Literature Review
All posts tagged with “Regulatory News | Medicare.”
CMS posts revised Model Election Statement and Addendum
09/11/26 at 03:00 AMCMS posts revised Model Election Statement and Addendum CMS; compiled by Guest Editor, Judi Lund Person; 9/10/26 CMS has posted the revised model election statement and addendum to the CMS website, which includes language for the mandatory addendum effective October 1, 2026. Hospice providers can use these model forms as the guide to the revised form. Pay particular attention to using the forms with an August 2026 date.
Don’t let ‘bad actors’ sour the value of caring for California seniors at home
09/10/26 at 03:00 AMDon’t let ‘bad actors’ sour the value of caring for California seniors at home The Press-Enterprise; by John Fund; 9/8/26 We’re hearing a lot about fraud in federal programs lately. The new Ground Zero for fraud is in California, where a perfect storm of bad government has formed in the last few years. The worst cases involve Medicare and Medicaid. ... I’ve felt personal pain and anger over these types of scandals. A few years ago, my 87-year-old father in Sacramento mistakenly and prematurely went into hospice which meant Medicare payments for his ailments were foregone. ... Legitimate hospice remains important for people who actually need it. The fraud problem puts that care at risk.
Update to 2026 hospice payment rate correction
09/10/26 at 03:00 AMUpdate to 2026 hospice payment rate correctionFrom CMS; by Guest Editor Judi Lund Person; 9/9/26CMS has informed us on September 9, 2026 that there is a correction notice in clearance right now, which hopefully will be out soon. The change is minor and the wage index issue was across all payment systems, not just hospice.
As home health moratorium nears expiration, advocates press CMS against extension
09/10/26 at 03:00 AMAs home health moratorium nears expiration, advocates press CMS against extension Home Health Care News; by MK Manoylov; 9/9/26 LeadingAge and the National Alliance for Care at Home (the Alliance) submitted new letters urging the Centers for Medicare & Medicaid Services (CMS) to allow the moratorium on Medicare home health enrollment to expire — even after LeadingAge has supported the freeze. These new letters also urge CMS to adopt more targeted enforcement measures to avoid implicating compliant providers.
CMS recalculating 2027 hospice payment rates due to error
09/09/26 at 03:00 AMCMS recalculating 2027 hospice payment rates due to errorHospice News; by Jim Parker; 9/8/26 The 2027 hospice payment rates likely will change based on a technical error by the U.S. Centers for Medicare & Medicaid Services (CMS). The agency made a mistake that affected the Fiscal Year 2027 hospice wage index and has recalculated those numbers. CMS is in the process of developing a correction notice to update the wage index and hospice payment rates for all four levels of care. This will not require another proposed rule.
LeadingAge, coalition partners tell CMS: don’t punish good Medicare providers
09/08/26 at 03:00 AMLeadingAge, coalition partners tell CMS: don’t punish good Medicare providers LeadingAge, Washington, DC; contact Colleen Knudsen; 8/31/26 In a joint sign-on letter led by LeadingAge, the association of nonprofit and mission-driven providers of aging services and submitted to the Centers for Medicare and Medicaid Services (CMS) today, a coalition of 19 partners representing hospitals, physician and clinician practices, post-acute and long-term care providers, home health and hospice agencies, suppliers, and the beneficiaries served by all, warn the agency that the proposed changes to Medicare provider enrollment provisions, included in the Calendar Year (CY) 2027 Home Health Prospective Payment System (PPS) Rule, risk penalizing legitimate providers and could result in limiting beneficiary access to care. The coalition fundamentally supports CMS’ responsibility to protect the Medicare Trust Fund and beneficiaries from fraud, waste, and abuse. However, ...
