Literature Review

'One Big Beautiful Bill Act': Key final Medicaid changes explained Morgan Lewis; by Jeanna Palmer Gunville and Tesch Leigh West; 7/9/25 The One Big Beautiful Bill Act was signed into law on July 4 and includes significant changes to the Medicaid program, particularly with regard to state and federal financing for the program. This LawFlash provides a high-level summary of certain key provisions that will impact various Medicaid stakeholders, including states, providers, and enrollees. ...

Health care attorneys: Hospice investigations coming from all sides Hospice News; by Jim Parker; 7/8/25 Hospices are subject to a rising number of investigations and audits from Medicare contractors, the U.S. Department of Health and Human Services Office of the Inspector General and, in some cases, the U.S. Justice Department, among others. Hospices need to understand the various types of investigations they may encounter and how to respond to them. Key factors are completely and accurately documenting the medical necessity of the care they receive. Hospice News sat down with Guillermo Beades and Todd Brower, partners with the law firm Frier Levitt to discuss the ins-and-outs of hospice investigations and how providers should respond.

Joint Commission cuts standards by 50% in sweeping overhaul Becker's Clinical Leadership; by Paige Twenter; 6/30/25 The Joint Commission is transforming its accreditation process by reducing the number of requirements by 50% — from 1,551 to 774 standards — in its most significant rewrite since Medicare was established in 1965. The overhaul, first shared with Becker’s, underscores the organization’s effort to reduce the regulatory burden on hospitals and healthcare organizations, uphold public trust and help organizations achieve the highest level of safety and quality, according to Jonathan Perlin, MD, PhD, president and CEO of The Joint Commission Enterprise. ... The redesign, called Accreditation 360: The New Standard, features an updated manual with clearer definitions of CMS conditions of participation and the Joint Commission’s national performance goals, now distilled into 14 critical categories.

CMS launches new model to target wasteful, inappropriate services in original Medicare CMS Newsroom; 6/27/25 The Centers for Medicare & Medicaid Services (CMS) is announcing a new Innovation Center model aimed at helping ensure people with Original Medicare receive safe, effective, and necessary care. Through the Wasteful and Inappropriate Service Reduction (WISeR) Model, CMS will partner with companies specializing in enhanced technologies to test ways to provide an improved and expedited prior authorization process relative to Original Medicare’s existing processes, helping patients and providers avoid unnecessary or inappropriate care and safeguarding federal taxpayer dollars. This model builds on other changes being made to prior authorization as announced by the U.S. Department of Health and Human Services and CMS on [6/23].

CMS Age-Friendly Measure: Overview for hospitals and health systems Institute for Healthcare Improvement; retrieved from the internet 7/2/25 Starting with the 2025 reporting period, hospitals will attest to providing age-friendly care through a new measure introduced by the Centers for Medicare & Medicaid Services (CMS). The CMS Age Friendly Hospital Measure advances the Age-Friendly Health Systems movement’s vision to ensure that all older adults receive age-friendly care that is evidence-based and aligns with what matters most to the older adult and their family caregivers. To date, nearly 5,000 sites of care have been recognized as Age-Friendly Health Systems — Participants and celebrated by IHI and The John A. Hartford Foundation. The measure has five domains that cover all four elements of age-friendly care, known as the 4Ms: What Matters, Medication, Mentation, and Mobility.

United Palliative & Hospice Care accused of $87M hospice scam Hospice News; by Jim Parker; 7/2/25 Three women associated with Houston-based United Hospice & Palliative Care (UPHC) have been charged with Medicaid and Medicare fraud after allegedly bilking more than $87 million in federal health care funds. The trio includes UPHC owner Dera Ogudo, an UPHC employee Victoria Martinez and a psychiatric hospital employee, Evelyn Shaw, ABC-13 Houston reported. The prosecutor’s indictment also includes an unnamed physician who allegedly received kickbacks for referrals to UPHC. “Ogudo and her co-conspirators preyed on the vulnerable residents of those group homes by enrolling them in hospice services with UPHC when they were not terminally ill,” the indictment indicated.

CMS to test prior authorization model in traditional Medicare MedPageToday; by Joyce Frieden; 6/30/25 The Centers for Medicare & Medicaid Services (CMS) announced a new experimental model late last week to streamline some prior authorizations under the traditional Medicare program, but some politicians and experts are concerned that it could result in more delays in care. Under the model, known as the Wasteful and Inappropriate Service Reduction (WISeR) Model, "CMS will partner with companies specializing in enhanced technologies to test ways to provide an improved and expedited prior authorization process" under traditional Medicare, the agency said Friday [6/27] in a press release ...

