Medicare Care Choices Model

Through the Medicare Care Choices Model (MCCM), the Centers for Medicare and Medicaid Services (CMS) will provide a new option for Medicare beneficiaries, allowing those with certain diagnoses to receive hospice-like services from certain providers, while also receiving curative treatments provided by other care providers.

This pilot program will test whether Medicare and dually eligible beneficiaries who qualify for coverage under the Medicare/Medicaid Hospice Benefit would elect to receive the palliative and supportive care services provided by hospice if they could continue to seek curative care from their providers.

Fewer than half of eligible Medicare beneficiaries use hospice care, and most only utilize the service for a short period of time. Currently those electing the hospice benefit must forgo curative treatment in order to qualify for the Medicare/Medicaid Hospice Benefit. The model will allow greater flexibility to those deciding between hospice care and curative treatment when faced with a life limiting illness.

CMS will use data gathered from this program to investigate whether providing these supportive services can improve quality of life and care, increase patient satisfaction, and reduce Medicare expenditures.

In order to participate in the program patients must meet the following criteria:

  • Diagnosed with one of the following: chronic heart failure (CHF), chronic obstructive pulmonary disorder (COPD), human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) or advanced cancer
  • Meets eligibility requirements under the Medicare/Medicaid Hospice Benefit, including a life expectancy prognosis of six months or less
  • Enrolled in Medicare Part A or B as primary insurance for the past 12 months
  • Has not elected the Medicare/Medicaid Hospice Benefit within 30 days prior to participating in the model
  • Has had a least one hospital encounter in the last 12 months
  • Has had a least three office visits in the last 12 months with any Medicare-certified provider
  • Must receive services from a hospice agency participating in MCCM

Patients participating in MCCM will receive supportive services that are currently available under the Medicare Hospice Benefit including nursing, social work, aides, volunteers, and spiritual and bereavement counseling. Patients will also be eligible for respite; however it is defined differently for those in the MCCM program. Patients will be reviewed at IDG, and quality outcomes will continue to be measured. Bereavement care begins the day of admission and continues for 13 months following the patient death.

There are some noted differences between hospice and the care provided as part of MCCM.

  • The patient must be eligible for MCCM to qualify initially, but can remain on the program even if they improve and no longer meet criteria
  • There are no benefit periods, so patients can remain on MCCM indefinitely
  • If the patient revokes MCCM they cannot be readmitted to the program
  • MCCM forms differ from hospice forms; therefore a new admission packet has been created
  • Traveling hospice contract is not available in MCCM
  • MCCM patients must maintain their residence in the hospice agency’s service area
  • Patients may transfer to hospice but not until the day following discharge from the MCCM program
  • No hospital/SNF respite, but the MCCM team can do brief respite in the patient’s home
  • Any inpatient hospitalization (including GIP) is covered under Medicare Part A
  • Non-hospice eligibility requirements apply for medications and DME which can be supplied by any provider
  • While the patient must have an in-person visit every 15 days from the RNCM, in general visit frequency can be much less than with typical hospice service
  • The RNCM cannot pronounce a patient death
  • Patients can only reside in a skilled nursing facility for less than 90 days to be eligible for MCCM

Participating hospices were randomly assigned to two cohorts. The first began providing services under the model in January 2016. SSM Health at Home Hospice – Wisconsin is participating in the second cohort of the study beginning January 1, 2018. The program is currently scheduled to run through December 31, 2020.

Patients participating in the MCCM program will receive care through our hospice program but will still be allowed to seek curative treatment. SSM Health at Home Hospice – Wisconsin will receive payment for hospice services provided as part of MCCM through the standard Medicare claims process.

Some services will be billed separately under Medicare Parts A, B or D. Non-hospice providers and suppliers will bill Medicare for reasonable and necessary services furnished to beneficiaries participating in the model including physical, occupational or speech therapy, medication for pain or symptom management, medical equipment and supplies, short-term inpatient care for pain or symptom management that cannot be managed in the home, physician services, and any other service in the plan of care for which payment may otherwise be made under Medicare.

MCCM referrals must be initiated and provided by a non-hospice physician. There has been a small group of physicians identified who will be referring to SSM Health at Home Hospice – Wisconsin as part of the MCCM program.

If you have any questions regarding SSM Health at Home’s participation in the MCCM program, please contact Tammy La Rocco, Home Care Clinical Manager – NP at 608-355-4662.