Bill Aims to Expand HDHP Coverage for Chronic Disease Management

The bill would permit high-deductible health plans (HDHPs) to provide chronic disease prevention and treatment—which some say is critical to reducing health care costs—prior to participants having met their deductible.

The Chronic Disease Management Act of 2018 has been introduced in both the Senate and House of Representatives.

The bill notes that a small number of chronic diseases account for the majority of health care spending in the U.S., and targeted interventions prevent the need for additional, more costly therapies for chronic diseases.

In the absence of an expansion to the preventive care safe harbor, whereby preventive care is covered before any deductible is met by a health benefit plan participant, the bill would permit high-deductible health plans (HDHPs) to provide chronic disease prevention and treatment, subject to certain limitations, prior to participants having met their deductible.

Specifically, the bill says, “A plan shall not fail to be treated as a high deductible health plan by reason of failing to have a deductible for care related to the treatment of any medically complex chronic condition which: is substantially disabling or life threatening, has a high risk of hospitalization or other significant adverse health outcomes, and requires specialized delivery systems across domains of care.”

The writers of the bill say amending regulations in this way promotes the concept of value-based insurance design. A report from UBS Wealth Management says value-based care is growing as a way to reduce health care costs for both employees and employers. In addition, a white paper from HealthyCapital suggests that effectively managing health conditions can save money for employees, and if that savings is invested in retirement plans, generate more income in retirement.

“We strongly support these efforts to address the real culprit in our health care system: rising costs,” American Benefits Council President James A. Klein says. “A principal problem is the high unit cost of health services and the disconnect between the price and the value of many services.”