WASHINGTON -- Sen. Chuck Grassley of Iowa and Sen. Bob Casey of Pennsylvania said today they hope to advance their proposal to make it easier for the residents of Continuing Care Retirement Communities to receive Medicare services through care coordination and disease management services provided onsite.  These services would avoid hospitalizations and lower the total cost of care for seniors as they age in place, and their needs increase.  

“The physician payments bill approved in committee depends on the creation of models where providers are willing to take on risk and provide quality care,” Grassley said.  “If nursing home communities are willing to meet those goals and standards, we should allow them that opportunity.  The Center for Medicare and Medicaid Innovation should be testing models like the one suggested in this amendment.”


“While Congress has taken steps to more toward better care coordination, we must continue to look for innovative ways to move the Medicare program forward when treating beneficiaries with multiple chronic conditions,” Casey said.  “I believe Continuing Care Retirement Communities (CCRC) in Pennsylvania and around the country are up to this challenge.”  

Grassley and Casey filed but not offer an amendment to the physician payments bill considered in the Finance Committee last week that would require the federal Center for Medicare and Medicaid Innovation to consider allowing Continuing Care Retirement Communities to receive Medicare services provided under a risk-adjusted, per-person payment arrangement.   Grassley and Casey said these arrangements could improve the efficiency and quality of senior care and align incentives to provide the right care, at the right time, in the right setting. 

Medical homes, care coordination and disease management are among the most promising strategies for cost containment and quality improvement in health care delivery, especially the costs associated with Medicare beneficiaries with chronic conditions, the senators said.  There are currently 2,000 Continuing Care Retirement Communities in the United States.  Recent studies, including one in the New England Journal of Medicine, demonstrate that a congregate senior living environment such as in Continuing Care Retirement Communities is the ideal setting to integrate strategies to lower costs and improve outcomes for Medicare seniors because of the near-constant interaction between staff and residents.

Under the Grassley-Casey proposal, the Continuing Care Retirement Communities would accept a diverse group of independent, non-acute seniors whose mix of chronic conditions could benefit from the care coordination and disease management services provided onsite to avoid hospitalizations and lower the total cost of care for seniors as they age in place and their needs increase.  An interdisciplinary health care team led by salaried primary care physicians would integrate comprehensive primary and post-acute health care services into the residential community and coordinate acute and specialist care.  Beneficiaries would receive Medicare services provided under a risk-adjusted, capitated payment arrangement.

Grassley and Casey said they will look for legislative opportunities to advance this proposal in the coming months.