The Alliance Responds to CY 2026 Home Health Proposed RuleNational Alliance for Care at Home, Alexandria, VA and Washington, DC; Press Release; 6/20/25The National Alliance for Care at Home (the Alliance) issued the following statement today in response to the Centers for Medicare & Medicaid Services (CMS) Calendar Year (CY) 2026 Home Health Prospective Payment System Rate and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Competitive Bidding Program Updates proposed rule, which proposes payment and regulatory updates for Medicare home health agencies (HHAs). The proposed rule includes policies that would reduce payments to HHAs by over $1 billion dollars in 2026, at a time when providers also continue to experience unmatched inflationary pressure in a challenging labor market — making it difficult, if not impossible in some areas, to deliver care to Medicare beneficiaries entitled to receive it.

California man pleads guilty in connection with laundering proceeds of $16M hospice fraud schemeUS Department of Justice press release; 6/23/25A California man pleaded guilty today to laundering more than $4.6 million in connection with a years-long scheme to defraud Medicare of nearly $16 million through sham hospice companies. According to court documents, Mihran Panosyan, ...worked with others to launder the proceeds of a massive Medicare fraud scheme, transferring the fraudulently obtained funds between multiple accounts before spending them. The scheme comprised three parts. First, three of Panosyan’s co-defendants used the identities of foreign nationals no longer in the United States to operate several sham hospice companies... Second, the co-defendants caused the submission of false and fraudulent claims to Medicare for hospice services for patients who were not terminally ill and who never requested nor received hospice services... Third, Panosyan and his co-defendants laundered the proceeds of the scheme to conceal the source of the funds and their control over them... He faces a maximum penalty of 20 years in prison.

MedPAC releases June 2025 report on Medicare and the health care delivery systemMedPAC press release; 6/12/25The Medicare Payment Advisory Commission (MedPAC) today releases its June 2025 Report to the Congress: Medicare and the Health Care Delivery System. Each June, as part of its mandate from the Congress, MedPAC reports on issues affecting the Medicare program as well as broader changes in health care delivery and the market for health care services.

Families demand end to Medicare waiting period for early-onset Alzheimer’s patients Washington Examiner; by Elaine Mallon; 6/15/25 Jason Raubach was diagnosed at 50 years old with early-onset Alzheimer’s disease — a diagnosis that affects nearly 200,000 Americans. He received the diagnosis in 2018, completely upending life for his family. His youngest child was just a freshman in high school. ... Shortly before receiving an official diagnosis, Jason Raubach lost his job, having to move his family onto a consolidated omnibus budget reconciliation act health plan, or COBRA plan, which allows a person to keep their health insurance even after losing their job. “It wasn’t cheap,” Elizabeth Raubach said.However, once diagnosed, Jason Raubach had to wait two and a half years before he could receive coverage under Medicare, health insurance for those 65 years and older or those with qualifying disabilities. But Elizabeth Raubach, along with dozens of other caretakers for people diagnosed with Alzheimer’s, called on Congress in a letter to eliminate the 29-month waiting period required for those under the age of 65 to receive coverage under Medicare. ...

Alliance official: Medicare Advantage growth, PDGM cuts create converging crises for at-home care Home Health Care News; by Morgan Gonzales; 6/13/25 At-home care is reaching a crisis point, according to Scott Levy, chief government affairs officer  at the National Alliance for Care at Home (the Alliance). The pressure on providers is not only unsustainable – it threatens access to cost-saving in-home care. Already, over one-third of patients referred to home health fail to receive those services. Home health is facing a triple threat, with deepening patient-driven groupings model (PDGM) payment cuts, Medicare rate updates that fail to keep up with real inflation and increased Medicare Advantage (MA) penetration. Meanwhile, home- and community-based services are in the crosshairs of the budget reconciliation bill passed by Congress and now in the Senate’s hands. Access to care is sure to be impacted, Levy said, but questions remain as to what extent. ...

Georgia hospice provider reaches $9.2M settlement with DOJ over kickback allegations McKnights Home Care; by Adam Healy; 6/13/25 Georgia-based Creative Hospice Care Inc paid the Department of Justice $9.2 million to settle claims that it entered kickback arrangements with medical professionals in exchange for patient referrals, the DOJ disclosed Wednesday. “Decisions regarding end-of-life care are incredibly difficult and personal, and families must be able to trust the intentions of their chosen providers,” Georgia Attorney General Chris Carr said in a statement. “Those who instead take advantage of the system for their own personal gain will be held accountable.”