Posted Wednesday, August 23, 2023
This year CMS introduced changes to the VBID model that included modifications to network adequacy requirements for Medicare Advantage Organizations (MAOs) participating in the demonstration.
Commonly called the hospice carve-in, MAOs that have participated since the program’s launch in 2021 can now offer beneficiaries incentives to use their plans’ in-network providers. New entrants to the VBID program, however, are still under its first-phase requirements, which required MA plans to pay 100% of the fee-for-service per diem regardless of whether the patient chooses an in-network or out-of-network provider.
“As part of that [VBID] model CMS announced big changes that relate to network adequacy, and this is very important,” Theresa Forster vice president for hospice policy at NAHC said during NAHC’s Financial Management Conference in New Orleans. “This is sort of the other shoe dropping, because this is one of the biggest concerns that we have around this model. We are moving more toward a traditional approach under Medicare Advantage, and the Medicare Advantage plans being able to control who those patients utilize for these services. And that’s a big concern when it comes to hospice care.”
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