Literature Review

Texas did not calculate or collect hospice cap overpayments totaling $10.5 million HHS-OIG; Report number: A-06-24-09001; Issued on 9/17/25, Posted on 9/22/5 

The Alliance expresses concerns regarding MACPAC approach to HCBS rate setting National Care at Home, Alexandria, VA and Washington, DC; Press Release; 9/18/25 The National Alliance for Care at Home (the Alliance) released the following statement in response to the Medicaid and CHIP Payment and Access Commission’s (MACPAC) discussion regarding home- and community-based services (HCBS) rate-setting held during today’s September MACPAC meeting. The Alliance appreciates MACPAC’s interest in addressing issues related to worker pay in HCBS. These workers should receive higher wages and benefits as they are the backbone of the long-term care system in our country. ... Unfortunately, we are concerned about the draft recommendation MACPAC discussed during today’s meeting. Rather than seeking to address the root-cause of low worker wages, MACPAC’s recommendation instead focuses on collecting additional information that would further describe the issue. This approach increases administrative burden on states and providers without actually proposing solutions to this problem.

Wound care marketing can create confusion around hospice relatedness Hospice News; by Jim Parker; 9/16/25 Hospices provide wound care to many patients, but confusion can arise over questions of relatedness to the terminal illness. The goals of palliative wound care include primarily symptom management, comfort and dignity, but it does not always focus on healing the injury, a 2023 study indicated. This differs from general wound care, which does target healing. Palliative wound care is essential for hospice patients and most of the time should be considered related to the patient’s terminal condition, according to Felicia Walz, director of hospice quality for Colorado-based provider HopeWest. “Providing wound care to hospice patients is always appropriate,” Walz told Hospice News.

Medicare cuts & tech gaps drive home health nurse exodus Access Newswire - Regulatory; by Black Book Survey; 9/16/25 Black Book Research today released 2025 survey findings from U.S. home health executives, finance leaders, and clinical directors showing that technology inefficiencies are a primary driver of nurse attrition. Respondents also warn that proposed Medicare home health payment reductions totaling 6.4% over 2026-2027 will intensify workforce pressure unless agencies can invest in modern IT.Key 2025 Survey Findings (U.S. Home Health & Hospice):

Over 240 advocates rally in DC for the future of care at home: National Alliance for Care at Home hosts Inaugural Advocacy Week on Capitol Hill National Alliance for Care at Home, Alexandria, VA and Washington, DC; Press Release; 9/12/25 More than 240 care at home care advocates from across the country met with over 275 congressional offices this week to discuss key legislative and regulatory priorities for expanding access to home-based care services. The meetings were part of the 2025 National Alliance for Care at Home’s inaugural Advocacy Week. Alliance Advocacy Week brings together leaders, advocates, and supporters to unite as one voice for care at home, driving positive legislative change and shaping the future of care to ensure broader access to the life-changing home care services for all Americans. 

Medicare Advantage plan spending and payments under the hospice carve-outJAMA Network Open; by Meghan Bellerose, Andrew M Ryan, Claire K Ankuda, David J Meyers; 8/25In 2021, the Centers for Medicare & Medicaid Services implemented a Value-Based Insurance Design (VBID) model to test the impact of including hospice services in the Medicare Advantage (MA) benefits package. In December 2024, the VBID was ended following widespread dissatisfaction ... Under the carve-out model, after an MA enrollee elects hospice, health care related to their terminal illness is paid for by fee-for-service (FFS) Medicare. MA plans stop receiving the inpatient and outpatient portions of that enrollee's capitated payment but continue to receive premium and rebate payments. In this cross-sectional study, MA plans received high premium and rebate payments for beneficiaries enrolled in hospice despite low health care spending after enrollees elected hospice. To reduce excess payments, the Centers for Medicare & Medicaid Services could require MA plans to submit information on enrollees' use of supplemental benefits and adjust payments made after election of hospice to align with spending.

