New care model allows more end-of-life care choice for Medicare beneficiaries

The Centers for Medicare & Medicaid Services (CMS) has introduced a new model that offers Medicare beneficiaries greater flexibility in end-of-life care choices.

The Medicare Care Choices 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, while continuing to receive curative services. 

Hospice care is covered by both the Medicare and Medicaid programs. When hospice care is chosen, a beneficiary is no longer eligible to receive curative care. According to March 2015 Medicare Payment Policy Report to the Congress, only 47.3 percent of Medicare and 42 percent of dually eligible beneficiaries used hospice care and most only for a short period of time. This data reflects the struggle in having to choose between palliative and curative care during these difficult times.

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. But, due to robust interest, CMS has invited over 140 Medicare-certified hospices to participate in the model and expanded the duration of the model to five years. This will enable up to 150,000 eligible Medicare and dually eligible beneficiaries to participate.

Delivery of services under the model will be phased-in over two 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. Hospices participating in the model will be randomly assigned to Phase 1 or Phase 2.

Beth Walsh,

Editor

Editor Beth earned a bachelor’s degree in journalism and master’s in health communication. She has worked in hospital, academic and publishing settings over the past 20 years. Beth joined TriMed in 2005, as editor of CMIO and Clinical Innovation + Technology. When not covering all things related to health IT, she spends time with her husband and three children.

Around the web

The tirzepatide shortage that first began in 2022 has been resolved. Drug companies distributing compounded versions of the popular drug now have two to three more months to distribute their remaining supply.

The 24 members of the House Task Force on AI—12 reps from each party—have posted a 253-page report detailing their bipartisan vision for encouraging innovation while minimizing risks. 

Merck sent Hansoh Pharma, a Chinese biopharmaceutical company, an upfront payment of $112 million to license a new investigational GLP-1 receptor agonist. There could be many more payments to come if certain milestones are met.