WASHINGTON, D.C. (November 23, 2020)—Beginning on Jan. 1, 2021, through the VBID Model, participating Medicare Advantage Organizations (MAOs) can voluntarily participate in the Hospice Benefit Component of the Model, according to a November 13 transmittal (10458/CR 12045) from the Centers for Medicare & Medicaid Services (CMS).
During CY2021, nine plans will test coverage of hospice as part of their MA offerings under the model in 13 states and Puerto Rico. The CMS transmittal, Direct Mailing Notification to Hospice Providers Regarding the Hospice Advantage Organizations, directs the Home Health and Hospice Medicare Administrative Contractors (MACs) to direct mail information to hospice providers operating in areas covered by the Model providing education on participation and billing for Medicare Advantage enrollees receiving services in affected areas.
CMS has directed participating MAOs to communicate with hospice providers in the service area of their participating plans, and has also recommended that hospice providers communicate with MA plans regarding any questions about the model, billing, coverage and enrollment. For the first two years of the model (CY2021 and CY2022) enrollees may elect to receive hospice care from any hospice in the plan area (provided the hospice has not been excluded due to concerns that they may pose potential harm to patients). Thus, even non-contracted hospices may serve patients enrolled in the model so it is important that they are familiar with the ,odel’s requirements, including that they must submit claims and notices to participating MA plans to receive payment, and submit claims and notices to their MAC for informational purposes. MA plans are required to accept notices and claims in the same format as currently accepted by the MACs.
The mailing from the MACs will serve as additional guidance on the model, and contains information regarding the MAO participating in the model in the hospice’s service area, main points of contact for the MAO, information related to submission of claims, information related to confirmation of enrollment in a model-participating plan, and other important items. The MACs are also required, subsequent to concluding the mailing, to post the information online.
As of this writing only Palmetto GBA has posted a copy of the direct mailing online; the letters that were sent to hospices in Palmetto states where the model is operating are available for viewing here. Additional useful information about the Model is available on the VBID Model Hospice Benefit Component Overview webpage.