Termination of the Hospice Benefit Component of the VBID Model

The Centers for Medicare & Medicaid Services (CMS) has announced that the Hospice Benefit Component of the Value-Based Insurance Design (VBID) Model will officially end on December 31, 2024, at 11:59 PM. This decision impacts Medicare Advantage Organizations (MAOs) participating in the Hospice Benefit Component and requires them to make adjustments to ensure continued compliance with CMS policies.

Key Details for Medicare Advantage Organizations

Until the termination date, MAOs participating in the Hospice Benefit Component must maintain coverage for all hospice care elections made by beneficiaries in applicable Plan Benefit Packages. This includes ensuring that all necessary hospice care is provided through the program until December 31, 2024.

However, starting January 1, 2025, the responsibility for hospice coverage will shift back to Original Medicare. This change means that hospice services previously managed under the Hospice Benefit Component will no longer be covered through Medicare Advantage plans. Instead, beneficiaries requiring hospice care will transition back to receiving these benefits directly from Original Medicare.

What This Means for Physicians and Hospice Providers

Physicians, hospice providers, and healthcare organizations should be prepared for this shift in financial responsibility and coverage. Here are key actions to consider:

1. Educate Your Staff: Ensure your team is aware of the upcoming transition and understands how it will affect hospice claims processing after December 31, 2024.
2. Review Patient Coverage: Assess the current hospice patients covered under the VBID Model and plan for their transition back to Original Medicare starting January 1, 2025.
3. Update Billing Processes: Prepare for changes in billing and claims submissions. Hospice care services provided after the termination date will no longer be billed to participating MAOs but to Original Medicare.

Next Steps

CMS has urged all providers, payers, and stakeholders to review this update thoroughly to ensure compliance and a smooth transition for beneficiaries. Medicare Advantage Organizations should also communicate clearly with their enrollees to minimize confusion regarding hospice care benefits during and after the transition.

With the program ending in just under a year, early preparation will be crucial to avoid disruptions to patient care or delays in reimbursement.

For additional information and guidance on this change, review the full announcement on the Palmetto GBA website or visit the CMS VBID Model webpage.

Source: Palmetto GBA