Fact Sheets

Medicare Care Choices Model

Medicare Care Choices Model

Overview
Today, the Centers for Medicare & Medicaid Services launched an initiative to develop innovative payment systems to improve care options for beneficiaries by allowing greater beneficiary access to comfort and rehabilitative care in Medicare and Medicaid. The Medicare Care Choices Model will test improvements to certain Medicare beneficiaries’ quality of life while they are receiving both curative and palliative care.

“The Medicare Care Choices Model empowers clinicians and patients with choices.  Specifically, clinicians, family members, and caregivers in this model will no longer need to choose between hospice services and curative care,” said Patrick Conway, M.D., deputy administrator for innovation and quality and CMS chief medical officer.  

“This initiative represents a fundamental change in the way health care is delivered,” said U.S. Sen. Ron Wyden of Oregon, who authored the provisions that established the model. “Patients and their families should have every choice available to them when faced with life-threatening illness. Allowing Medicare coverage to continue while under hospice care means that patients no longer have to make a false choice between hospice and curative care.”

The Medicare Care Choices Model provides a new option for Medicare beneficiaries with advanced cancers, chronic obstructive pulmonary disease, congestive heart failure and HIV/AIDS who meet hospice eligibility requirements under the Medicare hospice benefit, to receive palliative care services from certain hospice providers while concurrently receiving services provided by their curative care providers.

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 and patient and family satisfaction, and whether there are any effects on use of curative services and the Medicare hospice benefit.

Purpose
According to Medicare claims data, only 44 percent of Medicare patients use the hospice benefit at the end of life, and most use the benefit for only a short period of time.  This model enables beneficiaries to receive palliative care services that are provided by the Medicare Care Choices Model participating hospice concurrently with services from their curative care provider.

Eligible Organizations
The applicant 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.

Payment Model
Hospices that apply and are selected to participate in Medicare Care Choices Model will provide services available under the Medicare hospice benefit for routine home care and inpatient respite levels of care that cannot be separately billed under Medicare Parts A, B, and D.  These services must be available 24/7, 365 calendar days per year.  CMS will pay a $400 per beneficiary per month fee to the Medicare Care Choices Model participating hospices for these services.  Providers and suppliers furnishing curative services to beneficiaries participating in Medicare Care Choices Model will be able to continue to bill Medicare for the reasonable and necessary services they furnish.

Application Process
Eligible hospice organizations interested in participating in this model must submit the application materials as provided in the link below.  Applications are due no later than June 19, 2014.

For application materials, please see the following: http://innovation.cms.gov/initiatives/Medicare-Care-Choices.  

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