Literature Review

[Palmetto] Hospice Coalition Questions and Answers: March 6, 2025Palmetto GBA press release; 4/18/25The March 6, 2025, Hospice Coalition Meeting Minutes are now available. Please review this information and share it with your staff.

HHS OIG: Greater oversight needed among new hospices Hospice News; by Holly Vossel; 4/28/25 The U.S. Department of Health & Human Services (HHS) Office of Inspector General (OIG) is readying to unveil a new report that will unveil common billing trends among potentially fraudulent newly licensed hospices. The report, “Trends, Patterns, and Key Comparisons Related to New Medicare Hospice Provider Enrollments May Indicate the Need for Further Oversight” is expected to publish in Fiscal Year (FY) 2026. It will examine potential red flags of fraud, waste and abuse among newly enrolled Medicare hospice providers’ claims data. ... “The data brief may help CMS evaluate the need for additional monitoring and program integrity efforts to ensure that hospices meet all the requirements,” OIG stated in a recent announcement. “Our objective is to identify trends, patterns and key comparisons that indicate potential vulnerabilities related to new Medicare hospice provider enrollments.”

Part D Plans cover a larger share of Medicare Beneficiaries in rural counties Managed Healthcare Executive; by Denise Myshko; 4/25/25 Medicare beneficiaries living in more rural counties are enrolled in traditional Medicare and rely on stand-alone prescription drug plans (PDPs), according to recent analysis from KFF.In fact, in 27 states, at least half of Medicare Part D enrollees living in the most rural areas are enrolled in stand-alone prescription drug plans. This includes 8 states with 75% or more of Part D enrollees in the most rural areas in prescription drug plans (Nevada, Alaska, Massachusetts, California, Kansas, Wyoming, Nebraska, and South Dakota). Nationwide, 58% of beneficiaries living in rural areas are enrolled in stand-alone prescription drug plans in 2025. The remainder (42%) are enrolled in Medicare Advantage drug plans (MA-PDs).

Health sector answers Trump's call for deregulation ideas Modern Healthcare; by Bridget Early; 4/29/25 The Trump administration wants the healthcare industry to recommend rules and regulations to toss. Trade groups representing hospitals, health insurance companies and others have ideas. The White House, the Centers for Medicare and Medicaid Services and other parts of the federal government are seeking suggestions to guide President Donald Trump's campaign to radically restructure and diminish the federal government. ... CMS included a request for information in Medicare payment rules the agency proposed this month. Comments are due June 10.

Accountable Care Organizations join forces to protect critical Medicare programs Home Health Care News; by Audrie Martin; 4/23/25 A group of accountable care organizations (ACOs) have joined forces to advocate for the expansion of high-needs care models that improve outcomes and reduce costs for Medicare’s most vulnerable patients. The newly-formed Complex Care Alliance has taken a stand, urging the Centers for Medicare and Medicaid Services (CMS) to extend crucial Medicare initiatives beyond their slated 2026 expiration. On Tuesday [4/22], home-based primary care provider HarmonyCares announced its partnership with the Complex Care Alliance, expressing its support for the High-Needs ACO model, which helps provide care for Medicare’s sickest patients.

Walgreens will pay up to $350M in settlement with DOJ to resolve opioid prescription lawsuit Fierce Healthcare; by Heather Landi; 4/21/25 Walgreens has agreed to pay $300 million to settle allegations from federal prosecutors that it illegally filled millions of invalid prescriptions for opioids and other controlled substances, the Department of Justice (DOJ) announced Monday. The DOJ also alleges that the retail pharmacy chain sought payment for many of those "invalid" prescriptions by Medicare and other federal healthcare programs in violation of the False Claims Act. The settlement amount is based on Walgreens’s ability to pay, the DOJ said, but Walgreens will owe the U.S. an additional $50 million if the company is sold, merged or transferred prior to fiscal year 2032. 

