Congress Members Call on CMS to Delay Hospice Carve-In

Members of the Ways and Means Committee in the U.S. House of Representatives have called for a one-year delay for the value-based insurance design model hospice demonstration, commonly called the Medicare Advantage carve-in.

Reps. Adrian Smith (R-Neb.), Jackie Walorski (R-Ind.) and Terri Sewell (D-Ala.) sent a letter to Seema Verma, administrator of the U.S. Centers for Medicare & Medicaid Services (CMS), arguing that hospice providers lack sufficient time to prepare for the carve-in as they cope with the COVID-19 pandemic. The demonstration is currently scheduled to begin Jan.1, 2021.

“We share a commitment to ensure all Americans including current and future Medicare beneficiaries have access to affordable, high quality health care,” the representatives wrote. “However, in light of the current COVID-19 pandemic, we are very concerned the model could have the opposite effect by hindering access and diminishing quality of care due to the strain on resources all providers are facing, as well as the limited time available to operationalize the model by Jan. 1, 2021.”


The demonstration, according to CMS, is intended to increase access to hospice services and facilitate better coordination between patients’ hospice providers and their other clinicians. To date CMS has not indicated whether it would consider delaying the carve-in.

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.

Hospice industry groups and other stakeholders had previously requested a similar delay from CMS, even prior to the pandemic. The National Hospice and Palliative Care Organization (NHPCO) in December asked the agency to push back the implementation date by one year. The health care and senior advocacy groups LeadingAge, the Visiting Nurse Associations of America, ElevatingHOME, and the Better Medicare Alliance (BMA) made the same request in mid-April.


“The issues are actually all centered around patient access to care. If you try to rush something this complicated through without adequately thinking through the parameters and the patient protections that would need to be put into place to make sure that health plans don’t inadvertently or on purpose reduce access to care, then that’s going to happen,” NHPCO President and CEO Edo Banach told Hospice News. “Fewer people are going to have access to the robust care that we call hospice care unless we really pay attention to the details, and I just don’t think there’s an adequate time to do that. COVID-19 puts an enormous strain on on providers and health plans, there’s so much to do to make sure that we can provide people adequate access to care.”

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