Don't Be Left On The Sidelines: CMS Is Seeking Applications For A New Hospice Demonstration Program

by Polsinelli
Contact

Currently, Medicare patients that wish to receive palliative hospice care have a tough choice to make—forgo any curative treatment or incur all hospice care costs. This could change, however, with the recent launch of CMS's Medicare Care Choices Model ("MCCM"). CMS is currently accepting applications for the MCCM, a three year demonstration project under which eligible beneficiaries can receive certain types of services from participating hospice providers while concurrently receiving services from their regular, curative care providers. Central to the MCCM is hospice providers' continued active role in care coordination and case management.

Eligibility to Participate in the MCCM

Only Medicare certified and enrolled hospice providers are eligible to participate in the MCCM. Further, any Medicare and certain dual-eligible beneficiaries who wish to participate, in part: (1) must be diagnosed with terminal cancer, chronic obstructive pulmonary disease, HIV, or congestive heart failure; (2) must not have elected the Medicare or Medicaid Hospice Benefit within 30 days of participation in the MCCM; and (3) otherwise meet the Medicare hospice benefit eligibility and admission criteria.

The Role of the Hospice Provider

Participating hospice providers are expected to engage in the following:

Care Coordination. Hospice providers must coordinate care within the participating hospice as well as between the hospice and a beneficiary's curative providers. Further, hospice providers must (i) manage the beneficiary's pain and other symptoms and (ii) engage in shared decision-making between the beneficiary, family, and the beneficiary's providers. The MCCM still requires hospice providers to establish a plan of care as currently required by the Medicare hospice Conditions of Participation; however, hospice providers must also complete a patient-centered goals plan within three days of the beneficiary's enrollment in the MCCM. This plan must be reviewed and, if necessary, revised at least every 15 days, as needed based on the beneficiary's condition, or as requested by the beneficiary.

Ongoing Communication. Hospice providers must communicate with the beneficiary regarding the beneficiary's goals, treatment plans, and treatment options. While beneficiaries are still seeking curative care, the need for face-to-face encounters with hospice providers will be limited—hospice providers will function more as a source of information. As a result, the MCCM expects providers to educate beneficiaries on available hospice support services.

Quality & Data Reporting. Hospice providers must submit to CMS a monthly log of services and activities provided to beneficiaries in accordance with their plans of care. CMS may randomly audit these logs through the MCCM period to compare beneficiaries' plans of care with the providers' service and activity log. On a quarterly basis, hospice providers must also submit to CMS data on certain quality measures. These quality measures will include those selected for the Hospice Quality Reporting Program as well as other measures focused on pain management, care coordination and case management, care transitions, communication, patient-centered goals, and patient and family satisfaction.

Payment Model

Under the MCCM, CMS will pay participating hospice providers a fee, which constitutes the total reimbursement for MCCM services and includes all services available under the Medicare Hospice Benefit for routine home care and inpatient respite levels of care that cannot be billed separately under Medicare Parts A, B, and D. Hospice services covered under the MCCM do not include general inpatient or continuous home care levels of hospice care. Participating hospice providers will receive $400 per beneficiary per month for providing services for 15 or more days per calendar month or $200 per beneficiary per month for less than 15 days. No providers, including any primary care providers, can bill the beneficiary for any care coordination or case management services. However, because participating beneficiaries do not receive the Medicare Hospice Benefit, providers can bill Medicare for drugs, durable medical equipment, therapy services, and ambulance transports normally covered through the Medicare hospice per diem in addition to any curative services received.

What Providers Should Know

  • CMS is currently accepting applications from hospice providers that wish to participate in the MCCM. Applications are due June 19, 2014, and information regarding the application's contents can be found here. CMS expects to announce participants by fall of 2014.
  • In selecting participants, CMS indicated it will give preference to those hospice providers that can demonstrate mature and effective relationships with curative care providers and have experience developing, reporting, and analyzing quality data.
  • CMS's demonstration projects, such as the MCCM, can give providers insight into what CMS may expect in the future. The MCCM encourages hospice providers to take a lead role in coordinating all types of end-of-life care. Those hospice providers that already have or can gain experience coordinating with curative care providers will be ahead of the game. However, given that hospice providers are in the position to gain referrals from curative care providers, hospice providers must ensure that these relationships remain compliant with federal and state fraud and abuse laws.

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.

