Hospice Providers Get a Head Start on Medicare Advantage

Hospice providers can now get a “sneak preview” as to how their organization can start working with Medicare Advantage plans by applying to participate in demonstration the U.S. Centers for Medicare and Medicaid Services (CMS) is offering for 2020.

CMS has announced an array of Medicare advantage (MA) health plan innovations that will be tested in the value-based insurance design (VBID) model for calendar year (CY) 2020. Among the innovations being tested is the Medicare Advantage hospice carve-in that becomes effective in 2021.

In a recent survey by Elevating Home and the Visiting Nurse Association of America (VNAA), 95 percent of hospice providers who responded said they they believed the carve-in would impact their businesses. Only 3 percent said they were very well prepared.


“This is the time to start getting your organization ready for any innovations and to be a part of a demonstration that could impact the hospice care in the United States for years to come,” said Jenna Paladino, policy consultant for VNAA in a Feb. 20 webinar.

CMS said it would release additional information and guidance on the demonstration in the coming months through its VBID model website and through open forum-type events.

Medicare Advantage plans are offered by private insurance companies approved by the US Centers for Medicare & Medicaid Services, and include HMO, PPO, and fee-for-service plans among other options. More than 34 percent of Medicare beneficiaries are covered under Medicare Advantage plans, upwards of 20 million people.


Though hospice care is not currently covered under Medicare Advantage, CMS has unveiled a hospice carve-in to become effective in 2021. The carve-in is intended to expand access to hospice services and enable greater coordination between hospice providers and the patient’s other clinicians.

“Right now hospice is in a silo when it comes to Medicare Advantage,” Paladino said. “[Through the carve-in] Hospices will be brought back into the circle. The goal is to improve access, to develop better relationships with referring organization, reduce costs, and get hospice out of their silo.”

Industry groups reacted to the demonstration announcement with cautious optimism, urging that the demonstration not restrict patients’ access to care. .

“To the extent that this expansion of the Value-Based Insurance Design (VBID) demonstration is about enhanced access and a potential opportunity to ensure that more beneficiaries will get high-quality interdisciplinary care when it is most appropriate, we are encouraged,” said National Hospice and Palliative Care Organization President and CEO Edo Banach, JD. “If this demonstration restricts choice and access, we will take appropriate action. We will also assure that Congress is engaged on this issue and provides appropriate oversight.”

The hospice community at large is only beginning to address the changes that may come with the carve-in. Many organizations are wrestling with questions about how to work with companies offering Medicare Advantage plans, as well as how the changes could affect staffing, contracting, and care coordination.

Communication is essential to any successful relationship, and for hospice organizations preparing for the 2021 Medicare Advantage hospice carve-in building and strengthening relationships is a top priority.

“I think it really comes down to relationships,” Paladino said. “Start by identifying the relationships you already have.Have a conversation in your C-suite. Find out who knows who and how and where. Start talking to the people who are already at the table with you and ask how to bring their plans into your hospice”

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