CMS to Test New Models of Care for Hospice: Summary of the Medicare Care Choices Model

by Baker Donelson
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On March 18, 2014, CMS launched an initiative to “develop innovate payment systems to improve care options for beneficiaries by allowing greater beneficiary access to comfort and rehabilitative care in Medicare and Medicaid.” See CMS’s "Fact Sheet: Medicare Care Choices Model" (Fact Sheet). This new initiative, called the Medicare Care Choices Model (Model), allows beneficiaries to receive palliative care concurrently with services provided by their “curative care provider.” Currently, beneficiaries must decline curative care in order to receive palliative care offered by hospices.

In its Fact Sheet, CMS states that only 44% of beneficiaries elect their hospice benefit at the end of life, and most beneficiaries only use the benefit for a short period of time. The Model will test whether eligible beneficiaries will elect to receive their hospice benefit if they have the choice to receive both palliative and curative care. The Model will also test improvements to participating beneficiaries’ quality of life through receipt of both palliative and curative care.

Hospices that apply and are selected to participate in the Model are required to “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 days a year. CMS will reimburse the participating hospices $400/month per beneficiary for these services. The providers and suppliers furnishing curative services to beneficiaries participating in the Model will continue to bill Medicare for the services. For an explanation of the services covered under the Model, see CMS’s "Request for Applications Medicare Care Choices Model" [PDF] (Request for Applications).

CMS’s Request for Applications also details beneficiary eligibility and enrollment in the Model. For example, the beneficiary must be diagnosed with certain, identified terminal illnesses such as advanced cancers, chronic obstructive pulmonary disease, congestive heart failure, or HIV/AIDs. Further, the beneficiary must have not elected the Medicare or Medicaid Hospice Benefit within the last 30 days prior to participating in the Model. The beneficiary must meet all of the other criteria as listed in the Request for Applications.

Hospices must apply by June 19, 2014. CMS will select at least 30 rural and urban Medicare certified and enrolled hospices to participate for 3 years in its Model. Each Request for Application must include an explanation of the applicant’s experience providing care coordination services and/or case management and shared decision-making with beneficiaries prior to electing hospice in conjunction with their referring providers/suppliers. The applicant must also detail how the program will be staffed as well as detailing the hospice’s ability to perform the Model’s duties along with the hospice’s responsibilities under the Medicare hospice program. For an overview of the application process, as well as a full list of the application criteria, see CMS’s Request for Applications.

Ober|Kaler’s Comments

CMS established this Model to allow eligible beneficiaries to have more options in their care, without having to choose between receiving either palliative or curative care. CMS intends to test whether these beneficiaries’ quality of life improves while receiving both of these services. Interested hospices must submit their application by June 19, 2014. See CMS’s website, http://innovation.cms.gov/initiatives/Medicare-Care-Choices/, for more information regarding the Model, application criteria, and how to submit your application.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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