In 2019, Hawai’i Med-QUEST Division (MQD), the state’s Medicaid agency, set out to develop a defined set of coordinated, interdisciplinary community-based palliative care services that would enable access to palliative care to Medicaid beneficiaries of all ages with serious illness. This benefit to Medicaid beneficiaries fills a critical gap in care for people in Hawai’i living with a serious illness and helps them to seek care for their pain and other symptoms outside of the hospital, while still receiving treatment for their condition. The development of this palliative care benefit included substantial engagement by stakeholders across the state, providing input into the design of the benefit and the guidance for implementation. This initiative was generously funded by the Stupski Foundation.
On May 7, 2024, the Centers for Medicare and Medicaid Services (CMS) approved the state’s application to include community-based palliative care services as a benefit in their State Plan Amendment (SPA). This makes Hawai’i the first state to implement palliative care as part of standard care, adjusting the state’s Medicaid budget to include these necessary services. As reported by C-TAC in October 2023, this approval is hugely significant, as it paves a path to enable other states wishing to cover palliative care services as part of a state plan amendment. This policy route differs from previous ones in California and other states by successfully including CMS in the process of approval, requiring a specific standard of care available to all Medicaid beneficiaries, and standardizing the payment model so that it can be part of the state Medicaid fee schedule.
This approval also defines palliative care as a preventive service. As palliative care continues to be associated and confused with hospice and end-of-life care, defining it as preventive care marks a meaningful, and more accurate, shift in the way palliative care is seen by patients and providers. Preventive care, including palliative care, is defined as: services that prevent disease, disability, and other health conditions or their progression; prolong life; and promote physical and mental health and efficiency. Palliative care is based on the needs of the patient, not on the patient’s prognosis. It is appropriate at any age and at any stage in a serious illness, and it can be provided along with curative treatment. This significant policy change can be a major opportunity to communicate differently about the benefits of palliative care.
This approval also defines a payment methodology for community-based palliative care that standardizes the payment methodology for palliative care services using a bundled payment rate that covers services delivered by an interdisciplinary team. This payment methodology leverages codes that currently exist on the Medicare fee schedule and that can be leveraged by other states in a more standardized way. C-TAC was pivotal in the creation of the reimbursement codes utilized, working with private payors in 2016 to request a standardized way to reimburse for services for people with serious illness by health plans interested in piloting this reimbursement methodology. Now, these codes can be requested by state Medicaid programs and used by health plans wishing to standardize their payment for services.
This groundbreaking work opens pathways in states across the country seeking to transform care for the seriously ill using a care model that is high-quality, evidence-based, and sustainable. Hawai’i has already kicked off implementation of these services by launching a substantive initiative to improve the infrastructure for delivering palliative care services and educating the community about its benefits. This includes funding for C-TAC members Hawai’i Care Choices and Kokua Mau, both serving as subject matter experts in the delivery of high-quality palliative care throughout the state. View the approved SPA.
