CMS Issues Guidance on Determining Hospice Enrollment in MA VBID Model for FY2022

Posted Sunday, August 22, 2021

In calendar year 2022, the Medicare Advantage (MA) Value-based Insurance Model (VBID) Hospice Component demonstration model will enter its second year of operation and it is believed the number of MA plans participating in the model will expand, affecting more hospice programs. Hospices impacted by the model will be required to modify operations and processes to accommodate billing the MA plan and other requirements if they serve a patient enrolled in a participating model.

Through the Hospice Benefit Component, we are testing the impact on payment and service delivery of adding the Medicare Part A hospice benefit with the goal of creating a seamless care continuity in the MA program for Part A and Part B services. For Medicare Advantage Organizations (MAOs) that volunteer to be part of the VBID Model, we will evaluate the impact on cost and quality of care for MA enrollees, including how the Model:

  • Improves quality and timely access to the hospice benefit
  • Enables innovation through fostering partnerships between MAOs and hospice providers

While participating in this component of the Model, MAOs will incorporate the current Medicare hospice benefit into MAO-covered benefits. This is in combination with offering palliative care services outside the hospice benefit for enrollees with serious illness and providing individualized transitional concurrent care services. Currently, when an enrollee in an MA plan elects hospice, Fee-for-Service (FFS) Medicare is financially responsible for most services, while the MAO is responsible for certain services (such as supplemental benefits). Under the Hospice Benefit Component of the VBID Model, participating MAOs retain responsibility for all Original Medicare services, including hospice care.

Eligibility Check

Beginning CY 2022, here is how to determine if your patient has enrolled in a plan of an MAO that is participating in the VBID Model Hospice Benefit Component:

STEP ONE: Confirm your patient’s Medicare eligibility and check for MA enrollment using either your normal process or any of the following online tools or services to check for MA enrollment:

  • MAC Portal
  • Health Insurance Portability and Accountability Act (HIPAA) Eligibility Transaction System (HETS)
  • Billing agencies, clearinghouses or software vendors

STEP TWO: If the patient is in an MA plan and the hospice election date is on or after January 1, 2021, identify the MA contract number and plan benefit package identification information on the MA enrollment card or by using one of the online tools or services in Step 1. Note: Check the effective and termination dates to ensure the patient’s enrollment in the participating plan is for 2022.

STEP THREE: Compare the patient’s plan information to the list of plans participating in the Hospice Benefit Component of the VBID Model. This list will be updated in Fall 2021 to reflect plans participating in CY 2022. If their plan is part of the Model, follow the directions for submitting claims.

Click here for the full guidance.


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