Plan Participation in CY2023 to Expand for MA VBID Model to Test Hospice Coverage

–CMMI Releases List of Plans, Operating Locations for Next Year On September 29, 2022, the Centers for Medicare & Medicaid Services (CMS) released the list of Medicare Advantage (MA) plans that will participate in the Medicare Advantage (MA) Value-Based Insurance Design (VBID) Model during Calendar Year (CY) 2023, including those that will participate in the…

NAHC Submits Comments to CMS on Medicare Advantage

On August 31, 2022, the National Association for Home Care & Hospice (NAHC) submitted comments in response to a request for information (RFI) from the Centers for Medicare & Medicaid Services (CMS) about the Medicare Advantage (MA) program. It is projected that over 50 percent of Medicare beneficiaries will be enrolled in an MA plan…

CMS Seeks Public Feedback to Improve Medicare Advantage

The Centers for Medicare & Medicaid Services (CMS) released a Request for Information seeking public comment on the Medicare Advantage program. CMS is asking for input on ways to achieve the agency’s vision so that all parts of Medicare are working towards a future where people with Medicare receive more equitable, high quality, and person-centered care that is affordable and sustainable.

“Medicare Advantage is a critical part of CMS’ vision to advance health equity; expand access to affordable coverage and care; drive high quality, person-centered care; and promote affordability and sustainability of Medicare,” said CMS Administrator Chiquita Brooks-LaSure. “Medicare Advantage plans are essential partners in this work.”

“We see a huge opportunity for partnership with as many stakeholders as possible to better understand how care innovations are changing outcomes and costs and how Medicare Advantage is working for enrollees,” said Dr. Meena Seshamani, CMS Deputy Administrator and Director of the Center for Medicare. “It’s important that CMS engage as many stakeholders as possible to achieve our collective vision of equity, access, quality and affordability.”

The CMS Strategic Pillars prioritize increased engagement with the agency’s partners and the communities we serve throughout the policy development and implementation process. CMS is committed to creating additional opportunities to engage the public and drive innovation in ways that best serve people with Medicare.

In the Medicare Advantage program – also known as Medicare Part C – Medicare contracts with private insurers that must offer all Traditional Medicare services to people with Medicare and may offer added supplemental benefits, such as vision or dental benefits. Most Medicare Advantage Plans also include prescription drug coverage (Part D).

CMS encourages the public to submit comments to the Request for Information. Feedback from plans, providers, beneficiary advocates, states, employers and unions, and other partners to this Request for Information will help inform the Medicare Advantage policy development and implementation process.

NAHC will be submitting comments and we urge all interested NAHC members to do the same.

The Request for Information can be accessed from the Federal Register at:
https://www.federalregister.gov/public-inspection/2022-16463/request-for-information-medicare-program

CMS Seeks Public Feedback to Improve Medicare Advantage

The Centers for Medicare & Medicaid Services (CMS) released a Request for Information seeking public comment on the Medicare Advantage program. CMS is asking for input on ways to achieve the agency’s vision so that all parts of Medicare are working towards a future where people with Medicare receive more equitable, high quality, and person-centered care that is affordable…

CMS Seeks Public Feedback to Improve Medicare Advantage

  • NAHC will be submitting comments & we encourage our members to do the same

Today, the Centers for Medicare & Medicaid Services (CMS) released a Request for Information seeking public comment on the Medicare Advantage program. CMS is asking for input on ways to achieve the agency’s vision so that all parts of Medicare are working towards a future where people with Medicare receive more equitable, high quality, and person-centered care that is affordable and sustainable.

“Medicare Advantage is a critical part of CMS’ vision to advance health equity; expand access to affordable coverage and care; drive high quality, person-centered care; and promote affordability and sustainability of Medicare,” said CMS Administrator Chiquita Brooks-LaSure. “Medicare Advantage plans are essential partners in this work.”

“We see a huge opportunity for partnership with as many stakeholders as possible to better understand how care innovations are changing outcomes and costs and how Medicare Advantage is working for enrollees,” said Dr. Meena Seshamani, CMS Deputy Administrator and Director of the Center for Medicare. “It’s important that CMS engage as many stakeholders as possible to achieve our collective vision of equity, access, quality and affordability.”