© Polsinelli | Attorney Advertising

Written by:

Polsinelli
Contact
more
less

Polsinelli on:

Readers' Choice 2017
Reporters on Deadline

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:
Sign up using*

Already signed up? Log in here

*By using the service, you signify your acceptance of JD Supra's Privacy Policy.
Custom Email Digest
Privacy Policy (Updated: October 8, 2015):
hide

JD Supra provides users with access to its legal industry publishing services (the "Service") through its website (the "Website") as well as through other sources. Our policies with regard to data collection and use of personal information of users of the Service, regardless of the manner in which users access the Service, and visitors to the Website are set forth in this statement ("Policy"). By using the Service, you signify your acceptance of this Policy.

Information Collection and Use by JD Supra

JD Supra collects users' names, companies, titles, e-mail address and industry. JD Supra also tracks the pages that users visit, logs IP addresses and aggregates non-personally identifiable user data and browser type. This data is gathered using cookies and other technologies.

The information and data collected is used to authenticate users and to send notifications relating to the Service, including email alerts to which users have subscribed; to manage the Service and Website, to improve the Service and to customize the user's experience. This information is also provided to the authors of the content to give them insight into their readership and help them to improve their content, so that it is most useful for our users.

JD Supra does not sell, rent or otherwise provide your details to third parties, other than to the authors of the content on JD Supra.

If you prefer not to enable cookies, you may change your browser settings to disable cookies; however, please note that rejecting cookies while visiting the Website may result in certain parts of the Website not operating correctly or as efficiently as if cookies were allowed.

Email Choice/Opt-out

Users who opt in to receive emails may choose to no longer receive e-mail updates and newsletters by selecting the "opt-out of future email" option in the email they receive from JD Supra or in their JD Supra account management screen.

Security

JD Supra takes reasonable precautions to insure that user information is kept private. We restrict access to user information to those individuals who reasonably need access to perform their job functions, such as our third party email service, customer service personnel and technical staff. However, please note that no method of transmitting or storing data is completely secure and we cannot guarantee the security of user information. Unauthorized entry or use, hardware or software failure, and other factors may compromise the security of user information at any time.

If you have reason to believe that your interaction with us is no longer secure, you must immediately notify us of the problem by contacting us at info@jdsupra.com. In the unlikely event that we believe that the security of your user information in our possession or control may have been compromised, we may seek to notify you of that development and, if so, will endeavor to do so as promptly as practicable under the circumstances.

Sharing and Disclosure of Information JD Supra Collects

Except as otherwise described in this privacy statement, JD Supra will not disclose personal information to any third party unless we believe that disclosure is necessary to: (1) comply with applicable laws; (2) respond to governmental inquiries or requests; (3) comply with valid legal process; (4) protect the rights, privacy, safety or property of JD Supra, users of the Service, Website visitors or the public; (5) permit us to pursue available remedies or limit the damages that we may sustain; and (6) enforce our Terms & Conditions of Use.

In the event there is a change in the corporate structure of JD Supra such as, but not limited to, merger, consolidation, sale, liquidation or transfer of substantial assets, JD Supra may, in its sole discretion, transfer, sell or assign information collected on and through the Service to one or more affiliated or unaffiliated third parties.

Links to Other Websites

This Website and the Service may contain links to other websites. The operator of such other websites may collect information about you, including through cookies or other technologies. If you are using the Service through the Website and link to another site, you will leave the Website and this Policy will not apply to your use of and activity on those other sites. We encourage you to read the legal notices posted on those sites, including their privacy policies. We shall have no responsibility or liability for your visitation to, and the data collection and use practices of, such other sites. This Policy applies solely to the information collected in connection with your use of this Website and does not apply to any practices conducted offline or in connection with any other websites.

Changes in Our Privacy Policy

We reserve the right to change this Policy at any time. Please refer to the date at the top of this page to determine when this Policy was last revised. Any changes to our privacy policy will become effective upon posting of the revised policy on the Website. By continuing to use the Service or Website following such changes, you will be deemed to have agreed to such changes. If you do not agree with the terms of this Policy, as it may be amended from time to time, in whole or part, please do not continue using the Service or the Website.

Contacting JD Supra

If you have any questions about this privacy statement, the practices of this site, your dealings with this Web site, or if you would like to change any of the information you have provided to us, please contact us at: info@jdsupra.com.

- hide
*With LinkedIn, you don't need to create a separate login to manage your free JD Supra account, and we can make suggestions based on your needs and interests. We will not post anything on LinkedIn in your name. Or, sign up using your email address.