Hospice Care for VNS Health Medicare Patients
For patients who are diagnosed with a terminal illness, VNS Health Medicare offers a Hospice Benefit.
VNS Health Medicare is one of a handful of designated CMS Innovation Center Model participants for the Hospice Benefit Program, designed to increase patient access to hospice services, simplify payment by moving it from Medicare to the patient’s Medicare Advantage plan, and improve coordination between hospice providers and other clinicians at the patient’s end of life.
The Hospice Benefit component of the Value Based Insurance Design (VBID) Model is an opportunity for VNSNY CHOICE Medicare, physicians, and hospice providers to collaborate and improve care coordination, transparency, and quality of life for our Medicare members at the end of life.
Part of the Hospice Benefit includes the provision of Transitional Concurrent Care (TCC) service for members who elect hospice with an in-network hospice provider. To ease care transitions, we offer TCC services that are necessary to address continuing care needs, as clinically appropriate, for the treatment of the patient’s terminal condition. Under the TCC benefit, patients who elect hospice care with an in-network hospice provider can choose to maintain their usual curative care for up to one month from the date of hospice election.
We currently have two in-network hospice providers available to plan members:
- VNS Health Hospice Care. For more information or to refer a VNS Health Medicare patient, call 212-609-1920.
- MJHS Hospice Care. For more information or to refer a VNS Health Medicare patient, call 855-921-4057.
Note that out-of-network hospice services are also covered by the patient’s health plan. Other hospice providers may be added to the network at any time.
Hospice Care Frequently Asked Questions
Hospice care requires that the patient has a certified prognosis of six or fewer months to live.
Hospice care requires that two physicians certify that the patient has less than six months to live, based on the physician’s estimate, if the terminal illness runs its course as expected.
The hospice care team is a group of specially trained health professionals that includes a physician, nurse, hospice aide, social worker, volunteer, chaplain, and bereavement counselor. This interdisciplinary team works together to ensure that the patient’s needs are met. Among its major responsibilities, the interdisciplinary hospice team:
- Manages the patient’s pain and symptoms
- Provides physical, emotional, and spiritual support
- Provides medications, medical supplies, and equipment
- Provides coaching to caregivers on how to care for a patient
- Delivers special services like physical therapy when needed
- Makes short-term inpatient care available when caregivers need respite time
- Provides bereavement support
- Doctor services
- Nursing care
- Medical equipment (such as hospital bed or wheelchair)
- Medical supplies (such as bandages and catheters)
- Drugs to control pain and other symptoms
- Home health aide and homemaker services
- Physical and occupational therapy
- Speech therapy (to help with problems such as swallowing)
- Social worker services
- Dietary counseling
- Emotional and spiritual counseling
- Respite care designated to provide family members a short break from caring for their loved one at home
- Transitional Concurrent Care for patients who elect hospice with an in-network provider
Most hospice organizations encourage the PCP to remain involved in the patient’s care. PCPs often have the best knowledge of the patient’s overall health and can remain the patient’s primary care physician once the decision to refer to hospice is made. The PCP can offer reassurance and support to the patient and family during the very difficult end of life period. Additionally, the PCP can assist with offering clear communication to the hospice team if the patient or family has any difficulty doing so. In turn, Hospice is a valuable physician resource when it comes to medications, symptom management, and communication with patients and families.
- VNS Health Medicare Resources
- External Resources
- NHPCO- Facts-Figures 2021 (Available in PowerPoint or pdf)
Frequently Asked Questions for Hospice Care Providers
If you are a physician who ordinarily provides primary or specialty care services to a patient who is now in hospice, you should bill us directly. You do not need to bill both CMS and VNS Health Medicare, unless you are specifically a hospice provider or facility.
Claims must be submitted to both VNS Health Medicare and to the Centers for Medicare and Medicaid Services (CMS).
Please note: In addition to your usual Notice of Election (NOE) and Notice of Termination/Revocation (NOTR) submission to CMS, all providers are also required to submit the NOE to us within 5 days of hospice election and the NOTR within 5 days of hospice termination. Please submit all Hospice NOE and NOTR material to [email protected].
Or you can mail your Notice of Election to:
VNS Health
Health Plans – Membership Eligibility Unit
220 East 42nd Street
New York, NY 10017
These services are offered in the Bronx, Kings, Nassau, New York, Queens, Richmond, Suffolk, and Westchester Counties.
Hospice Network Administrative Contact:
John Caralyus
[email protected]
646-300-2898
Clinical and Patient Support Contact:
Esther Conteh
[email protected]
212-609-1898