Eli's Hospice Insider

Published on Tue Jun 20, 2017 PDF

Education for next phase of MCCM should begin soon.

Loosening MCCM’s eligibility criteria has taken the program only so far.

For the first time, the Centers for Medicare & Medicaid Services publicly released its Medicare Care Choices Model participation figures. The demonstration project that is testing concurrent care has enrolled 834 beneficiaries, a CMS official revealed in its May 3 Open Door Forum for hospice providers.

Since the program began in 2016, hospices had complained that the eligibility criteria made it very difficult to enroll. In response, CMS in May 2016 eliminated the requirement for Part D enrollment, and reduced the requirement for two prior inpatient hospital stays to one hospital encounter. When that didn’t seem to go far enough, CMS in January 2017 reduced the requirement for Medicare enrollment prior to model participation from 24 months to 12 months, and scaled down the requirement that within 12 months of model enrollment, the beneficiary must have three office visits with the same physician practice for the eligible diagnosis to three office visits with any physician practice for any condition.

Now those changes are in writing. They are included in a transmittal and MLN Matters article at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM10094.pdf.

MCCM enrollment is increasing, the CMS staffer said. “We are pleased that the model appears to be introducing the Medicare hospice benefit to individuals who might not have considered hospice otherwise.”

Underwhelming: In the transmittal, CMS notes that the program’s target for participation is 150,000 beneficiaries. That compares to the 834 beneficiaries announced in the May forum.

However, the program is expected to pick up speed now that the enrollment criteria have been relaxed, and after 70 more hospices join the program in January 2018. MCCM started with 71 participating hospices in 2016. The demo is scheduled to conclude Dec. 31, 2020.

But hospices may not be cheering yet. “The changes that CMS made to the eligibility criteria have improved the circumstances,” allows Theresa Forster with the National Association for Home Care & Hospice. “But it appears that additional action may be needed to get a level of participation that ensures that the results of the demonstration provide guidance for potential future policy changes,” Forster tells Eli.

More stats: CMS released some more figures about theprogram. Beneficiaries who chose the hospice benefit immediately following MCCM screening numbered 392. And 371 benes (79 percent) entered MCCM and then were discharged from MCCM and elected the Medicare hospice benefit, the CMS officialsaid.

More information about MCCM is at https://innovation.cms.gov/initiatives/Medicare-Care-Choices. Education and training for the next phase of MCCM will begin this summer, the CMS source noted in the May forum.