November 2015, Volume 1, Issue 11

New Medicare Care Choices Model Seeks to Expand Access to Palliative Care

Last Updated Wednesday, October 12th, 2016

On July 20, 2015, the Centers for Medicare& Medicaid Services (CMS) announced the 141 hospices that have been selected to participate in the new Medicare Care Choices Model (MCCM), a pilot program designed to expand patients’ access to palliative and hospice care.1 The new model provides clinicians, beneficiaries, and their families with greater flexibility in deciding between hospice care and active treatment when faced with life-limiting illness.2

Under current payment rules, Medicare and dually eligible beneficiaries have to forgo active treatment to receive palliative services under the Medicare or Medicaid Hospice Benefit.

According to the March 2015 Medicare Payment Policy Report to Congress, only 47.3 percent of Medicare and 42 percent of dually eligible beneficiaries used hospice care and most only for a short period of time.3

With the MCCM, CMS is addressing this gap in care: Medicare beneficiaries with certain life-limiting illnesses can elect to receive supportive hospice or palliative care services and active treatment concurrently.

“This model empowers clinicians, beneficiaries, and their families with choices and is part of our broader efforts to transform our health-care system into one that delivers better care, makes smarter payments, and puts patients in the center of their own care,” said Health and Human Services Secretary Sylvia M. Burwell. “We want to do what we can to help families find the care that is right for their loved one.”

Over the next two years, CMS will evaluate how well the MCCM increases access to supportive care services provided by hospice and whether it improves quality of life and patient/family satisfaction. The model is also designed to inform new payment systems for the Medicare and Medicaid programs.

Who Can Participate?

The MCCM will be phased in over two years. Participating hospices will be randomly assigned to phase one or phase two; services in phase one will start on January 1, 2016, and on January 1, 2018, for phase two. Originally, CMS anticipated that only 30 Medicare-certified hospices would be enrolled, and the model would be installed for only three years. However, “due to robust interest,” the model was expanded to more than 140 centers and the duration was extended to five years, according to a CMS press release announcing the participating centers.

The selected centers were chosen based on their responses to a Request for Application issued by CMS in May 2015. Applications were reviewed and scored by an expert panel in hospice care and model implementation; hospices with the highest scores were recommended to be included in the model.

The 141 hospices currently participating in the program will provide services available under the Medicare Hospice Benefit for routine home care and respite levels of care, but cannot be billed under Medicare Parts A, B, and D. For a list of the hospice services available under the MCCM program, see the FIGURE.

FIGURE. MCCM Services to Beneficiaries
  • Counseling services to the beneficiary and family that includes:
    • Bereavement
    • Spiritual
    • Dietary
    • Family support
  • Psycho-social assessment
  • Nursing services
  • Medical social services
  • Hospice aide and homemaker services
  • Volunteer services
  • Comprehensive assessment
  • Plan of care
  • Interdisciplinary group
  • Care coordination/case management services
  • In-home respite care

If the centers provide these services for 15 or more calendar days per month, they will be paid a fee of $400 per beneficiary per month; if services are provided under the model for fewer than 15 calendar days per month during the first month that the beneficiary is in the model, the hospices will be paid a $200 per-beneficiary/per-month fee.

An estimated 150,000 Medicare beneficiaries will be eligible to receive concurrent hospice and active treatments as a result of this expansion. Participation is limited to Medicare beneficiaries who have certain terminal illnesses (advanced cancers, chronic obstructive pulmonary disease, congestive heart failure, and human immunodeficiency virus/acquired immune deficiency syndrome) and meet the following criteria:

  • Satisfaction of hospice eligibility requirements under the Medicare or Medicaid Hospice Benefit
  • Satisfaction of MCCM-specific eligibility criteria
  • Have not elected the Medicare or Medicaid Hospice Benefit within the last 30 days prior to their participation in the MCCM

Beneficiaries will be able to refuse to participate in the model, and services provided under the model are not subject to a co-pay.

The Future of Palliative and Hospice Care

Will the MCCM be the turning point for incorporating palliative care and hospice services into patients’ treatment plans? It is too soon to tell, but if the MCCM proves successful, it could lead to a shift in the delivery of end-of-life health care.

Typically, patients obtain hospice and palliative services only when they are expected to have six months or less to live; the MCCM model will allow Medicare beneficiaries who elect to participate to receive these benefits earlier in their treatment plan.

In addition, the MCCM will potentially eliminate some of the burden on the health-care system. For instance, under the traditional hospice benefit, CMS reimburses approximately $160 per beneficiary, per day for hospice services – in contrast to the $200 to $400 per-beneficiary, per-month fee under the new model. The model is also expected to reduce hospital admissions, emergency department visits, intensive care unit days, and physician office visits, according to CMS.

There are, however, concerns that the MCCM does not include skilled and long-term care nursing centers, which often care for many Medicare beneficiaries nearing the ends of their lives. Health-care providers who treat older patients and those with life-limiting illnesses will also need to be trained in how to discuss these types of services with the patients and their surrogate decision-makers.

“With passage of the Affordable Care Act, we took one of the most important steps toward a more accessible and affordable health-care system in almost 50 years,” Sec. Burwell said. “With the new tools provided under the law, we have an opportunity to seize this historic moment to transform our health-care system into one that works for the American people.”


 

References

  1. U.S. Department of Health & Human Services, “CMS announces Medicare Care Choices Model awards.” Accessed October 17, 2015 from http://www.hhs.gov/news/press/2015pres/07/20150720a.html.
  2. CMS.gov, “Medicare Care Choices Model awards.” Accessed October 17, 2015 from www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-07-20.html.
  3. Medicare Payment Advisory Commission. “Report to the Congress: Medicare Payment Policy, March 2015.” Accessed October 17, 2015 from www.medpac.gov/-documents-/reports.
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