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All posts tagged with “Regulatory News.”
MedPAC releases June 2025 report on Medicare and the health care delivery system
06/23/25 at 03:00 AMMedPAC 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.
MedPAC Report: Medicare Advantage enrollees receive 11% fewer home health visits
06/18/25 at 03:05 AMMedPAC Report: Medicare Advantage enrollees receive 11% fewer home health visits Home Health Care News; by Morgan Gonzales; 6/13/25 The Medicare Payment Advisory Commission’s (MedPAC) June report to Congress examined home health care use among Medicare Advantage (MA) and traditional Medicare patients and found that MA enrollees receive 11% fewer home health visits compared to Medicare fee-for-service. ...
Families demand end to Medicare waiting period for early-onset Alzheimer’s patients
06/17/25 at 03:20 AMFamilies 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. ...
[Congressional Research Service] Medicare Coverage: Background and resources
06/17/25 at 03:10 AM[Congressional Research Service] Medicare Coverage: Background and resources Congressional Research Service - In Focus; 6/13/25 This In Focus provides an overview of Medicare coverage of services and items, coverage determination processes, and core resources on these topics for beneficiaries, health care providers, and policymakers. ...
Alliance official: Medicare Advantage growth, PDGM cuts create converging crises for at-home care
06/17/25 at 03:00 AMAlliance 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. ...
Trump administration shared Medicaid data with immigration officials: Report
06/17/25 at 02:00 AMTrump administration shared Medicaid data with immigration officials: Report Straight Arrow News; by Kalé Carey; 6/13/25 A newly obtained government memo reveals that immigration officials received access to Medicaid data to assist in deportation efforts. ... The Associated Press reported that emails and a memo show the Department of Health and Human Services ordered staff at the Centers for Medicare and Medicaid Services to release data, including immigration status, on millions of federal program enrollees. The Department of Homeland Security was reportedly given the information, according to the Associated Press. Advisers to HHS Secretary Robert F. Kennedy Jr. gave CMS staff 54 minutes to hand over the data. CMS staff objected to the request, citing legal and ethical concerns over the type of data being shared. ...
Chapter 6: Medicare’s measurement of rural provider quality
06/16/25 at 03:00 AMChapter 6: Medicare’s measurement of rural provider quality MedPAC; 6/12/25 ... Because of low patient volumes in many rural health care settings, there are practical challenges in measuring some individual rural providers’ quality of care and in holding these providers accountable in quality reporting programs. ... The Commission acknowledged these difficulties when it established specific principles to guide expectations about quality in rural areas. These principles were developed with hospitals in mind but could be applied to other providers. ... [On page 4 of 40] Rural skilled nursing facilities and dialysis facilities had lower shares of providers with publicly reported quality results compared with their urban counterparts; in contrast, rural home health agencies and hospices had higher shares of providers with publicly reported quality results compared with their urban counterparts.Editor's Note: For ranking of hospices by quality scores, examine the National Hospice Locator, provided to the public by Hospice Analytics (a sponsor of this newsletter).
Georgia hospice provider reaches $9.2M settlement with DOJ over kickback allegations
06/16/25 at 03:00 AMGeorgia 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.”
CMS budget proposal would shift nursing facility oversight
06/06/25 at 03:00 AMCMS budget proposal would shift nursing facility oversight Becker's Hospital Review; by Elizabeth Gregerson; 6/4/25 Key changes put forth in President Donald Trump’s proposed fiscal year 2026 budget may have downstream effects on the survey and certification of skilled nursing facilities. ... Here are three things to know about the proposed changes:
For Public Awareness: If you think you may have experienced Medicare hospice fraud, call 1-800-Medicare to report it.
06/06/25 at 02:00 AMPublic: If you think you may have experienced Medicare fraud, call 1-800-Medicare to report it. Posted on X; by Mehmet Oz, "DrOzCMS"; 6/2/25 There’s a Medicare scam out there that can really hurt people, and I want to make sure you’re aware! People are targeting older Americans to trick them to sign up for Hospice without their knowledge. If you think you may have experienced fraud, call 1-800-Medicare to report it. To learn more, go to http://Medicare.gov/fraud.
Experts warn of scams during Medicare Fraud Prevention Week
06/05/25 at 03:30 AMExperts warn of scams during Medicare Fraud Prevention Week Public News Service; by Suzanne Potter; 6/4/25 Medicare loses $60 billion to $80 billion a year to fraud and this year, for Medicare Fraud Prevention Week, your local Senior Medicare Patrol has good advice on how to spot a con. There are plenty of scams to be aware of. Karen Joy Fletcher, communications director with the nonprofit California Health Advocates, said beware if a caller asks to verify your Medicare number, claiming the program needs to send out a new type of card. ... ... Caregivers can be on the lookout for medical equipment arriving at the house even though the beneficiary never ordered it. Another red flag? A stranger may approach you in a parking lot asking you to sign up for new, free Medicare services like house cleaning or meals, which are then fraudulently billed to the government. ... Another scam involves tricking people into unknowingly signing up for hospice care. It is especially dangerous, because once a person is on hospice, Medicare will only approve palliative care and could mistakenly deny an essential surgery or medication.
