On July 20th, 2015, the Centers for Medicare and Medicaid Services (CMS) announced the award of Medicare Care Choices demo contracts to 141 hospice providers across the country.

Section 3021 of the Affordable Care Act authorized CMS  to test innovative payment and service delivery models that have the potential to reduce expenditures while maintaining or improving the quality of care for beneficiaries. The Medicare Care Choices model comes out of the Center for Medicare and Medicaid Innovation and involves empowering clinicians, beneficiaries and their families with greater flexibility in deciding between hospice care and curative treatment when faced with life limiting illness.

This model is designed to test whether Medicare and dually eligible beneficiaries who qualify for coverage under the Medicare or Medicaid Hospice Benefit would elect to receive the palliative and supportive care services typically provided by a hospice if they could continue to seek curative care from their providers. CMS will study whether access to such services will result in improved quality of care, patient and family satisfaction, and whether there are any effects on use of curative services and the Medicare or Medicaid Hospice Benefit.

“The Medicare Care Choice Model is designed to evaluate whether eligible Medicare and dually eligible beneficiaries would elect to receive supportive care services typically provided by hospice if they could also continue to receive curative services and whether providing both palliative and curative care concurrently impacts quality of care, as well as patient and family satisfaction. 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. These services include nursing, social work, hospice aide, hospice homemaker, volunteer, chaplain, bereavement, nutritional support, and respite care services.” See, CMS’s Fact Sheet

To participate in the model, beneficiaries must meet certain criteria to participate, the beneficiary must –

  • be diagnosed with certain terminal illnesses: advanced cancers, chronic obstructive pulmonary disease, congestive heart failure and human immunodeficiency virus/acquired immune deficiency syndrome;
  • meet hospice eligibility requirements under the Medicare or Medicaid hospice benefit;
  • not have elected the Medicare or Medicaid hospice benefit within the last 30 days prior to their participation in the Medicare Care Choices Model;
  • receive services from a hospice that is participating in the model; and
  • have satisfied the model’s other eligibility criteria.

According to CMS, the model will be phased-in over two years. Approximately half of the participating hospices will begin providing services under the model on January 1, 2016. The remaining participant hospices will provide services under the model starting January 1, 2018. The demo is slated to end on December 31, 2020.

A list of participating hospices can be found in CMS’ Fact Sheet.

Additional information on the Medicare Care Choices Model can be found on CMS’s website under the Center for Medicare and Medicaid Innovation – > here