MACs to Send Direct Mailing to Hospices Regarding MA VBID Hospice Component Model

In January 2021, the Centers for Medicare & Medicaid Services (CMS) initiated a four-year demonstration model (the MA VBID Hospice Component) under which eligible Medicare Advantage (MA) plans are permitted to offer hospice services as part of the benefit packages. For calendar year (CY) 2022, the MA VBID Hospice Component will expand such that plans in 22 states and territories will participate in the model in some areas of each state. In order to ensure that plans appropriately pay hospices serving patients enrolled in a participating plan and that plans are properly paid by CMS for those patients, special billing rules apply to hospices serving patients in the model.

In an effort to raise general awareness of the MA VBID Hospice Component model and to provide education on participation and billing for MA enrollees that receive hospice services in affected areas, CMS recently issued Change Request 12524/Transmittal 11160 – Direct Mailing Notification to Hospice Providers Regarding the Hospice Benefit Component, Value-Based Insurance Design (VBID) Model, Medicare Advantage Organizations (MAOs), directing the Medicare Administrative Contractors (MACs) to conduct a direct mailing to all hospice providers in their jurisdictions affected by the service areas identified for the CY2022 MA VBID Hospice Component.  These service areas are in the following states and territories:

  • Alabama
  • California
  • Colorado
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Kentucky
  • New Mexico
  • New York
  • Ohio
  • Oklahoma
  • Oregon
  • Pennsylvania
  • Texas
  • Utah
  • Virginia
  • Washington
  • Wisconsin
  • Puerto Rico

According to the transmittal, CMS requires participating MA organizations to communicate with hospice providers in the service area of their participating plans. Hospice providers are also encouraged to communicate with MA plans regarding any questions about the model, billing, coverage, and enrollment. Hospice providers must submit claims and notices to participating MA plans to receive payment when their enrollees elect to receive hospice care. Hospice providers must submit claims and notices to their Medicare contractor, as well, for informational purposes. Enrollees of participating MA plans may seek hospice care with any Medicare-certified hospice provider.

In addition to this specific direct outreach, the MACs have also been directed to conduct education for hospice providers about the CY2022 MA VBID Hospice Benefit Component through relevant outreach events, listserv messages and web postings, which shall include information about CMS and MAC educational products and resources about the model.

Recent NAHC Report coverage of issues related to the MA VBID Hospice Benefit Component Model is available at the following links:

CMS Releases List of MA Plans Offering Hospice under VBID Model in CY2022

CMS Issues Guidance on Determining Hospice Beneficiary Enrollment in MA VBID Hospice Model for CY2022