The CCM Copay Is the Quiet Reason Your Care Management Program Stalls. A New Bill Would Remove It.

The 20% beneficiary coinsurance on Chronic Care Management is one of the most underrated barriers to enrolling patients in CCM, and a bipartisan bill now in Congress would eliminate it. The Chronic Care Management Improvement Act of 2026 (H.R. 8261) would waive both the coinsurance and the Part B deductible for CCM services furnished on or after January 1, 2027. It is not law yet. But if you've watched eligible patients decline enrollment over a small recurring charge, the policy direction is worth understanding now, and the enrollment problem is solvable without waiting for Congress.

I run CCM in my own practice. I've also failed at it before, years ago, when I tried to hold the whole thing together on spreadsheets and didn't understand the documentation requirements well enough to defend it. So this is written from the operator's seat, not the vendor's.

What would H.R. 8261 change for CCM billing?

The bill removes patient cost-sharing for Chronic Care Management. It amends Section 1833 of the Social Security Act so that, for CCM services furnished on or after January 1, 2027, Medicare pays 100% of the allowed amount and the Part B deductible no longer applies. In plain terms, your CCM claims would carry no patient responsibility line.

The scope is narrow and you should represent it accurately to your team. The bill's text waives cost-sharing for "chronic care management services (as described in subsection (b)(8) of section 1848)," which is the CCM-specific definition. It is not a care-management-wide waiver. Remote patient monitoring, Advanced Primary Care Management, Principal Care Management, and Behavioral Health Integration are defined under separate provisions and keep their existing cost-sharing. If you tell referral partners or patients that "care management copays are going away," you'll be wrong and you'll create a billing dispute later. The honest line is: the CCM copay specifically would go away.

Why does a small copay block enrollment at all?

Because the charge is recurring, often invisible to the patient, and hard to explain. CCM is delivered largely as non-face-to-face work, so the patient gets a monthly bill for a service they never physically saw. That generates confusion, billing calls, and refusals.

The data is blunt. A 2022 federal analysis of 2019 Medicare fee-for-service claims found that only about 4% of potentially eligible beneficiaries received CCM, roughly 882,000 out of about 22.5 million eligible. McDowell et al., ASPE, 2022 The endorsing coalition behind H.R. 8261 points directly at cost-sharing as a driver: beneficiaries are billed for services that don't always involve seeing their provider, which reads as confusing, and many consider any added out-of-pocket cost untenable.

There's a cost-of-care argument too. A CMS-commissioned evaluation found Medicare spent about $95 less per patient per month for CCM patients over an 18-month period. Schurrer et al., CMS, 2017 That's the policy logic for waiving the copay: enrollment is low, the service appears to lower total spend, and the copay is a barrier sitting between the two.

How do I solve the copay objection before the bill passes?

You don't wait. The enrollment barrier is addressable now, through process. Here's the practical sequence we use.

1. Screen proactively for the two-chronic-condition threshold instead of waiting for patients to ask. Most eligible patients have never heard of CCM.
2. Explain the copay before the first bill arrives, not after. The refusals come from surprise, not from the dollar amount.
3. Check supplemental coverage. Many patients with a Medigap plan have the 20% covered already and don't realize it.
4. Frame CCM as the coordination layer, not an extra service. Patients accept the value when they understand someone is managing their conditions between visits.
5. Document the consent and the care plan cleanly. The compliance exposure in CCM is almost always thin documentation, not the copay.

The copay is real friction. It is not an unsolvable objection, and practices that handle the conversation well enroll patients today at copay rates that the bill would later zero out.

The harder part isn't the conversation. It's making the documentation defend itself once the patient says yes. Consent at enrollment, a care plan tied to the initiating visit, a monthly eligibility and conflict check, time logged to the activity and the person who did it. Miss any of those and the revenue turns into clawback liability. I got tired of policing it by hand, so I built a tool that enforces it, and I'm piloting it in my own practice right now. It's early. First month of billing just went out.

Why CCM is the front door to the rest of the care management stack

Here's the strategic point most practices miss. CCM isn't the destination. It's the entry point.

Once a patient is enrolled in CCM and the relationship is established, layering on the rest of the care management family becomes a clinical and operational extension rather than a cold start. Remote patient monitoring fits the same chronically ill population. Behavioral Health Integration addresses the depression and anxiety that ride alongside chronic disease. Principal Care Management covers the single-high-acuity-condition patients who don't meet the CCM two-condition bar.

Lowering or removing the CCM copay doesn't just help CCM. It widens the front door. Every patient who enrolls in CCM because the cost objection got smaller is a patient already inside your care management infrastructure, where the rest of the stack becomes a natural next step. If H.R. 8261 passes, that front door gets materially wider.

Is the bill likely to become law?

Unknown, and any honest assessment says so. The bill was introduced April 14, 2026, and referred to the Energy and Commerce and Ways and Means committees. It is at the start of the legislative process, and most bills introduced never reach a floor vote.

What's different here is the coalition. The bill is led by Reps. Suzan DelBene (D-Washington) and Mike Kelly (R-Pennsylvania), and more than 40 organizations have endorsed it, including the American Medical Association, the American Hospital Association, MGMA, the National Association of ACOs, and AARP. AHA, 2026 Bipartisan sponsorship plus a broad provider-and-patient coalition is the profile of a bill worth tracking.

Frequently asked questions

The copay is friction. The system is the program.

If H.R. 8261 passes, the CCM copay goes away and the front door gets wider. If it doesn't, the door is still open, just narrower, and the practices that learned to handle the copay conversation keep walking patients through it. Either way, the program that lasts is the one whose documentation defends itself. Build that first. The legislation, if it comes, is upside on top of a program that already works.

Dr. Wyzscx Patacxil, MD, CWSP

Physician-Owner, Mobile Health Providers

Dr. Patacxil is the physician-owner of Mobile Health Providers, a house-call primary care and advanced wound care practice serving patients across San Bernardino, Riverside, Los Angeles, and Orange counties. He treats homebound and mobility-limited Medicare beneficiaries in their homes, skilled nursing facilities, and assisted living communities. His clinical focus includes chronic wound management, chronic care management, and preventive medicine. He writes about wound care, aging, health technology, and what modern house-call medicine actually looks like.

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