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.

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…

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.

CMS Limits MA Plan Cost Sharing for Home Health Services

The Centers for Medicare & Medicaid Services (CMS) has issued a final rule with comment period that finalizes two remaining proposals from the proposed rule titled “Medicare and Medicaid Programs; Contract Year 2021 and 2022 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicaid Program, Medicare Cost Plan Program,…

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

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…

Medicare to Cover Free Over-the-Counter COVID-19 Tests

People enrolled in either Original Medicare or Medicare Advantage will be able to get over-the-counter COVID-19 tests at no cost starting in early spring, the Biden administration recently announced. Under the new initiative, Medicare beneficiaries will be able to access up to eight over-the-counter COVID-19 tests per month for free. Tests will be available through eligible pharmacies and other participating entities.

This policy will apply to COVID-19 over-the-counter tests approved or authorized by the U.S. Food and Drug Administration (FDA).

This is the first time that Medicare has covered an over-the-counter test at no cost to beneficiaries. There are a number of issues that have made it difficult to cover and pay for over-the-counter COVID-19 tests. However, given the importance of expanding access to testing, the Centers for Medicare & Medicaid Services (CMS) has identified a pathway that will expand access to free over-the-counter testing for Medicare beneficiaries. This new initiative will enable payment from Medicare directly to participating pharmacies and other participating entities to allow Medicare beneficiaries to pick up tests at no cost. CMS anticipates that this option will be available to people with Medicare in the early spring.

Until then, people with Medicare can access free tests through a number of channels established by the Biden-Harris Administration. Medicare beneficiaries can:

  • Request four free over-the-counter tests for home delivery at covidtests.gov.
  • Access COVID-19 tests through healthcare providers at over 20,000 free testing sites nationwide. A list of community-based testing sites can be found here.
  • Access lab-based PCR tests and antigen tests performed by a laboratory when the test is ordered by a physician, non-physician practitioner, pharmacist, or other authorized health care professional at no cost. In addition to accessing a COVID-19 lab test ordered by a health care professional, people with Medicare can also already access one lab-performed test without an order, also without cost sharing, during the public health emergency.

In addition:

  • Medicare Advantage plans may offer coverage and payment for over-the-counter COVID-19 tests as a supplemental benefit in addition to covering Medicare Part A and Part B benefits, so Medicare beneficiaries covered by Medicare Advantage should check with their plan to see if it includes such a benefit.
  • All Medicare beneficiaries with Part B are eligible for the new benefit, whether enrolled in a Medicare Advantage plan or not.

For more information, please see these Frequently Asked Questions, https://www.cms.gov/files/document/covid-19-over-counter-otc-tests-medicare-frequently-asked-questions.pdf

Medicare to Cover Free Over-the-Counter COVID-19 Tests

People enrolled in either Original Medicare or Medicare Advantage will be able to get over-the-counter COVID-19 tests at no cost starting in early spring, the Biden administration recently announced. Under the new initiative, Medicare beneficiaries will be able to access up to eight over-the-counter COVID-19 tests per month for free. Tests will be available through…