her dream to live away from the hustle and bustle of Northern Virginia for quite a while, but to still be close to the grandchildren. Among my concerns is access to medical care, since we will no longer as close to everything we need. Do you know if Medicare covers telehealth? Also, does Medicare cover non-medical, but much needed accommodations to our new home to make it safe, such as bathroom grab bars and a wheelchair ramp. I heard about the CHRONIC Care Act, but I’m not sure it will cover what we need, and when it will begin. Thanks very much!

A. Due to the recent passage of the CHRONIC Care Act (“Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care”), which became a law earlier this year, those enrolled in Medicare Advantage plans who have chronic illnesses will be covered for certain supplies and services not previously covered. The new benefits will begin in the year 2020.

The CHRONIC Care Act includes new telehealth measures, safety measures for the home, and services such as home meal delivery, at-home visits from personal assistants and pharmacists, and transportation to and from doctors’ visits.

When it comes to telehealth, Medicare has traditionally put barriers to services that could be provided over the telephone. But requiring a person with chronic illness to come to a doctor’s office every time he or she needs care or has a question has become inefficient and can be risky. That’s especially true in flu season and for people with weak immune systems. That’s where the new telehealth measures in the CHRONIC Care Act could make a huge difference.

What Else Does the CHRONIC Care Act Do?

Sixty percent of those with Medicare have a Medicare Advantage plan. For them, the law does the following:

  • Gives Medicare Advantage plans more flexibility so they can now cover “non-medical” benefits such as bathroom grab bars and wheelchair ramps for the chronically ill;
  • Makes more telehealth services (providing health care remotely through electronic means) available for Medicare Advantage members;
  • Expands telehealth services for people having stroke symptoms, covering the cost of a neurologist to remotely review CT scan images and recommend treatments, including the use of highly-effective clot-busting drugs;
  • Provides kidney disease patients with more access to home dialysis through telehealth;
  • Addresses lack of coordination between Medicare and Medicaid, which has caused much aggravation for patients. Before the law, Medicare wouldn’t issue a coverage denial letter for something it didn’t consider as a benefit, but without the letter, Medicaid also wouldn’t pay.
  • Promotes better coordination of services for people in Special Needs Plans (Medicare Advantage plans for people with particular diseases or characteristics) who also receive Medicaid.

The Independence at Home Program

Another group that will hopefully benefit from the new law are people enrolled in an Independence at Home program, a project of the Affordable Care Act. Such programs, operating at 14 sites around the country, are testing whether having doctors and nurses provide house calls for the chronically ill and disabled might improve care and cut costs. In our area, the program is operating through the Medical House Call Program at MedStar Washington Hospital Center in DC.

To participate in the Independence at Home program, beneficiaries must:

  • Have two or more chronic conditions;
  • Have coverage from original, fee-for-service (FFS) Medicare (not Medicare Advantage);
  • Need assistance with two or more functional dependencies (e.g., walking or feeding);
  • Have had a non-elective hospital admission within the last 12 months;
  • Have received acute or subacute rehabilitation services in the last 12 months.

Under the CHRONIC Care law, the number of patients in the program will expand from 10,000 to 15,000, and medical practices can participate in the program for up to seven years, instead of five. The program has proven in its early phases to be very successful, not just in its economic performance but really improving the lives of older adults. It has also helped caregivers, who bear the burden of caring for their serious needs.

According to the Centers for Medicare and Medicaid Services, Independence at Home has already saved Medicare a total of $7,821,374, an average of $746 per beneficiary, in its second year. On average, patients had fewer hospital readmissions and used inpatient hospital and emergency room services less for conditions such as diabetes, high blood pressure, asthma, pneumonia, and urinary tract infection.

What to do until 2020 when the CHRONIC Care Act begins?

With strong community support services, a senior can remain in his or her home safely. From aging-in-place technology to home modifications to support available in the community, we have written many articles with tips for seniors aging in their homes. To find the articles, visit https://www.farrlawfirm.com/?s=age-in-place or https://www.farrlawfirm.com/?s=aging-in-place. We also have trusted senior-serving professionals listed on our website, in case you need assistance. Hope these resources are helpful!

When Aging-in-Place is No Longer an Option

Most people want to stay in their home for as long as possible. However, if you or your loved one cannot live independently and are showing signs that living at home is a strain, it may be time to consider nursing care (or at least planning for it for the future).

It is always wise to plan ahead for when the need for nursing home care eventually comes. Life Care Planning and Medicaid Asset Protection is the process of protecting assets from having to be spent down in connection with entry into assisted living or nursing home care, while also helping ensure that you and your loved ones get the best possible care and maintain the highest possible quality of life, whether at home, in an assisted living community or in a nursing home. Please know that we are here when you need us — just call to make an appointment for a no-cost initial consultation:

Fairfax Medicaid Asset Protection Attorney: 703-691-1888
Fredericksburg Medicaid Asset Protection Attorney: 540-479-143
Rockville Medicaid Asset Protection Attorney: 301-519-8041
DC Medicaid Asset Protection Attorney: 202-587-2797

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