The CMS Strategic Pillars prioritize increased engagement with the agency’s partners and the communities we serve throughout the policy development and implementation process. CMS is committed to creating additional opportunities to engage the public and drive innovation in ways that best serve people with Medicare.

In the Medicare Advantage program – also known as Medicare Part C – Medicare contracts with private insurers that must offer all Traditional Medicare services to people with Medicare and may offer added supplemental benefits, such as vision or dental benefits. Most Medicare Advantage Plans also include prescription drug coverage (Part D).

CMS encourages the public to submit comments to the Request for Information. Feedback from plans, providers, beneficiary advocates, states, employers and unions, and other partners to this Request for Information will help inform the Medicare Advantage policy development and implementation process.

The Request for Information can be accessed from the Federal Register at:
https://www.federalregister.gov/public-inspection/2022-16463/request-for-information-medicare-program

Medicare Advantage Plans Send Pals to Seniors’ Homes for Companionship — And Profits

Phil Galewitz, Kaiser Health News Widowed and usually living alone, Gloria Bailey walks with a cane after two knee replacement surgeries and needs help with housekeeping. So she was thrilled last summer when her Medicare Advantage plan, SummaCare, began sending a worker to her house in Akron, Ohio, to mop floors, clean dishes, and help…

Hospice Notes for July 13, 2022

Congress is facing a packed few weeks in the lead-up to the monthslong August recess. The potential revival of a slimmed-down reconciliation package sought by Senate Democrats remains top-of-mind for many DC watchers. While nothing is concrete at this point, it unfortunately appears likely that any smaller party-line reconciliation bill will omit major funding investments in Medicaid home-and-community-based services (HCBS). Last year’s House-passed Build Back Better Act included $150 billion for HCBS, seen as a transformative injection of resources that would increase access and better support the frontline home care workforce.

NAHC continues to work with other diverse coalitions to push for the inclusion of HCBS funding in any emerging deal.

Elsewhere on Capitol Hill, the House Appropriations committee recently approved a number of FY2023 government funding bills, including the Labor, Health and Human Services, Education, and Related Agencies (LHHS) package that contains discretionary spending for federal health programs. While it is certain that future Senate-side bipartisan negotiations will ensure any final government funding package that will ultimately become law will differ from what the House Appropriations committee has cleared, it is still instructive to keep track of the Democrat-led House deal, as it provides insight into that group’s policy priorities. A few provisions relevant to home-based care providers, detailed in the bill’s accompany report, include the following (note -many of these are merely signaling in nature, as opposed to explicitly directive):

  • Medicare Coverage of Home-based Extended Care Services.—The Committee encourages CMS to consider options to improve extended care services for Medicare beneficiaries, such as through home-based extended care by home health agencies (bottom of pg 184)
  • Patient Access to Home Health Care.—The Committee supports the intent of the network adequacy rules of CMS for Medicare Advantage organizations and for Medicaid managed care organizations under 42 C.F.R. 438 and 457 to maintain a network of qualified providers sufficient to provide adequate access for covered services to meet the health care needs of the patient population served. The Committee requests a report within 180 days of the date of enactment of this Act on regulatory actions related to network adequacy (bottom of pg. 186)
  • Home Health Aides.—The Committee recognizes that home health aides (HHAs) are the foundation of professional home-based caregiving, and that the growing population of disabled, chronically ill, and elderly Americans receiving home-based care requires a skilled and highly trained HHA workforce prepared to manage complex care needs. The Committee encourages HHS to explore how HHAs are meeting clinical competencies necessary to provide high-quality home-based care (pg. 221)
  • Direct Care Workforce Demonstration.—The Committee provides $3,000,000 for a Direct Care Workforce Demonstration project, to reduce barriers to entry for a diverse and high-quality direct care workforce, including providing wages, benefits, and advancement opportunities needed to attract or retain direct care workers. (pg. 211)
  • Dementia Care Management Model.—The Committee urges the Center for Medicare & Medicaid Innovation (CMMI) consider how best to test a Medicare dementia care management model. The Committee encourages CMMI to continue working with stakeholders to find a way to test a value-based dementia care management model that could reach dementia patients across the stages and include coordinated care management and caregivers. The Committee requests an update not later than one year after the date of enactment of this Act on the progress for this model. (pg. 180)

The bill also includes several provisions that would help to increase the health care workforce. Among other things, the bill includes: nearly $2 billion in new money for the Department of Labor, including for apprenticeship programs, Workforce Innovation and Opportunity state grants, and Senior Community Service Employment; $15,6 billion in new money for HHS to enhance nursing workforce development and other health care programs; and enhanced funding for targeted programs of the Administration on Community Living.

