Medicare Advantage Value-Based Insurance Design Model Calendar Year 2021 Fact Sheet

Medicare Advantage Value-Based Insurance Design Model
Calendar Year 2021 Fact Sheet

The Centers for Medicare & Medicaid Services (CMS) is announcing Calendar (CY) 2020 participation in the Value-Based Insurance Design (VBID) Model and details for the application process for CY 2021 for eligible Medicare Advantage (MA) organizations.

In January 2019, CMS announced a broad array of changes to the VBID Model for CY 2020 and CY 2021. The changes for CY 2020 included testing value-based insurance design by socioeconomic status, MA and Part D rewards and incentives, telehealth networks, and wellness and health care planning. CMS announced that it would begin testing the inclusion of the Medicare hospice benefit in MA for the CY 2021.

As a part of CMS continuing its testing of the VBID Model for CY 2021, we have generated a streamlined request for applications (RFA) process where eligible MA organizations may apply to CMS from January 2020 through March 2020, with a final program design to be submitted with CY 2021 bid submission on June 1, 2020 (details of the streamlined application can be found below). CMS is not testing the telehealth network component of the VBID Model in CY 2021.

CY 2020 VBID Model Participation

MA organization participation in the VBID Model increased between CY 2019 and CY 2020. For CY 2020, the VBID Model has 14 parent organizations (increased from 10 in CY 2019) providing care to over 1.2 million beneficiaries (increased from ~440,000 beneficiaries in CY 2019) in 30 states and Puerto Rico (from 7 states in CY 2019).

The following parent organizations are participating in the VBID Model for CY 2020:

CY 2021 VBID Request for Applications

CMS is releasing the CY 2021 Model RFAs in two parts. First, CMS is releasing an RFA specific for the hospice benefit component. Second, CMS will release an updated RFA that outlines how eligible MA plans may include: (i) Value-Based Insurance Design by Condition, Socioeconomic Status, or both; (ii) MA and Part D Rewards and Incentives; and (iii) Wellness and Health Care Planning. To the extent CMS includes any additional components in the VBID Model for CY 2021, those will be outlined as well. CMS is releasing the first RFA – the Medicare hospice benefit component – today and intends to release the second CY 2021 RFA in January 2020. CMS has streamlined the application process, including the required supporting financial analysis, and MA organizations will have until March 2020 to apply for participation in the Model and indicate the one or more Model components it requests to include in its plan benefit design for CY 2021, including Wellness and Health Care Planning. Working with CMS, MA organizations will have until the MA bid submission deadline (June 1, 2020) to finalize their plan benefit designs for the VBID Model.

VBID Model - Hospice Benefit Component Request for Applications

The Centers for Medicare & Medicaid Services announced in January 2019 that beginning in CY 2021, through the VBID Model, participating MA organizations could include the Medicare hospice benefit in their Part A benefits package. CMS chose to announce this component of the VBID Model almost two years in advance of it beginning to allow CMS to work with MA organizations, palliative and hospice care providers, beneficiary advocate groups, and other stakeholders on how to ensure quality and safety for those beneficiaries enrolled in a VBID-participating MA plan who elect the Medicare hospice benefit. CMS received broad engagement and perspectives from MA organizations, palliative and hospice care providers, and others over the past year on improving access to high-quality palliative and hospice care.

Currently, enrollees may enroll into MA and have access to all original Medicare benefits plus additional supplemental benefits beyond what original Medicare covers. When a MA enrollee elects hospice, Fee-For-Service (FFS) Medicare becomes responsible for most services while the MA organization retains responsibility for certain services (e.g. supplemental benefits). This hospice “carve-out” from MA results in a convoluted set of coverage rules for MA enrollees who elect hospice and fragments accountability for care and financial responsibility across the care continuum.

By including the Medicare hospice benefit in the MA benefits package, CMS will test the impact on service delivery and quality of MA plans providing all original Parts A and B Medicare items and services required by statute. Additionally, CMS is testing how the hospice benefit component can improve beneficiary care through greater care coordination, reduced fragmentation, and transparency in line with recommendations by the Office of Inspector General (OIG), the Medicare Payment Advisory Commission (MedPAC) and others. CMS will require that MA organizations provide beneficiaries with broad access to the complete original Medicare hospice benefit. MA organizations participating in the hospice benefit component will be required to outline how they will provide palliative care to eligible enrollees, irrespective of the election of hospice, and may make transitional, concurrent care services as well as hospice-specific supplemental benefits available to enrollees who elect hospice through network hospice providers.

Consistent with eligibility for the VBID Model in CY 2021, eligible MA health plans in all 50 states and territories may apply for the hospice benefit component.

For more information please visit: https://innovation.cms.gov/initiatives/vbid or email CMS at VBID@cms.hhs.gov.