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Medicare Advantage Hospice Carve-in Will Bring Challenges

According to Anne Tumlinson, Nexus Fellow and CEO of ATI Advisory, moving hospice benefits to more value-based payment models comes with some challenges and some growth opportunities for providers. Her remarks appear in a Hospice News article titled MA Hospice Carve-In Doubles in Size for 2022.

Beginning in 2021, a number of Medicare Advantage plans began participating in a CMS experiment to provide hospice benefits to their members who elected to receive them. Typically, a MA member who elects to receive hospice benefits does so through traditional Medicare, not through their MA plan. Now in 2022 the number of MA plans participating in the program will double, going from 53 plans to 115. The experiment to allow MA payers to provide hospice benefits is slated to run for four years. Participation is voluntary for both payers and providers.

“In the short term, this growth represents primarily an opportunity for hospice providers in the markets where these plans are operating. The plans must pay Medicare rates and accept any hospice provider for a limited time,” Tumlinson told Hospice News. “The key opportunity/potential longer term threat is that the plans may move forward and establish special ‘value-based’ arrangements with a subset of the hospice market.”

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