CMS budget puts complaint surveys over routine inspections as main nursing home oversight
06/05/25 at 03:15 AMCMS budget puts complaint surveys over routine inspections as main nursing home oversight McKnights Long-Term Care; by Kimberly Marselas; 6/2/25 A proposed 2026 Trump administration budget request would shift nursing home survey priorities, further delaying the time between standard inspections at many facilities. The Centers for Medicare & Medicaid Services budget justification published late Friday calls for a $45 million increase in survey spending across multiple sectors next fiscal year. But it also prioritizes complaint surveys in a way that would reduce the availability of surveyors to conduct routine, annual inspections mandated by law. The document from the Department of Health and Human Services shows the percentage of nursing home standard surveys completed each year would fall from 74% in fiscal year 2024 to a projected 65% completion rate in fiscal year 2026.
HHS faces $31B cuts in proposed FY ’26 budget: 6 notes
06/05/25 at 03:00 AMHHS faces $31B cuts in proposed FY ’26 budget: 6 notes Becker's Hospital Review; by Madeline Ashley; 6/2/25 President Donald Trump’s proposed fiscal 2026 budget slashes funding for the National Institutes of Health by $18 billion to $27.5 billion as part of a sweeping overhaul to realign federal healthcare spending. The NIH received $46.4 billion in program level funding in 2024 and just over $46 billion in 2025, according to the budget proposal. [Continue reading for this article's lists of (1) consolidated institutes and centers; and (2) "six things to know."]
Medicaid increase, program changes detailed in CMS Budget Proposal
06/05/25 at 03:00 AMMedicaid increase, program changes detailed in CMS Budget Proposal InsideHealthPolicy; by Dorothy Mills-Gregg; 5/30/25 Medicaid would see a nearly $57.5 billion increase under the Trump administration’s proposed 2026 budget, though federal Medicaid matching funds for state administrative expenses would be reduced by $1.2 billion compared to this year’s estimate, according to the CMS budget justification document for fiscal 2026 released Friday (May 30).
CMS’s Hospice Star Rating System limited by missing data
06/04/25 at 03:00 AMCMS’s Hospice Star Rating System limited by missing data Health Affairs; by Amanda C. Chen and David C. Grabowski; 6/3/25 Two-thirds of US hospices were not given a star rating when the Centers for Medicare and Medicaid Services (CMS) introduced its hospice star rating system in 2022. Since then, the share of hospices without a star rating has steadily increased, including through the most recent reporting period of 2024. This suggests that the CMS hospice star rating is having limited impact. We provide recommendations for CMS and other policy makers to improve the value for hospice patients of publicly reported star ratings.
A glossary of Medicare terms
06/03/25 at 02:00 AMA glossary of Medicare termsMedicalNewsToday; by Mandy French, medically reviewed by Oluwatoyin Kuloyo, Pharm.D., BCPS; 6/2/25 When a person first signs up for Medicare, they may come across many terms and abbreviations. Learning the definitions of these terms can help make it easier to understand and navigate Medicare. Medicare information can be confusing. This A to Z glossary can help individuals understand some common terms, acronyms, and abbreviations. ... Editor's note: A must-have resource to use and distribute, with multiple links to more depth information at Medicare.gov and MedicalNewsToday.
Why CMS’ GUIDE Model could move home care from side act to main stage
06/02/25 at 03:00 AMWhy CMS’ GUIDE Model could move home care from side act to main stage Home Health Care News; by Joyce Famakinwa; 5/29/25 The Guiding an Improved Dementia Experience (GUIDE) Model might be one of the biggest steps in the right direction for recent Medicare policy. The eight-year voluntary nationwide program was launched last year by the Centers for Medicare & Medicaid Services (CMS), with the goal of supporting individuals living with dementia, as well as their unpaid caregivers. The program’s focus is more important than ever, with an estimated 6.7 million people living with dementia. This amount is expected to skyrocket to 14 million cases by 2060, according to data made available by CMS.
Door remains closed on CMS forums as new rules, requirements are phased in
05/30/25 at 03:00 AMDoor remains closed on CMS forums as new rules, requirements are phased in McKnights Long-Term Care News; by Kimberly Marselas; 5/28/25 Four months into the new presidential administration, skilled nursing leaders have had no opportunity to hear directly from Centers for Medicare & Medicaid Services staff during traditional Open Door Forums or National Stakeholder Calls. Open Door Forums have been held three-to-five times annually in a practice that started more than 20 years ago. The online meetings give providers, vendors and other stakeholders an opportunity to learn more about regulatory and logistical changes being pursued by CMS, as well as providing question-and-answer sessions with policy architects. In addition to skilled nursing forums, CMS has in the past also hosted similar events for home health, long-term care services and supports, rural health and other provider types. But CMS in January cancelled a skilled nursing forum and all others planned for February and has yet to add any new forums or stakeholder calls — which often feature the administrator discussing major policy or clinical updates — to its calendar.
