Hospice Advocates Push for CMS to Delay Medicare Advantage Carve-In

The National Hospice and Palliative Care Association (NHPCO) has called on the U.S. Centers for Medicare & Medicaid Services (CMS) to delay the start of the Medicare Advantage hospice carve-in demonstration beyond its current expected start date of January 2021.

CMS earlier this year announced that it would test coverage of hospice care through Medicare Advantage plans beginning in 2021. NHPCO has asked CMS to delay the carve-in in a letter.

The most significant concern from NHPCO about the carve-in is that hospices, health plans and other stakeholders have too little time to prepare for the carve-in due to a lack of details from CMS on the nuts and bolts of the demonstration’s workings.


“Given the timing — and given that we’re at the tail end of 2019 — we are growing increasingly concerned that, any attempt to carve hospice into Medicare Advantage would be rushed, wouldn’t be fully baked,” Edo Banach, president and CEO of NHPCO. “We have concerns about individuals continuing to be able to access hospice care for a couple of reasons. First of all, we’ve yet to see full details. Second, health plans also have yet to see full details, and health plans have to bid for the 2021 plan year soon after the [2020] new year, which means that they’re going to bid on something that they don’t fully understand. That’s dangerous.”

Medicare Advantage plans are offered by private insurance companies approved by CMS and include HMO, PPO, and fee-for-service plans among other options.

The program is designed to represent an integrated care model that promotes coordination of services and provides incentives for quality and patient satisfaction. Beginning in 2020, the program will be available in all 50 states as well as U.S. territories.


CMS indicated to Hospice News that the agency will release a request for application for Medicare Advantage plans to offer the Medicare Hospice Benefit to their enrollees in the near future, but could not provide specific time frame.

“To ensure the model best promotes beneficiary access to high-quality hospice care, NHPCO and the Medicare Rights Center urge CMS to release information about the policy and its operational details without delay,” NHPCO said in the letter. “NHPCO and the Medicare Rights Center are also requesting that an ombudsman program be established to support the model and those who will be impacted by its implementation – payers, providers, and most importantly, patients.”

Other hospice and health care groups have also voiced concerns about the carve-in. Earlier this year, the National Association for Home Care & Hospice expressed complete opposition to the carve in.

“The carve-in is perhaps a solution that is looking for a problem. We think the Medicare hospice benefit has proven itself to be an incredibly well-run, well-designed program that will not benefit from being integrated into Medicare Advantage,” NAHC president William Dombi told Hospice News in April.

Companies featured in this article: