Literature Review
All posts tagged with “Regulatory News | Medicare.”
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.
Value-based palliative care moving toward risk-based models
04/22/25 at 03:00 AMValue-based palliative care moving toward risk-based models Hospice News; by Jim Parker; 4/21/25 Risk-based contracts may be the future of palliative care reimbursement as Medicare Advantage continues to ascend. The simple term “value-based care” belies its complexity. The term can refer to any number of payment models that are designed to reduce total cost of care and improve outcomes. While most palliative care remains locked in the fee-for-service realm, most value-based organizations like MA plans are moving towards it, according to Dr. Gavin Baumgardner, vice president and national medical director for complex and palliative care at Contessa Health, a subsidiary of Amedisys (Nasdaq: AMED).
Supreme Court hears ‘crucial’ case today on free preventive health care
04/22/25 at 03:00 AMSupreme Court hears ‘crucial’ case today on free preventive health care KFF Health News; 4/21/25 The lawsuit, Kennedy v. Braidwood Management, could have far-reaching consequences for the health coverage of tens of millions of Americans. A ruling is expected in June. ... The Supreme Court on Monday is set to hear arguments in a case challenging a provision of the Affordable Care Act that requires private insurers to cover health care screenings, tests and checkups for free. Experts say the court’s ruling in the case, called Kennedy v. Braidwood Management, could have sweeping consequences for patient access to preventive health care across the United States.
Appropriate deprescribing and payment in hospice dementia care
04/19/25 at 03:15 AMAppropriate deprescribing and payment in hospice dementia careJAMA Internal Medicine; Nathan M. Stall, MD, PhD; Sharon K. Inouye, MD, MPH; Lona Mody, MD, MSc; 3/25People living with dementia are one of the largest growing users of hospice care in the US, with approximately 20% of enrollees having a terminal diagnosis of dementia. In the setting of advanced dementia specifically, guidelines recommend deprescribing cholinesterase inhibitors and memantine as there is insufficient evidence for benefit, and there are risks of adverse events including bradycardia, falls, and gastrointestinal adverse effects. The Centers for Medicare & Medicaid Services specifies that hospices are responsible for covering all medications under the Medicare Part A hospice benefit, but audits have revealed that millions of dollars of prescription drug costs are being inappropriately shifted to Medicare Part D. The study by Hunt et al occurs within a context of growing concerns about shifts in US hospice care where more than 70% of hospice agencies serving patients with terminal illness across all settings now operate on a for-profit basis, with increasing acquisition of hospices by private equity firms and publicly traded corporations. Compared with nonprofit hospices, for-profit hospices have more acute care utilization, provide less direct care, and have poorer caregiver-reported care experiences. For-profit hospices also enroll a higher proportion of persons living with dementia, which may relate to their lower acuity and longer stays, as well as more profitable margins under the per-beneficiary daily payment.
Regulatory leaked HHS budget signals $40B in cuts, assumes ACA subsidies expire
04/18/25 at 03:00 AMRegulatory leaked HHS budget signals $40B in cuts, assumes ACA subsidies expire Fierce Healthcare; by Noah Tong; 4/17/25 Department of Health and Human Services (HHS) reorganization plans appear to have been revealed through a leaked Office of Management and Budget (OMB) document. The 64-page PDF with HHS’ plans were first reported by Inside Medicine and later reported by The Washington Post and other news publications. In an update, Inside Medicine said the entire document was authenticated by The Washington Post. ... While the restructuring was broadly announced, and individual offices have been reportedly axed in recent weeks, the leak provides greater insight into how the reorganization, firings, reductions in force and office eliminations and consolidations will fundamentally alter the agency.
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.
