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Transmittal Issued on Medicare Care Choices Model

The U.S. Centers for Medicare and Medicaid Services (CMS) has posted a transmittal that provides detailed information on its Medicare Care Choices Model (MCCM).

The transmittal is at https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R121DEMO.pdf.

Under MCCM, Medicare and dual eligible beneficiaries with advanced cancers, chronic obstructive pulmonary disease, congestive heart failure, or HIV/AIDS who meet hospice eligibility requirements under the Medicare hospice benefit will be eligible to receive palliative care services from certain hospice providers while concurrently receiving services from curative care providers.

The MCCM will be operational January 1, 2016 and is expected to last for five years.

Participating hospices will be paid the full $400 PBPM (per beneficiary per month) for providing services for 15 or more days per calendar month and $200 PBPM for services provided for less than 15 days in a calendar month, with the exception of the month of discharge, which will be paid $400 PBPM.

Model services covered by the PBPM fee include: counseling services to the beneficiary and family (bereavement, spiritual, dietary); family support; psycho-social assessment; nursing services; medical social services; hospice aide and homemaker services; volunteer services; comprehensive assessment; plan of care; interdisciplinary team; care coordination/care management; and in-home respite care.

Those services that can be billed as a separate claim under Parts A, B, or D include: 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; physician services; and short-term inpatient care for pain or symptom management which cannot be managed in the home environment.

According to CMS, it does not expect to see claims in the Medicare or Medicaid claims systems for home health services that should be provided by the hospice (ex. skilled nursing and aide services).

Still, there may be occasions where necessary home health services require the use of a home health agency that possesses the required skill level (ex. certified enterostomal therapy nurse for new colostomy education).

Additional MCCM material and eligibility information, including a list of awardees (three in New York State), is at http://innovation.cms.gov/initiatives/Medicare-Care-Choices/.

For more information, contact HCA Policy staff.

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