Insights

On March 13, 2024, the Centers for Medicare and Medicaid Services (CMS) announced its decision to incorporate a competitive application screening and scoring process into the Value-Based Insurance Design (VBID) program beginning with the 2025 benefit year. This represents a substantial shift from the way the program has been administered in prior years and introduces a range of new requirements and risks Medicare Advantage organizations (MAOs) will need to consider.

VBID applications have always been subject to an application and review process, but until now CMS has not used a competitive bidding process to score applications. In the calendar year (CY) 2025 Request for Applications (RFA), CMS stated that Model participation selection may be competitive, and that it reserves the right to reject applications that do not support the objectives of the VBID program.

With the new guidance, CMS solidifies its decision to have a competitive application for CY 2025 and introduces its application screening process and scoring rubric. CMS asserts its intention with this change is to ensure VBID participants are following program requirements and introducing benefits that are expected to improve the quality of care for Medicare beneficiaries, save CMS money through reduced medical expenditures, and address health-related social needs. MAOs will need to react quickly to respond to this new requirement because applications for 2025 are due April 12, 2024.