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C-TAC Congratulates Chairman Hatch and Ranking Member Wyden on Passage of CHRONIC

May 25, 2017


The Honorable Orrin Hatch


Senate Finance Committee

United States Senate

Washington, D.C. 20510


The Honorable Ron Wyden

Ranking Member

Senate Finance Committee

United States Senate

Washington, D.C. 20510


The Honorable Johnny Isakson

United States Senate

131 Russell Senate Office Building

Washington, D.C. 20510


The Honorable Mark Warner

United States Senate

703 Hart Senate Office Building

Washington, D.C. 20510


Dear Chairman Hatch, Ranking Member Wyden, Senator Isakson and Senator Warner:

On behalf of the Coalition to Transform Advanced Care (C‑TAC), we would like to congratulate you on the unanimous passage of the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act.  We commend you and your Senate Finance Committee colleagues on your hard work and commitment to the development of bipartisan solutions to addressing the needs of the millions of Americans nationwide experiencing chronic conditions and advanced illness.

C-­TAC is a national non-­partisan, not‑for‑profit organization dedicated to ensuring that all those with advanced illness, especially the sickest and most vulnerable, receive comprehensive, high‑ quality, person-­ and family‑centered care that is consistent with their goals and values and honors their dignity.  C‑TAC is made up of over 150 national and regional organizations including patient and consumer advocacy groups, providers, health plans, faith‑based and community organizations, and others who share a common vision of improving advanced illness care in the U.S.

Despite living longer and healthier lives, many Americans will eventually develop some form of serious or advanced illness, which occurs when one or more medical conditions become serious enough that general health and functioning begin to decline, treatment may no longer lead to patient preferred outcomes, and care‑oriented toward comfort may take precedence over attempts to cure.  This is the population on which C‑TAC — and its innovative clinical model development — squarely focuses.

Evidence shows that the needs of those with advanced illness are not being met and their treatment and outcomes often times are inconsistent with their goals and preferences.  Americans want to avoid burdens on their families, receive care in the home or community setting, and maintain a high quality of life. In order to ensure high‑ quality care, we must continuously examine, document, and record individual goals, values, and treatment preferences. Without this crucial piece of information, individuals with complex chronic conditions or advanced illness are unable to receive care that aligns with their wishes. Furthermore, recent research shows that while 42 percent of individuals have had discussion on end of life issues, only 21 percent put their care directives in writing and 90 percent said that their physician never asked about this issue.

Overall, the CHRONIC Care Act well‑reflects the spirit C‑TAC’s approach to ensuring that all American’s have access to high‑quality advanced illness care by expanding options for persons to receive care in the home setting, improving care management for those with multiple chronic conditions, and developing quality measures for those with chronic conditions.  In summary, C-TAC supports each of the following policies described in the Act:

1. Expanding the Independence at Home Model of Care

C‑TAC strongly supports expansion of the Independence at Home care model and recommends establishing it as a permanent part of the Medicare program. The IAH model is an example of how a coordinated, team‑based care approach can improve the quality of care for Medicare beneficiaries. That being said, C‑TAC recommends that incentives be in place to ensure that care planning is supported for those eligible for IAH consistent with national best practices.

2. Providing Continued Access to Medicare Advantage Special Needs Plans for Vulnerable Populations

SNPs were originally introduced in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, which authorized the plans through 2008.  Subsequent legislation has extended SNP authority on four separate occasions, with the result being that SNPs are currently authorized through December 31, 2018.  Since 2006, the number of SNP enrollees has increased from 0.5 million to 2.1 million enrollees in 2016, and enrollment for dual eligible accounts for 82% of total enrollment in SNPs.  The CHRONIC Care Act would permanently authorize the I-SNP, D-SNP, and C-SNP programs if certain requirements are met.  C-TAC is strongly supportive of that pathway to permanent extension, as it would bring much-needed certainty to these plans that are specifically tailored to the most vulnerable Americans.

3. GAO Study on Serious or Life Threatening Illness

Importantly, the CHRONIC Care Act requires the GAO to conduct a number of studies on topics ranging from comprehensive care planning services under Medicare part B to improving medication synchronization. Studying the extent to which longitudinal comprehensive care planning is occurring, and the usage of the newly-developed CPT codes that allow physicians and other qualified health professionals is critical to ensuring that individuals facing advanced illness receive care that is consistent with their goals, values, and wishes.

4. Expanding Telehealth

We support the use of telehealth and/or other remote access technology as a valid method for patients and families to be in close contact with their medical providers, especially for a population that is particularly susceptible to the inconveniences of multiple visits to healthcare providers in the absence of this option.

Consistent with C‑TAC’s evidence‑based care model development, we also wish to highlight the bipartisan Care Planning Act (S. 1549) authored by Senators Isakson and Warner in the 114th Congress.  This critical legislation will test a person-centered team-based care approach for frail elders, would assist individuals with serious illness in making informed decisions about their care and ensure that treatment paths honor individual goals, values, wishes, and preferences. The legislation also would develop quality measures related to advanced illness, increase public awareness of advance care planning, enhance advance directive portability, and support studies to help develop enhanced standards of care.

Once again, congratulations on the unanimous passage of legislation that would improve care for those with multiple chronic conditions and those with advanced illness.  If we can be of additional assistance, please do not hesitate to contact C‑TAC’s Senior Policy Advisor, Andrew MacPherson, at AMacPherson@thectac.org or C‑TAC’s Regulatory and Legislative Counsel, Brad Wilhelm, at BWilhelm@thectac.org.


Andrew MacPherson

Senior Policy Advisor

1299 Pennsylvania Ave, Suite 1175

Washington, DC 20004

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