CMMI Announces Plan Participants for VBID

Center for Managed Care | September 25, 2020 | by Mollie Gurian

On September 24th, the Center for Medicare and Medicaid Innovation (CMMI) released a list of the managed care organizations (MCOs) that will be participating in the Value-Based Insurance Design (VBID) Model as well as the Hospice Benefit Component of that model.

The VBID model began in January 2017 and will be test through December 2024. The Model is designed to test whether furnishing certain flexibilities in coverage and payment to MCOs, specifically targeted at promoting innovation, would reduce costs, increase quality, and improve coordination and efficiency of care delivery in the Medicare program. The VBID model has evolved since its initial implementation in 2017. In January 2019, for the 2020 plan year, CMS announced a number of changes including allowing MA plans to provide reduced cost sharing and additional benefits to enrollees based on chronic condition, socioeconomic status, or both, even for non-primarily health related benefits. They also allowed for more flexibility in allow Part C and D rewards and incentives and required plans to improve beneficiary wellness and health care planning, including advance care planning. CMS was also required by the Bipartisan Budget Act of 2018 to expand the demonstration to all 50 states

Also announced in January 2019 was the opportunity for participating MCOs to apply to test the Medicare hospice benefit as a covered benefit – colloquially know as testing the “MA carve-in” – starting in plan year 2021. With plan year 2021 fast approaching, CMMI announced the plans that elected to participate in the hospice benefit component of the demonstration and they are listed below along with the states in which the demonstration will be offered by the participating MCO. This list includes what states have a participating MCO but a majority of the participating MCOs are not testing the carve-in statewide – they have selected specific plans that will offer this benefit.

Please refer to this document to see if one of the MCOs listed in the table below is participating in your service area and who the contact person for each participating plan organization is. If there is a plan participating in your area, we encourage you to reach out the plan contact listed if you are interested in exploring contracting to participate in the hospice benefit component of the VBID demonstration.

Managed Care Organization  State
Commonwealth Care Alliance  MA
Hawaii Medical Service Association HI
Humana GA, IN, KY, OH, VA
Intermountain Health Care  ID, UT
Kaiser Foundation Health Plan CA
Presbyterian Healthcare Services NM
Summit Master Company PR
Triple-S Management Corporation PR
Visiting Nurse Services of NY NY

More information about VBID generally (including which plans are participating in the broad demo and not the carve-in) and the hospice benefit component can be found on CMMI’s VBID home page.