Medicare Advantage Hospice Carve Ins
Medicare Advantage hospice care beneficiaries may enroll into Medicare Advantage (MA) have access to all original Medicare benefits plus additional supplemental benefits beyond what original Medicare covers.
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- In the past, when an MA enrollee elects hospice, Fee-For-Service (FFS) Medicare becomes responsible for most services while the MA organization retains responsibility for supplemental benefits.
- This hospice “carve-out” from MA results in a confusing coverage conundrum for MA enrollees with hospice. It fragments accountability for care and financial responsibility across the care continuum.
- Medicare Advantage (MA) plans currently pay a capitated monthly rate for services provided under Medicare Parts A and B, exclusive of costs related to hospice care.
- CMS announced Medicare Advantage hospice value-based model participants in 2019.
In the interest of increasing accountability, and controlling costs, CMS introduced a new value based model has evolved called value-based insurance design model or VBID.
- VBID is also known as an MA carve-in.
- Medicare Advantage plans participating in the Hospice Benefit Component VBID generally cover all of Medicare benefits, including hospice. In other words, VBID participating MA plan must include all the services covered by the Part A hospice benefit under Fee-For-Service Medicare, which may not be unbundled.
Hospice health care providers who bill MA payers for care provided to their beneficiaries need to be aware of new data elements. The data dictionary below itemizes some of the data elements:
| Data Field | Data Field Description |
|---|---|
| Contract ID | The unique number CMS assigns to each contract that a Medicare Advantage (MA) plan has with CMS |
| Plan ID | The unique number CMS assigns to identify a specific MA plan benefit package within a contract |
| Segment ID | Segment identifier |
| Plan Name | Name of the Plan participating in the Hospice Benefit Component of the Value-Based Insurance Design (VBID) Model in Calendar Year (CY) 2021 |
| Parent Organization | Name of the Parent Organization participating in the Hospice Benefit Component of the Value-Based Insurance Design (VBID) Model in Calendar Year (CY) 2021 |
| County Code | County code of the county in which the MA plan benefit package (segment) provides coverage |
| County Name | Name of county in which the MA plan benefit package (segment) provides coverage. Please note that a few MA plan benefit packages have partial service areas, covering part of the county listed; these include contracts H0524, H5216, H5619 and H6622. For questions, please reach out to the VBID Model Team at [email protected]. |
| State Code | State code of the state in which the MA plan benefit package (segment) provides coverage |
| Hospice Network Administrative Contact | Name of individual who is the Hospice Network Administrative Contact for the MA Organization (MAO) participating in the CY2022 Hospice Benefit Component of the VBID Model |
| Email Address for Hospice Network Administrative Contact | Email address for the Hospice Network Administrative Contact for the MAO participating in the CY2022 Hospice Benefit Component of the VBID Model |
| Business Phone Number for Hospice Network Administrative Contact | Business phone number of the Hospice Network Administrative Contact for the MAO participating in the CY2022 Hospice Benefit Component of the VBID Model |
| Other Phone Number or Notes for Hospice Network Administrative Contact | Other phone number of the Hospice Network Administrative Contact for the MAO participating in the CY2022 Hospice Benefit Component of the VBID Model or note provided by the MAO |
| Clinical and Patient Support Contact | Name of individual who is the Clinical and Patient Support Contact for the MAO participating in the CY2022 Hospice Benefit Component of the VBID Model |
| Email Address for Clinical and Patient Support Contact | Email address for the Clinical and Patient Support Contact for the MAO participating in the CY2022 Hospice Benefit Component of the VBID Model |
| Business Phone Number for Clinical and Patient Support Contact | Business phone number of the Clinical and Patient Support Contact for the MAO participating in the CY2022 Hospice Benefit Component of the VBID Model |
| Other Phone Number or Notes for Clinical and Patient Support Contact | Other phone number of the Clinical and Patient Support Contact for the MAO participating in the CY2022 Hospice Benefit Component of the VBID Model or note provided by the MAO |
| Other Contact Information | Name of individual who is another point of contact listed, such as Provider Billing Contact, for the MAO participating in the CY2022 Hospice Benefit Component of the VBID Model |
| Email Address for Other Contact Information | Email address (as applicable) for another point of contact listed, such as Provider Billing Contact, provided by the MAO participating in the CY2022 Hospice Benefit Component of the VBID Model |
| Phone Number for Other Contact Information | Business phone number (as applicable) for another point of contact listed, such as Provider Billing Contact, provided by the MAO participating in the CY2022 Hospice Benefit Component of the VBID Model |
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