Forthcoming Legislation Seeks to Delay Medicare Advantage Hospice Carve-In

Legislation will likely be forthcoming in Congress this week or next to delay implementation of the value-based insurance design (VBID) model demonstration project, commonly called the Medicare Advantage hospice carve-in. If enacted, the bill would move the program’s start date to 2023. 

Currently, the carve-in is slated to begin Jan. 1, 2021. While hospice industry groups and some members of Congress have urged the U.S. Centers for Medicare & Medicaid Services (CMS) to delay the carve-in by one year — arguing that providers have had insufficient time and information to prepare — this legislation, if enacted, would push back the start by two years.

“[The National Hospice & Palliative Care Organization (NHPCO)] has supported a delay to the hospice carve-in component of VBID since December 2019, when we and the Medicare Rights Center wrote to the administration seeking a delay of at least one year on behalf of beneficiaries,” Edo Banach, NHPCO president and CEO, told Hospice News. “We do not believe that this demonstration is ready and remain concerned about potential consumer harm. We are also concerned about making changes in the midst of a pandemic. Therefore, we support any effort to delay this demonstration. We look forward to continuing our work with the administration and Congress to improve access to high quality hospice and palliative care.”  

The health care and senior advocacy groups LeadingAge, the Visiting Nurse Associations of America and ElevatingHOME have made similar requests for a delay. To date, CMS has not indicated whether it would consider pushing back the start date, though the agency could be compelled by Congressional action.

Sources were unable to confirm which members of Congress would be sponsoring the bill or in which chamber of Congress it will be introduced.

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.

Many in the hospice space expect the carve-in to have extensive repercussions for the ways hospice providers conduct business, fueling additional calls to delay the program, particularly in light of the uncertainties posed by the ongoing pandemic. 

“We support a brief delay. The [Medicare Advantage] VBID Hospice model represents the most dramatic change to our nation’s approach to end-of-life care since creation of the hospice benefit, and we believe hospices are not yet ready to take this on, particularly in light of the status of the COVID-19 public health emergency,” said Theresa Forster, vice president for hospice policy for the National Association for Home Care and Hospice. “If this experiment is implemented prematurely or without appropriate preparation by both the MA plans and hospices, it will pose significant risks to hospice patients who need the full scope of hospice care at the end of life. Any shortcomings in care for these most vulnerable of patients cannot be corrected after the fact.”

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.

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

Even amid the pandemic, not everyone agrees that a delay is appropriate. The Better Medicare Alliance, which supported delaying the program in the early days of the COVID-19 outbreak, has changed its position and is encouraging CMS to continue with the 2021 implementation. 

“We expect that the demonstration model will offer insights on the inclusion of hospice services in Medicare Advantage and look forward to the forthcoming start in January 2021,” said Allyson Y. Schwartz, president and CEO of the Better Medicare Alliance. “Recognizing the unprecedented onset of the COVID-19 pandemic, Better Medicare Alliance joined other supporters of the demonstration project to request a brief delay earlier this year so as to ensure the best chance of success. The fact is that the demonstration project has moved forward and a number of Medicare Advantage plans across geographic regions are set to participate in the model. It is now apparent that any delays would be untenable and unnecessary. We urge an on-time start to this promising demonstration project and are hopeful that CMMI will release an opportunity for other Medicare Advantage plans to be able to offer these benefits to their members starting in 2022.”