The Value-Based Insurance Design (VBID) model has included a hospice carve-in since 2021. Shockingly, it has been announced within the VBID demonstration framework that the hospice carve-in will conclude on December 31, 2024.

The hospice carve-in, which was announced in 2021, was initially extended through 2030. However, a recent surprising announcement reveals that it will cease on December 31, 2024. It’s important to note that while you may see information regarding the VBID model continuing with Medicare Advantage, there’s an exception regarding the hospice carve-in.

As of now, CMS hasn’t provided us with specific details regarding how hospices will manage the transition from the end of 2024 to 2025. There’s an assumption that patients enrolled in a VBID model Advantage plan would automatically transition to Traditional Medicare services on January 1, 2025. However, we lack written confirmation to support this assumption.

In the announcement, CMS assured that hospices will be compensated fully for the care they deliver until December 31, 2024.

There are two years of reports that have been published concerning the VBID demonstration and the hospice carve-in. Reading these reports would be highly beneficial, as they shed light on various issues that have arisen during the demonstration, offering valuable insights from both the hospice and Medicare Advantage Organization perspectives. Click here to read the 2022 and 2023 VBID Model Evaluation Reports.

A significant event that may have contributed to the ending of hospice participation in VBID was United Healthcare withdrawing 24 of their Medicare Advantage benefit plans from the model, effective January 1, 2024. This surprising action resulted in the reduction of participating benefit packages from 119 to less than 85.

Medicare Advantage benefit plans have struggled to meet hospice requirements, particularly in efficiently processing claims and accepting Notice of Elections, among other issues. However, there have also been challenges on the hospice side regarding payment and getting organizations to comprehend the workings of how hospice payments even work in certain instances. Additionally, there was even pressure put on hospices by Medicare Advantage Organizations to essentially recruit patients, which is highly concerning.

While the involvement of hospice with Medicare Advantage is set to conclude on December 31, 2024, it’s important to recognize that this doesn’t signify the permanent end of hospice involvement. Rather, it marks a temporary pause. The anticipation is that there will be a thorough review of all the issues and benefits stemming from the VBID demonstration with the Hospice carve-in. After which, there will likely be a resurgence of hospice involvement with Medicare Advantage plans. Hospices are believed to become integrated into Medicare Advantage benefit packages again, potentially sooner than many would prefer.

With nine months remaining in 2024, understand that if you admit a patient who is currently enrolled in one of the participating plans, full compliance with VBID regulations is still necessary to ensure payment for your patient.

Providers outside the network should receive full payment at Traditional Medicare rates. However, they might undergo additional medical reviews of their charts before these payments are processed. In-network providers have agreements with VBID plans and will be compensated based on the negotiated rates.

It’s important to note that if you encounter a situation where you have a patient enrolled in a VBID participating plan between now and December, you must remember to bill both the Medicare Advantage Organization and your Medicare MAC (Palmetto GBA, NGS, or CGS) to ensure proper reimbursement.

Should you have any specific questions or require assistance regarding the VBID hospice carve-in, please feel free to reach out to us.

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