CMS tests providing hospice care without loss of curative services

CMS has announced that over 140 hospices have been selected to participate in the Medicare Care Choices Model. The 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.

Background

Under Section 1115A of the Social Security Act (as added by section 3021 of the Affordable Care Act) (ACA) (P.L. 111-148), the Center for Medicare and Medicaid Innovation may 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 quality of care.

Current hospice access rules

Medicare beneficiaries are currently required to give up curative care in order to receive access to palliative care services offered by hospices. The model is designed to give clinicians, beneficiaries, and their families greater flexibility in deciding between hospice care and curative treatment when faced with life-limiting illness.

Robust hospice interest

CMS planned to select 30 Medicare-certified hospices to participate in the model and enroll 30,000 beneficiaries throughout a three-year period. However, due to robust hospice interest, CMS invited over 140 Medicare-certified hospices to participate in the model and expanded the duration of the model to 5 years. This will enable up to 150,000 eligible Medicare and dually eligible beneficiaries to participate.

Services provided under 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. Services will be provided 24-hours a day, 365 calendar days per year. CMS will pay a monthly fee ranging from $200 to $400 per beneficiary to participating hospices for delivering these services.

Beneficiary requirements

To participate in the model, beneficiaries must: (1) be diagnosed with certain terminal illnesses, such as advanced cancers, chronic obstructive pulmonary disease, congestive heart failure and human immunodeficiency virus/acquired immune deficiency syndrome; (2) meet hospice eligibility requirements under the Medicare or Medicaid hospice benefit; (3) not have elected the Medicare or Medicaid hospice benefit within the last 30 days prior to their participation in the model; (4) receive services from a hospice that is participating in the model; and (5) have satisfied the model’s other eligibility criteria.

Two year phase-in

The selected Medicare-certified hospices come from both urban and rural geographic areas. One-half of the selected hospices will begin providing services on January 1, 2016. The remaining hospices will provide services under the model starting January 1, 2018. The model is slated to end on December 31, 2020. Hospices participating in the model will be randomly assigned to Phase 1 or Phase