Literature Review

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.

Columbus Foundation grant to support Wexner Heritage Village hospice music therapy program Columbus Jewish News; by Noell Wofgram Evans; 7/31/26   The transition to a hospice can be emotional, stressful and scary. Zusman Community Hospice at Wexner Heritage Village was recently awarded a grant from the Columbus Foundation to help reduce the negative feelings that can be connected with that transition. The $25,000 grant will establish a Hospice Music Therapy Program, a new program that joins their pet therapy and aromatherapy care components which accompany traditional hospice services. Sophia Elias, director of development at Wexner Heritage Village, told the Columbus Jewish News, “The grant will support year-long access to a board-certified music therapist who will provide approximately six to seven visits each week.”

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.

Savings in Medicare hospice payments for care provided in nursing homes U.S. HHS-OIG; Project Number OEI-02-26-00180; 7/15/26 The fixed daily rates that Medicare pays hospices for routine home care provided in a nursing home include personal care services.  However, nursing homes are already required to provide personal care services to their residents.  Paying the hospice the full routine home care rate that covers personal care services when these services are already required from the nursing home can undermine the efficiency of Medicare payments and add to the incentives that bad actors have to exploit the program.  This review will determine Medicare payments for routine home care provided to hospice beneficiaries in nursing homes, estimate potential cost savings from reducing the payment to address the inefficiency in the payment structure, and examine practices of hospices with a high percentage of their beneficiaries in nursing homes.

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. ...

Compassus, Providence Execs: greater transparency needed on hospice quality Hospice News; by Jim Parker; 6/29/26 Greater transparency around hospice quality could help counter eroding trust among the public due to widespread fraud, according to executives from the home health and hospice provider Compassus and the Providence Health System. ... “We’ve got a big narrative about fraud and to use that that should, and probably does, engender fear in the average person who is not working in the industry,” Compassus CEO Mike Asselta told Hospice News. “Can I trust the provider if this industry is fraught with abuse? Am I going to be on the receiving end of that abuse? Just that narrative by itself could have a chilling effect on beneficiaries and families who otherwise need hospice.”

Walking with Purpose fundraiser: hospice volunteer shares story of 520-mile journey WBUP/WJMN, Marquette, MI; by Rebecca Bartelme; 6/23/26 A volunteer with Lake Superior Life Care & Hospice gives back to hospice patients and their families in a unique way. Bart Carroll set out on a 520-mile journey along the Camino de Santiago in Spain, turning every step into support for hospice patients and families. Now, he’s back to share stories, reflections, and the powerful impact of walking with purpose ... "All the funds that Bart has raised from the walks goes to support our Patient Care Fund," said Jennifer Voegtline, CEO, Lake Superior Life Care & Hospice.