Alliance submits comments in response to CY 2026 Home Health Proposed Rule National Alliance for Care at Home, Alexandria, VA and Washington, DC; Press Release; 8/29/25 As the federal comment period draws to a close, the National Alliance for Care at Home (the Alliance) has joined an unprecedented number of providers and patients in submitting formal feedback to the Centers for Medicare & Medicaid Services (CMS) on the agency’s proposed 9% cut to the home health payment rate for 2026. The unusually high volume of responses collected throughout the comment window underscores broad concern that the $1 billion payment reduction will limit access to care at home, compromise patient safety, and burden the wider healthcare system.  

The Medicare Advantage, ACA and No Surprises Act lawsuits to watch Modern Healthcare; by Bridget Early; 8/18/25 Legal challenges to Medicare Advantage marketing, health insurance exchange regulations and the No Surprises Act are working their way through the courts with major implications for the healthcare sector. Here are some key cases that could change how health insurance companies sell Medicare plans, how insurers and providers resolve out-of-network billing disputes, how consumers sign up for health insurance exchange plans, and how preventive healthcare is covered. 

The state of pediatric concurrent hospice care in the United States American Academy of Pediatrics; by Meaghann S. Weaver, MD, PhD, MPH, HEC-CCorresponding Author; Steven M. Smith, MD; Christy Torkildson, PhD, RN, PHN; Deborah Fisher, PhD, RN, PPCNP; Betsy Hawley, MA; Alix Ware, JD, MPH; Holly Davis, MS, APRN; Conrad S. P. Williams, MD; Lisa C. Lindley, PhD, RN, FPCN, FAAN; 8/1/25 The Patient Protection and Affordable Care Act (ACA) required all state Medicaid programs to pay for both curative and hospice services for children and adolescents. The purpose of this Special Article report is to quantify and describe the use of concurrent care for children, including a depiction of the barriers and benefits according to community-based hospice organizations in the United States. A total of 295 hospice organizations from 50 states and Washington, DC responded to the National Alliance for Care at Home call for engagement.

How proposed home health cuts could impact hospices  Hospice News; by Jim Parker; 8/1/25Proposed cuts to home health payments for 2026 could have somewhat of a ripple effect on hospices. The U.S. Centers for Medicare & Medicaid Services has called for a 6.4% aggregate cut to home health payments for 2026 in a proposed rule. The total reductions amount to $1.135 billion. This is the fourth straight year in which CMS has cut or proposed to cut home health payments. Due to this proposed rule, the agency has “failed” providers, according to Dr. Steven Landers, CEO for the National Alliance for Care at Home.

CMS FY 2026 Hospice Wage Index FINAL Rule posted in Federal Register

National Alliance for Care at Home hosts inaugural Financial Summit National Alliance for Care at Home, Alexandria, VA and Washington, DC; Press Release; 7/30/25 The National Alliance for Care at Home (the Alliance) successfully hosted its inaugural event, the 2025 Alliance Financial Summit, July 27-29 in Chicago, IL. The Summit brought together financial leaders from across the care at home community, with expert-led sessions, peer collaboration, and insights into market shifts and emerging technologies. More than 700 attendees and exhibitors participated in the comprehensive program, which featured keynote presentations, concurrent educational sessions, networking opportunities, awards, and celebration. ... “This first Alliance event exceeded our expectations, bringing together care at home leaders from across the nation to connect, learn, and recommit to our shared vision of an America where everyone has access to the highest quality, person-centered healthcare wherever they call home,” said Alliance CEO Dr. Steve Landers.

Hospice | CMS.gov/Fraud Fast FactsCMS.gov/Fraud; by CMS; July 2025 ... Medicare hospice utilization has increased in recent years. In Fiscal Year 2024, Medicare payments for hospice reached over $27 billion, with approximately 1.8 million Medicare beneficiaries receiving hospice care. CMS has taken significant action to address likely fraudulent behavior occurring in Medicare-enrolled hospices, including long lengths of stay, co-located hospices, and high rates of beneficiaries discharged alive. [This Fast Facts one-page sheet includes:]