Hospice patients will be able to receive concurrent care with Medicare Advantage as the Centers for Medicare and Medicaid Services (CMS) extended its Value-Based Insurance Design for calendar years 2025 through 2030. The extension also grants health plans the ability to restrict Medicare Advantage Organizations (MAOs) from using out-of-network providers in 2026.
The Medicare Advantage (MA) Value-Based Insurance Design (VBID) model will be extended for calendar years 2025 through 2030 and will introduce changes intended to more fully address the health-related social needs of patients, advance health equity and improve care coordination for patients with serious illness.
CMS said addressing financial and social barriers to care and supporting care innovations continue to be key parts of the CMS Innovation Center’s strategy.
"The model extension and changes build on the model’s successes to date and encourage even greater focus on addressing health-related social needs, such as food insecurity, safe living environments and transportation access, and enhancing the seamless delivery of care across settings," said a press release from CMS.
The model is testing a broad array of changes that aim to improve the quality of care for Medicare enrollees, including those with low incomes; improve the coordination and efficiency of health care service delivery; and reduce Medicare spending without compromising quality of care. The model also has a Hospice Benefit Component, which helps patients needing end-of-life care experience a seamless transition to hospice care, if desired. In 2023, the model will reach a projected 6 million people enrolled in 52 MAOs across 49 states, DC, and Puerto Rico. In addition, in 2023, the model’s Hospice Benefit Component will reach a projected 20,000 people with serious or terminal illness enrolled in 15 MAOs across 23 states and Puerto Rico.
The VBID model began in 2017 and was previously extended in 2020. The third phase of the model that begins in 2025 will include several new policies, such as the hospice benefit component outlined below:
VBID Hospice Benefit Component
- Typically, Medicare enrollees who choose hospice services give up their right to receive health care services that are “curative.” Under the model extension, beginning in 2025, CMS will more closely align flexibilities for concurrent care with those offered in other CMS Innovation Center models. By offering greater flexibilities for MAOs to partner with in-network providers to deliver innovation, this will allow patients to receive more person-centered care at end of life.
When the Hospice Benefit Component was introduced, CMS required MAOs to pay for all out-of-network hospice services for their enrollees in the model because MAOs did not yet have any relationships with hospice providers. Since then, participating MAOs have developed networks of hospices that can deliver timely, comprehensive and high-quality services aligned with enrollee preferences in a culturally-sensitive and equitable fashion. Under the model extension, beginning in 2026, participating MAOs will have more flexibility to require their enrollees to only receive hospice services from hospice providers in their network, as long as the MAOs meet CMS’s qualitative and quantitative network adequacy requirements. This change is expected to help ensure that model enrollees have greater care continuity and receive higher quality hospice care.