Medicare Advantage VBID Extension Offers More Flexibility in Hospice Coverage
The extension of the Medicare Advantage (MA) Value-Based Insurance Design (VBID) Model from 2025 through 2030 will include new flexibilities for participating MA plans in relation to the hospice benefit. In a Fact Sheet released on April 5, 2023, the Centers for Medicare and Medicaid Services (CMS) highlighted two key changes it will introduce in hospice coverage under the VBID Model extension:
- Beginning in 2025, CMS will more closely align flexibilities for concurrent curative care and hospice with those offered in other CMS Innovation Center models.
- Beginning in 2026, participating MA plans will have more flexibility to require their enrollees to receive hospice services only from hospice providers in their network, as long as the plans meet CMS’s network adequacy requirements.
VNS Health and ArchCare MA plans offer the VBID Model with a hospice benefit in selected New York State counties for calendar year (CY) 2023.
Other changes introduced with the 2025-2030 VBID extension include a requirement for participating MA plans to offer supplemental benefits to address health-related social needs in at least two of the following areas: food, transportation, housing, and/or living environment and new flexibility to target benefits to underserved communities. CMS will also require additional data collection to improve its understanding of the use of supplemental benefits and their impacts.
The VBID Model tests an array of benefit design, service delivery, and payment strategies in order to mitigate obstacles to health and health care. For instance, under this Model, participating MA plans may provide patients with tailored supplemental benefits like grocery assistance, transportation services to medical appointments, and support managing chronic health conditions. Under VBID, MA plans may also include the hospice benefit in their benefit package. More information about the VBID Model is available here.
Contact: Karen Lipson, klipson@leadingageny.org