Eli's Hospice Insider

Published on Tue Oct 13, 2020 PDF

Model will play out in 206 counties nationwide.

To find out whether you may get swept into the program testing hospice as a part of Medicare managed care next year, check out the states where the Value-Based Insurance Design Model Hospice Benefit will run.

In 2021, 19 Medicare Advantage Organizations (MAOs) will participate in VBID, with nine of them offering the hospice benefit, the Centers for Medicare & Medicaid Services reveals. The nine MAOs will offer 53 plan benefit packages in 206 counties in California, Colorado, Georgia, Hawaii, Idaho, Indiana, Kentucky, Massachusetts, New Mexico, New York, Ohio, Utah, Virginia, and Puerto Rico.

“CMS will require that MAOs provide beneficiaries with broad access to the complete original Medicare hospice benefit,” the agency assures on its VBID webpage. Participating MAOs “will be required to outline how they will provide palliative care to eligible enrollees, irrespective of the election of hospice, and may make transitional, concurrent care services as well as hospice-specific supplemental benefits available to enrollees who elect hospice through network hospice providers,” CMS maintains.

Hospices and their representatives largely remain skeptical.

For example: When CMS announced the project, National Hospice and Palliative Care President Edo Banach called it “a missed opportunity for [CMS] to innovate the way hospice care is delivered. While the application mentions ‘palliative care’ and ‘transitional concurrent care,’ and encourages plans to innovate, it does not mandate particular coverage for that care. We have seen that innovation without baseline requirements can sometimes lead to barriers to care.”

Further, VBID fails to take advantage of potential flexibility. “The model does not waive the six-month prognosis requirement for hospice eligibility. This is a missed opportunity to expand access to hospice,” Banach said.

Download an Excel sheet with the specific cities and counties affected at https://innovation.cms.gov/innovation-models/vbid — scroll down to the “Hospice Benefit Component” section.