The hospice moratorium: what CMS is really signaling about the future | part two
09/08/26 at 12:00 AMThe hospice moratorium: what CMS is really signaling about the future | part one Teleios Collaborative Network (TCN); podcast hosted by Chris Comeaux with Dr. Jennifer Kennedy; 9/2/26 In Part One of this timely conversation, host Chris Comeaux and co-host Cordt Kassner, sit down with Dr. Jennifer Kennedy, Vice President for Quality, Standards and Compliance at CHAP, to unpack what the CMS hospice moratorium means, why it was implemented, and what hospice leaders should be watching next. Jennifer explains how escalating concerns around fraud and abuse, rapid market expansion, transactional hospice models, accreditation oversight, and Medicare enrollment have created an unprecedented regulatory environment. She also shares why she believes the moratorium could be extended as CMS continues strengthening enrollment screening and program-integrity efforts.
The Medicare Hospice Benefit's origins: Lessons on end-of-life caregiving
09/05/26 at 03:00 AMCMS oversight did not prevent Medicare Part D sponsors from making $587.7 million in ineligible payments to pharmacies for drugs available over the counter but labeled as prescription-only
09/04/26 at 03:00 AMCMS oversight did not prevent Medicare Part D sponsors from making $587.7 million in ineligible payments to pharmacies for drugs available over the counter but labeled as prescription-only United States Government HHS-OIG; Report number OAS-24-02-004; issued on 8/31/26, posted on 9/2/26
Mercy Hospice change in operator created conditions that posed ‘immediate jeopardy’ to patient well-being, state regulators say
09/03/26 at 03:15 AMMercy Hospice change in operator created conditions that posed ‘immediate jeopardy’ to patient well-being, state regulators say The Journal; by Jessie Bowman; 9/1/26 The ownership transition of Durango’s hospice program created serious problems in patient care and organizational oversight, according to state inspections that found multiple deficiencies and twice determined patients were at immediate risk of serious harm or death. In October 2025, the for-profit arm of the national CommonSpirit Health system – CommonSpirit Health at Home – took over ownership of the Mercy Hospice program. CommonSpirit assured the community the quality of care would not decline as a result of the transition. ... However, in May, the Colorado Department of Public Health and Environment conducted two concurrent relicensing inspections that found the ownership transition created system-wide deficiencies that led to clinical care practices and poor organizational oversight that put patient health and safety at serious risk.
The hospice moratorium: what CMS is really signaling about the future | part one
09/03/26 at 03:00 AMThe hospice moratorium: what CMS is really signaling about the future | part one Teleios Collaborative Network (TCN); podcast hosted by Chris Comeaux with Dr. Jennifer Kennedy; 9/2/26 In Part One of this timely conversation, host Chris Comeaux and co-host Cordt Kassner, sit down with Dr. Jennifer Kennedy, Vice President for Quality, Standards and Compliance at CHAP, to unpack what the CMS hospice moratorium means, why it was implemented, and what hospice leaders should be watching next. Jennifer explains how escalating concerns around fraud and abuse, rapid market expansion, transactional hospice models, accreditation oversight, and Medicare enrollment have created an unprecedented regulatory environment. She also shares why she believes the moratorium could be extended as CMS continues strengthening enrollment screening and program-integrity efforts.
Hospice exclusion correction announced for the long-stay antipsychotic measure
09/03/26 at 03:00 AMHospice exclusion correction announced for the long-stay antipsychotic measure American Health Care Association (AHCA) and National Center for Assisted Living (NCAL); by Amy Miller; 9/1/26 The Centers for Medicare and Medicaid Services (CMS) has identified a subset of hospice residents who should have been excluded from the long-stay (LS) antipsychotic measure for the first quarter of 2026. These residents were inadvertently included because of incomplete hospice data in the CMS Centralized Data Repository. The issue affected approximately 2% of residents included in the measure for the quarter. CMS does not anticipate that it will significantly affect facilities’ overall measure results or quality measure ratings. CMS is updating its calculation to ensure that these residents are appropriately excluded going forward. The correction to first-quarter 2026 data will appear in the October 28, 2026, refresh of Nursing Home Care Compare.
