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CMS Gives Early Plans for Testing Hospice in Medicare Advantage

Posted on Monday, April 15, 2019 12:13 PM

This week, CMS hosted a webinar to provide a “first look” at plans for a test program under which Medicare Advantage (MA) plans participating in the Value-Based Insurance Design (VBID) model will have the option to offer hospice as part of the MA benefit package.

“Current Medicare coverage rules require that, upon electing hospice care, the hospice covers all services related to the terminal illness but services that are part of the basic Medicare benefit package that are unrelated to the terminal diagnosis and related conditions are covered under fee-for-service (FFS) Medicare.  If the hospice patient revokes hospice care, coverage of Medicare benefits under MA resumes on the first day of the month following revocation.  This “fragmentation” of care – under which the MA plan is not accountable for coordination of unrelated care while a patient is on service — is a key area that CMS indicates it wants to address. CMS also maintains that “carving” hospice into the MA benefit package could improve access to hospice care (by fostering awareness of hospice), enable innovation (through plan development of services “upstream” from hospice that support patient needs and ease the transition to hospice care) and foster partnerships between plans and hospice providers.”

CMS indicated that it is their intention to stress to interested plans, the comprehensive and bundled nature of the hospice benefit and that the benefit should remain “intact,” but did not provide specifics about how this would be addressed. Also, CMS did not provide information about how they would measure improved quality and coordination of care.

Source: NAHC


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