Q&A: Medicare Care Choices Model and end-of-life care

June 19, 2019
Medicare Web

Q: How does the Medicare Care Choices Model help patients who need hospice care?

A: The Centers for Medicare & Medicaid Services (CMS) is amid a five-year, 40-state test program to determine a better way to help adult beneficiaries deal with end of life. Through the Medicare Care Choices Model (MCCM), the Centers for Medicare & Medicaid Services (CMS) will test a new option for Medicare beneficiaries to receive supported care services from selected hospice providers while continuing to receive services provided by other Medicare providers, including care for their terminal condition.

  • CMS will evaluate whether providing these supportive services can improve the quality of life and care received by Medicare beneficiaries, increase patient satisfaction, and reduce Medicare expenditures.
  • Under current payment rules, Medicare and dually eligible beneficiaries are required to forgo Medicare payment for care related to their terminal condition in order to receive services under the Medicare or Medicaid hospice benefit.

The model is designed to:

  • Increase access to supportive care services provided by hospice
  • Improve quality of life and patient/family satisfaction
  • Inform new payment systems for the Medicare and Medicaid programs

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.
  • Model services are available around the clock, 365 calendar days per year.
  • CMS pays a per-beneficiary per-month (PBPM) fee ranging from $200 to $400 to participating hospices when delivering these services under the model.

Sites are open to patients with:

  • Advanced-stage cancer
  • Chronic obstructive pulmonary disease
  • Congestive heart failure
  • AIDS
  • A prognosis of six months or less to live

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