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Health Law

Access to Better Care Act to Reduce Deductibles for Managing Chronic Illness

The Access to Better Care Act of 2016, H.R. 5652, is currently sitting in the Congressional Ways and Means Committee. Introduced by Representatives Diane Black (R-TN) and Earl Blumenauer (D-OR) on July 7, 2016, with bi-partisan and industry support, this bill seeks to change insurance coverage related to care of chronic disease. The bill seeks to add a safe harbor to the definition of a high-deductible health plan to allow Medical Management of Chronic Disease to be covered without a deductible.



Defining Chronic Condition/Disease

A Chronic Condition or Disease means a condition or disease that is expected to last for more than one year, limits what a person can do, and requires ongoing medical monitoring Medical Management of Chronic Disease means medical care for which the primary purpose is managing a Chronic Condition or Disease by preventing the onset of, further deterioration from, or complications associated with such chronic condition or disease.


Effect of H.R. 5652 Passing

If this bill passes, it means that individuals with high-deductible health insurance plans could see increased coverage for medical care needed to manage chronic illness, such as diabetes. Under current treasury regulations, preventative care services already have a safe harbor allowing such services to be provided without any deductible.  Such preventive care includes periodic health evaluations, routine prenatal and well-child care, immunizations, tobacco cessation programs, obesity weight-loss programs and screening services. However, care intended to treat or manage an existing illness, injury or condition is exempted from this preventative care safe harbor. If H.R. 5652 passes, that will change, and Americans with chronic illness will have reduced out-of-pocket costs and thus more affordable access to preventative care services and other treatments associated with managing chronic disease.


According to a recent article in Modern Healthcare, “The American Heart Association, consumer group Families USA and pharmaceutical companies Pfizer and Merck & Co. are among groups that have endorsed the bill. Even AHIP and Blue Cross and Blue Shield Association, which represent the largest health insurance companies in the country, have lent their support.”


Increasing access to preventative care services could help millions of Americans reduce chronic illness and the costs associated with the long-term care required to manage it. Continue following the Allen & Gooch blog as we bring you the latest updates on this and other health law legislation.

Allen & Gooch is providing this legal update for informational purposes only. This article should not be construed as legal advice or a legal opinion as to any specific facts or circumstances. You should consult your own attorney concerning your particular situation and any specific legal questions you may have.