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Medicare & Medicaid News

Medicare, Medicaid Patients Can Receive Palliative Care While Still in Treatment as Test Program

Test program authorized by Obamacare to measure if seniors with deadly illness will choose hospice and curative care

March 20, 2014 - Medicare and Medicaid patients will be allowed to continue receiving medical care for their ailment, while at the same time receiving access to palliative care, in a new initiative that began Tuesday. The Medicare Care Choices Model will test improvements to certain beneficiaries’ quality of life while they are receiving both curative and palliative care, according to information from the Centers for Medicare & Medicaid Services.

The MCCM, authorized by the Affordable Care Act, will test whether more seniors who qualify for coverage under the Medicare Hospice Benefit, would choose to receive the services typically provided by a hospice if they could also continue to receive curative care.

 “This initiative represents a fundamental change in the way health care is delivered,” said U.S. Sen. Ron Wyden of D-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 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.  

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.

 

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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.

“End of life is a sensitive and difficult time for patients and families, filled with confusing and complicated choices.  For far too long, the decision to elect hospice has been tantamount to ‘giving up’ since a patient must forgo ongoing curative care in order to benefit from hospice care,” said J. Donald Schumacher, President of the National Hospice and Palliative Care Organization, in a statement congratulating Secretary Kathleen Sebelius, Department of Health and Human Services, for moving forward with the Medicare Care Choices Model.

He also praised the Innovation Center of the Centers for Medicare and Medicaid Services on behalf of NHPCO.

 “Such patients who choose to continue with aggressive medical services are denied the opportunity to benefit from the holistic, interdisciplinary care provided by the hospice team. Similarly, family caregivers are denied the support from the hospice team that is a hallmark of this model of care,” said Schumacher.

“This new CMMI project will allow Medicare to pilot the innovations that have long benefited patients in the private market.  We trust that the Medicare Care Choices Model project will demonstrate that patients who have access to hospice alongside of curative care have better outcomes, higher family caregiver satisfaction, and benefit from the expert support of hospice earlier in their care.

“The findings will provide an answer to an important question regarding healthcare delivery for the terminally ill and access within the Medicare population – and beyond.  We’re thrilled that Medicare is leading the quest for answers and a thorough understanding of the concurrent care provision.”

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.

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.

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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