Medicare Advantage Carve-In Pilot

As we move closer to the end of the year, more and more information regarding Medicare Advantage’s hospice benefit inclusion continues to release. CR11754 has given us the most information to date. This pilot program will test Medicare Advantage plans service delivery and payment approaches to hospice across the country. Each Medicare Advantage plan decides whether or not to participate. 

Through CMS’s interactive Value-Based Insurance Design (VBID) model, we can explore the offered service areas, anticipated participants (Humana, WellCare Health Plans, Aetna, etc), and will soon know what areas of the country will be covered by those plans chosen to participate. CMS will release the final list of participating plans in the fall.

Although it’s a pilot model, it provides a lot for hospice agencies to learn and think about. We’ve put together a list of some steps we highly recommend hospice agencies take leading up to the hospice carve-in which is schedule to begin with admissions on and after January 1, 2021 and is scheduled to conclude December 31, 2024. 

  1. Check the VBID model as soon as possible
    1. Every hospice’s first step should be to monitor this model and check the map to see the states currently involved. If the state is green and is covered by participating plans, hospices must participate. It’s also extremely important to see which plans are covering your state because this will undoubtedly impact the revenue of some of your patients. 
  2. Track your current patients
    1. Keeping track of your patients and their plans is an absolutely critical step before the carve-in takes place. New information regarding the MA inclusion constantly releases, and it will be overwhelming if you attempt to analyze it all at once. By making a list of plans participating in the pilot and your patients’ current plans, you can get an understanding of any potential financial impact because issues will inevitably arise. Your work now will prepare your agency for any possible revenue delays while these problems are sorted out. 
  3. Review your EMR
    1. As hospice is carved into MA plans, billing will obviously become an agency’s primary concern. Agencies will now have to submit claims to two payers (Medicare and those participating in Advantage plans) through an EMR. For some agencies, this could prove to be a problem. We highly recommend checking your EMR as soon as possible to determine if it’s capable of sending secondary claims. 

Our team is ready to help your agency through the carve-in. Whether you are unclear about the pilot program or need help preparing for the inclusion, we are here to assist in any way we can. Call 888-737-3585 or email [email protected] to learn more!

Explore the VBID model here

Check health care facilities where innovation models are being tested here


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