Eli's Hospice Insider

Published on Mon Mar 16, 2020 PDF

Participation level for VBID model still unknown.

Medicare has revealed more details about payment for the Medicare Advantage hospice carve-in program.

Recap: The Centers for Medicare & Medicaid Services’ hospice carve-in plan under the Value-Based Insurance Design model will include hospice and related services starting in 2021.

CMS is planning to offer these capitation base rates to participating MA plans for the first month of a patient’s hospice care, it said in a recent webinar: Days 1 – 6 $1,764; Days 7 – 15 $3,320; Days 16+ $5,291.For the second month and beyond, CMS would pay a capitation base rate of $5,187 per month.

Don’t expect that money to flow through to hospices intact, warns the National Association for Home Care & Hospice. The rates are “preliminary and represent what CMS anticipates payment to MA plans that participate in the model,” the trade group points out. “Payments to hospice providers that become part of an MA network, however, will be governed solely by contractual arrangements between the plan and the hospice.”

Plus: “As is the case in other parts of the MA program, services provided by out-of-network hospices under the VBID model will be paid at FFS rates,” NAHC adds.

For an overview and details about the capitation rate, see the slides from a recent webinar at https://innovation.cms.gov/Files/slides/vbid-cy21hospicecap-pymactmeth.pdf.