The Centers for Medicare and Medicaid Services (CMS) is moving toward providing greater access to care for patients who are terminally ill. In addition to paying for two advance care planning sessions with a medical provider as proposed in the 2016 Medicare Physician Fee Schedule, CMS also has created a new model to allow hospice patients to receive supportive, or palliative, services while continuing to receive curative services.
While hospice care is covered by both the Medicare and Medicaid programs (including dual-eligible patients), beneficiaries who choose hospice care are no longer eligible to receive curative care under current guidelines. According to a March 2015 Medicare Payment Policy Report to Congress, only 47.3 percent of Medicare and 42 percent of dually eligible beneficiaries used hospice care and most only for a short period of time. This data likely reflects the struggle in having to choose between palliative and curative care during these difficult times.
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.
Medicare beneficiaries that elect to participate in the model will have access to palliative services around the clock, 365 calendar days per year, and CMS will pay a per beneficiary per month fee ranging from $200 to $400 to participating hospices when delivering the specified services, including nursing, social work, hospice aide, hospice homemaker, volunteer, chaplain, bereavement, nutritional support, and respite care services. Providers and suppliers furnishing curative services will bill Medicare for the reasonable and necessary services furnished, including physical or occupational therapy, speech language pathology services, drugs for the management of pain or other symptoms from the terminal illness or related conditions, medical equipment and supplies, or any other service that is specified in the patient’s plan of care for which payment may otherwise be made under Medicare.
CMS has invited over 140 Medicare-certified hospices to participate in the model which will be phased in over two years. This will enable up to 150,000 eligible Medicare and dually eligible beneficiaries to participate. Three Indiana providers are part of the model: Community Home Health Services, Inc. dba Community Home Health, Indiana University Health Inc. dba Indiana University Health Hospice, and Visiting Nurse & Hospice Home.
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