8 health system CEOs on the turbulence defining 2025
04/18/25 at 02:00 AM8 health system CEOs on the turbulence defining 2025 Becker's Hospital Review; by Kelly Gooch and Kristin Kuchno; 4/16/25 From capacity constraints to reimbursement pressures, health system CEOs are navigating a changing healthcare landscape. One of the top concerns in 2025 is the potential for Medicaid funding cuts. A recent report estimates hospitals could face a $31.9 billion loss in revenue if federal proposals to scale back Medicaid expansion move forward. CEOs from across the country — including safety-net systems, academic medical centers and expanding regional providers — recently shared how they are preparing for continued uncertainty and what strategies they are prioritizing in response.
CMS to withdraw federal Medicaid match for workforce, social needs, and infrastructure: What states, health care providers and community organizations need to know
04/17/25 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 The National Law Review; by Margia Corner, Adam Herbst of Sheppard, Mullin, Richter & Hampton LLP; 4/16/25 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. ... 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 restructuring and workforce reductions – key implications for the health care industry
04/17/25 at 02:00 AMHHS restructuring and workforce reductions – key implications for the health care industry JD Supra; by Mintz.com; 4/15/25 ... As part of the department-wide restructuring plan, HHS is in the process of consolidating 28 different divisions into 15 divisions. As of April 4, 2025, it had also reduced the number of Regional Offices from ten to five. ...
Where bills stand in the Nevada legislature in 2025: ... AB161 - Hospice Care
04/16/25 at 03:10 AMWhere bills stand in the Nevada legislature in 2025: ... AB161 - Hospice Care Fox 5 - KU-TV, Las Vegas, NV; by FOX5 Staff; 4/14/25 FOX5 gathered the most high-profile bills moving in the Nevada legislature this year. Here’s where they stand: ...
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.
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, ...
Closing the gap in end-of life care coverage: The role of nonprofits in policy advocacy
04/15/25 at 03:00 AMClosing the gap in end-of life care coverage: The role of nonprofits in policy advocacy Forbes; by James Dismond; 4/14/25... As the demand for end-of-life care grows, so will the gap between the care that patients need and what they receive. ... Workforce shortages, restrictive regulations, outdated reimbursement models and misconceptions around hospice services are keeping millions of Americans from accessing quality hospice and palliative care services. ... These barriers disproportionately affect low-income families, rural communities and communities of color. ... Unlike for-profit entities, we can prioritize community needs over shareholders. We can prioritize patient well-being over profits—or, to say it more directly, we put people over profits. And I’ve seen firsthand how advocacy can drive progress. Nonprofits must engage in:
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: ...
National Alliance for Care at Home responds to the FY 2026 Hospice Proposed Rule
04/15/25 at 02:00 AMNational Alliance for Care at Home responds to the FY 2026 Hospice Proposed Rule National Alliance for Care at Home, Alexandira, VA and Washington, DC; Press Release; 4/11/25 The National Alliance for Care at Home (the Alliance) issued the following statement [Fri 4/11] in response to the Centers for Medicare & Medicaid Services (CMS) Fiscal Year (FY) 2026 Hospice Wage Index proposed rule, which proposes payment and regulatory updates under the Medicare hospice benefit. The proposed 2.4% payment update fails to adequately address the mounting financial pressures facing hospices nationwide. With escalating operational costs driven by inflation, workforce shortages, and rising expenses for supplies and services, the proposed payment increase would threaten the ability of hospices to sustainably provide quality end-of-life care. “The proposed payment update for FY 2026 falls short of what is needed to sustain high-quality hospice care,” said Dr. Steve Landers, CEO of the Alliance. “Without meaningful adjustments, hospices across the country will face serious challenges—jeopardizing access to care for terminally ill patients and placing added strain on families already facing the unimaginable. ..."
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.
