Chronic Care · Legislative Update · Medicare Policy
June 24, 2026
6 min read
H.R.8261
CCM
Medicare Copay
When practices discuss Chronic Care Management (CCM) enrollment with Medicare patients, one question comes up consistently: what will this cost me? Under current Medicare rules, beneficiaries owe a 20 percent coinsurance for CCM services, roughly $8 to $15 per month, for care coordination that happens entirely outside the exam room. That cost-sharing requirement is one of the primary barriers keeping eligible patients from enrolling. A bipartisan bill introduced on April 14, 2026 proposes to eliminate it entirely.
What H.R.8261 Would Do
Introduced by Representatives Suzan DelBene (D-WA) and Mike Kelly (R-PA), the bill would waive the 20 percent coinsurance Medicare beneficiaries currently owe for CCM services, the structured care coordination and between-visit support provided to patients with two or more chronic conditions expected to last at least 12 months.
The Enrollment Gap
The data cited by endorsing organizations including the American Hospital Association and AMGA illustrates the problem directly.
Source: AHA, AMGA endorsement letters, April 2026
Eligible but not enrolled
CCM utilization has grown since the program launched in 2015, from roughly 1 percent to around 4 percent, but has remained a small fraction of the eligible population. Cost-sharing is one identified reason. The confusion of being billed for a service that happens invisibly between appointments is another, patients often cannot connect a monthly statement to a specific interaction they recall, making the charge feel unexpected.
The Case for Removing the Barrier
A study commissioned by CMS and cited across endorsement letters measured Medicare spending for CCM enrollees compared to non-enrollees. The findings were consistent: enrolled patients cost Medicare less, and the gap widened over time.
The copay is not simply a dollar barrier. Patients being billed each month for services that happen between visits, with no visible face-to-face encounter to point to, creates confusion that compounds the cost disincentive. Removing cost-sharing addresses both problems at once.
The endorsing organizations note that CCM was intentionally created as a non-face-to-face service, that is by design, not a gap in care. The billing structure that emerged from its 2015 introduction, however, inadvertently created a cost-sharing obligation that patients experience as unexpected and confusing.
Who Is Behind the Bill
national healthcare organizations have endorsed H.R.8261
AMA
AAMC
AMGA
MGMA
AAFP
AARP
Premier Inc.
National Patient Advocate Foundation
“Removing barriers to chronic care management is key to lowering healthcare costs and delivering better results for seniors. Chronic health conditions account for 90 percent of national health care spending, yet too few seniors are receiving these incredibly impactful services.”
Rep. Suzan DelBene (D-WA), April 14, 2026
The bill is bipartisan by design, its sponsors come from opposite sides of the aisle, and the endorsing coalition spans hospitals, physician practices, specialty societies, and patient advocacy groups. Similar legislation was introduced in prior Congresses with comparable organizational support. H.R.8261 is the most recent iteration of a multi-year legislative effort.
What This Means for Practices Running CCM Programs
For practices currently offering CCM or evaluating whether to build a program, H.R.8261 matters for one practical reason: the copay question is often the first objection when staff introduce CCM to patients. Removing that friction could meaningfully shift enrollment conversations, particularly for patients on fixed incomes managing multiple healthcare costs.
H.R.8261 has been introduced and referred to committee. Track progress at Congress.gov and be prepared to update patient-facing enrollment materials if the bill advances.
Until it passes, the 20% coinsurance remains in effect. Patients with supplemental Medigap or dual Medicare-Medicaid coverage often have this offset already.
How DrKumo Supports CCM Program Delivery
DrKumo provides HIPAA-compliant digital health technology that supports the care coordination workflows at the center of CCM. The platform supports practices in delivering remote patient monitoring (RPM) alongside CCM, giving care teams both between-visit physiologic data and the structured coordination that CCM requires. For community providers and FQHCs and RHCs serving Medicare populations with high chronic disease burdens, having infrastructure in place before enrollment conversations happen is what determines whether a program scales or stalls.
DrKumo’s evidence-based Disease Management Protocols (DMPs) provide structured clinical pathways for the conditions most prevalent among CCM-eligible Medicare patients: hypertension, diabetes, heart failure, and COPD. If H.R.8261 advances and removes the cost-sharing barrier, practices with established CCM and RPM programs will be positioned to respond quickly to increased patient interest.
DrKumo is not a clinical entity and does not provide clinical services. Providers retain full clinical responsibility for patient care decisions.
Key Takeaways
H.R.8261, the Chronic Care Management Improvement Act of 2026, was introduced April 14, 2026 by Representatives DelBene and Kelly. It would eliminate the 20 percent Medicare coinsurance for CCM services. As of June 2026 the bill is in committee review and has not passed.
Only approximately 4 percent of the 22.5 million eligible Medicare beneficiaries are currently enrolled in CCM. Cost-sharing and patient confusion about billing for between-visit services are cited as primary barriers. CMS-commissioned research found Medicare spent $95 less per patient per month on CCM enrollees over 18 months.
More than 40 organizations including AHA, AMA, AMGA, MGMA, AAFP, and AARP have endorsed the bill. If it passes, provider billing rules and documentation requirements remain unchanged, only the patient coinsurance obligation would be removed.
Data-driven care starts here
Build the chronic care infrastructure your patients need between visits.
To learn how DrKumo can help your organization deliver secure, HIPAA-compliant remote patient monitoring and care management, contact us today. Our team is ready to support your journey toward better patient care.
Frequently Asked Questions
Questions about H.R.8261 and what it means for CCM enrollment and practice operations.
What is H.R.8261 and what would it change?
Has H.R.8261 passed?
Why do so few eligible Medicare patients enroll in CCM?
Does removing the copay affect how providers bill for CCM?
What does the current Medicare copay for CCM cost patients?
Can CCM and RPM be provided to the same patient?
References
- Congress.gov. (2026). H.R.8261, Chronic Care Management Improvement Act of 2026. 119th Congress.
- DelBene, S. (2026). DelBene, Kelly Introduce Bipartisan Bill to Increase Care Coordination for Seniors. U.S. House of Representatives.
- American Hospital Association. (2026). AHA, Others Express Support for Chronic Care Management Improvement Act of 2026. AHA.org.
- AMGA. (2026). AMGA Endorses Chronic Care Legislation Reform. AMGA.org.
- MGMA. (2026). MGMA Endorses Chronic Care Management Improvement Act. MGMA.com.
- American Academy of Family Physicians. (2026). Joint Letter of Support: Chronic Care Management Improvement Act of 2026. AAFP.org.
- Newsweek. (2026). Medicare Payments Would Change Under New Bill. Newsweek.com.
