On September 24, 2020, the Centers for Medicare & Medicaid Services Innovation Center (CMMI) released the list of Medicare Advantage Organizations (MAOs) approved to participate in the hospice component of the MA Value-Based Insurance Design (VBID) Model for CY 2021. CMMI also announced a second application period which will open this fall to interested MAOs that would like to be approved for the model in CY 2022. Hospice providers were not eligible to apply directly for the model but may be considered for in-network or out-of-network status as a provider for participating MAOs. The hospice benefit component will be tested over four performance years, and participation in the model is voluntary.
The following MA organizations have been approved to participate in the hospice component of CY 2021 VBID Model:
- Commonwealth Care Alliance, Inc. (Massachusetts)
- Hawaii Medical Service Association (Hawaii)
- Humana, Inc. (Kentucky, Virginia, Ohio, Colorado, Georgia)
- Summit Master Company, LLC (Puerto Rico)
- Kaiser Foundation Health Plan, Inc. (California)
- Presbyterian Healthcare Services (New Mexico)
- Intermountain Health Care, Inc. (Idaho, Utah)
- Triple-S Management Corporation (Puerto Rico)
- Visiting Nurse Service of New York (New York)
MAOs have been encouraged by CMMI to “develop innovative payment arrangements” with in-network providers in their service area. For enrollees that utilize an out-of-network provider, a participating MAO is required to cover these services and to make payment at the same amount that the hospice provider would receive from Original Medicare for covered hospice services in order to ensure enrollees are not balanced billed.