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Printed Date: 9/22/2015
Question: What is the Medicare Care Choices Model (MCCM)?
Answer: The Centers for Medicare & Medicaid Services (CMS) will test 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.
Question: How is the MCCM designed?
Answer: The model is designed to:
Question: How many hospices are participating in MCCM?
Answer: There are 85 hospices participating in the Medicare Care Choices Model. For an all-inclusive list of participating providers and/or to view an interactive map of this model, visit the Where Innovation is Happening page.
Question: How does the MCCM apply to the Medicare Hospice benefit, specifically the Targeted Probe and Educate (TPE) initiative?
Answer: Medicare beneficiaries participating in MCCM have, by definition, not elected the Medicare hospice benefit. As such, hospice-specific TPE activities, which are, by definition, aimed at reducing the improper payment rate associated with hospice claims, would not apply to their MCCM claims. Aside from a natural disaster or other reason to exclude a hospice provider, the TPE process has always applied to hospices submitting claims for beneficiaries that have elected the hospice Medicare benefit.
Question: Has Palmetto GBA reversed any decisions for the MCCM?
Answer: No. Palmetto GBA has not reversed any decisions regarding MCCM. Any edits that have been implemented have been tailored to help select the appropriate claims for beneficiaries cared for by said providers.
Question: What steps have been taken to ensure there are no overlapping efforts with MCCM?
Answer: Palmetto GBA has paused the editing process to ensure the claims processing activities were working as intended and not overlapping with MCCM. Because providers were never removed from the edit; they were only paused in claim selections due to the MCCM claim selection reports; therefore, no formal notice is required.
Reference: For additional information about the background, target population and the overall initiative of the MCCM, please visit the Where Innovation is Happening page.
Questions about the Medicare Care Choices Model can be sent to CareChoices@cms.hhs.gov.
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Last Updated: 01/28/2020