Targets of Opportunity in Chronic Illness Care Policy

In the past few weeks, NCCC representatives made a series of Hill visits to assess health policy directions for the 107th Congress. Following are highlights of their findings and a refined NCCC legislative strategy.

Congress will talk about but not enact major Medicare reform legislation.

• Major Medicare reform is unlikely - mid-term elections, the war on terrorism, and budget deficits will dominate.
  
• Limited payment adjustments are likely - planned M+C, physician, and provider payment cuts won't stick.
  
• Minor structural reform shows promise - moderate congressional leadership want to do "something."
  
• Selected NCCC provisions are compatible - key congressional staff recommend inclusion in existing bills.

One or more of the following seven NCCC provisions could get folded into emerging bi-partisan legislation.
1. Address frailty issues in health status adjustment - part of the Medicare Chronic Care Improvement Act (MCCIA)
2. Hold harmless existing payment to specialized plans - part of the MCCIA
3. Demonstrate new M+C specialized plan payment method - part of the MCCIA
4. Demonstrate complex care supplement - a compatible, low-cost, fee-for-service effort
5. Demonstrate episodic care payment - a compatible, low-cost, fee-for-service effort
6. Require IOM study of barriers to chronic illness care - part of the MCCIA
7. Require MedPAC study on FFS complex care costs - a compatible, low-cost, fee-for-service effort

We will use the following principles as a guide to maintain focus and maximize our chances for success.

• Maintain the Medicare Chronic Care Improvement Act of 2001 as a framework for our 2002 legislative effort.
  
• Obtain targeted member support on key provisions to maximize our potential for success.
  
• Target provisions that show the greatest promise for inclusion in bills that are most likely to pass.
  
• Seek opportunities to promote our legislative agenda through congressional hearing.
  
• Complement this legislative agenda with a regulatory reform effort that emerges in conjunction with recommendations emanating from NCCC Working Session in March.
  
• Support other legislation, e.g., restoring payment rates and care management benefit, but maintain a narrow focus on NCCC priorities.