Through the Medicare Care Choices Model, the Centers for Medicare & Medicaid Services (CMS) will provide a new option for Medicare beneficiaries to receive palliative care services from certain hospice providers while concurrently receiving services provided by their curative care providers. CMS will evaluate whether providing hospice services can improve the quality of life and care received by Medicare beneficiaries, increase patient satisfaction, and reduce Medicare expenditures.
Under current payment rules, Medicare and dually eligible beneficiaries are required to forgo curative care in order to receive services under the Medicare or Medicaid Hospice Benefit.
Fewer than half of eligible Medicare beneficiaries use hospice care and most only for a short period of time.
The model is designed to:
- Increase access to supportive care services provided by hospice;
- Improve quality of life and patient/family satisfaction;
- Inform new payment systems for the Medicare and Medicaid programs.
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Under Section 1115A of the Social Security Act (as added by section 3021 of the Affordable Care Act), the Center for Medicare and Medicaid Innovation is authorized to test innovative payment and service delivery models that have the potential to reduce Medicare, Medicaid or Children’s Health Insurance Program (CHIP) expenditures while maintaining or improving the quality of care for Medicare beneficiaries.
Currently, Medicare beneficiaries are required to forgo curative care in order to receive access to palliative care services offered by hospices. The model empowers clinicians, beneficiaries and their families with greater flexibility in deciding between hospice care and curative treatment when faced with life limiting illness.
This model will test whether Medicare and dually eligible beneficiaries who qualify for coverage under the Medicare or Medicaid Hospice Benefit would elect to receive the palliative and supportive care services typically provided by a hospice if they could continue to seek curative care from their providers. CMS will study whether access to such services will result in improved quality of care, patient and family satisfaction, and whether there are any effects on use of curative services and the Medicare or Medicaid Hospice Benefit.
The target population for the Medicare Care Choices Model is Medicare beneficiaries who are eligible for the Medicare Hospice Benefit and dually eligible beneficiaries who are enrolled in traditional Medicare and eligible for the Medicaid hospice benefit. Additionally, Medicare and dually eligible beneficiaries must not have elected the Medicare Hospice Benefit (or the Medicaid hospice benefit) within the last 30 days prior to participating in the model and satisfy all the eligibility criteria listed in the Request for Applications.
Participation is limited to beneficiaries with advanced cancers, chronic obstructive pulmonary disease, congestive heart failure and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS).
Participating hospices will provide services under the model that are currently available under the Medicare hospice benefit for routine home care and respite levels of care, but cannot be separately billed under Medicare Parts A, B, and D. Services will be available around the clock, 365 calendar days per year and CMS will pay a per beneficiary per month fee ranging from $200 to $400 to participating hospices when delivering these services under the model.
Due to robust interest, CMS has expanded the model from an originally anticipated 30 Medicare-certified hospices to over 140 Medicare-certified hospices and extended the duration of the model from 3 to 5 years. This is expected to enable as many as 150,000 eligible Medicare beneficiaries with advanced cancers, chronic obstructive pulmonary disease, congestive heart failure, human immunodeficiency virus/ acquired immunodeficiency syndrome who receive services from participating hospices to experience this new option and flexibility.
The model will be phased in over 2 years. Participating hospices will be randomly assigned to Phase 1 or Phase 2. Services will begin starting January 1, 2016 for the first phase of participating hospices and in January 2018 for the remaining participating hospices. Participating hospices will receive payment under the model through the standard Medicare claims process.
Questions about the Medicare Care Choices Model can be sent to CareChoices@cms.hhs.gov.
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