Welcome to the Humana Hospice VBID information landing page

The Centers for Medicare & Medicaid Services (CMS) recently announced a demonstration under the VBID model, to learn whether hospice benefits provided within the Medicare Part A benefits package allow for a better patient experience.

The demonstration works to improve patient care through greater care coordination and reduced fragmentation. Beginning January 1, 2021, Humana is participating in this demonstration program on select plans, to ease care transitions and ensure hospice-eligible patients can access and receive the full benefits of hospice care.

Whether or not you participate in the Humana provider network, this is where you will find all the information necessary to do business with Humana under the Hospice VBID demonstration.

This includes information about Humana’s participating plans for calendar year 2021, operational guidelines and contact information, member notification submission information, and details surrounding billing and claims submissions.

About Humana’s Hospice VBID model

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 will partner with a VBID-specific Palliative Care providers to identify and support members who may benefit from a palative care program in tandem with their Medicare Advantage plan coverage.

Humana’s Hospice Value-Based Insurance Design (VBID) model

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.

2021 Humana Hospice VBID - Participating Plans

Location Medicare Plan County Service Areas Plan/Option Atlanta, GA Humana Gold Plus H4141-015-000 (HMO) Clayton, DeKalb, Fulton, Gwinnett, Henry 076/938 Atlanta, GA HumanaChoice H5216-073-000 (PPO) Bartow, Carroll, Cherokee, Clayton, Cobb, Coweta, Dawson, DeKalb, Douglas, Fayette, Floyd, Forsyth, Fulton, Gwinnett, Haralson, Henry, Meriwether, Newton, Paulding, Pickens, Rockdale, Walton 079/424 Cleveland, OH Humana Cleveland Clinic Preferred H6622-023-000 (HMO) Cuyahoga, Lake, Lorain, Medina, Summit 076/165 Denver, CO Humana Gold Plus H0028-025-001 (HMO) Adams, Arapahoe, Broomfield, Denver, Douglas, Jefferson 076/209 Denver, CO Humana Gold Plus H0028-025-002 (HMO) Boulder, Clear Creek, El Paso, Elbert, Fremont, Larimer, Pueblo, Teller, Weld 076/218 Denver, CO Humana Gold Plus H0028-047-000 (HMO) Adams, Arapahoe, Boulder, Broomfield, Clear Creek, Denver, Douglas, El Paso, Elbert, Fremont, Jefferson, Larimer, Pueblo, Teller, Weld 076/329 Louisville, KY HumanaChoice H5216-018-000 (PPO) KY: Bullitt, Hardin, Henry, Jefferson, Marion, Nelson, Oldham, Shelby, Spencer

IN: Clark, Floyd, Harrison
079/260
Louisville, KY Humana Gold Plus H5619-073-000 (HMO) KY: Bullitt, Hardin, Henry, Jefferson, Larue, Meade, Nelson, Oldham, Shelby, Spencer

IN: Clark, Floyd, Harrison
076/128
Richmond/Tidewater, VA Humana Gold Plus H6622-004-000 (HMO) Chesterfield, Colonial Heights City, Dinwiddie, Hanover, Henrico, Hopewell City, Petersburg City, Richmond City 076/897 Richmond/Tidewater, VA Humana Gold Plus H6622-005-000 (HMO) Chesapeake City, Hampton City, Newport News City, Norfolk City, Portsmouth City, Suffolk City, Virginia Beach City 076/898

Operational Guidelines for In-Network Providers

To become an in-network provider with Humana for hospice VBID CY2021, 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 for CY2021.

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:

  • 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 and 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

Humana Hospice VBID operational guidelines for in-network providers, opens new window

Hospice care assistance allowance benefit community resource directory for in-network providers, opens new window

Transitional Concurrent Care Process Flow for INN Providers, opens new window

Operational Guidelines for Out-of-Network Providers

This guidance is for hospice providers serving participating members in the Humana hospice VBID. The aims of Hospice VBID model demonstration are:

  • 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 and 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.

Humana Hospice VBID operational guidelines for out-of-network providers, opens new window

Transitional Concurrent Care Coverage

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.

Humana’s Election Statement Addendum: Transitional Concurrent Care Coverage Form for In-Network Providers , opens new window