Literature Review

CMS Proposed Rules and Comment Deadlines HealthIT Answers; by HHS/ONC/CMS Communications; 5/5/25 Center for Medicare & Medicaid Services have issued the following proposed rules and have opened comment periods.

Courts diverge in challenges to CMS's minimum staffing requirements for LTC facilities JD Supra; by Kayla Stachniak Kaplan, Scott Memmott, Sydney Menack, Jonathan York, Howard Young; 4/30/25On May 10, 2024, the Centers for Medicare and Medicaid Services (CMS) published its Final Rule to implement minimum staffing standards for long-term care (LTC) facilities in the United States. However, as discussed in our prior blog post, the Final Rule was immediately challenged under the Administrative Procedure Act (APA) in two major lawsuits. These cases have resulted in divergent rulings, injecting more uncertainty across the LTC industry about the future of the application and validity of the Final Rule. ... This and further developments in these cases will have significant impact on the future of CMS’s oversight of the country’s nursing homes.

Trends, patterns, and key comparisons related to new Medicare Hospice Provider Enrollments may indicate the need for further oversight HHS Office of Inspector General; 4/29/25 Federal requirements state that hospices must be certified by CMS and be licensed as required by State and local law. Medicare also requires that hospices meet its Conditions of Participation to receive payment. Our objective is to identify trends, patterns, and key comparisons that indicate potential vulnerabilities related to new Medicare hospice provider enrollments. The data brief may help CMS evaluate the need for additional monitoring and program integrity efforts to ensure that hospices meet all the requirements. ... 

CMS releases HOPE Guidance Manual (V. 1.01) and TablesCenters for Medicare and Medicaid Services (CMS); by CMS; 4/22/25On April 22, 2025, CMS released the HOPE Guidance Manual (V. 1.01) and connected tables. Providers can use v1.01 for HOPE planning, as this is considered final before HOPE implementation. Also note that earlier this month, the final HOPE data specs have also been released, helping software developers to finalize their HOPE software for testing in the coming months.

CMS to withdraw federal Medicaid match for workforce, social needs, and infrastructure: What states, health care providers and community organizations need to know Mondaq; by Sheppard Mullin Richter & Hampton; 4/22/25 In a move signaling a major shift in federal priorities, the Centers for Medicare & Medicaid Services ("CMS") recently announced it will limit federal funding for state Medicaid initiatives that support services beyond direct medical care. New policy guidance indicates that CMS intends to narrow the scope of the federal-state Medicaid partnership, refocusing matching funds on core healthcare services delivered to Medicaid beneficiaries. ... On April 10, CMS notified states that it will no longer approve new, or renew existing, state proposals for Section 1115(a) Demonstration Project expenditure authority to provide federal matching funds for state expenditures for designated state health programs ("DSHP") and designated state investment programs ("DSIP").

What's at stake if CDC's Infection Control Practices Committee is cut MedPage Today; by Alexander Sundermann, DrPH; 4/17/25 Whether you are placing a central line, managing a Clostridioides difficile case, or keeping a surgical field sterile, you're likely following standards influenced by the Healthcare Infection Control Practices Advisory Committee (HICPAC). While it may not be widely known outside of infection prevention circles, HICPAC plays a central role in shaping the evidence-based guidelines that frontline clinicians use every day to protect both patients and healthcare workers. ... Frontline clinicians ... rely on HICPAC guidance every day. Its recommendations shape the protocols used to prevent device-related infections, respond to emerging outbreaks, and meet regulatory and accreditation requirements. ...Eliminating HICPAC wouldn't just slow progress -- it would erode the foundation of infection prevention in U.S. healthcare.

