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CMS has released a Request for Applications (RFA) for eligible Medicare Advantage (MA) plans to participate in a demonstration that would test the “carve-in” of the Medicare hospice benefit into the MA program under the Value-Based Insurance Design (VBID) model beginning in 2021.
Interested MA organizations must submit an application by 11:59 PM ET on March 16, 2020. Beneficiaries enrolled in MA plans participating in this demo would be able to access the Medicare Hospice Benefit beginning on Jan. 1, 2021.
The RFA is available here.
The demo aims to improve the ability of MA plans to coordinate palliative and hospice care for beneficiaries by reducing fragmentation and increasing financial accountability.
“Upon early review of the RFA, we are encouraged by many of the model details. It is clear that CMMI has worked to ensure that the needs of seriously ill patients and families are prioritized, while still incentivizing innovative partnerships between plans and providers that will further support a true care continuum for the most vulnerable patients.” said C-TAC Executive Director Jon Broyles. “C-TAC applauds CMMI’s continued commitment to testing new care innovations for seriously ill Americans.”
Critically, the demo requires MA plans to maintain the full Medicare hospice benefit structure under their arrangement with providers, and will preserve beneficiary choice of hospice for the first year, regardless of whether that hospice is in the plan’s network. It will require plans and their partners to deliver upstream palliative care, as well as transitional concurrent care for appropriate beneficiaries. The RFA also includes a meaningful set of hospice quality measures, strong provider network adequacy standards, a prohibition on plans’ use of prior authorization for hospice, and reasonable payment structures. All of these elements will serve to build a strong foundation upon which the model can be successfully implemented in every state across the country.
C-TAC looks forward to serving as a convener and resource for our members and partners interested in this new initiative. More information about the test is available in this fact sheet, prepared by CMS. The full RFA is available here.
For more information about C-TAC’s legislative and regulatory efforts, please contact Policy & Advocacy Manager Davis Baird at DBaird@theCTAC.org.