Alliance submits comments in response to CY 2027 Home Health Proposed Rule
09/03/26 at 03:00 AMAlliance submits comments in response to CY 2027 Home Health Proposed Rule National Alliance for Care at Home, Alexandria, VA; Press Release; 9/1/26 The National Alliance for Care at Home (the Alliance) has submitted comments in response to the Centers for Medicare & Medicaid Services’ Calendar Year (CY) 2027 Home Health Prospective Payment System Rate and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Competitive Bidding Program Updates proposed rule. The letter notes that the Alliance appreciates that, for the first time since CY 2022, CMS proposes a full annual payment update, does not propose to apply a new permanent adjustment, [and ...] However, the comment also emphasizes that these decisions do not undo the harm already built into the payment rate, nor do they do enough to protect access to care across the country.
Alzheimer’s blood test gets FDA clearance, but not CMS coverage
09/03/26 at 03:00 AMAlzheimer’s blood test gets FDA clearance, but not CMS coverage Inside Health Policy, Washington, DC; by Jessica Karins; 9/2/26 A blood test aiming to help with early identification of Alzheimer’s disease, including in primary care settings, by detecting buildup in the brain of the key Alzheimer’s biomarker amyloid beta plague, has been cleared by FDA, but the test and others in its category are not yet covered by CMS or any Medicare Administrative Contractors, its developer confirmed, with MACs having to make an individual determination for each patient of whether payment for the test is appropriate.
2027 Final hospice rule could slow M&A
09/02/26 at 03:00 AM2027 Final hospice rule could slow M&A Hospice News; by Jim Parker; 8/31/26 Regulatory scrutiny is slowing down hospice M&A deals in 2026, and the recently approved 2027 final rule will be no hope. Interest in hospice acquisitions remains high, particularly among publicly traded companies and private equity firms. However, buyers are painstakingly combing through any potential compliance or billing issues during the diligence process, which is delaying closures, according to Mark Kulik, senior managing director of the M&A advisory firm The Braff Group.
CHAP: The Compliance Monitor 9/1/26
09/02/26 at 03:00 AMCHAP: The Compliance Monitor 9/1/26 Community Health Accreditation Partner (CHAP); 9/1/26August/September 2026 Compliance Activity:
AHA comments on CY 2027 Home Health proposed payment rule
09/01/26 at 03:00 AMAHA comments on CY 2027 Home Health proposed payment rule American Hospital Association; Press Release; 8/28/26 On behalf of our nearly 5,000 member hospitals, health systems and other healthcare organizations, including approximately 1,000 hospital-based home health (HH) agencies, our clinician partners — more than 270,000 affiliated physicians, 2 million nurses and other caregivers — and the 43,000 healthcare leaders who belong to our professional membership groups, ... The AHA has two significant concerns. First, CMS’ proposed payment update of 2.4% is inadequate. ... Second, the proposed rule includes substantial changes to Medicare provider enrollment authorities that would apply not only to HH agencies but also to all providers and suppliers enrolled in Medicare.
CMS says it has blocked or recovered more than $1.6 billion in suspect Medicare lab payments
09/01/26 at 03:00 AMCMS says it has blocked or recovered more than $1.6 billion in suspect Medicare lab payments VIN News, Washington, DC; by Reven Rosenfeld; 8/28/26 The Trump administration has blocked or clawed back more than $1.6 billion in potentially improper Medicare laboratory payments since President Donald Trump took office and removed 157 laboratory providers from the program over alleged billing fraud, officials with the Centers for Medicare & Medicaid Services said Friday.
Week ahead in health care: MedPAC meeting with in-person audience
09/01/26 at 02:00 AMWeek ahead in health care: MedPAC meeting with in-person audience Inside Health Policy; by Jessica Karins and Amy Lotven; 8/28/26 The Medicare Payment Advisory Commission (MedPAC) will meet Thursday (Sept. 3) and Friday (Sept. 4) virtually and, for the second time since the COVID-19 pandemic, with limited in-person public seating.
DOJ prioritizes hospice, home health fraud enforcement
08/28/26 at 03:00 AMDOJ prioritizes hospice, home health fraud enforcement Hospice News; by MK Manoylov; 8/26/26 The U.S. Department of Justice (DOJ) Fraud Division has designated home health and hospice as among its top enforcement priorities. The agency plans to use innovative data analysis to target fraud schemes in these industries, according to a Thursday memorandum. The agency plans to further crack down on healthcare fraud by increasing the headcount of its Health Care Fraud Strike Force model to about 500 attorneys and staff by Aug. 24.
California and the federal government battle over hospice fraud, as victims lose coverage and care
08/28/26 at 03:00 AMCalifornia and the federal government battle over hospice fraud, as victims lose coverage and care Regional Media News, Los Angeles, CA; by wrnnews.com; 8/26/26At 71 and a few years into retirement, Linda Henry felt like she was in good health, and only went to her doctor in Southern California for the occasional checkup. So it was a shock when she found out in 2024 that she had been enrolled in hospice, a specialized end-of-life care usually provided to people with six months or less to live. A Medicare worker told her the system said she had heart failure. Henry was a victim of rampant fraud in the hospice industry, a problem that’s been especially extreme in California, ... Henry believes her Medicare number was stolen after a healthcare payment portal that services insurances was hit by a cyberattack. She found out about her hospice enrollment in September 2024 after her doctor billed Medicare for an allergy test and was denied. Soon, other claims were being returned unpaid.
Ready, Fire, Aim: The CY 2027 Home Health Proposed Rule's shoot-first approach to provider enrollment
08/28/26 at 03:00 AMReady, Fire, Aim: The CY 2027 Home Health Proposed Rule's shoot-first approach to provider enrollment Husch Blackwell | Hospice Insights; by Bryan Nowicki and Andrew Brenton; 8/26/26 CMS’s CY 2027 Home Health Proposed Rule tucks a sweeping set of Medicare provider enrollment changes inside what is nominally a routine payment rule, expanding the grounds on which CMS can deny or revoke a provider’s enrollment. In this episode, Husch Blackwell’s Bryan Nowicki and Andrew Brenton unpack several of the rule’s most consequential proposals, including new denial and revocation grounds and retroactive revocation effective dates. They also discuss why home health agencies and hospices should be paying close attention as the rule moves toward finalization.
American Society of Nephrology (ASN) comments on CY2027 ESRD PPS QIP Requests for Information (RFIs)
08/27/26 at 03:00 AMAmerican Society of Nephrology (ASN) comments on CY2027 ESRD PPS QIP Requests for Information (RFIs)American Society of Nephrology; official comments letter from ASN to Centers for Medicare & Medicaid Services; 8/24/26RE: CMS-1846 Medicare Program; CY2027 Changes to the End-Stage Renal Disease (ESRD) Prospective Payment System, Acute Kidney Injury Dialysis (AKI) Payment, and ESRD Quality Incentive Program On behalf of the more than 37,000,000 Americans living with kidney diseases and the 22,000 nephrologists, scientists, and other kidney health care professionals who comprise the American Society of Nephrology (ASN) ... In this letter, ASN provides feedback on the following requests of information (RFIs): ...
What CMS's CY2027 home health proposal means for palliative care
08/27/26 at 03:00 AMWhat CMS's CY2027 home health proposal means for palliative care JD Supra; by Edo Banach and Lauren Carboni; 8/25/26 The Centers for Medicare & Medicaid Services’ (“CMS”) CY 2027 Home Health Prospective Payment System proposed rule (“HH PPS Proposed Rule”) confirms that community-based palliative care may be covered under the existing Medicare home health benefit-creating near-term operational questions, and longer-term strategic opportunities, for home health agencies, hospices, and other health care providers serving a frail and declining population.Key Takeaways:
Wound care fraud: key insights for healthcare providers in 2026
08/25/26 at 03:00 AMWound care fraud: key insights for healthcare providers in 2026 JD Supra; by Lynette Byrd; 8/21/26 The U.S. Department of Justice (DOJ) and U.S. Department of Health and Human Services Office of Inspector General (HHS OIG) are prioritizing wound care fraud enforcement in 2026. Healthcare providers are facing scrutiny under the False Claims Act and Anti-Kickback Statute, with audits and investigations leading to substantial liability (among other consequences) in many cases. ... Allegations of wound care-related health care fraud can take many different forms. ... While it is critical that elderly patients (including hospice patients and other terminally ill patients) receive appropriate care, there are limits to what is considered appropriate when billing Medicare or Medicaid for wound care. ...