CMS Webinars on Rules Governing 3rd Year of Medicare Advantage-Hospice Demonstration

  • Recent Request for Applications from MA Plans for CY2023 to be addressed
  • Webinars on March 10, April 5

The Centers for Medicare & Medicaid Services (CMS) has scheduled two webinars in the near future to provide an overview of the CY2023 VBID-Medicare Hospice Benefit RFA. These webinars will allow time for audience questions.

On March 1, 2022, CMS released a Request for Applications (RFA) for Medicare Advantage (MA) plans interested in participating in the third year (CY2023) of the Hospice Benefit Component of the Value-Based Insurance Design Model (VBID). In addition to the RFA, CMS released other materials that may be of interest to MA plans and hospice providers, including a CY2023 VBID Model Fact Sheet and a memorandum providing the Calendar Year 2023 Preliminary Hospice Capitation Payment Rate Actuarial Methodology for the Hospice Benefit Component of the Medicare Advantage Value-Based Insurance Design Model.

Among the items of note included in the CY2023 RFA is the network adequacy methodology that CMS plans to use beginning in CY2023. CMS indicates in the RFA that Plan Benefit Packages (PBPs), a set of benefits for a defined MA service area, entering their second or later year of participation in the model must meet a Minimum Number of Providers (MNP) standard relative to contracted hospice programs. The MNP calculation is a modified version of the existing standard for MA network adequacy.

In addition to meeting the MNP standard, “mature” PBPs mut also provide coverage for out-of-network hospice services. Out-of-network providers will be paid at existing fee-for-services rates.

Additional details and analysis regarding the CY2023 RFA will be forthcoming from NAHC in a future edition of NAHC Report.

We urge you to put these two webinars on your calendar:

1. Webinar — Medicare Advantage Value-Based Insurance Design Model – 2023 Hospice Benefit Component Overview

WHEN:  Thursday, March 10, 2022, from 3 to 4 PM EASTERN

During this webinar, presenters will provide a brief review of the recently released Calendar Year (CY) 2023 Requests for Applications (RFAs) for the VBID Model and the Hospice Benefit Component as well as the payment design related to the Hospice Benefit Component of the VBID Model. This session will also offer attendees an opportunity to ask follow-up questions.

2. Webinar — Office Hours: Medicare Advantage Value-Based Insurance Design Model – 2023 Hospice Benefit Component Overview

WHEN: Tuesday, April 5, 2022, from 3 to 4 PM EASTERN

The CMS Innovation Center will host an office hours session to discuss the Medicare Advantage Value-Based Insurance Design (VBID) Model and its Hospice Benefit Component. Attendees will receive an overview of the Model and the CY 2023 application process, and have an opportunity for questions and answers with the Model team.

CMS Webinars on Rules Governing 3rd Year of Medicare Advantage-Hospice Demonstration

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Hospice Star Rating, Updated HCI Provider Preview Reports, and HQRP Tip Sheets

A Centers for Medicare & Medicaid Services’ (CMS) webinar on the CAHPS hospice star rating on December 16, 2021 revealed additional detail about the rating, which will be publicly reported on Care Compare beginning in August 2022. CMS is calling this star rating the “Family Caregiver Survey Rating Summary Star” and it will range from one star (worst) to five stars (best).

CMS will calculate nine CAHPS Hospice Star Ratings: one for each of the eight publicly reported CAHPS Hospice measures and a Family Caregiver Survey Rating, which is a summary star rating that combines the star ratings of the eight family caregiver experience measures. Only the CAHPS Hospice Summary Star Rating will be publicly reported on Care Compare and only those hospices with 75 or more completed surveys over the reporting period will have their star rating publicly reported. The rating will be updated every other quarter (every 6 months). CMS is using the February 2022 and May 2022 Care Compare refresh period as a “dry run”. This allows hospices to see their star ratings and what the summary star rating would be if it were to be posted on Care Compare.

Again, CMS will not post the Star Rating on Care Compare until August 2022. Hospices can see their first “dry run” ratings in their CMS Preview Report that became available in November 2021. This is an “on demand” report so it does not automatically appear in the CASPER folder. Hospices need to run the report from the “Hospice Quality Reporting Program” report category. The reporting period for the dry run is October 1, 2018 – December 31, 2019; July 1, 2020 – March 31, 2021. More information about how to access the Star Rating Preview Report is found in the Hospice Quality Reporting Measure Specifications User’s Guide.

During the webinar, CMS explained the calculation of the star rating, which is similar to calculations CMS uses in other quality reporting programs. Top-box scores, the proportion of respondents who gave the most favorable response(s) for each of the CAHPS Hospice Survey measures that are publicly reported, are used and adjusted for the case mix of the hospice and mode of survey administration. CMS intended with the calculation to have maximal differentiation between the star categories and to have minimal differentiation of hospices within the star category making the star rating more meaningful. Detailed information regarding the calculation can be found in the CAHPS Star Rating Technical Notes.

A little more than 2000 hospices met the eligibility criteria to be assigned a star rating for the dry run period. This is not an overwhelming majority of hospices so it is possible there are pockets where only some of the hospices will have a publicly reported Star Rating which may make comparison among hospices confusing. Approximately 90 percent of Medicare beneficiaries enrolled in hospice in 2020 were enrolled in a hospice that does have a Star Rating during the dry run.

The slides and recording of the December 16 webinar will also be available soon on the CMS Hospice Quality Reporting webpage. Additionally, NAHC is developing a resource for providers which will be available at the beginning of 2022.

HCI UPDATE
Due to an issue identified with the national averages and percentile calculations for the Hospice Care Index (HCI) measure, CMS revised the data for the HCI Preview Reports. Hospices are able to access these revised reports via the Hospice Quality Reporting Program category in their CASPER folders now.

CMS is targeting the May 2022 refresh for the inaugural public display of the HCI and Hospice Visits in the Last Days of Life (HVLDL) claims-based measures. The eight quarters of claims data used to calculate these measures for a May 2022 refresh would include Q2 2019–Q4 2019 and Q3 2020–Q3 2021. CMS is also planning to provide annual updates to the claims-based measures in November 2022 and each following November refresh. Learn more about HCI and HVLDL in the Q&A on Claims-Based Measures downloadable (PDF) located on the Background and Announcements webpage.

HQRP TIP SHEETS
CMS updated the Hospice Quality Reporting Program (HQRP) resources on December 16 by posting two new Tip Sheets

Second Edition HQRP Public Reporting Tip Sheet
HQRP Compliance Tip Sheet_ FY 2022 and Future Years​
The Second Edition HQRP Public Reporting Tip Sheet explains how CMS will handle the impact of the temporary exemption of quality reporting that occurred due to the COVID-19 Public Health Emergency (PHE) in the HQRP going forward and incorporates the changes to the HQRP from the FY 2022 hospice final rule. The HQRP Compliance Tip Sheet_FY 2022 and Future Years provides information on the HQRP, compliance requirements and how to track compliance.

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