Recently, 2023 specific information related to the Hospice component of the Value-Based Insurance Design (VBID) Model was released. The VBID Model is specific to elements that are being tested in a demonstration with Medicare Advantage. Understand that the Hospice component of the VBID Model is only one component of the model.  

What is the VBID Demonstration 

While VBID itself began in 2017, the Hospice component of the VBID Model did not begin until January 1, 2021 and is set to run for four years from that date. That means that as we enter January of 2023, the Advantage plans that have participated in the VBID Model since January 2021 will be entering their third year of the VBID demonstration.  

In this demonstration, Hospice is a built-in component of any Medicare Advantage plan in which the MAO (Medicare Advantage Organization) has volunteered the plan to participate in VBID. This program is participation by the MAO on a volunteer basis and must be approved through CMMI/CMS.  Specific Medicare Advantage Plan packages under a MAO are volunteered, not all plans a MAO offer are volunteered.  As far as Hospices are concerned, for you to be a part of the model, you simply admit a Hospice patient that is enrolled in an Advantage plan that is participating in the VBID Model. If you admit a patient that is enrolled in one of these packages, you will be required to bill the Medicare Advantage plan for the payment for Hospice services provided to this patient and you must also bill both Traditional Medicare.    

Participating Medicare Advantage Organizations 

They have released the exact MAOs that will be participating. There are ones that have participated in the past that will no longer participate, but they also have additional participants bringing the total MAOs that are participating to 15. Additionally, the number of actual benefit plans that are included in the VBID Model is now 119. These benefit plan packages cover 25 states (up from 22) and over 800 counties within that area. That has almost doubled the number of counties that are included in participation.   

Will Medicare Advantage Hospice Coverage Continue? 

It is significant that Medicare Advantage plans are now dipping their toes into the Hospice world, and we do anticipate that it will be a nationwide event, as we are fully convinced that Medicare Advantage will continue to provide the Hospice benefit moving forward. We do not know for sure that is going to happen, and we do not know that it will happen coinciding with the end of the VBID Model. 

For additional information about the VBID Model, click here. To view the updated list of participating MAOs, click here. If you do admit one of these patients, you will know exactly who you need to contact within that Medicare Advantage Organization.

Medicare Advantage has been difficult for Home Health agencies to deal with in the past and we are concerned about the impact that its involvement could have on the Hospice benefit. This is especially important for you to investigate if you have not done so already, especially if you find that there are Medicare Advantage organizations in your area that will be participating. 

Healthcare Provider Solutions is here so that you have what you need readily at your fingertips. If you need help navigating these updates, feel free to contact us.