2022 changes to the Medicare Advantage hospice benefit

Starting Jan. 1, 2022, the hospice benefit component of the Centers for Medicare & Medicaid Services (CMS) Value-Based Insurance Design (VBID) model will change the UnitedHealthcare® Medicare Advantage member’s hospice service benefits and how those benefits are billed in Alabama, Illinois, Oklahoma and Texas.

Eligible members

These UnitedHealthcare Medicare Advantage and Dual Special Needs Plan (DSNP) members will be eligible for services under the VBID hospice model starting Jan. 1, 2022.

State Area CMS contract

Alabama

Statewide

H0432-003-000, H0432-004-000, H0432-009-000, H0432-010-000, H0432-012-000, H0432-013-000, H2802-041-000, H2802-044-000, H6528-033-000

Illinois

Chicago

H8768-005-000, H8768-010-000

Oklahoma

Statewide

H3749-001-000, H3749-017-000, H3749-018-000, H3749-020-000, H5322-031-000, H8125-003-000, H8768-008-000, H8768-009-000, H8768-016-000, H8768-028-000

Texas

Corpus Christi

H4527-001-000

Starting Jan. 1, 2022, the hospice benefit component of the Centers for Medicare & Medicaid Services (CMS) Value-Based Insurance Design (VBID) model will change the UnitedHealthcare® Medicare Advantage member’s hospice service benefits and how those benefits are billed in Alabama, Illinois, Oklahoma and Texas.

Eligible members

These UnitedHealthcare Medicare Advantage and Dual Special Needs Plan (DSNP) members will be eligible for services under the VBID hospice model starting Jan. 1, 2022.

You can check a member’s plan through the HIPAA Eligibility Transaction System (HETS) by signing in at UHCprovider.com/eligibility or by checking the member’s UnitedHealthcare ID card. Members of group Medicare Advantage plans or Institutional Special Needs Plans (I-SNP) won’t be affected.

The VBID hospice model

Members under the VBID hospice model may be eligible to continue some short-term curative care services after hospice election. These transitional concurrent care services may help members choose hospice services at a more appropriate time.

Under the VBID model and in states and jurisdictions where UnitedHealthcare has been approved to offer such benefits, UnitedHealthcare will be responsible for coverage and payment of all hospice-related services for UnitedHealthcare Medicare Advantage members covered by Original Medicare. Eligible members will remain enrolled in UnitedHealthcare Medicare Advantage while receiving hospice services.

Members in these plans who qualify will continue to have access to home-based palliative care services through either Prospero Health (Alabama, Oklahoma, Chicago) or WellMed (Texas).

There will be no prior authorizations for hospice services under the VBID model.

Services included in the VBID model

  • Transitional concurrent care − Members who select network hospices may be eligible to continue a subset of short-term curative care services that:
    • Are billed by community health care professionals directly to UnitedHealthcare
    • Allow members to continue certain treatments from other health care professionals that would not normally be covered by Medicare for a limited time while transitioning to hospice
  • Optional pre-hospice consultation − Members can choose to have a pre-hospice consultation to better understand the transition process to hospice care as well as their in-network and out-of-network hospice options
  • Care navigation − Members who select a network hospice will have the option to receive navigation support services, including coordination of hospice services with existing providers and helping with answers to questions and concerns for members and their families

Questions?

Please visit UHCprovider.com/mahospice for more information.

PCA-1-21-02731-M&R-NEWS