Medicare Care Choices Model (MCCM) encompasses all aspects of care — Palliative Care, End-of-Life Care, Hospice Support Services, and traditional health care. Like Palliative Care and Hospice, MCCM offers Care Coordination, Symptom & Pain Management and promotes Patient and Family preferences and shared decision making. Like Hospice, MCCM focuses on quality of life at the end of life. Unlike Hospice, MCCM allows continued Medicare payment for treatment of the end-stage condition.
- Increase Access to Supportive Care Services provided by Hospice
- Improve the Quality of Life and Patient/Family Satisfaction
- Inform New Payment Systems for Medicare & Medicaid
MCCM empowers Clinicians, Beneficiaries and their families with greater flexibility in deciding between Hospice Care and continuing treatment when faced with life-limiting illness.
Consider referring your Hospice-eligible Patient who has an end-stage diagnosis of cancer, CHF, COPD, or HIV and is not ready to choose Hospice Care.
The MCCM Hospice is responsible for coordinating care among all providers. The Primary Community Practitioner continues to direct the patient’s care. Medicare Care Choices Model (MCCM) revolves around the care of the beneficiary with certain life-limiting illnesses — end-stage diagnosis of cancer, CHF, COPD, or HIV. MCCM has four intervening components — Centers for Medicare and Medicaid Services (CMS), the MCCM Hospice and the Community Practitioner, focusing on the patient and family.
PRIMARY COMMUNITY PRACTITIONER
MCCM patients may continue to receive care for their terminal illness from their usual provider(s), and therefore, in addition to possibly signing the Certificate of Terminal Illness, the Primary Community Practitioner continues to direct the patient’s care in conjunction with the Hospice Care Coordinator and Medical Director.
- Nursing — In-Home Nursing Services, telephonic support, and coordination of services
- Social Work — Assist with identifying additional community supports and assist with identifying patient and family needs for social or emotional support services
- Hospice Aid & Homemaker — Personal care and assists in maintaining a safe and sanitary environment in areas of the home used by the patient
- Counseling & Chaplain — Bereavement, spiritual and nutrition
- Symptom & Pain Management — In collaboration with the patient’s provider, to ensure patient’s needs and preferences are addressed
- In-Home Respite Care — Allows family short-term relief from caregiving responsibilities
- Volunteers (Direct Services) — Provides direct services and social support for the patient and family
PHYSICIAN – RELATED FAQ’S
Who Signs the MCCM Certificate of Terminal Illness?
This form must be completed and signed by both the Non-Hospice Community Practitioner, most likely the patient-identified Primary Community Practitioner, and the Hospice Medical Director.
Does a Patient need to be pursuing “Curative/Aggressive” Therapy to participate in MCCM?
No – Patients do not have to actively pursue curative or aggressive care to participate in Medicare Care Choices Model (MCCM).
Must an MCCM Patient be discharged from the Model if they are no longer believed to have only six (6) months to live?
No – MCCM does not have a recertification of the terminal illness requirement and does not require beneficiaries to leave the Model if they no longer meet the ‘six months to live’ end-of-life criteria. If the patient chooses to leave the Model, they may not return to the Model at a future date.
Can other Physicians be consulted and write orders (e.g., symptom management) for the MCCM patient?
Yes – The Primary Community Practitioner continues to direct the patient’s care and confers with other practitioners (both hospice and non-hospice) to provide orders and establish the patient’s plan of care, following their State Practice laws.
For After-Hours Calls, does the Primary Community Practitioner need to be contacted?
CMS expects the MCCM Hospice to collaborate with the Primary Community Practitioner to establish a plan for after-hours calls, and how to ensure the Beneficiary’s pain and symptoms are managed during the nights, weekends, and holidays.