HHS proposal slashes Medicare SHIP funds MSN; by Mary Helen Gillespie; 4/22/25 The Trump administration is proposing federal budget cuts to Medicare State Health Insurance Assistance Programs (SHIP) and seven additional elder health care safety net programs that assist older Americans. ... SHIP programs have been under the umbrella of the Health and Human Services agency Administration for Community Living. The pre-decisional budget lists funds for seven other ACL programs that would be eliminated are:

Jury convicts home health agency executive of fixing wages and fraudulently concealing criminal investigation U.S. Department of Justice - Office of Public Affairs; Press Release; 4/14/25 A federal jury convicted a Nevada man today for participating in a three-year conspiracy to fix the wages for home healthcare nurses in Las Vegas and for fraudulently failing to disclose the criminal antitrust investigation during the sale of his home healthcare staffing company.  According to court documents and evidence presented at trial, Eduardo “Eddie” Lopez of Las Vegas, Nevada conspired to artificially cap the wages of home healthcare nurses in the Las Vegas area between March 2016 and May 2019. The three-year conspiracy affected the wages of hundreds of Las Vegas registered nurses and licensed practical nurses who provide care to patients in their homes. During the pendency of the government’s investigation, Lopez then sold his home healthcare staffing company for over $10 million while fraudulently concealing the government’s criminal investigation from the buyer.  

HHS cuts pose threat to older Americans' health and safety Newsweek; by Kristin Lees Haggerty and Scott Bane - The National Collaboratory to Address Elder Mistreatment at Education Development Center (EDC); The John A. Hartford Foundation; 4/17/2 On March 27, 2025, the federal government announced major cuts to the department of Health and Human Services (HHS). ... Sounding the Alarm for Elder Justice: The population of older adults is rapidly growing, and one in 10 experience abuse, neglect, and/or exploitation—a risk that is even higher for those living with dementia. ... Cutting services to older adults will increase these risks and costs. Moreover, ... 11.5 million family and friend caregivers provide over 80 percent of help needed for people living with dementia in the U.S. Without access to services like Meal on Wheels, adult day care, and respite care, we can expect caregiver burden and strain to increase significantly and with it, rates of elder abuse, emergency department visits, hospitalizations, and nursing home placements. We know this because of the abuse spike seen clearly during the COVID-19 pandemic, which doubled to over 20 percent of older adults, as services were limited, and older adults were socially isolated. HHS cuts are also likely to result in loss of specialized expertise in identifying and addressing elder mistreatment, so that when elder abuse does occur, we won't have the services to stop it and make sure it won't happen again.

CMS clarifies physician referral authority, tightens attestation requirements in proposed hospice ruleInside Health Policy; by Jalen Brown; 4/11/25... The proposed rule would explicitly allow the physician member of the hospice interdisciplinary group (IDG) to recommend patients for hospice care, addressing a gap in current regulations over which physicians have that authority. While CMS already lets IDG physicians certify that a patient is terminally ill and eligible for hospice, the existing admission rules only name the hospice medical director or physician designee as authorized to recommend admission. CMS also wants to strengthen documentation requirements for hospice recertification, ... Starting at day 180 and every 60 days thereafter, Medicare requires a hospice physician or nurse practitioner (NP) to conduct a face-to-face visit with the patient before recertifying eligibility. After the visit, the clinician must provide a written attestation confirming that the visit occurred and was used to assess whether the patient still qualifies for hospice care. Under CMS' proposal, that attestation would also need to include the clinician's signature and the date signed, submitted as a clearly labeled section or addendum to the recertification form. 

How ACOs think CMS should change the rules for value-based careModern Healthcare; by Bridget Early; 4/11/25Providers participating in accountable care organizations and other value-based payment arrangements with Medicare have a wish list for the new team running the Centers for Medicare and Medicaid Services... These are three top priorities for value-based care program participants in 2025:

CMS Refocuses on its Core Mission and Preserving the State-Federal Medicaid PartnershipCMS press release; 4/11/25The Centers for Medicare & Medicaid Services (CMS) is taking action to preserve the core mission of the Medicaid program by putting an end to spending that duplicates resources available through other federal and state programs or isn’t directly tied to healthcare services. Mounting expenditures, such as covering housekeeping for individuals who are not eligible for Medicaid or high-speed internet for rural healthcare providers, distracts from the core mission of Medicaid, and in some instances, serves as an overly-creative financing mechanism to skirt state budget responsibilities.

2026 Medicare Advantage and Part D rate announcementCMS press release; 4/7/25Today, the Centers for Medicare & Medicaid Services (CMS) released the Announcement of Calendar Year (CY) 2026 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (the CY 2026 Rate Announcement)... The final policies in the CY 2026 Rate Announcement are projected to result in an increase of 5.06%, or over $25 billion, in MA payments to plans in CY 2026.