Geriatric and Chronic Care Management Act
Background
Shortly after the 109th Congress convened in January 2005,
Senator Blanche Lincoln (D-AR) and Representative Gene Green
(D-TX) reintroduced the “Geriatric and Chronic Care
Management Act” (S. 40/H.R. 467). This legislation would
provide Part B Medicare coverage for geriatric assessment
and care management for beneficiaries who have five chronic
conditions or who have one chronic condition in addition to
mental or cognitive impairment.
Geriatric assessment is defined in the legislation as an
assessment of an eligible individual’s medical condition,
functional and cognitive capacity, primary caregiver needs,
and environmental and psychosocial needs. Care management
services would include the following:
- development of a care plan
- multi-disciplinary team conferences
- coordination with other providers
- medication management
- patient and family caregiver education
- self-management services
- telephone consultations, including 24-hour telephone availability
- management of transitions across settings, including end
of life care planning
- referral to and coordination with community services
The Secretary of Health and Human Services (HHS) would determine
the payments for the geriatric assessment services under the
physician fee schedule. Care management payments would be
separate from the physician fee schedule and would be developed
by the Secretary of HHS upon consultation with physician and
patient associations. In addition, S. 40/H.R. 467 would require
an evaluation of the effectiveness of the payment methodologies,
the effectiveness of pay-for-performance models, and process
measures and outcomes for evaluating beneficiary quality of
care.
AAGP Position
AAGP strongly supports the “Geriatric and Chronic Care
Management Act.” It will help to correct the current
system’s disincentives for integrating and coordinating
health care, which, in turn, will provide for higher quality
health care and increased efficiency and cost-effectiveness.
This legislation recognizes that mental and cognitive impairment
among older adults makes it especially difficult for these
Medicare beneficiaries to manage their own care and reimburses
physicians and other health care professionals appropriately
for providing care management services. AAGP believes that
Medicare reimbursement of care coordination and assessment
services, as provided for in S. 40 and H.R. 467, will allow
geriatricians to manage medication effectively, work with
other health care providers as a team, and provide necessary
support for caregivers.
March 2005
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