Hospice VBID: Understanding the 2023 Program Changes

Hospice VBID: Understanding the 2023 Program Changes

The hospice component of the Value Based Insurance Design (VBID) model will enter its third year on January 1, 2023, which means some of the program rules will change.

Often referred to as the Hospice MA Trimming, the Voluntary Demonstration is designed to assess hospice-related payer and provider performance within Medicare Advantage (MA). The US Centers for Medicare & Medicaid Services (CMS) said hospices should ensure their billing staff are familiar with the 2023 changes.

According to Bill Dombi, president of the National Association for Home Care & Hospice (NAHC).

“It operates within a framework [in 2021-2022] it’s not going to continue [as of 2023]Dombi told Hospice News. “There will be greater reliance on network providers, as well as plan-controlled payment rates more than current fee-for-service rates. VBID was on our radar from day one, and unfortunately it’s still on our radar because of this expansion.

For the first two years of the carve-in, CMS required MA plans to pay 100% of the fee-for-service per diem regardless of whether the patient chooses an in-network or out-of-network provider. This allowed beneficiaries to receive care from the provider of their choice regardless of network status. It also gave plans and vendors time to build those network relationships.

For 2023, VBID rules vary based on how long a Medicare Advantage Organization (MAO) has participated in the demonstration. MAOs that have participated since the program launched in 2021 can offer beneficiaries incentives to use the network providers in their plans, while new entrants to the program are still bound by these phase one requirements.

Before “mature” plans can offer these incentives, they must have a minimum number of networked providers in their service areas, as well as a comprehensive strategy to provide adequate access to necessary, appropriate and equitable palliative care, according to the CMS guidelines. .

As the second year of the carve-in draws to a close, data on the state of the network in 2022 is not yet available. Figures from the program’s first year offer few clues for the 2023 landscape.

A total of 9,630 VBID recipients received palliative care through the VBID demonstration in 2021, and 525 used the program’s additional benefits, according to a report the RAND Corporation prepared for CMS. Of these, only about 37% received care from network providers.

Of the 596 participants in the first year of the program, just over 17% were part of the network.

In interviews with CMS, providers listed several reasons for joining plan networks. Among the most common factors was the desire to ensure that patients who wanted it could choose to have palliative care coverage as part of their PA plan.

Some hospices have also sought to build on their existing relationships with these payers or establish themselves as early adopters of payment innovations. But some also said they felt participation was necessary to ensure their long-term sustainability.

“There’s a very good chance that in the future this will be our new world, where we have to participate in these Medicare Advantage plans,” representatives of an unnamed hospice told CMS. “Whether [the payment rate is] something reasonable, I think it is in our interest to sign these agreements and participate in them. Because let’s say in three or four years. if we are to network with these planes, we have to establish this relationship. We need experience. We need to be networked.

In 2023, the VBID hospice component will increase in participation and geography. CMS said 119 health plans will participate next year, up from 53 in 2021. Geographically, the program will be available in 806 counties in 24 states, up from 461 in 2022.

Also new for 2023 is a voluntary health equity incubation program, although participating AAMs will prepare health equity plans detailing how they will address disparities in outcomes, access or experiences of care. beneficiaries.

This aligns with previous CMS statements that health equity will be a key part of their payment model demonstrations going forward.

“CMS works hard to advance health equity by designing, implementing and operationalizing policies and programs that support the health of all people served by our programs by eliminating avoidable differences in health outcomes experienced by disadvantaged or underserved people and providing the care and support our enrollees need to thrive,” said Laurie McWright, Deputy Director of CMMI’s Seamless Patterns of Care Group, during a CMS webinar . “I think it’s safe to say that the VBID model’s health equity incubation program aligns well with that vision and reflects the priority and emphasis we place on health equity in the VBID model.”


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