The VBID (Value-Based Insurance Design) model is a voluntary program where Medicare Advantage Organizations submit an application and undergo a bidding process to participate in the demonstration. In January of 2021, the Hospice benefit was added to the VBID model. Not all benefit packages participate in the demonstration, and even among those who do, many only do so in limited regions within their coverage area.
Under the VBID model, hospices are subject to the activity involved in the demonstration when a patient, upon the election of hospice, is enrolled in one of the participating benefit plan packages.
In September 2023, the VBID demonstration participation list was updated, as it is every September, for the period of January – December of 2024. The list affords access to MAO contact details including name, email address and phone numbers.
The list update revealed a decrease in the number of participating plans from over 110 to 78. Notably, the United Health Group withdrew all their participating plans from the program. While the exact reason for their withdrawal is unclear, it is likely linked to cost-benefit considerations for the MAO plans.
Originally scheduled to conclude in 2025, the demonstration has been extended until 2030. The belief is that there will eventually be complete participation from all Medicare Advantage plans in offering the Hospice Benefit. Although it remains uncertain if this can be achieved by 2030, it is anticipated that it will come to fruition.
For hospices who operate in an area with extensive coverage by Medicare Advantage plans, consideration must be given on whether you intend to be an in-network, contracted provider with participating Medicare Advantage plans.
Starting from January 1, 2026, participating plans will have the choice to mandate that their beneficiaries elect hospice care from in-network hospices only. Currently, many hospices do not consider this to be a significant factor since, before the start of this demonstration, patients with Medicare Part A were allowed to be admitted and billed under the Traditional Medicare benefit. Focus must be placed on training your eligibility verification staff immediately. This will enable them to properly identify a patient’s Medicare Advantage plan involvement and not automatically default to Traditional Medicare without research. This will lead to investigation as to whether the specific Medicare Advantage plan is participating in the VBID model.
In the event of active participation in the VBID model, agencies will be required to submit billing to both the Medicare Advantage plan and Traditional Medicare to ensure payment. It is crucial for hospices, in as of yet unaffected areas, to grasp the logistics and workings of this model, as we anticipate its expansion to neighboring regions in the near future.
To receive updates on future webinars and educational resources offered by CMS regarding the VBID demonstration, click here.
Should you have any questions about updates to the VBID model, please feel free to reach out to us.
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