NHPCO NewsLine Winter 2020 - 23

What is the MCCM
Through the Medicare Care Choices Model, the
Centers for Medicare & Medicaid Services is testing a
new option for Medicare beneficiaries to receive
supported care services from selected hospice
providers, while continuing to receive services provided
by other Medicare providers, including care for their
terminal condition. CMS will evaluate whether
providing these supportive services can improve the
quality of life and care received by Medicare
beneficiaries, increase patient satisfaction, and reduce
Medicare expenditures. Under current payment rules,
Medicare and dually eligible beneficiaries are required
to forgo Medicare payment for care related to their
terminal condition in order to receive services under
the Medicare or Medicaid hospice benefit.
The model is designed to:
* Increase access to supportive care services
provided by hospice;
* Improve quality of life and patient/family
satisfaction;
* Inform new payment systems for the Medicare and
Medicaid programs.

(To view an interactive map of this model, visit the
Where Innovation is Happening page.)

MCCM Background and Model Details
As providers well know, currently, Medicare
beneficiaries are required to forgo Medicare payment
for care related to their terminal condition in order to

receive access to hospice services. Through MCCM,
CMS is studying whether access to such services will
result in improved quality of care, and improved
patient and family satisfaction, and whether there
are any effects on use of health services and the
Medicare or Medicaid Hospice Benefit.
The target population for the Medicare Care Choices
Model is Medicare beneficiaries and Medicaid
beneficiaries with Medicare coverage ('dually eligible
beneficiaries'), who are eligible for either the Medicare
or Medicaid hospice benefit. Also, to be eligible,
beneficiaries must not have elected the Medicare (or
Medicaid) hospice benefit within the last 30 days prior
to enrolling in the model. Other Model requirements
include living in a traditional home (no institutional
care); having Medicare Parts A and B for the 12
months prior to enrolling in the model (no Medicare
managed care plan during that 12 months); having a
diagnosis of one of the following terminal illnesses -
advanced cancer, chronic obstructive pulmonary
disease, congestive heart failure, or human
immunodeficiency virus/acquired immunodeficiency
syndrome (HIV/AIDS); and living in the service area of
a hospice selected to participate in the model.
Under the model, participating hospices 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. Model services are
available around the clock, 365 calendar days per year.
CMS pays a per-beneficiary per-month (PBPM) fee
ranging from $200 to $400 to participating hospices
when delivering these services under the model.
Due to robust interest, CMS originally expanded the
model participation from an anticipated 30
Medicare-certified hospices to over 140 Medicarecertified hospices and extended the duration of the
model from 3 to 5 years.

Third Annual MCCM Report
CMS reports that 85 MCCM hospices (60%) of the
original 141 participants remained in the model as of
September 30, 2019.

Newsline / Winter 2020

23
https://innovation.cms.gov/innovation-models/map#model=medicare-care-choices-model
NHPCO NewsLine Winter 2020

Table of Contents for the Digital Edition of NHPCO NewsLine Winter 2020
