Through the Medicare Care Choices Model (MCCM), the Centers for Medicare & Medicaid Services (CMS) will test a new option for Medicare beneficiaries to receive supported care services from selected hospice providers, while continuing to receive services provided by other Medicare providers, including care for their terminal condition. CMS will evaluate whether providing these supportive 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 Medicare payment for care related to their terminal condition in order to receive services under the Medicare or Medicaid hospice benefit.
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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Recent MedPAC reports indicate that fewer than half of eligible Medicare beneficiaries use hospice care and most only for a short period of time. Currently, Medicare beneficiaries are required to forgo Medicare payment for care related to their terminal condition in order to receive access to hospice services.
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.
Through MCCM, CMS will study whether access to such services will result in improved quality of care, and improved patient and family satisfaction, and whether there are any effects on use of health services and the Medicare or Medicaid Hospice Benefit.
The target population for the Medicare Care Choices Model is Medicare beneficiaries and Medicaid beneficiaries with Medicare coverage (‘dually eligible beneficiaries’), who are eligible for either the Medicare or Medicaid hospice benefit. Also, to be eligible, beneficiaries must not have elected the Medicare (or Medicaid) hospice benefit within the last 30 days prior to enrolling in the model. Other Model requirements include living in a traditional home (no institutional care); having Medicare Parts A and B for the 12 months prior to enrolling in the model (no Medicare managed care plan during that 12 months); having a diagnosis of one of the following terminal illnesses – advanced cancer, chronic obstructive pulmonary disease, congestive heart failure, or human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS); and living in the service area of a hospice selected to participate in the model.
Under the model, participating hospices will provide services 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. Model services are available around the clock, 365 calendar days per year. CMS pays a per-beneficiary per-month (PBPM) 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. Participating hospices were randomly assigned to one of two cohorts. The first cohort began providing services to beneficiaries on January 1, 2016, and the second cohort began providing services on January 1, 2018.
Questions about the Medicare Care Choices Model can be sent to CareChoices@cms.hhs.gov.