The Committee also adopted a manager’s amendment from House Appropriations Committee Chairwoman Rosa DeLauro (D-CT), that added language to the committee report that urges the Health Resources and Services Administration  (HRSA) to “address the skilled care workforce needs of seniors through existing workforce education and training programs.”

The most hospice and palliative care-specific bills in Congress right now include the Palliative Care and Hospice Education and Training Act (PCHETA) (S.4260) and the Expanding Access to Palliative Care Act (S. 2565). PCHETA would bolster the serious illness professional workforce and boost palliative and hospice research funding, while S.2565 would require CMMI to test a dedicated community-based palliative care demonstration informed by the recently-ended, hospice-only Medicare Care Choices Model (MCCM). Both bills are currently Senate-only at this point, and we need your continued advocacy and outreach to continue to garner co-sponsors for these important policies. Use NAHC’s grassroots outreach campaigns to ask your Senators to support these bills.

Elsewhere in DC, much of the policy conversation on palliative care in particular is occurring within CMMI. In light of the Innovation Center’s strategic refresh late last year, it has become apparent that leadership there is focused on streamlining their demonstration portfolio and developing ways to better integrate specialty care (which is how they conceptualize palliative care) into broader, population health-style models, primarily the ACO programs.

Recently, CMMI posted a blog that broadly spells out their early vision for this kind of integration. In the piece, they specifically write: “Until more ACOs can assume full risk, collaborative care codes, as currently used in behavioral health, could support integration and co-location of some specialty care, such as palliative care.”

NAHC, in tandem with other members of the National Association of Hospice & Palliative Care, continues to work with CMMI to explore how best to support and scale home and community-based palliative care.

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.

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…

NAHC Seeks Dialogue with Hospices Involved in MA VBID Hospice Component Model

Beginning in January 2022, the Medicare Advantage (MA) Value-Based Insurance Design (VBID) Hospice Benefit Component model entered its second year of operation. Under the model, participating MA plans include the hospice benefit among their benefit offerings, as well as transitional concurrent care, palliative care, and hospice-specific supplemental benefits. The Centers for Medicare & Medicaid Services (CMS) plans to operate the model for a total of four years (CY2021 through CY2024).

During the first year, nine MA plans participated in the model in 14 states and territories through 53 separate plan benefit packages (PBPs).  During CY2022, the second year, the model expanded to 13 MA plans (through 115 PBPs) operating in 22 states and territories.  In CY2022, that translates to a total of 461 counties in which the MA VBID Hospice Component model is operating across the nation.

The National Association for Home Care & Hospice (NAHC) is seeking to connect hospice providers participating in the model – either as in-network or out-of-network hospices — for individual conversations about their experience in the model. If you are a hospice that has served patients enrolled in the MA VBID Hospice Component model, we urge you to contact Theresa Forster (tmf@nahc.org), NAHC’s VP for Hospice Policy & Programs, to schedule a brief discussion of your discuss your experience.  Your participation will help NAHC assess the impact that the model may be having on hospice providers and the hospice benefit.

Following are the states in which the MA VBID Hospice Component Model is or has operated during CY2021 and CY2022:

  1. Alabama
  2. California
  3. Colorado
  4. Florida
  5. Georgia
  6. Hawaii
  7. Idaho
  8. Illinois
  9. Indiana
  10. Kentucky
  11. Massachusetts
  12. New Mexico
  13. New York
  14. Ohio
  15. Oklahoma
  16. Oregon
  17. Pennsylvania
  18. Puerto Rico
  19. Texas
  20. Utah
  21. Virginia
  22. Washington

Please note:  If you are a hospice provider and the VBID Hospice Benefit Component is offered in your state and you are interested in determining whether it is being offered in your service area, you must consult the list of PBPs for which CMS has posted a link HERE, sort by state and review the list of counties and zip codes where the PBPs are operating.