Reminder: MA VBID for Hospice Ends This Month

In March 2024, CMS announced the conclusion of the Value-Based Insurance Design (VBID) Hospice Benefit Component as of December 31, 2024. In August CMS published technical and operational guidance for providers participating in the model. As the end of this month draws near, the Alliance would like to remind hospices of the procedures to follow for MA VBID beneficiaries on service this month and those with hospice service dates that began prior to 12/31/2024 and service carries over into 2025.

• For hospice care that began under a participating PBP, for services provided prior to January 1, 2025, hospices should follow current Model billing procedures and requirements.
• For hospice elections that extend beyond the termination date (December 31, 2024) of the Hospice Benefit Component, hospice providers should not discharge any patient solely because of their coverage in a plan participating in the Hospice Benefit Component prior to CY 2025. For those hospice elections that continue, no new NOEs will be required, and timely filing requirements for hospice providers stated in 42 CFR 418.24 and described in further guidance within the Medicare Claims Processing Manual, Ch. 11 will continue to apply. For hospice elections that began under the Model and continue into CY 2025, for services that occur in CY 2025 and beyond, hospices must follow the requirements under Original Medicare as described in the Medicare Claims Processing Manual, Ch. 11.
• Model-participating MAOs’ enrollees’ hospice experience will not be included in either payment cap calculation (the aggregate cap or the inpatient cap). In CY 2025, Original Medicare retains responsibility for the hospice coverage and the payment caps will apply.

Previous Alliance coverage on this topic and additional information can be found here.