Calls Grow Louder to Delay Hospice Medicare Advantage Carve-In

Stakeholders in the hospice space are calling on the U.S. Centers for Medicare & Medicaid Services (CMS)  to delay the inclusion of hospice in the agency’s value-based insurance design model, commonly called the Medicare Advantage hospice carve-in, on the grounds that providers will not be able to prepare due to the pressures brought on by the ongoing pandemic. 

The health care and senior advocacy groups LeadingAge, the Visiting Nurse Associations of America (VNAA), ElevatingHOME (EH) and the Better Medicare Alliance (BMA) have written to CMS to request that the agency delay implementation to Jan. 1, 2022. The demonstration program is currently set to being on Jan. 1, 2021.

“The success of the demonstration is really going to be dependent on close relationships between the health plans that participate and the hospices that are in their network. Trying to work through what the mechanisms for doing this is not going to happen during the pandemic,” said Mollie Gurian, director of hospice, palliative and home health policy for LeadingAge. “It’s an all-hands-on-deck situation for hospice providers right now and trying to figure out what normal looks like after [the pandemic] is going to take some time both from a financial and an operational perspective. It just doesn’t seem like it’s timely to be starting a new demonstration that could that requires new processes, new operations and close partnerships to be successful.”


Through Medicare Advantage, CMS contracts with private insurance companies to provide coverage for Medicare beneficiaries. CMS in early 2019 year announced that it would test coverage of hospice care through Medicare Advantage plans beginning in 2021.The agency began accepting applications for participation in the program in Dec. 2019.

The carve-in, according to CMS, is intended to increase access to hospice services and facilitate better coordination between patients’ hospice providers and their other clinicians. Reactions to the carve-in demo have been mixed.

The Medicare Advantage program has been growing in recent years. The number of participating beneficiaries tripled between 2019 and 2020, totaling nearly 1.2 million enrollees in 30 states, according to CMS.


These groups are not the first to call for such a delay.

In December of 2019, the National Hospice and Palliative Care Association (NHPCO) made a similar request, arguing that hospices, health plans and other stakeholders have too little time to prepare for the carve-in due to a lack of detail on how the program would work. The National Association for Home Care & Hospice (NAHC) has 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 last year.

The four groups that signed the recent letter to CMS expressed overall support for the carve-in but said they believe that 2021 is no longer a feasible timeframe.

“As supporters of the high-quality, coordinated care that are driving principles of both the Medicare Hospice Benefit and Medicare Advantage, we recognize the potential of the demonstration and have previously expressed our support for it,” the letter indicated. “However, BMA, Leading Age, and its partner organizations, VNAA and Elevating Home share the concerns of hospice providers who believe that it would be best to delay implementation of this demonstration project for one year while plans, providers, and community partners seek to address immediate, unforeseen needs arising from this global health care emergency and the dramatic disruption this emergency has caused to the entire health care system.”

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