stay so long as the patient begins receiving palliative care services prior to admission. Services shall not be disrupted solely due to change in location from a residence to an in-patient setting, and shall be part of care coordination and care planning following hospital discharge. (7) Services The model shall include items and services based on specific patient needs with respect to pain, symptom management, education, disease modifying treatments, advance care planning and shared decision making, goals clarification, mental health services, family and caregiver support services, spiritual support care, personal care assistance, and stress reduction therapies. This includes a comprehensive assessment of symptoms and stress factors that impact quality of life. (8) Access Care shall be available under the model 24 hours a day, 7 days a week, and 365 days a year, including telehealth services. The CMI shall specifically consider the needs of rural and underserved areas and adjust accordingly to ensure equitable access to care. A broad range of providers must be included with no geographic limitations. (9) Metrics The CMI shall assess the model by comparing participants to other members of the target population who are receiving care outside of the model, including with respect to the following: (A) Demographics (including age, diagnosis, residence type, medical encounters in preceding 12 months leading to enrollment, geographic location (such as urban or rural) and others as determined by the CMI). (B) Impact on utilization of items and services under title XVIII (such as emergency department services, hospital observation services, inpatient admissions, and intensive care unit (ICU) stays). (C) Election of hospice care. (D) Duration of hospice care. (E) Care Experience (beneficiary and caregiver). .