CMS: Kidney Care Choices (KCC) Model
05/29/25 at 03:00 AMCMS: Kidney Care Choices (KCC) Model CMS.gov - Centers for Medicare & Medicaid Services; 5/27/25 The Centers for Medicare & Medicaid Services (CMS) is announcing a coordinated set of changes to the Kidney Care Choices (KCC) Model starting in performance year 2026 that are expected to improve the model test by adjusting the financial methodology and participation options to improve model sustainability. In addition, the model is being extended by one year for continuation of quality care to beneficiaries through 2027. For more information, please visit KCC Model Performance Year 2026 Updates.
CMS rolls out aggressive strategy to enhance and accelerate Medicare Advantage audits
05/27/25 at 03:00 AMCMS rolls out aggressive strategy to enhance and accelerate Medicare Advantage audits CMS Newsroom; Press RElease; 5/21/25 Agency Will Begin Auditing All Eligible Medicare Advantage Contracts Each Payment Year and Add Resources to Expedite Completion of 2018 to 2024 AuditsToday, the Centers for Medicare & Medicaid Services (CMS) announced a significant expansion of its auditing efforts for Medicare Advantage (MA) plans. Beginning immediately, CMS will audit all eligible MA contracts for each payment year in all newly initiated audits and invest additional resources to expedite the completion of audits for payment years 2018 through 2024.
Proposed California budget calls for prior authorization for hospice in Medicaid
05/23/25 at 03:00 AMProposed California budget calls for prior authorization for hospice in Medicaid Hospice News; by Jim Parker; 5/22/25 The proposed California budget would require prior authorizations for hospice care within the state’s Medicaid program. Currently, Medicaid managed care plans who provide coverage through the state’s Medicaid system, Medi-Cal, may not perform prior authorizations for hospice. California’s Department of Health Care Services (DHCS) indicated in a 2025-2026 budget revision that this could save $25 million over the next two years and more than $50 million in the long term. If enacted, this would make California the first state in the nation to implement such a rule, according to the California Hospice & Palliative Care Association (CHAPCA). The association contends that the anticipated $25 million in cost savings is “speculative and fails to account for the downstream costs and systemic burdens this proposal would create,” according to a position paper shared with Hospice News. ... CHAPCA recommended to the state government three alternative approaches: ...
‘We need you to work with us’: Home health providers renegotiate better Medicare Advantage deals
05/22/25 at 03:00 AM‘We need you to work with us’: Home health providers renegotiate better Medicare Advantage deals Home Health Care News; by Joyce Famakinwa; 5/20/25 As Medicare Advantage (MA) enrollment continues to surge, home health providers have seen slim margins deteriorate further. Some providers have openly expressed their decision to reject financially unsustainable MA contracts. Abandoning unfavorable MA contracts may sometimes be necessary, industry executives told Home Health Care News. However, some providers have improved their MA standing by renegotiating rates or returning after walking away, leveraging data and understanding the needs of payer partners. “We have walked away, in specific states, from payers and Medicare Advantage groups because of rates and the inability to raise those rates, and pre-authorization terms,” G. Scott Herman, CEO of New Day Healthcare, told HHCN.
HHS wants input on how to improve digital health tech for Medicare patients
05/19/25 at 03:00 AMHHS wants input on how to improve digital health tech for Medicare patients Fierce Healthcare; by Heather Landi; 5/14/25 The Department of Health and Human Services (HHS) wants feedback on how it can develop better digital health tools for Medicare beneficiaries and drive adoption. The Centers for Medicare & Medicaid Services (CMS), in partnership with HHS' health IT arm, now called the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP/ONC), is seeking public input on how best to "advance a seamless, secure, and patient-centered digital health infrastructure."
AHA urges HHS to cut regulations that burden hospitals and staff
05/19/25 at 03:00 AMAHA urges HHS to cut regulations that burden hospitals and staff OR Manager; by Matt Danford; 5/16/25 The American Hospital Association (AHA) has called on the Department of Health and Human Services (HHS) to eliminate or ease a variety of federal regulations, arguing that excessive administrative rules drive up costs, reduce patient access, and hinder innovation, Modern Healthcare reported May 13. According to the article, the AHA submitted more than 100 deregulatory suggestions to HHS, the Centers for Medicare and Medicaid Services (CMS), and the Office of Management and Budget. [Continue reading for descriptions specific to billing and payment, quality and safety regulations, and workforce-related recommendations.]
Medicaid hospice payments for room-and-board to resume in California
05/16/25 at 03:00 AMMedicaid hospice payments for room-and-board to resume in California Hospice News; by Jim Parker; 5/15/25 After years of nonpayment, the California Department of Health Care Services (DHCS) has instructed Medicaid managed care plans to pay hospices for nursing home room and board. The issue pertains to patients who are dually eligible for Medicare and Medicaid. When caring for patients in nursing homes, hospices typically pay for their room and board with the expectation that they will be reimbursed by Medicaid for those expenses. However, due to confusion among managed care plans that oversee Medicaid in most states, those hospices have not been receiving those payments.