CMMI May Allow Second Cohort of Health Plans for MA Hospice Carve-In

The Center for Medicare & Medicaid Innovation (CMMI) will offer a second opportunity for Medicare Advantage plans to participate in the demonstration of hospice coverage through Medicare Advantage. The implementation date for this second cohort would occur in 2022.

CMMI Director Brad Smith discussed this move at the Better Medicare Alliance Medicare Advantage Summit.

“In addition to a lot of the flexibilities that [CMMI] has had historically, we are also implementing a new hospice benefit where hospice will be part of Medicare Advantage,” Smith said at the conference. “We’ve actually heard a lot of great feedback from this from our Medicare Advantage plans, and we’re even thinking based on the feedback we receive about potentially having another opportunity for folks to apply for 2022, if they’re interested in having hospice be part of the Medicare Advantage program.”


Among Medicare Advantage plans, 53 will be covering hospice and palliative care in 2021 through the value-based insurance design (VBID) model, according to the U.S. Centers for Medicare & Medicaid Services (CMS). Medicare Advantage is seeing record-high levels of participation for 2021 among beneficiaries, reaching about 42% for 2021, CMS reported.

While the 53 plans represent a small start for the program, this level of participation is typical for the first year of a CMMI demonstration project. Overall participation in the VBID program, excluding hospice, has significantly grown in recent years.

“Our Medicare Advantage VBID mode is where we test out different kinds of flexibilities in Medicare advantage that we hope to be able over time to implement in the entire Medicare Advantage program,” Smith said. “We’re especially excited that participation is really up this year. In fact, going into 2021 our participation will have tripled from 157 plans participating to 451 plans participating and now the VBID will be working in 45 different states across the country.”


Inclusion of hospice within VBID is set to begin Jan. 1, despite some calls to delay the program by one year on the grounds that providers and payers were not able to prepare adequately due to the COVID-19 pandemic.

Smith also displayed enthusiasm for the direct contracting geographic payment model, also coming in 2021, citing high levels of participation. The number of hospices that are participating is unclear at this point, either directly or via partnerships with other organizations such as primary care practices. Anecdotally, several hospices have told Hospice News that they plan to participate.

Through the geographic option, contracted providers would accept 100% of the risk of shared savings or losses on the total cost of care for a particular geographic area. Within this program is a voluntary Total Care Capitation option, which includes a capitated, risk-adjusted payment for all services the contracted agency provides, as well as preferred providers who have contractual relationships with the contracted agency, such as a hospice that contracts with a primary care practice to provide services to eligible patients under their care.

CMS would select agencies to participate in the geographic option through a competitive bidding process and would have to offer CMS a specified discount on the cost of care for the patient population in the designated region.

“This is a model that would allow either plans or large provider groups to come in and take risk for Medicare fee-for-service beneficiaries across an entire region. They’ll have the opportunity to offer additional benefits to beneficiaries, to offer lower deductible or lower premiums, lower cost sharing lower copays,” Smith said. “In return, [CMS] will give the direct contractor a tremendous amount of flexibility around things like care management, around things like additional benefits and programs that they can offer to help improve the care and improve the quality for beneficiaries. This will also allow them to build essentially a preferred provider network where they can move with certain providers off of the Medicare fee-for-service rates. At the same time, we’ll make sure that beneficiaries have access to every provider in Medicare, regardless of which direct contractor they’re working with.”