Medicare Care Choices Model

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.

Background

Currently, Medicare beneficiaries are required to forgo curative care in order to receive access to palliative care services offered by hospices. This Model will test whether Medicare beneficiaries who qualify for coverage under the Medicare hospice benefit would elect to receive the palliative and supportive care services typically provided by a hospice if they could continue to seek services from their curative care 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 hospice benefit.

Initiative Details

The target population for the Medicare Care Choices Model is Medicare beneficiaries who are eligible for the Medicare Hospice Benefit and dual eligible beneficiaries who are enrolled in traditional Medicare and eligible for the Medicaid hospice benefit. Additionally, Medicare and dual 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. 

CMS will limit participation to beneficiaries with advanced cancers, chronic obstructive pulmonary disease, congestive heart failure and HIV/AIDS.

CMS will select at least 30 rural and urban Medicare certified and enrolled hospices that have demonstrated experience with an established network of providers for referrals to hospice. Preference will be given to hospices that can demonstrate experience in developing, reporting, and analyzing quality assurance and performance improvement data. Through selected hospices, CMS expects to enroll 30,000 beneficiaries throughout a 3-year period.

Eligibility and How To Apply

Parties interested in applying must be a Medicare certified and enrolled hospice. CMS seeks a diverse group of hospices representative of various geographic areas, both urban and rural, and hospices of varying sizes. Further, the applicant must be able to demonstrate experience providing coordination services and/or case management, as well as shared decision-making to beneficiaries prior to electing the Medicare hospice benefit in conjunction with their referring providers/suppliers.

Eligible hospice organizations interested in participating in this model must submit application materials no later than June 19, 2014. CMS will not accept applications by facsimile transmission or by email. Applications received after the deadline will not be considered. Applicants must submit their application in a manner that provides proof of timely delivery of their application.

Please note that the Request For Applications (PDF) now includes corrections to typographical errors and minor revisions to the Beneficiary Eligibility and Enrollment section. These revisions have been addressed correctly in the Frequently Asked Questions.

Additional Information

Questions about the Medicare Care Choices Model can be sent to CareChoices@cms.hhs.gov.



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