FOR PROVIDERS

Medicare Advantage Value-Based Insurance Design (VBID) Program

Dealing with a serious condition or illness may be stressful for a Member and their family. For that reason, starting January 1, 2024, we will participate in the CMS Value-Based Insurance Design (VBID) Hospice Benefit Component and will cover all hospice costs for our Medicare Members who are enrolled in Medicare Choice, Medicare Circle and Medicare Access plans offered in Dade and Broward counties,* and elect Hospice enrollment on are after 1/1/2024.

2024 Hospice Guidelines for all AvMed Medicare Members

• No Authorization Required - For any Medicare members to use Hospice Services.
• Hospice Providers can use any Medicare-approved Hospice provider (including Hospice providers who are participating and non-participating with AvMed).
• Additional Benefits for our Medicare Members in VBID-Eligible Plans
  • Transitional Benefits (must use AvMed participating providers; no authorization required).
    • Continuous use of AvMed provided hospital bed throughout duration of Hospice care.
    • Dialysis services throughout duration of Hospice Care.
    • 30 days of Radiation treatment for palliative purposes.

Additional Resources

Medicare Advantage Value-Based Insurance Design Model | CMS

2024 VBID Hospice Claims Process

All hospice billing for Medicare Members in a VBID-participating plan should be sent directly to AvMed at AvMed Health Plans, Claims Department, P.O. Box 569000 Miami, FL 33256.

*All other AvMed Medicare plans will continue to follow traditional hospice billing processes and claims for Hospice-related services should be sent directly to Medicare for payment.

Notification of Hospice Election

To ensure accuracy of claims payment for all Members in Hospice, and access to transitional and supplemental benefits for VBID-eligible members, you must notify us when our Member elects Hospice.

Make sure to include the following information in your message:

• Member Name
• AvMed Member #
• Member DOB
• Name of Hospice Provider
• Date of Enrollment or Disenrollment
• Notice of Election form signed by our Member