Literature Review

Hospice Wage Index, the Final Rule, and the signals CMS is sending | part one Teleios Collaborative Network (TCN); pocast hosted by Chris Comeaux with Annette Kiser and Judi Lund Person The 2027 Hospice Final Rule is more than a reimbursement update—it’s a window into where Centers for Medicare & Medicaid Services (CMS) believes hospice care needs to go next. In Part One, host Chris Comeaux sits down with hospice regulatory experts Annette Kiser and Judi Lund Person to look beyond the numbers and “read the tea leaves” in CMS’s latest rule.  They unpack what hospice leaders need to understand about the Hospice Election Statement Addendum, the growing scrutiny of unrelated services and non-hospice Medicare spending, telehealth reporting, and the Service and Spending Variation Index (SSVI).  As Judi explains, CMS’s commentary and responses to industry feedback can reveal as much about the agency’s direction as the regulations themselves.

4 huge Medicare pay reforms are part of new bipartisan House bill American Medical Association (AMA); by Tanya Albert Henry; 8/11/26 With more physician Medicare pay cuts proposed for 2027, a new comprehensive, bipartisan bill introduced in the U.S. House of Representatives would finally make structural changes that are needed to prevent those cuts and create a payment system that helps ensure that America’s seniors have access to quality, value-based healthcare. The AMA-supported Patients First Act (H.R. 9693) addresses four core reforms that the AMA and organized medicine have long sought from Washington. If passed, the bill would:

CMS: Hospice claim rejections due to admission and election date editLeading Age; 8/12/26 A Centers for Medicare and Medicaid Services (CMS) change request prevents overpayments of long-term hospice care that took effect April 1, 2026. Unfortunately, the edit is now impacting hospice institutional claims. Medicare Administrative Contractors, Wellpoint Federal, CGS, and Palmetto, sent notices to providers that claims are failing system edits when the transfer date is populated as the admission date. The claims return with edits U5565 and U5566, preventing successful claim creation/submission. The MACs are overriding the edit and allowing the impacted claims to process. 

Sixth Circuit clarifies Medicare safe harbor for hospice providers in landmark coverage decision JD Supra; by Jason Bring and Bill Dombi; 8/5/26 Key Takeaways

Hospice groups ‘disappointed’ by 2027 Final Rule Hospice News; by Jim Parker; 8/3/26 Hospice organizations are expressing “disappointment” following the release of the U.S. Centers for Medicare & Medicaid Services’ (CMS) hospice final rule for 2027. A chief sticking point was the 2.3% base rate increase, which was less than the 2.4% the agency originally proposed. Members of industry trade groups contend that this is an insufficient amount in today’s economy and cost environment. ... New for 2027, the Service and Spending Variation Index (SSVI) includes a scoring system using nine claims-based measures, each representing different aspects of hospice utilization as well as non-hospice spending. This is designed to identify hospices in need of increased transparency and oversight. CMS established the SSVI amid the agency’s concerns over non-hospice spending in particular. The Alliance, LeadingAge and the National Partnership for Healthcare and Hospice Innovation (NPHI) opposed the SSVI in comments on the proposed rule.

CMS Fact Sheet: Fiscal Year 2027 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements Final Rule (CMS-1851-F) CMS Newsroom; Press Release; 7/30/26 On July 30, 2026, the Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-1851-F) that would update Medicare hospice payments and the aggregate cap amount for fiscal year (FY) 2027 under existing statutory and regulatory requirements. This final rule also highlights Medicare non-hospice spending under a hospice election, using data from the hospice service and spending variation index (SSVI).

6th Cir. vacates district court ruling against Medicare hospice Bloomberg Law; by Ganny Belloni; 7/26/26 

Sterling Hospice home to close, expected to reopen under new ownership KWQC-6, Sterling, IL; by KWQC Staff; 7/22/26 The Rock River Hospice & Home is closing Aug.1, officials announced Wednesday. The organization, which has been serving people throughout the Sauk Valley area for over 40 years, is closing due to longstanding financial challenges, officials said in a media release. “Changes in healthcare reimbursement, increasing operating costs, and other economic pressures have made it increasingly difficult for standalone hospice providers to remain financially sustainable,” officials said. However, officials said care will continue to be available in the community. 

H.R.9703 - Improving access to transfusion care for hospice patients act of 2026 U.S. Congress.gov, House Ways and Means Committee; sponsored by Rep. Debbie Dingell (D-MI-6); bill introduced 7/15/26 H.R. 9703: To require the Center for Medicare and Medicaid Innovation to test allowing blood transfusions to be paid separately from the Medicare hospice all-inclusive per diem payment.

Calendar Year (CY) 2027 Medicare Physician Fee Schedule Proposed Rule CMS Newsroom; Fact Sheet; 7/14/26 paired with U.S. Department of Health and Human Services, CMS CY 2027 Payment Policies under the Physician Fee Schedule, 7/16/26; summary by guest editor Judi Lund Person On July 14, 2026, the Federal Register posted the CY 2027 Medicare Physician Fee Schedule proposed rule – CMS-1848-P. The CMS Fact Sheet on the proposed rule can be found here. While the proposed rule is 1,592 pages, there are two items of note to hospice and palliative care readers: 1) Supporting Beneficiaries Planning for Future Medical Decisions.CMS is proposing to create two new HCPCS codes to describe advance care planning (ACP) services furnished by clinical staff under the direct supervision of the billing physician or other practitioner. These new codes will more accurately distinguish and value the work done by billing practitioners from time spent by their clinical staff providing ACP services. We are further proposing that the existing ACP CPT codes 99497 and 99498 would only be used to report time personally spent by the billing practitioner. 2) RFI on Community-based Palliative Care, asking questions on eligibility for serious illness care and palliative care, the future of care management services and advanced primary care management.   

Medicare’s hospice bill doubled over the last decade U.S. Government Accountability Office (GAO); WatchBlog Post; 7/14/26 In recent years, Medicare’s spending on hospice has nearly doubled. We looked at this spending and found that the way Medicare pays for hospice care could be costing taxpayers billions more than it should. Today’s WatchBlog post looks at our new report about inefficiencies in Medicare's payments.

The hidden cost of cancer's end: how financial strain shapes final months of care Fred Hutch Cancer Center, University of Washingon, Seattle, WA; by D. Moosavi; 6/25/26 ... Previous Fred Hutch research has shown that people with cancer are more than twice as likely to file for bankruptcy, and nearly twice as likely to experience what researchers call an “adverse financial event,” compared with people who don’t have cancer. But most of that earlier work focused on financial hardship as an outcome caused by cancer. This study flips the question: once someone is already dealing with financial strain, what happens to the care they receive as their illness progresses? 

CMS is right about hospice fraud but wrong about the moratorium on new enrollments Health Affairs; by Tamara Weaver; 6/30/26 Under CMS’s six-month moratorium on new enrollments, I have effectively been told to sit still, burn cash, and hope I survive long enough to eventually serve patients. That is not good policy. That is collateral damage. I am exactly the kind of hospice agency owner the federal government should want in this industry. I am not a private equity fund. I am not a shell company. I am not a fraudster who enrolled patients who did not qualify, billed for services never rendered, or relocated across state lines to outrun regulators. I am a founder who spent years building something genuinely different—investing my life savings, my retirement, and my professional identity into a mission-driven hospice designed specifically as an antidote to the failures that have eroded trust in end-of-life care. ...