Regulatory leaked HHS budget signals $40B in cuts, assumes ACA subsidies expire Fierce Healthcare; by Noah Tong; 4/17/25 Department of Health and Human Services (HHS) reorganization plans appear to have been revealed through a leaked Office of Management and Budget (OMB) document. The 64-page PDF with HHS’ plans were first reported by Inside Medicine and later reported by The Washington Post and other news publications. In an update, Inside Medicine said the entire document was authenticated by The Washington Post. ... While the restructuring was broadly announced, and individual offices have been reportedly axed in recent weeks, the leak provides greater insight into how the reorganization, firings, reductions in force and office eliminations and consolidations will fundamentally alter the agency.

CMS to withdraw federal Medicaid match for workforce, social needs, and infrastructure: What states, health care providers and community organizations need to know The National Law Review; by Margia Corner, Adam Herbst of Sheppard, Mullin, Richter & Hampton LLP; 4/16/25 In a move signaling a major shift in federal priorities, the Centers for Medicare & Medicaid Services (“CMS”) recently announced it will limit federal funding for state Medicaid initiatives that support services beyond direct medical care. ... On April 10, CMS notified states that it will no longer approve new, or renew existing, state proposals for Section 1115(a) Demonstration Project expenditure authority to provide federal matching funds for state expenditures for designated state health programs (“DSHP”) and designated state investment programs (“DSIP”). 

NABIP responds to HHS Proposed Rule on Marketplace Integrity National Association of Benefits and Insurance Professionals; by Kelly Lousedes; 4/14/25 The National Association of Benefits and Insurance Professionals (NABIP) submitted formal comments to the Department of Health and Human Services (HHS) on the Centers for Medicare & Medicaid Services’ (CMS) proposed rule, CMS-9884-P: Marketplace Integrity and Affordability. While NABIP strongly supports efforts to enhance program integrity, it strongly objects to elements that could lead to unfair treatment of licensed health insurance professionals. ...

Statement by the American Nurses Association on organizational restructuring within the US Department of Health and Human Services American Nurses Association (ANA); Press Release; 4/8/25 The American Nurses Association is aware of the recent personnel changes and organizational restructuring within the US Department of Health and Human Services (HHS). These developments have sparked concerns among nurses nationwide regarding the potential impact on essential programs and services delivered by HHS in collaboration with nurses, patient advocates, and other healthcare providers. ... The association will monitor that re-structured capacity and promptly report any gaps we identify to the Administration and Congress to ensure the needs of nurses, and the public are met by our federal partners. It is imperative that Secretary Kennedy and Administration leaders ensure the uninterrupted continuation of the vital work of these agencies. Federal agencies must have the necessary staff to carry out the public health, research, quality, and operational work that the American people rely on for their health and well-being. [Continue reading ...]

AGG talks: Home health & hospice podcast - Episode 10: Anti-Kickback Compliance for hospice and skilled nursing providers JD Supra; by Arnall Golden Gregory, LLP; 4/3/25 In this episode, AGG Healthcare attorneys Bill Dombi and Jason Bring discuss recent OIG guidance on hospice and skilled nursing facility relationships, focusing on anti-kickback risks and fraud concerns. They cover key issues such as the importance of documenting fair market value for any services or space provided, being cautious of payments exceeding Medicaid room and board rates, and avoiding arrangements that appear to be made solely to secure referrals. Bill and Jason also touch on increased oversight and enforcement in the healthcare sector under a new presidential administration.

HHS restructures duals, PACE offices amid department overhaul Modern Healthcare; by Bridget Early; 4/3/25 The Health and Human Services Department is reorganizing a handful of key programs for dually eligible enrollees and older adults, including laying off numerous staffers. HHS is shuffling how it manages care coordination for people dually eligible for Medicare and Medicaid under the Medicare-Medicaid Coordination Office and the Program of All-Inclusive Care for the Elderly. PACE, which had been poised for growth, offers home and center-based care mostly to dual-eligible Medicare and Medicaid enrollees who qualify for skilled nursing but can still live in their communities. A spokesperson for HHS said the department has “planned productivity enhancements for the PACE management department.” HHS did not elaborate on what management changes for the PACE program might look like.