Hospice leaders are, for the most part, encouraged by the move to explore a Medicare Advantage (MA) carve-in for hospice through an expanded demonstration. But several questions remain, they caution, with the bulk of them focusing on whether the hospice benefit could somehow be diluted or lessened. 

The Centers for Medicare & Medicaid Services (CMS) and other federal policymakers outlined the move on Friday.

“Our main focus is: How do we make sure that consumers, patient and families are assured of their access to hospice care in a transition to hospice that is at least as good as what they have now — and ideally better?” Edo Banach, CEO and president of the National Hospice and Palliative Care Organization (NHPCO), told Home Health Care News. “Going forward, we’re going to be watching to make sure this is a plus and not something that detracts from care.”

n the U.S., the hospice benefit can trace its roots back to when Congress included a provision to create a Medicare hospice benefit in the Tax Equity and Fiscal Responsibility Act of 1982. The Health Care Financing Administration (HCFA) — a precursor to CMS — assessed the cost-effectiveness of hospice care in a demonstration of three years prior.

In its present form, the hospice benefit is for terminally ill individuals projected to have six or fewer months to live. In general, hospice care focuses on caring and comfort, as opposed to curative care, while also providing family support.

Unlike home health services, hospice care is not currently covered by MA plans, despite enrollment skyrocketing. An estimated 22.6 million Medicare beneficiaries are expected to sign up for MA plans in 2019, according to CMS.

MA enrollees who elect hospice remain in their MA plans, but fee-for-service (FFS) Medicare pays for their hospice services.

The fact that hospice is covered by traditional Medicare but not Medicare Advantage has, in some instances, created beneficiary confusion and contributed to late admissions into the hospice setting. Roughly 35% of hospice patients die or are discharged within seven days of admission, NHPCO statistics show.

The plan CMS announced last week calls for the agency to test out a hospice MA carve-in using the Value-Based Insurance Design (VBID) model, which launched in seven states in 2017 and will be expanded to all 50 by 2020. Plans participating in the VBID model will be able to offer a hospice benefit starting in 2021.

“I think plans are looking forward to this,” Tom Koutsoumpas, CEO and president of the National Partnership for Hospice Innovation (NPHI), told HHCN. “I don’t know what all the plans’ views are, but I think there’s a general sense that it would be an opportunity that they would embrace. It ultimately depends on how it would work, how it’s constructed and what the results of the demonstration are, frankly.”

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