Thursday, November 19, 2015

Health Care Law: Hospice or Curative Care - Patients Can Choose Both

By Linda L. Fleming and Keebler Straz

        Under current Medicare and Medicaid rules, when a patient and family members make the difficult decision to seek hospice care, they are forced to forgo curative care in favor of supportive care. Earlier this year, the Centers for Medicare and Medicaid Services (CMS) announced a new program known as the Medicare Care Choices Model (MCCM), which will eliminate this draconian choice for some Medicare and Medicaid beneficiaries.

        Although hospice care is a covered service under Medicare and Medicaid, fewer than half of eligible beneficiaries elect to use it. In an effort to increase use of hospice services for certain patients, CMS rolled out the MCCM and the option to seek both curative and supportive care. CMS will evaluate whether the MCCM increases the number of beneficiaries who elect to receive hospice services, patient quality of life, and patient/family satisfaction, as well as whether the MCCM reduces Medicare expenditures.

        In order to participate in the MCCM and receive both supportive and curative care, the patient must: (i) be eligible for hospice services under the Medicare or Medicaid Hospice Benefit; (ii) have been living at home for the past 30 days; (iii) be diagnosed with a terminal illness, including advanced cancer, COPD, congestive heart failure, or HIV/AIDS; and (iv) have been hospitalized at least two times in the past 12 months for the qualifying diagnosis. In addition, the patient cannot have elected the Medicare Hospice Benefit in the prior 30 days and must receive services through a MCCM participating hospice.

        CMS responded to the strong demand of hospices that wanted to participate in the MCCM by expanding it from 30 hospices in a three-year program to 141 hospices in a five-year program.  The five-year model will operate in two phases: Half of the selected hospices will begin providing services under the model January 1, 2016, and the other half will begin January 1, 2018. Both phases will conclude December 31, 2020. CMS will randomly assign the invited hospices to one of the two phases. Locally, both LifePath Hospice and Suncoast Hospice were selected to participate.

        Hospices participating in the MCCM will be paid a per-beneficiary per-month fee of $200 or $400 through the standard Medicare claims process. Beneficiaries participating in MCCM will not be subject to a co-pay. Hospice services will be available to beneficiaries around the clock, 365 days a year, and beneficiaries may leave the MCCM at any time. CMS estimates that up to 150,000 beneficiaries may participate in the model.