Medicare Care Choices Model (MCCM): The First Two Years

WASHINGTON, Dec. 11 -- The U.S. Department of Health and Human Services' Centers for Medicare & Medicaid Services issued the following fact sheet:

The Centers for Medicare & Medicaid Services (CMS) is conducting the Medicare Care Choices Model (MCCM) to provide beneficiaries, and their caregivers and providers, with greater flexibility when facing a life-limiting illness. MCCM provides Medicare beneficiaries who qualify for the Medicare hospice benefit, (and dually eligible beneficiaries who may qualify for the Medicaid hospice benefit in their state), the option to receive supportive care services typically furnished under the Medicare hospice benefit, while continuing to receive care from other Medicare providers for their terminal condition. Absent the model, Medicare beneficiaries who elect to receive hospice care cannot also receive curative treatment for their life-limiting condition.

Background Information

According to the Medicare Payment Advisory Commission's March 2016 Report to Congress: Medicare Payment Policy, less than half of Medicare beneficiary decedents enrolled in hospice care, and the median length of stay in hospice is a relatively short 17 days. Having to forgo Medicare payment for treatment aimed at curing the terminal condition may impede the choice of electing hospice care. Unlike the Medicare hospice benefit where a beneficiary must waive Medicare payment for treatment of the terminal condition, MCCM enrollees may continue treatment.

MCCM tests whether eligible Medicare and dually eligible beneficiaries would chose to receive hospice support services, if they could also continue to receive treatment for their terminal condition. The evaluation design will look at how this flexibility impacts quality of care and satisfaction of the beneficiary, family and caregivers. Under the Model, selected hospices furnish support services available under the Medicare hospice benefit that 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.

CMS pays a per beneficiary per month (PBPM) fee of $400 to participating hospices for each month a beneficiary is enrolled in the Model (except for a reduced fee of $200 in the first month if enrollment is less than 15 days). Providers and suppliers continue to bill Medicare when furnishing reasonable and necessary services covered by Medicare, and not covered by the Model. Medicare continues to cover treatment of the beneficiary's terminal condition.

Beneficiary Criteria

In response to stakeholder concerns about the eligibility requirements and lower than expected initial enrollment in the Model, CMS revised MCCM eligibility criteria in April, 2016 and January, 2017.

Current eligibility criteria are:

* Having Medicare Part A and Part B as their primary health insurance for 12 months prior to enrollment in MCCM

* Being diagnosed with: 1) advanced cancers; 2) chronic obstructive pulmonary disease; 3) congestive heart failure or 4) human immunodeficiency virus/acquired immune deficiency syndrome

* Having at least one hospital-based encounter in the last 12 months (emergency department visit, observation stay or admission)

* Having at least three office visits (with a Medicare-certified provider for any reason)

* Being eligible for the Medicare or Medicaid hospice benefit;

* Not having elected the Medicare or Medicaid hospice benefit within the last 30 days prior to enrolling in the MCCM

* Living in a traditional home for at least 30 days prior to MCCM enrollment

Model Implementation

CMS originally planned to select at least 30 Medicare-certified hospices to participate in the Model. Due to robust interest, CMS invited over 140 Medicare-certified hospices to participate in the Model and increased the duration of the Model to 5 years.

Selected hospices were randomly assigned to one of two cohorts. Cohort 1 began furnishing MCCM services on January 1, 2016. Cohort 2, will begin to furnish services January 1, 2018. Both cohorts will end December 31, 2020.

As Cohort 1 approaches the end of the Model's second year, 1,325 beneficiaries have been enrolled and have been offered more than 21,149 encounters. Ten percent of beneficiaries approached about the Model have elected hospice immediately and nearly 80 percent of those who enroll in MCCM elect hospice when they leave the Model.

The application period for hospices to seek participation in this model is closed, and all selected hospices have been notified and assigned to a cohort. Beneficiaries will continue to be enrolled through June 30, 2020.

For more information, visit https://innovation.cms.gov/initiatives/Medicare-Care-Choices/. AddThis - Opens in a new window Settings (http://www.addthis.com/personalize).