Update on Medicare Care Choices Model

Categories: Policy.

Under the CMS Center for Medicare and Medicaid Innovation, the MCCM is intended to improve care coordination and case management, beneficiary (and family) satisfaction and quality of care.

Participating hospices in Cohort 1 have expressed concerns with the restrictions required for a Medicare beneficiary to access the MCCM. Considering lessons learned to date, enrollment restrictions have been relaxed. The adjustments include:

April 2016:

  • Two hospitalizations, reduced to one encounter of any kind, including ED, observation or inpatient admission.
  • No participation in Part D, but provider gathers information on drug coverage.

January 1, 2017:

  • Reduced 24 months to 12 months of Medicare enrollment to include both Medicare A and Medicare B as the primary insurance.
  • Three office visits for eligible diagnosis reduced  to three office visits for any Medicare enrolled physician for any diagnosis.

National Hospice and Palliative Care Organization has worked closed with the CMS MCCM staff on eligibility concerns, is pleased with the two additional enrollment changes and will continue the dialogue with CMS to identify additional enrollment barriers and encourage success for both Cohort 1 and for the hospice awardees in Cohort 2, with start up on January 1, 2018.