Situation Report | November 23, 2020
The U.S. Centers for Medicare and Medicaid Services (CMS) is directing Medicare Administrative Contractors (MACs) to conduct outreach with providers on the Value Based Insurance Design (VBID) Model.
Participating Medicare Advantage Organizations (MAOs) can voluntarily participate in the Hospice Benefit Component of VBID beginning January 1. Among them are nine VBID-participating plans (including HCA member the Visiting Nurse Service of New York) who will test coverage of hospice in 13 states and Puerto Rico.
The MAC outreach to providers is intended to: offer additional guidance on the model; identify which participating MAOs are in the hospice’s service area; and give information on the submission of claims, confirmation of enrollment, and other important items. New York’s MAC, National Government Services, has already posted this information on its website.
For the first two years of the model (2021 and 2022), enrollees may elect to receive hospice care from any hospice in the plan area, even non-contracted hospices. Therefore, all providers should learn the model’s requirements, including the submission of claims and notices. MA plans are required to accept notices and claims in the same format as currently accepted by the MACs.
In addition to the MAC outreach, CMS has directed participating MAOs to communicate with hospice providers in their service area about participating in the model, and for hospice providers to likewise contact the plans regarding any questions about the model, billing, coverage and enrollment.