As of January 1, 2015, if you have Original Medicare, ask your primary care provider about a new benefit to help manage your health care if you have two or more chronic health conditions. A chronic health condition is a health issue that may last at least 12 months, and places you at significant risk of death or functional decline.
The goal of this benefit is to provide you with access to high quality, coordinated care in order to maintain your health and functioning. This will help avoid the unnecessary duplication of services and prevent medical errors. If your primary care provider offers this service, his or her office will take behind-the-scenes steps to manage and coordinate your health care on a monthly basis.
The benefit essentially pays your primary care provider to more intensively keep track of how you are doing by making sure all of your health care providers are working together and sharing information about your care.
The main parts of the chronic care management benefit require primary care providers on a monthly basis to:
- Manage all your health issues by adopting procedures, including those designed to make sure you are getting preventive care services as frequently as recommended and to ensure that your medications are working well for you.
- Develop and update an in depth care plan for all of your health care issues. The plan must be based on a comprehensive assessment of your overall condition that looks at your physical, cognitive, and mental health, as well as your living situation, your ability to function safely in that setting, and community supports or resources you receive. You must get a copy of the care plan.
- Coordinating your care and making sure your various providers share your health records and information on an ongoing basis and after emergency department visits or stays in a hospital, skilled nursing facility or other health care facility.
- Having the same doctor or other primary care practitioner each time you have an appointment.
- Allowing you round-the-clock access to a provider in the practice for urgent health care needs.
If your primary care provider offers this new Part B benefit, you will owe 20% of the cost of the benefit each month you receive it. Before providing this service, your primary care provider must tell you about it and obtain your permission to participate and to exchange information about your health with your other providers.
This benefit is separate from the care coordination you are entitled to after an inpatient hospital or skilled nursing facility (SNF) stay.