by Hannah Matherne,
Client Services Coordinator
From the premier of the film Finding Dory to the presidential election, 2016 promises to be a year full of change and opportunity. But for the terminally ill and their families, the most significant changes in 2016 may be the biggest revisions that Medicare has ever made – including counseling for end of life care decisions and the Medicare Care Choices Model.
As of January 1, 2016, the Centers for Medicare & Medicaid Services (CMS) rolled out their Medicare Care Choices Model to test the cost and effectiveness of allowing qualified beneficiaries to receive coverage for both curative and palliative care at the same time. (Curative care focuses on the goal of a cure, while palliative care focuses on comfort, relieving suffering and ensuring quality of life.) Currently, patients must make the difficult decision between the two types of care to receive Medicare benefits. Due to that limitation, only 47.3 percent of those who qualify for Medicare and 42 percent of those who are dually eligible for Medicare have used hospice care and usually for only a short time, according to the 2015 Medicare Payment Policy Report to Congress.
After the new model was announced last July, the overwhelming amount of interest led the CMS to expand the size of the model from 30 to 140 Medicare-certified hospices and the duration of the model from 3 to 5 years. Selected hospices were randomly assigned to Phase 1 and Phase 2. The 70 hospices in Phase 1 began the model January 1st and the 70 in phase 2 will begin the model on January 1, 2018. The revisions will allow up to 150,000 dually eligible Medicare beneficiaries to take part in the two phases of the model. Participants must meet requirements such as the following:
- Be diagnosed with advanced cancer, chronic obstructive pulmonary disease, congestive heart failure and human immunodeficiency virus/acquired immune deficiency syndrome
- Meet hospice eligibility requirements under the Medicare or Medicaid hospice benefit
- Not have elected the Medicare or Medicaid hospice benefit within the last 30 days prior to their participation in the Medicare Care Choices Model
- Receive services from a hospice that is participating in the model
- Also meet model’s other eligibility criteria.
The CMS will use the data to determine if the change allows for better patient care, support for families and use of resources long-term. HHS Secretary Sylvia M. Burwell stated, “This model empowers clinicians, beneficiaries and their families with choices and is part of our broader efforts to transform our health care system into one that delivers better care, makes smarter payments, and puts patients in the center of their own care.” Louisiana hospices selected to participate in the model are St. Joseph Hospice, St. Joseph Hospice of Cenla, and St. Joseph Hospice and Palliative Care Northshore.
As a law office that focuses every day on helping families walk through end-of-life health care directives and planning, the Medicare Care Choices Model is one of our favorite things about 2016. In fact, I just got off the phone with another caregiver who is watching her family member fight a terminal illness. Each one of these calls is difficult – though not nearly as difficult as I know it is to be in such a situation. To watch a spouse, family member or friend live their final days in pain is a terrible burden. One small comfort is that there are more resources, support groups and services available to terminally ill patients and their families than ever before. The Medicare Care Choices Model and other Medicare changes are more rays of hope to share and hold on to as our office serves these families in our community.
For more information about the Medicare Care Choices Model, visit www.cms.gov. And if you find yourself in the position of caring for a loved one with a terminal illness and need legal assistance to plan for their health directives, estate, VA or Medicaid qualification, please visit www.legacycenterla.com or call our office at (225) 744-0027 for more information about the services and resources we provide.
