On July 20, 2015, CMS announced the hospices invited to participate in the Medicare Care Choices Model. Under current Medicare rules, a Medicare beneficiary must forgo curative treatments to receive palliative care provided by hospices. The Model allows certain beneficiaries to receive hospice services while also pursuing curative treatments. According to CMS, fewer than half of eligible Medicare beneficiaries elect to receive hospice care and those beneficiaries electing hospice only do so for a short period of time. Accordingly, the Model is designed to: increase access to supportive care services provided by hospice; improve quality of life and patient/family satisfaction; and inform new payment systems for the Medicare and Medicaid programs. Due to the significant interest in the Model, CMS has expanded the Model from an anticipated scope of 30 Medicare-certified hospices to more than 140 Medicare-certified hospices. CMS also extended the duration of the Model from three years to five years. As a result of the expansion, CMS estimates that approximately 150,000 eligible Medicare beneficiaries may participate. Under the Model, CMS will reimburse hospice providers a monthly per-beneficiary fee ranging from $200 to $400. Providers and suppliers providing curative services to participating beneficiaries will bill Medicare for those reasonable and necessary services.
According to CMS, the Model will be implemented in two phases. Phase 1 is scheduled to begin on January 1, 2016 and Phase 2 is scheduled to begin on January 1, 2018. Hospices participating in the Model will be randomly assigned to Phase 1 or Phase 2. The Model is currently scheduled to conclude on December 31, 2020.
Currently, CMS is limiting participation in the Model to Medicare beneficiaries who:
- Are 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;
- Have not elected the Medicare or Medicaid hospice benefit within the last 30 days prior to their participation in the Model;
- Receive services from a hospice that is participating in the Model; and
- Have satisfied the Model’s other eligibility criteria.