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 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.
IN: Clark, Floyd, Harrison
IN: Clark, Floyd, Harrison
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
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.
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.
Billing Hospice services for VBID demonstration plans
Billing information applies to claims submitted for your patients with Humana Medicare Advantage for VBID demonstration plans in Colorado, Georgia, Kentucky, Ohio and Virginia.
Making It Easier
For more detailed information about billing Hospice services, please see our on-demand video presentation titled “Billing Hospice Services for VBID Demonstration Plans” found at: Humana.com/MakingItEasier