Eli's Hospice Insider

Published on Wed May 11, 2022 PDF

Here’s how to treat MA payments for cap purposes.

The longer Medicare’s Value-Based Insurance Design (VBID) Model’s Hospice Benefit Component goes along, the more it proves confusing. Note these three facts recently shared by a HHH Medicare Administrative Contractor to try to clear up the chaos.

Tip #1: If you have Medicare patients enrolled in the VBID hospice carve-in model, “you can’t include your Medicare Advantage plan payments for these patients in calculating your aggregate and inpatient cap payments for January 1, 2021–December 31, 2024, the performance period of the Model component,” MAC Palmetto GBA advises in a recent post on its website.

Tip #2: Medicare Advantage Organizations (MAOs) participating in the hospice model “retain responsibility for all Original Medicare services, including hospice care,” Palmetto stresses in a separate post. That means MAOs must pay for “non-hospice care provided to a hospice enrollee during a hospice stay, such as the items, drugs, or services that are furnished to treat a condition unrelated to the terminal illness and related conditions” and “other non-hospice care (items, drugs, or services) that are furnished after a hospice stay ends (in the event of a live discharge, including non-hospice care provided on the last day of the stay through the end of the calendar month that the hospice stay ends),” Palmetto specifies.

Tip #3: “Under the Hospice Benefit Component … [MAOs] retain responsibility for all Original Medicare services, including hospice care,” Palmetto explains in another separate post on its website. “MAOs must pay for non-hospice care provided to a hospice enrollee during a hospice stay, such as the items, drugs, or services that are furnished to treat a condition unrelated to the terminal illness and related conditions,” the MAC says. “And they must cover other non-hospice care (items, drugs, or services) that are furnished after a hospice stay ends (in the event of a live discharge, including non-hospice care provided on the last day of the stay through the end of the calendar month that the hospice stay ends),” Palmetto adds.