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
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
“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
“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.
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
“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
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.
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.
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