For Providers
Centers for Medicare & Medicaid Services’ update
CMS notified Humana on March 3, 3024 of their decision to terminate the Hospice Benefit Component of the Value-Based Insurance Design (VBID) Model effective December 31, 2024. We are evaluating the impact on a broader scale and anticipate communication to providers soon. We are committed to continuing to care for our members.
Understanding the VBID model
The Centers for Medicare & Medicaid Services (CMS) recently launched a demonstration under the Value-Based Insurance Design (VBID) model with the goal to assess and improve patients’ experience using the hospice benefits within their Medicare Part A benefits package. This demonstration works to improve care through greater care coordination and reduced fragmentation.
Humana has been participating in this demonstration program on select plans since January 1, 2021. Our goal is to ease care transitions and ensure hospice-eligible patients can access and receive the full benefits of hospice care.
About Humana’s Hospice VBID model
Update: Aspire Health name change to Carelon Health
On Jan. 1, 2024, Aspire Health changed their name to Carelon Health. Please note, individual documents may not reflect this name change.
Humana’s Hospice VBID model focuses on creating better continuity for our members who are moving from their Medicare Advantage experience and into end-of-life care via hospice.
Humana partners with VBID-specific Palliative Care providers to identify and support members who may benefit from a palliative care program in tandem with their Medicare Advantage plan coverage.
Humana’s Hospice VBID model focuses on creating better continuity for our members between their MA experience and end-of-life care receiving hospice. Palliative care may be elected, which leads to the member entering hospice. In-network benefits start with transitional concurrent care, which can be elected; then in-home respite care along with an assistance allowance for hospice care. Next, hospice care is provided for the member and after a member passes away, bereavement care is provided to family members.*
*The hospice benefit under CMS remains the same for these components.
2024 Humana Hospice VBID—participating plans
KY: Adair, Anderson, Ballard, Bath, Bell, Bourbon, Boyle, Bracken, Breathitt, Breckinridge, Bullitt, Caldwell, Calloway, Carlisle, Carroll, Casey, Christian, Clark, Clay, Clinton, Crittenden, Cumberland, Daviess, Elliott, Estill, Fayette, Fleming, Floyd, Franklin, Fulton, Gallatin, Garrard, Graves, Grayson, Green, Hancock, Hardin, Harlan, Harrison, Henry, Hickman, Hopkins, Jackson, Jefferson, Jessamine, Johnson, Knott, Knox, Larue, Laurel, Lawrence, Lee, Leslie, Letcher, Lewis, Lincoln, Livingston, Lyon, Madison, Magoffin, Marion, Marshall, Martin, Mason, McCracken, McCreary, McLean, Meade, Menifee, Mercer, Montgomery, Morgan, Muhlenberg, Nelson, Nicholas, Ohio, Oldham, Owen, Owsley, Perry, Powell, Pulaski, Robertson, Rockcastle, Rowan, Russell, Scott, Shelby, Spencer, Taylor, Todd, Trigg, Trimble, Union, Washington, Wayne, Webster, Whitley, Wolfe, Woodford
VBID guidelines for providers
To become an in-network provider with Humana for hospice VBID, the appropriate contract must be executed and the required credentialing completed. All other providers servicing Humana eligible plan members in the participating regional markets will have an Out-of-Network status.
This guidance is for hospice providers serving participating members in the Humana hospice VBID. The aims of the Hospice Value-Based Insurance Design (VBID) Model Demonstration are to:
- Ease care transitions and ensure that hospice-eligible enrollees do not need to choose between curative or hospice care when considering hospice election
- Improve quality and timely access to the Medicare hospice benefit
- Provide the full scope of hospice benefits, as defined in the Social Security Act (Section 1861 dd).
- Improve hospice utilization patterns and costs of care related and unrelated to the terminal condition, based on improving the coordination and quality of care and service delivery
- Enable enrollees, their families and caregivers to experience the benefits of hospice care over a more appropriate period of time as aligned with their wishes and the member’s needs
- Create an opportunity to provide additional support and value to hospice enrollees through the use of supplemental benefits with in-network hospice provider election
This guidance is for hospice providers serving participating members in the Humana hospice VBID. The aims of Hospice VBID model demonstration are to:
- Ease care transitions and ensure that hospice-eligible enrollees do not need to choose between curative or hospice care when considering hospice election.
- Provide the full scope of hospice benefits, as defined in the Social Security Act (Section 1861 dd).
- Improve hospice utilization patterns and costs of care related and unrelated to the terminal condition and related conditions based on improving the coordination and quality of care and service delivery.
- Enable enrollees, their families and caregivers to experience the benefits of hospice care over a more appropriate period of time as aligned with their wishes and the member’s needs.
Transitional Concurrent Care is the provision of curative care for a terminal condition for a member participating in the Value-Based Insurance Design model. Unlike the traditional hospice benefit, which focuses on non-curative care, transitional concurrent care includes all items or services that are part of the member’s plan of care with an existing provider as a result of the terminal diagnosis. Services may include but are not limited to, specialist provider visits, internist/PCP visits, access to specialized Durable Medical Equipment, and treatments for a variety of chronic and acute conditions.
The purpose of this addendum is to notify the Medicare beneficiary (or representative), in writing, of those conditions, items, services, and drugs that are covered under the Transitional Concurrent Care model by Humana.