Dr. Oz outlines vision for CMS: 8 notes
04/14/25 at 03:00 AMDr. Oz outlines vision for CMS: 8 notesBecker's Hospital Review; by Jakob Emerson; 4/10/25CMS Administrator Mehmet Oz, MD, said April 10 that his vision for the agency includes a commitment to President Trump’s “Make America Healthy Again” agenda and modernizing Medicare, Medicaid and the ACA marketplace. Eight notes:
Proposed FY26 Hospice Wage Index and Payment Rate
04/12/25 at 03:00 AMProposed FY26 Hospice Wage Index and Payment RateCMS press release; 4/11/25On April 11, 2025, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that proposes updates to Medicare payment policies and rates for hospices under the Fiscal Year (FY) 2026 Hospice Wage Index and Payment Rate Updated Proposed Rule (CMS-1835-P). [Major provisions include:]
Proposed FY26 Hospice Wage Index and Payment Rate
04/11/25 at 03:30 AMProposed FY26 Hospice Wage Index and Payment RateCMS press release; 4/11/25On April 11, 2025, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that proposes updates to Medicare payment policies and rates for hospices under the Fiscal Year (FY) 2026 Hospice Wage Index and Payment Rate Updated Proposed Rule (CMS-1835-P). [Major provisions include:]
Medicare and Medicaid officials finalize rule to clarify that medical marijuana isn’t covered by federal health programs
04/10/25 at 03:00 AMMedicare and Medicaid officials finalize rule to clarify that medical marijuana isn’t covered by federal health programsMarijuana Moment; by Kyle Jaeger; 4/8/25 The federal Centers for Medicare & Medicaid Services (CMS) has finalized a rule to clarify that marijuana products are not eligible for coverage under certain health plans for chronically ill patients because “they are illegal substances under Federal law.” In a notice set to be published in the Federal Register next week, CMS said that a series of policy and technical changes for its Medicare Advantage (MA) program and other services, including rulemaking related to cannabis products, will now take effect on June 3.[Continue reading ...]
Trump administration continues to defend nursing home staffing mandate in court
04/08/25 at 03:00 AMTrump administration continues to defend nursing home staffing mandate in court McKnights Long-Term Care News; by Kimberly Marselas; 4/7/25 The federal government continues to defend a national nursing home staffing mandate in court, despite several members of the new presidential administration having expressed major concerns about the rule finalized in 2024. Department of Justice attorneys on Thursday again outlined their justification for the rule, telling the Eighth Circuit Court of Appeals that the Centers for Medicare & Medicaid Services did not exceed its legal authority in dictating 24-hour registered nurse coverage and 3.48 hours a day of direct patient care from every US skilled nursing facility.
AGG talks: Home health & hospice podcast - Episode 10: Anti-Kickback Compliance for hospice and skilled nursing providers
04/07/25 at 03:00 AMAGG talks: Home health & hospice podcast - Episode 10: Anti-Kickback Compliance for hospice and skilled nursing providers JD Supra; by Arnall Golden Gregory, LLP; 4/3/25 In this episode, AGG Healthcare attorneys Bill Dombi and Jason Bring discuss recent OIG guidance on hospice and skilled nursing facility relationships, focusing on anti-kickback risks and fraud concerns. They cover key issues such as the importance of documenting fair market value for any services or space provided, being cautious of payments exceeding Medicaid room and board rates, and avoiding arrangements that appear to be made solely to secure referrals. Bill and Jason also touch on increased oversight and enforcement in the healthcare sector under a new presidential administration.
Executive orders and policy updates
04/07/25 at 03:00 AMExecutive orders and policy updates JD Supra; by Jones Day; 4/3/25 Since President Trump's inauguration, the Trump administration has issued a number of executive orders and policy actions ... Notable actions include rescinding Biden-era initiatives on health care access and equity, withdrawing from the World Health Organization, reducing indirect costs for NIH grants, and suspending foreign aid. While many of these actions may be subject to ongoing litigation, which is not addressed here, summaries of certain of these executive orders and policy actions are included below. ...
New administration’s appointees confirmed to lead key health agencies
04/07/25 at 03:00 AMNew administration’s appointees confirmed to lead key health agencies Association for Clinical Oncology (ASCO); Press Release; 4/3/25 Several presidential appointees have been confirmed to lead key health agencies that the Association for Clinical Oncology (ASCO) will work with during the new administration. These include: