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All posts tagged with “Regulatory News.”
[Palmetto] Hospice Coalition Questions and Answers: March 6, 2025
05/05/25 at 03:00 AM[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.
Courts diverge in challenges to CMS's minimum staffing requirements for LTC facilities
05/02/25 at 03:10 AMCourts 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.
HHS OIG: Greater oversight needed among new hospices
05/02/25 at 03:00 AMHHS 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.”
Administration to close HHS Civil Rights office
05/02/25 at 03:00 AMAdministration to close HHS Civil Rights office Newsmax; by Brian Freeman; 4/28/25 As part of massive cutbacks at the Department of Health and Human Services, the Centers for Medicare & Medicaid Services will shut down their civil rights office in June, according to an email sent to staff on Monday and viewed by Politico. HHS has already been reduced by some 20% as part of overall downsizing, with Secretary Robert F. Kennedy Jr. and President Donald Trump focusing on eliminating those programs and agencies they say promote diversity, equity, and inclusion. ... Complaints that are nearing completion connected to workplace harassment and discrimination will be closed out in the coming weeks, and remaining complaints will be "transferred to an appropriate entity," the email stated.Editor's note: Data from the 2024 NHPCO Facts and Figures Report states: "In CY 2022, 51.6% of White Medicare decedents used the Medicare Hospice Benefit. 38.1% of Asian American Medicare decedents and 37.4% of Black Medicare decedents enrolled in hospice. 38.3% of Hispanic and 37.1% of North American Native Medicare decedents used hospice in 2022." The discrepancies between white and non-white decedents demonstrate double-digit differences. Extensive evidence-based research validates wide gaps in hospice/healthcare for persons whom the HHS Civil Rights office is charged with protecting. For more, visit Office of Civi Rights Home | HHS.gov and Office of Civil Rights About Us.
Part D Plans cover a larger share of Medicare Beneficiaries in rural counties
05/01/25 at 03:10 AMPart 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).
Trends, patterns, and key comparisons related to new Medicare Hospice Provider Enrollments may indicate the need for further oversight
04/30/25 at 03:00 AMTrends, 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. ...
Health sector answers Trump's call for deregulation ideas
04/30/25 at 02:00 AMHealth 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.
HHS cuts funding for NIH-based Women's Health Initiative threatening decades-long study
04/25/25 at 03:00 AMHHS cuts funding for NIH-based Women's Health Initiative threatening decades-long study The American Journal of Managed Care (AJMC); by Giuliana Grossi; 4/23/25 HHS is defunding the regional research centers that have been conducting a long-term national health study focusing on preventive strategies for women's health since 1991, the largest study investigating women’s health in US history. The Women’s Health Initiative (WHI) regional centers will close by September 2025, at the end of the fiscal year, according to an announcement from the NIH-based initiative. Investigators at the WHI were informed by HHS earlier this week, although formal written notice from HHS is still pending.
Accountable Care Organizations join forces to protect critical Medicare programs
04/25/25 at 02:00 AMAccountable 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.
While claiming transparency, CMS quietly drops health equity elements of EOM
04/24/25 at 03:00 AMWhile claiming transparency, CMS quietly drops health equity elements of EOM American Journal of Managed Care (AJMC); by Mary Caffrey; 4/22/25 Key Takeaways:
Walgreens will pay up to $350M in settlement with DOJ to resolve opioid prescription lawsuit
04/24/25 at 03:00 AMWalgreens 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.
CMS to withdraw federal Medicaid match for workforce, social needs, and infrastructure: What states, health care providers and community organizations need to know
04/24/25 at 03:00 AMCMS 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").
HHS proposal slashes Medicare SHIP funds
04/23/25 at 03:00 AMHHS 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:
American Oncology Network achieves success in first performance period of CMMI’s enhancing oncology model
04/23/25 at 03:00 AMAmerican Oncology Network achieves success in first performance period of CMMI’s enhancing oncology model Stock Titan, Globe Newswire, Fort Myers, FL; 4/22/25 American Oncology Network (AON), one of the nation’s fastest-growing community oncology networks, today announced strong results from the first performance period in the Centers for Medicare & Medicaid Innovation’s (CMMI) Enhancing Oncology Model (EOM). AON practices participating in the program—in collaboration with value-based cancer care enabler Thyme Care—achieved nearly $6M in cost savings for the Centers for Medicare & Medicaid Services (CMS). AON also earned a performance-based payment while improving patient experience and outcomes.
Jury convicts home health agency executive of fixing wages and fraudulently concealing criminal investigation
04/22/25 at 03:00 AMJury 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.
Access to hospice and certain services under the hospice benefit for beneficiaries with end-stage renal disease and beneficiaries with cancer
04/21/25 at 03:00 AMAccess to hospice and certain services under the hospice benefit for beneficiaries with end-stage renal disease and beneficiaries with cancer MedPAC; by Kim Nueman, Grace Oh, and Nancy Ray; 4/11/25 [From MedPac Presentation Roadmap, Meetings held April 10 & 11, 2025]
HHS cuts pose threat to older Americans' health and safety
04/18/25 at 03:00 AMHHS 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.
NABIP responds to HHS Proposed Rule on Marketplace Integrity
04/16/25 at 03:10 AMNABIP 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. ...
CMS clarifies physician referral authority, tightens attestation requirements in proposed hospice rule
04/16/25 at 03:00 AMCMS 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.
CMS halts spending for nonmedical in-home Medicaid services, likely affecting providers
04/16/25 at 03:00 AMCMS halts spending for nonmedical in-home Medicaid services, likely affecting providers McKnights Home Care; by Adam Healy; 4/13/25 The Centers for Medicare & Medicaid Services told states last week that it would not approve future federal matching funds for designated state health programs (DSHPs) and designated state investment programs (DSIPs). These programs are widely used to help Medicaid beneficiaries remain at home and in their communities.
How ACOs think CMS should change the rules for value-based care
04/15/25 at 03:00 AMHow 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:
Community Catalyst leads national response against new rule that threatens health care access
04/15/25 at 03:00 AMCommunity Catalyst leads national response against new rule that threatens health care access Community Catalyst, Boston, MA; by Jack Cardinal; 4/11/25 Today, Community Catalyst organized hundreds of local, state and national partners to submit comments to the Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services (HHS) opposing a new proposed rule from the Trump administration that would make it harder and more expensive for people to buy their own insurance on Affordable Care Act (ACA) Marketplaces and increase their medical debt. ... The administration’s own estimates suggest that as many as 2 million people will lose their coverage under this proposal, ...
CMS Refocuses on its Core Mission and Preserving the State-Federal Medicaid Partnership
04/15/25 at 03:00 AMCMS 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.
CMS drops 5 proposed payment rules for 2026: 25 things to know
04/15/25 at 02:00 AMCMS drops 5 proposed payment rules for 2026: 25 things to knowBecker's Hospital Review; by Alan Condon; 4/11/25 CMS has released proposed payment rules for inpatient and long-term care hospitals, hospices and inpatient rehabilitation, psychiatric and skilled nursing facilities in fiscal year 2026. Twenty-five things to know: ...
2026 Medicare Advantage and Part D rate announcement
04/14/25 at 03:00 AM2026 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.