Over 140 Medicare-certified hospices have been invited to participate in a new five-year model of care that will allow for dual coverage of hospice and curative care, the Centers for Medicare & Medicaid Services announced on Monday.
Hospice care is covered by both Medicare and Medicaid. However, when hospice care is chosen, a beneficiary is no longer eligible to receive curative care.
Currently, only 47.3 percent of Medicare and 42 percent of dually eligible beneficiaries use hospice care, according to March 2015 Medicare Payment Policy Report to Congress.
CMS will evaluate whether eligible Medicare and dually eligible beneficiaries would elect to receive both hospice and curative services if available.
Under the Medicare Care Choices Model, participating hospices will provide services 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. These services include nursing, social work, hospice aide, hospice homemaker, volunteer, chaplain, bereavement, nutritional support, and respite care services.
Services under this model will be available to Medicare beneficiaries who elect to participate in the model, around the clock, 365 calendar days per year. CMS will pay a per beneficiary per month fee ranging from $200 to $400 to participating hospices when delivering these services.
Providers and suppliers furnishing curative care will bill Medicare for services 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, any other service that is specified in the patient's plan of care for which payment may otherwise be made under Medicare (for example, ambulance transports), short-term inpatient care for pain or symptom management that cannot be managed in the home environment, and physician services.
CMS originally anticipated selecting at least 30 Medicare-certified hospices to participate in the model and enrolling up to 30,000 beneficiaries throughout a three-year period. Due to robust interest,
the model was expanded to 140 hospices for five years.
Approximately half of the participating hospices will begin providing services under the model on January 1, 2016. The remaining participant hospices will provide services under the model starting January 1, 2018. This model is slated to end on December 31, 2020.
For beneficiaries, the new Medicare Care Choices Model provides greater flexibility in a decision for care when faced with a life-limiting illness, according to CMS.
The change will enable up to 150,000 eligible Medicare and dually eligible beneficiaries to use the dual services.
It 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 receive supportive care services typically provided by hospice, while continuing to receive curative services.