Medicare Monthly Review Details

Direct Mailing Notification to Hospice Providers Regarding the Hospice Benefit Component, VBID Model, Participating MAOs

The Centers for Medicare & Medicaid Services issued Change Request 12524 which requires Medicare Administrative Contractors who process hospice claims to complete a mailing to hospice providers regarding the Value-Based Insurance Design model. This VBID model allows participating Medicare Advantage Organizations to offer the hospice benefit to Medicare beneficiaries enrolled in the MAO. A letter will be sent out no later than 1/31/2022 to all hospice providers explaining the VBID model and will include a listing of participating MAOs. This model began in 2021 and additional MAOs have been added in 2022.

In the past when a Medicare beneficiary covered by a MAO elected the hospice benefit, the beneficiary’s Medicare benefits would revert to Medicare Fee-for-Service for all services related to their terminal illness. Any services not related would continue to be the responsibility of the MAO. Beginning in January 2021 and continuing on in 2022, those MAOs participating in the model which allows the beneficiary’s coverage to remain with the MAO even if the beneficiary elects the hospice benefit. In the event a Medicare beneficiary revokes or is discharged from the hospice benefit, that beneficiary will remain enrolled in the MAO plan. 

Information for Hospice Providers

CMS requires participating plans to communicate with hospice providers in its service area. CMS encourages hospice providers to communicate with participating plans regarding any questions about joining the plan’s network of hospice providers. For questions about enrollment, billing, claims and contracting related to enrollees of participating plans, hospice providers should contact the participating MAO. For questions about the Model, please contact CMS at VBID@cms.hhs.gov.

Top Three Things Hospice Providers Need to Know

  1. You must send all notices and claims to both the participating MAO and your MAC. The MAO will process payment, and the MAC will process the claims for informational and operational purposes and for CMS to monitor the Model.

  2. If you contract to provide hospice services with the plan, be sure to confirm billing and processing steps before the calendar year begins, as they may be different.

    Note: While we encourage you to reach out to participating MAOs about contracting opportunities, you are not required to contract. If you choose not to contract, the participating MAO must continue to pay you at least equivalent to Original Medicare rates for Medicare-covered hospice care.

  1. The Model does not permit prior authorization requirements around hospice elections or transitions between different levels of hospice care.

Attached are the instructions (R11160OTN) from CMS regarding this VBID model and below is a list of MAOs participating in the Model for CY 2022.

New Participants
  • AvMed, Inc. with plans in select counties in Florida
  • Cambia Health Solutions, Inc. with plans in select counties in Oregon, Utah and Washington
  • Catholic Health Care System with plans in select counties in New York
  • CVS with plans in select counties in Ohio and Pennsylvania
  • UnitedHealth Group with plans in select counties in Alabama, Illinois, Oklahoma and Texas
Returning Participants
  • Hawaii Medical Service Association with returning plans in select counties in Hawaii

  • Humana Inc. with new and returning plans in select counties in Colorado, Georgia, Indiana, Kentucky, Ohio, Virginia and Wisconsin

  • Intermountain Health Care Inc. with new and returning plans in select counties in Idaho and Utah

  • Kaiser Foundation Health Plan, Inc. with returning plans in select counties in California

  • Presbyterian Healthcare Services with returning plans in select counties in New Mexico

  • Anthem, Inc. with new and returning plans in select counties in Puerto Rico

  • Triple-S Management Corporation with returning plans in select counties in Puerto Rico

  • Visiting Nurse Service of New York with new and returning plans in select counties in New York

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