On April 26, Representatives Jeff Duncan (R, SC) and Suzan DelBene (D, WA) introduced legislation that would eliminate patient cost-sharing obligations from Medicare’s chronic care management (CCM) services. Representatives Duncan and DelBene originally introduced the same piece of legislation in 2021 but it failed to pass into law during the last Congress.
The Centers for Medicare & Medicaid Services (CMS) began paying for CCM services in 2015 under a separate code (99490) in an effort to reimburse providers for non-face-to-face care management services. In subsequent year, CMS expanded payment rules to include a broader set of CCM services and codes.
The CCM program was created to support the ability of providers to deliver such treatment care management services outside the face-to-face patient encounter. However, billable codes remained subject to the standard twenty percent patient cost-sharing obligation for Medicare beneficiaries, which has resulted in low utilization of the codes. According to CMS, only about 882,000, or four percent, of Medicare beneficiaries eligible for CCM have received these services.
Following the re-introduction of this bill, physician and provider specialty associations and trade groups have come out and publicly endorsed it. (See here and here for more details.)