Members

Hospice Care for Blue Advantage Dual Plus Members

For members enrolled in the Blue Advantage Dual Plus plan, and who are diagnosed with a terminal illness, Blue Advantage offers a Hospice Benefit.

Blue Advantage is participating in a designated CMS Innovation Center Model that was designed to increase member access to palliative care and hospice services, simplify payment by moving it from Original Medicare to the member’s Medicare Advantage plan, and improve coordination between the Blue Advantage, hospice providers, other practitioners, and members and caregivers.

The Value-Based Insurance Design (VBID) Model Hospice Benefit component is an opportunity for Blue Advantage to deploy a care model with a foundation of collaboration and goal of improving care coordination, transparency, and quality of life for our Dual Plus members at the end of life.

Part of the Blue Advantage Hospice Benefit includes the provision of Transitional Concurrent Care (TCC) services for members who elect hospice with an in-network hospice provider. To ease care transitions, Blue Advantage offers TCC services that are necessary to address continuing care needs, as clinically appropriate, for the treatment of the member’s terminal condition. Under the TCC benefit, members who elect hospice care with an in-network hospice provider can choose to maintain their usual curative care for up to one (1) month from the date of hospice election.

Refer to the Value-Based Insurance Design (VBID) Model Hospice Benefit Component Operational Guidelines for In-Network Hospice Providers for more information.

Hospice Provider Network:

Blue Advantage has a robust network of high-quality hospice providers available. To view a list of in-network providers, visit our Provider Search.

*Note that out-of-network hospice services are also covered by Blue Advantage. In-network benefits, such as transitional concurrent care, are not available for members that elect hospice with an out-of-network hospice provider.

Hospice Care Frequently Asked Questions for Members

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This program is only available to Blue Advantage’s Dual Plus Medicare Advantage members. Interested Dual Plus members, their caregivers or providers can contact Blue Advantage Integrated Care Team toll free at 1-866-508-7145 (TTY 711) for more information.
Hospice care requires that the member has a certified prognosis of six or fewer months to live.
  • Manages the member’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 member
  • Delivers special services like physical therapy when needed
  • Makes short-term in member care available when caregivers need respite time
  • Provides bereavement support
  • Doctor services
  • Nursing care
  • Medical equipment (such as a 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 work 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 members who elect hospice with an in-network provider
Most hospice organizations encourage the Primary Care Provider (PCP) to remain involved in the member’s care. PCPs often have the best knowledge of the member’s overall health and can remain the member’s primary care provider once the decision to refer to hospice is made. The PCP can offer reassurance and support to the member and family during the very difficult end of life period. Additionally, the PCP can assist with offering clear communication to the hospice team on behalf of the member and his/her caregivers if needed. In turn, hospice is a valuable provider resource for medications, symptom management, and communication with members and families.

Frequently Asked Questions for Hospice Providers

Providers should refer to the Value-Based Insurance Design (VBID) Model Hospice Benefit Component Operational Guidelines for In-Network Hospice Providers for more information.

Hospice Notices:

Hospice providers must submit copies of the Notice of Election (NOE), Transitional Concurrent Care addendum, and Notice of Termination and Revocation (NOTR) to Blue Advantage, consistent with requirements in the VBID Model Hospice Component Technical and Operational Guidelines supplied by CMS.

Hospice providers must notify Blue Advantage of member’s hospice election (NOE), including TCC addendum if applicable, by faxing a copy of the documentation to Blue Advantage at (318) 807-1115.

Hospice providers must also fax a copy of the NOTR to Blue Advantage at (318) 807-1115 to notify of the discharge date and disposition. The NOTR may include any of the following:

  • Member revokes
  • Member chooses to transfer to another hospice
  • Member is discharged due to cause
  • Member passes away

Claims:

Detailed claims submission, authorizations, and payment information can be found in the Value-Based Insurance Design (VBID) Model Hospice Benefit Component Operational Guidelines for In-Network Hospice Providers.