April 07, 2023

VBID Extension to Bring Hospice Flexibilities

Centers for Medicare & Medicaid Services (CMS) released a new Medicare Advantage Value-Based Insurance Design (VBID) Model Extension Fact Sheet on April 5. In March 2023, CMS announced that the VBID model would be extended from 2025 to 2030. With regards to the VBID Hospice Benefit Component, CMS plans two updates:

  • Typically, Medicare enrollees who choose hospice services give up their right to receive health care services that are “curative.” Under the model extension, beginning in 2025, CMS will more closely align flexibilities for concurrent care with those offered in other CMS Innovation Center models. By offering greater flexibilities for MAOs to partner with in-network providers to deliver innovation, this will allow patients to receive more person-centered care at end of life.
  • When the Hospice Benefit Component was introduced, CMS required MAOs to pay for all out-of-network hospice services for their enrollees in the model because MAOs did not yet have any relationships with hospice providers. Since then, participating MAOs have developed networks of hospices that can deliver timely, comprehensive and high-quality services aligned with enrollee preferences in a culturally-sensitive and equitable fashion. Under the model extension, beginning in 2026, participating MAOs will have more flexibility to require their enrollees to only receive hospice services from hospice providers in their network, as long as the MAOs meet CMS’s qualitative and quantitative network adequacy requirements. This change is expected to help ensure that model enrollees have greater care continuity and receive higher quality hospice care.