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Last Thursday, CMMI released technical and operational guidance to support hospice and Medicare Advantage Organization (MAO) participation in the upcoming hospice carve-in component of the Value-Based Insurance Design (VBID) model demonstration.

The guidance is focused on operational and programmatic issues, and is meant to help ensure the implementation of the Hospice Benefit component meets the needs of seriously-ill patients and families, while preparing participants for the model’s start date on Jan. 1, 2021.

The guidance covers topics such as:

  • MAOs’ responsibility for payment of services and continuity of care in enrollee coverage change scenarios
  • The voluntary consultation process
  • Strategies on transitions from palliative care to hospice care
  • Limitations to ensure beneficiary safety
  • Model-related MA payment guidance for out-of-network payments
  • Model-related appeals and grievances processes
  • Operational guidance on billing
  • Details around hospice capitation payment operations.

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. C-TAC continues to look forward to working with CMS and the serious illness stakeholder community to ensure the model’s implementation is a success.

For more information about the model, click here. To learn more about C-TAC’s policy and advocacy efforts, click here.

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