The Concurrent Care Requirement for Children with Life-Threatening Illness: Challenges and Opportunities (TH318): Pediatric SIG

Abstract

1.Explicate the intention of the Medicaid Concurrent Care for Children Requirement (CCCR) to provide concurrent curative/life-prolonging treatment and pediatric palliative care and hospice services for children with life-limiting or life-threatening conditions (LL/LTC) as well as the limitations of this provision.2.Recognize the challenges states have encountered in implementing the CCCR, successful strategies utilized to address these challenges, and how other states can learn from their experiences.3.Delineate strategies for expanding the scope of concurrent care to children with a prognosis of less than 6 months and challenges to implementing these strategies. Prior to the passage of the Patient Protection and Affordable Care Act (PPACA) in 2010, the same hospice Medicare benefit eligibility criteria were applied to children and adults, including the requirement to forgo curative or life-prolonging treatment. For families with children with life-limiting or life-threatening conditions (LL/LTC), this requirement posed a substantial barrier to accessing palliative care and hospice services. Furthermore, for children with medically complex conditions—especially those with technology dependence or continuous home nursing—the need to change home care teams, often with a concomitant decrease in hours of nursing support, represented another major barrier to palliative care and hospice services for children with LL/LTC. Section 2302 of the PPACA, termed the Concurrent Care for Children Requirement (CCCR), eliminated the stipulation to forgo curative or life-prolonging therapies for Medicaid patients under age 21. Medicaid programs in every state are now required to provide concurrent curative/life-prolonging treatment and pediatric palliative care/hospice services for children with LL/LTC who otherwise meet hospice eligibility criteria. The Centers for Medicare & Medicaid Services have left the implementation of the CCCR to individual states, which have been slow to develop systems and payment criteria that would make this care a reality. This session will describe the scope of the changes legislated by the CCCR, explore challenges and strategies in the implementation of the provision across the country, and discuss future implications for the expansion of concurrent palliative care services for children with LL/LTC. Specific program and case examples will be utilized to give participants ideas and language to navigate these issues in their own communities.