MA-VBID Request for Applications Released

The Centers for Medicare & Medicaid Services (CMS) has released the Request for Applications for the Medicare Advantage (MA) Value-Based Insurance Design (VBID) Model, which is an opportunity for MA plans to offer supplemental benefits or reduced cost sharing to enrollees with CMS-specified chronic conditions, focused on the services that are of highest clinical value to them. Applications are due by January 8, 2016.

CMS will tentatively select plans by April 2016.  The application document repeats most of the information CMS released in the original announcement and webinar.  However, the application will be submitted via a web portal which will be released in the near future.  The process is much like the MA contract application process.  CMS does provide information about the questions which will appear in the template.

Applicants will be required to present narrative explanations about their proposed interventions.  First, there is the general overview of the proposed interventions describing the overall approach and understanding.  This section must convey specific enough information tracking to details about interventions in later sections of the template. It will act to set the stage of an application.

Next, applicants must describe each separate VBID intervention.  This will include each combination of plan and enrollee group so every target population is described with repetitive plan information and interventions.  CMS describes the target population according to the eight qualifying diseases/conditions listed in the VBID demonstration.

Applicants must list specific benefits for each target population. CMS lists the various combinations of benefits:

• Reduction or Elimination of Cost Sharing (not conditional)
• Reduction or Elimination of Cost Sharing for High Value Provider
• Reduction or Elimination of Cost Sharing Conditioned on Participation
• Supplemental Non-Covered Benefits

CMS asks for “clear descriptions” in each of the four options and provides a number of elements applicants must discuss in their narratives.

While applicants must upload actuarial and financial documentation in this template, there are no specifications about the types of information for which CMS will ask.  Notably, there is a statement that such information may not be required.

Health plans must also discuss their compliance history extending to January 1, 2010.  Finally, an official of the applicant must certify their applications, their understanding about the conditions including marketing limitations, and bid requirements.

Data analysis is the key first step to identifying target populations and subsequent benefits which will become the focus of the demonstration.  A team of subject matter experts from Gorman Health Group will deliver actionable results, driven by data analysis of current capabilities and benefit designs, to achieve quality care for the target populations. Contact us to learn more >>

Resources

Download a copy of the recording from the October 5 webinar titled “Medicare Advantage Value-Based Insurance Design Model (MA-VBID)“, hosted by John Gorman.

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