CMS on Wednesday released more information about its plans to extend the Centers for Medicare and Medicaid Innovation’s MA VBID model from 2025 through 2030. The extension introduces changes to encourage a greater focus on addressing the health-related social needs of patients, and also advance health equity, and improve care coordination for patients with serious illness.
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The model tests a broad array of changes designed to improve the quality of care for Medicare enrollees, including those with low incomes; improve the coordination and efficiency of health care service delivery; and reduce Medicare spending without compromising quality of care. CMS said the model also has a hospice benefit component, which helps patients who need end-of-life care experience a seamless transition to hospice care, if desired. In 2023, the model will reach approximately six million people enrolled in 52 MA organizations across 49 states, the District of Columbia, and Puerto Rico. This year, the model’s hospice benefit component is expected to reach 20,000 people with serious or terminal illness enrolled in 15 MA organizations across 23 states and Puerto Rico.
The VBID model began in 2018 and was previously extended in 2020. The third phase of the model will begin in 2023 and includes the following new policies, according to the fact sheet.
Under the general VBID model:
- MA organizations must offer supplemental benefits to address health-related social needs in at least three health-related social needs areas: food, transportation, and housing insecurity and/or living environment. Those benefits would aim to meet enrollees’ needs and could include benefits, such as meals beyond a limited basis, transportation to medical appointments, air condition units to support enrollees in areas experiencing extreme heat, and housing assistances. Under the current model, MA plans can offer benefits to address health-related social needs, but they are not required to do so. Other flexibilities, including the ability to offer reduced cost sharing for Part D drugs, will remain a core part of the model.
- The model introduces a new flexibility to MA organizations to address health-related social needs in socioeconomically disadvantaged areas, using the Area Deprivation Index to direct benefits to enrollees in underserved communities. CMS said the model’s current flexibilities allow plans to focus on health-related social needs, but targeting criteria (namely Part D LIS and dual-eligible status) are based on income, and therefore, miss seniors who still may be relatively disadvantaged, and have health-related social needs, but do not qualify for these programs.
- The model will require additional data collection to improve CMS’ understanding of how enrollees use supplemental benefits and their impact on enrollees.
Under the model’s hospice benefit component:
- Typically, Medicare enrollees who choose hospice services give up their right to receive health care services that are “curative.” Beginning in 2025, CMS will more closely align flexibilities for concurrent care with those offered in other CMS Innovation Center models. CMS said by offering greater flexibilities for MA organizations to partner with in-network providers to deliver innovation, patients will receive more person-centered care at end of life.
- When the component was first introduced, CMS required MA plans to pay for all out-of-network hospice services for their enrollees in the model because the organizations did not yet have any relationships with hospice providers. Since then, participating MAO organizations have developed networks of hospices that can deliver timely, comprehensive, and high-quality services aligned with enrollee preferences in a culturally-sensitive and equitable fashion. Beginning in 2026, participating MA organizations will have more flexibility to require their enrollees to only receive hospice services from hospice providers in their network, as long as the MA plans meet CMS’ qualitative and quantitative network adequacy requirements. CMS expects this change will ensure seniors enrolled in the model will have greater care continuity and receive higher-quality hospice care.