VBID Model Hospice Benefit Component Overview

Background

Beginning on January 1, 2021, CMS is testing the inclusion of the Part A Hospice Benefit within the Medicare Advantage (MA) benefits package through the Hospice Benefit Component of the Value-Based Insurance Design (VBID) Model. This test allows CMS to assess the impact on delivery and quality of care, especially for palliative and hospice care, when participating MA plans are financially responsible for all Parts A and B benefits. After careful consideration, CMS has decided to terminate the Hospice Benefit Component as of 11:59 PM, December 31, 2024. For more guidance on the conclusion of the Hospice Benefit Component, please see the Announcement on Terminating the Hospice Benefit Component and the CY 2024 Technical and Operational Guidance on the Conclusion of the Hospice Benefit Component (PDF).

Outside the Model, when an enrollee in an MA plan elects hospice, Fee-for-Service (FFS) Medicare becomes financially responsible for most services, while the MAO retains responsibility for only certain services (e.g., supplemental benefits). Under the Hospice Benefit Component of the VBID Model, participating MAOs retain responsibility for all Original Medicare services, including hospice care. The Hospice Benefit Component of the Model implements a set of changes recommended by the Medicare Payment Advisory Commission (MedPAC), the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) and other audiences.

Information for Hospice Providers

CMS encourages hospice providers to communicate directly with participating MAOs regarding any questions about enrollment, billing, claims, and contracting related to enrollees of participating plans. Contact information is available on the Participating Plans page. 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 Medicare Administrative Contractor (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 these may vary.
   
   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.
3. The Model does not permit prior authorization requirements around hospice elections or transitions between different levels of hospice care.