Can I Get Curative Treatment for My Illness While on Hospice?

According to established Medicare rules, the Medicare hospice benefit does not cover care that is intended to cure a person’s illness or treat chronic conditions that might shorten a person’s life. This means that if a patient receives benefits for hospice care, curative treatment will not be covered. While this currently remains the case, federal lawmakers recently piloted a program called the Medicare Care Choices Model that examined whether expanding coverage to allow patients to receive both hospice and curative treatments would be of benefit.

In 2016, the Affordable Care Act authorized a limited test of this hospice model that allowed some terminally ill patients to receive both hospice and curative care. The program was created to help policymakers learn whether expanding treatment options would encourage greater participation in hospice, which is still vastly underutilized in the United States. The model was only made available to patients with advanced cancers, chronic obstructive pulmonary disease, heart disease and HIV/AIDS who had been certified by a physician as having six months or fewer to live. 

The patient must also have met the following conditions to participate in MCCM:

• Has been enrolled in Medicare Part A and B for at least 12 months
• Has not elected the Medicare hospice benefit within the previous 30 days
• Resides in a home (not an assisted living facility or nursing home)
• Has had at least one hospital “encounter” (admission, ED visit or observation stay) in the previous 12 months
• Has had a minimum of three office visits with any Medicare approved provider within the previous 12 months 

Patients enrolled in the program continued to receive medical care or curative treatment for their underlying diagnosis from the provider of their choice, while also receiving supportive services from hospice providers in their area. The hospice received a flat monthly fee for the services it provided. 

The MCCM test was implemented in two phases: The first began in 2016, and the second began in 2018. The program concluded in 2020, and was evaluated based on several factors, including cost-savings to Medicare, outcome improvement (fewer Emergency Room visits and hospitalizations) and patient satisfaction scores. 

The results of the MCCM test were deemed equivocal, and the Center for Medicare and Medicaid Services has not announced any decision about expanding the program as of October 2022. This means that terminally ill patients must continue to decide whether hospice or curative treatment is the right option for them.

Sources

“Hospice care”. Medicare. https://www.medicare.gov/coverage/hospice-care 

“Hospice Underutilization in the U.S.: The Misalignment of Regulatory Policy and Clinical Reality”. Journal of Pain and Symptom Management. https://pubmed.ncbi.nlm.nih.gov/30142388/ 

“Findings at a Glance: Synthesis of Evaluation Results across 21 Medicare Models 2012-2020”. Centers for Medicare and Medicaid Services. https://www.cms.gov/priorities/innovation/data-and-reports/2022/wp-eval-synthesis-21models-aag 

“Medicare Care Choices Model”. Centers for Medicare and Medicaid Services. https://www.cms.gov/priorities/innovation/innovation-models/medicare-care-choices