CMS Gears Up for Year Three of MA VBID Hospice Component Model

Beginning in January 2021, the Centers for Medicare & Medicaid Services (CMS) began testing inclusion hospice as part of the Medicare Advantage (MA) benefit package. This test model is being operated for four years (Calendar Years 2021 through 2024) under the umbrella of the Value-Based Insurance Design (VBID) Model and is officially called the MA VBID Model Hospice Benefit Component (Hospice Benefit Component).

Each year CMS issues transmittals that signal systems changes to ensure that notices and claims connected to beneficiaries enrolled in plans that are participating in the Hospice Benefit Component process correctly in CMS’ systems. In late April CMS issued Change Request 12688/Transmittal 11383 (SUBJECT:  Calendar Year 2023 Modifications/Improvements to Value-Based Insurance Design (VBID) Model – Implementation), which modifies previous Change Requests (CR 11754 and CR 12349) related to the VBID Hospice Benefit Component model. CR 12688 makes modifications to the previous two Change Requests to ensure proper operation of the model during CY 2023, including appropriate identification of patients enrolled in a model-participating MA plan when they elect hospice care.

CMS has also issued MLN Matters article MM12688 to accompany CR 12688.  MM12688 stresses that hospices serving patients in the Hospice Benefit Component model must ensure that their billing staff are familiar with the modifications in the VBID Model’s Hospice Benefit Component for CY2023 and other requirements established in CRs 11754 and 12349 that will still apply. During CY2023 hospices will still be required to submit notices and claims for services provided to model-enrolled beneficiaries to both the applicable Medicare Administrative Contractor (MAC) and the MA plan.

Previous NAHC Report coverage of the Hospice Benefit Component model describes ways in which CMS is modifying the model effective CY2023.

Detailed information regarding beneficiary eligibility checks and claim submission are available on the VBID Model Hospice Benefit Component website HERE.

Current postings are applicable to CY2022 (the current model year), but it is anticipated that any changes to the information applicable to CY2023 will be posted closer to the close of 2022.