Medicare to cover hospice and curative care simultaneously in new demonstration program

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Medicare will reimburse both hospices furnishing palliative care and providers offering curative services under a new demonstration program, the Centers for Medicare & Medicaid Services recently announced.

Currently, a beneficiary must end curative treatments in order to take advantage of Medicare's hospice benefit. This has created a “false choice” between the two types of care, said Sen. Ron Wyden (D-OR). Wyden was the architect of the Medicare Care Choices Model, which is part of the Affordable Care Act.

Through the Choices program, Medicare will reimburse hospices $400 a month for “routine home care and inpatient respite levels of care” that are not eligible to be billed under other parts of the Medicare program, according to a CMS fact sheet. Providers and suppliers offering the hospice patient “reasonable and necessary” curative services also will be eligible for Medicare reimbursement. The program initially will be limited to patients with certain conditions, including congestive heart failure and chronic obstructive pulmonary disease.

The hospice benefit is intended for Medicare beneficiaries who have an expected lifespan of six months or less. However, most people don't enter hospice care until their final days, possibly because they are pursuing curative treatment until that time, according to CMS. The demonstration is meant to test whether beneficiaries will pursue hospice care earlier, which potentially could increase their satisfaction while controlling Medicare costs.

The program should allow Medicare patients to access “innovations” in care that have “long benefitted patients in the private market,” said Donald Schumacher, president and CEO of the National Hospice and Palliative Care Organization.

Providers can apply through June 19. A notice with further details is scheduled for publication in the Federal Register today.

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