VBID Model Plans & Locations Announced

WASHINGTON, D.C. (September 29, 2020)—The Centers for Medicare & Medicaid Services (CMS) released the list of Medicare Advantage (MA) plans that will participate in the Medicare Advantage (MA) Value-Based Insurance Design (VBID) Model during Calendar Year (CY) 2021 and information about the 2022 application process for eligible MA organizations. 

Included among the list of plans are those that will participate in the MA VBID Hospice component, which will begin operation in January 2021. CMS has also indicated that it plans to operate the MA VBID Hospice component in CY2022, as well. Under the Model, in CY 2021, nine MA organizations, through 53 PBPs, will participate in the Hospice Benefit Component of the VBID Model. These PBPs will test the Hospice Benefit Component in service areas that cover 206 counties.

Following are the states/territories in which the MA VBID Hospice component will operate in CY2021, as well as the plans that will operate in those states/territories:

• California – Kaiser
• Colorado – Humana
• Georgia – Humana
• Hawaii – Hawaii Medical Service Association
• Idaho – Intermountain
• Indiana – Humana
• Kentucky – Humana
• Massachusetts – Commonwealth
• New Mexico – Presbyterian
• New York – Visiting Nurse Service of New York
• Ohio – Humana
• Puerto Rico – Summit Master Company and Triple-S Management Corporation
• Utah – Intermountain
• Virginia – Humana

To find out what areas of a state or territory a plan will be offering the MA VBID Hospice component in, please click here, and scroll down to CY2021 Materials and click on: CY 2021 Hospice Benefit Component Model Participant Service Area and Contact Information.   

Model Background: The VBID Model began in January 2017 and will be tested through December 2024. The model is designed to test whether furnishing certain flexibilities in coverage and payment for MA organizations, to promote MA health plan innovations, would reduce Medicare program expenditures, enhance the quality of care Medicare beneficiaries receive, including dual-eligible beneficiaries, and improve the coordination and efficiency of health care service delivery.

VBID originally tested allowing MA organizations to structure enrollee cost-sharing and other plan design elements to encourage enrollees to use high-value clinical services, first for a limited set of conditions in a limited set of states, then removing that limitation on the original set of conditions and increasing included states in 2018 and 2019. In January 2019, for the 2020 plan year, CMS announced a broad array of changes, including allowing MA plans to provide reduced cost sharing and additional benefits to enrollees based on chronic condition, socioeconomic status, or both, even for non-primarily health related benefits, provide higher value Part C rewards and incentives, provide Part D rewards and incentives and requiring participating plans have a strategy to improve beneficiary wellness and health care planning. CMS was also required, through the Bipartisan Budget Act of 2018, to begin testing the Model in all 50 states and territories.

Additionally, in January 2019, CMS announced that beginning in CY 2021, through the model, participating MA organizations could apply to test the Medicare hospice benefit as a covered benefit.