Haven Hospice has been selected to participate in the Medicare Care Choices Model, announced July 20 by Health and Human Services (HHS) Secretary Sylvia M. Burwell. The model provides Medicare beneficiaries who qualify for coverage under the Medicare Hospice Benefit and dually eligible beneficiaries who qualify for the Medicaid Hospice Benefit the option to elect to receive supportive care services typically provided by hospice and continue to receive curative services at the same time. The announcement is part of a larger effort at HHS to transform our health care system to deliver better care, spend our dollars in a smarter way, and put patients in the center of their care.
“This initiative will allow certain patients to continue to receive curative services while also receiving supportive, hospice care,” said Haven Hospice Vice President of Clinical Operations DeAnna Beverly, MBA, MSN, RN, LHRM. “At Haven, we believe this will improve the quality of life for many of those individuals who have a life-limiting illness who would not otherwise choose to receive hospice services.”
All eligible hospices across the country were invited to apply to participate in the model. Due to robust interest, the Centers for Medicare & Medicaid Services (CMS) expanded the model from an originally anticipated 30 Medicare-certified hospices to over 140 Medicare-certified hospices and extended the duration of the model from 3 to 5 years. This is expected to enable as many as 150,000 eligible Medicare beneficiaries with advanced cancers, chronic obstructive pulmonary disease, congestive heart failure, and human immunodeficiency virus/ acquired immunodeficiency syndrome who receive services from participating hospices to experience this new option and flexibility.
Participating hospices will provide services under the model that are currently available under the Medicare hospice benefit for routine home care and respite levels of care, but cannot be separately billed under Medicare Parts A, B, and D. Services will be available 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 these services under the model. Services will begin January 1, 2016, for the first phase of participating hospices and in January 2018 for the remaining participating hospices.
Individuals who wish to receive services under the model must fall into certain categories:
- Must be diagnosed with certain terminal illnesses (e.g., advanced cancers, chronic obstructive pulmonary disease, congestive heart failure and human immunodeficiency virus/acquired immune deficiency syndrome);
- Must meet hospice eligibility requirements under the Medicare or Medicaid Hospice Benefit;
- Must not have elected the Medicare or Medicaid Hospice Benefit within the last 30 days prior to their participation in the Medicare Care Choices Model;
- Must receive services from a hospice that is participating in the model; and
- Must have satisfied model’s other eligibility criteria.