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

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 to:

• 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, 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

Hospice care assistance allowance benefit community resource directory for in-network providers

Palliative care guidelines

DispatchHealth provider flyer

In-network hospice provider training video

Hospice VBID Health Equity Flyer

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

• 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, 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

Palliative care guidelines

DispatchHealth provider flyer

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.

Transitional Concurrent Care Process Flow for INN Providers

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

Caregiver’s Toolkit