Removing Barriers to Person-Centered Care Act of 2016

Removing Barriers to Person-Centered Care Act of 2016

This bill amends title XI (General Provisions) of the Social Security Act to establish an alternative payment model for patient-centered care with respect to Medicare beneficiaries with advanced illnesses. Through the voluntary pilot program, the Centers for Medicare & Medicaid Services (CMS) shall enter into demonstration project agreements with advance care collaboratives to provide Medicare services in a manner that promotes accountability, coordinates services, and encourages investment in infrastructure and redesigned care processes. An "advance care collaborative" is an affiliated group of providers, physicians, or practitioners.

Under the program, a participating advance care collaborative may use a pre-implementation grant to: (1) conduct a needs assessment; (2) modify, upgrade, or purchase health information technology; (3) conduct education and training; (4) hire staff to conduct care management and coordination activities; and (5) conduct other appropriate activities. 

With respect to coverage and payment for services provided to a target Medicare beneficiary by a participating collaborative, CMS shall waive specified requirements related to: (1) coverage of curative care with respect to individuals receiving hospice care, (2) alternative certification for home care and hospice care, (3) coverage of skilled nursing services without an inpatient stay, and (4) coverage of home health care without homebound status.

Under the program, a participating collaborative may receive payment for furnishing target Medicare beneficiaries with: (1) inpatient care as an alternative to routine hospice care, and (2) home-based respite care as an alternative to inpatient respite care.

A participating collaborative shall be eligible for shared savings payments.

CMS shall identify and develop a recommended set of advance care quality measures that may be tested in the pilot program.