Value-Based Insurance Design (VBID) Model Hospice Component
The Centers for Medicare & Medicaid Services (CMS) began testing the VBID Model in Calendar Year (CY) 2021. The hospice benefit component associated with the VBID Model applies to Medicare beneficiaries who have a hospice election start date on or after January 1, 2021, and are enrolled in a Medicare Advantage Organization (MAO) plan participating in the Model.
Prior to January 1, 2021
When a Medicare beneficiary is an MAO enrollee and elects hospice prior to January 1, 2021, the Medicare Administrative Contractor (MAC)/CGS processes claims for hospice services.
On or After January 1, 2021
When a Medicare beneficiary is enrolled in an MAO plan that participates in the hospice benefit component of the VBID Model and elects hospice on or after January 1, 2021, the MAO plan processes claims for payment, not the MAC/CGS.
The MAO participating in the VBID Model will cover:
- All hospice care from the effective date of election (on or after January 1, 2021) to the date of discharge or revocation
- Services provided through the end of the month when the beneficiary revokes or discharges from hospice alive
- Attending physician services
- All care unrelated to the terminal illness during the hospice election
Note: Patients enrolled in the hospice benefit component of the VBID Model will remain enrolled in the MA plan after a discharge or revocation.
Hospice Billing
Hospice providers MUST also submit a Notice of Election (NOE) and claims to your MAC/CGS Claims will deny with the following messaging on your Medicare Remittance Advice:
- Claim Adjustment Reason Code (CARC) 96: Non-covered charge(s)
- Remittance Advice Remark Code (RARC) MA73: Information remittance associated with a Medicare demonstration. No payment issued under Fee-For-Service Medicare as patient has elected managed care
- Group Code CO
The provider letters below identify MAOs participating in the Model:
- Calendar Year 2024 Hospice Benefit Component Hospice Provider Letter and Checklist
- Calendar Year 2023 Hospice Benefit Component Hospice Provider Letter and Checklist
- Calendar Year 2022 Hospice Benefit Component Hospice Provider Letter and Checklist
- California – Calendar Year 2021 Hospice Benefit Component Hospice Provider Letter
- Colorado/Nebraska/Wyoming – Calendar Year 2021 Hospice Benefit Component Hospice Provider Letter
- Connecticut/Massachusetts/Rhode Island – Calendar Year 2021 Hospice Benefit Component Hospice Provider Letter
- Georgia/Alabama/Tennessee – Calendar Year 2021 Hospice Benefit Component Hospice Provider Letter
- Hawaii – Calendar Year 2021 Hospice Benefit Component Hospice Provider Letter
- Idaho – Calendar Year 2021 Hospice Benefit Component Hospice Provider Letter
- Indiana – Calendar Year 2021 Hospice Benefit Component Hospice Provider Letter
- Kentucky – Calendar Year 2021 Hospice Benefit Component Hospice Provider Letter (link to the Kentucky PDF)
- New York/New Jersey – Calendar Year 2021 Hospice Benefit Component Hospice Provider Letter
- New Mexico – Calendar Year 2021 Hospice Benefit Component Hospice Provider Letter
- Puerto Rico – Calendar Year 2021 Hospice Benefit Component Hospice Provider Letter
- Utah/Wyoming – Calendar Year 2021 Hospice Benefit Component Hospice Provider Letter
- Virginia/North Carolina – Calendar Year 2021 Hospice Benefit Component Hospice Provider Letter
Resources:
- Termination of the Hospice Benefit Component of the Value-Based Insurance Design (VBID) Model on December 31, 2024
- CR13462: Direct Mailing Notification to Hospice Providers Regarding the Value-Based Insurance Design (VBID) Model, Hospice Benefit Component, Participating Medicare Advantage Organizations
- CR13040: Direct Mailing Notification to Hospice Providers Regarding the Value-Based Insurance Design (VBID) Model, Hospice Benefit Component, Participating Medicare Advantage Organizations
- CR12524: Direct Mailing Notification to Hospice Providers Regarding the Hospice Benefit Component, Value-Based Insurance Design (VBID) Model, Participating Medicare Advantage Organizations (MAOs)
- Medicare Advantage Value-Based Insurance Design Model
- VBID Model Hospice Benefit Component Overview
- VBID Model Hospice Benefit Component Participating Plans
- VBID Hospice Benefit Component CY 2021 Technical and Operational Guidance
- MM11754: Value-Based Insurance Design (VBID) Model – Implementation of the Hospice Benefit Component
- Value-Based Insurance Design (VBID) Model Hospice Benefit Component Overview
Updated: 11.05.24