Literature Review

A 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 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 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.

Inside the Medicare Advantage Reform Act Hospice News; by Jim Parker; 5/28/25 A bill currently before Congress seeks to overhaul aspects of the Medicare Advantage program. Rep. David Schweikert (R-Ariz.) recently introduced the Medicare Advantage Reform Act. If enacted, the bill, numbered H.R. 3467, would make wholesale changes to the Medicare Advantage (MA). A key provision of the bill is a proposed requirement that MA plans pay for hospice care. Hospice is currently “carved out” of Medicare Advantage. The potential impacts of moving hospice into MA at this time would be “devastating,” according to the National Alliance for Care at Home. ... [Other] changes to MA included in the text could have serious implications for hospices and other providers that also offer home health, palliative care or other services. ...

CMS 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 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: ...

Navigating the Future: HOPE, Wage Index, and CMS Quality Measures Teleios Collaborative Network (TCN; podcast by Chris Comeaux with Annette Kiser and Judi Lund Person; 5/21/25 What happens when ancient philosophical questions about "the good life" collide with modern healthcare regulations?  In this compelling episode of TCNtalks, host Chris Comeaux welcomes Hospice leaders Annette Kiser, Chief Compliance Officer with Teleios, and Judi Lund Person, Principal, Lund Person & Associates LLC,  for a deep dive into the regulatory crossroads facing hospice providers. In this episode,  we discuss the FY 2026 Proposed Rule, which focused on implementing the HOPE initiative, and two RFIs (Requests for Information) that were part of it. 

[Commentary] It’s time to bring value-based care principles to hospice Medical Economics; by Asher Perzigian; 5/20/25 In the health care industry, the conversation around value-based care (VBC) has been abuzz for a while now. The idea is simple: pay for outcomes, not for services, and shift our mindset from volume to value as we reduce unnecessary care, improve outcomes and bend the cost curve. However, when we talk about VBC, we often overlook a critical part of the health care continuum: hospice care. And when it comes to end-of-life care, traditional measures like survival rates and reduced readmissions lose their relevance. Hospice embodies some of the deepest principles of VBC: aligning care with patient goals, avoiding unneeded interventions and supporting the person as a whole. Here’s what primary care physicians need to know about the integration of value-based principles in hospice care. 

Podcast: Innovations and insights in the palliative care space Holland & Knight; podcast by Daniel Patten and Spencer Freeman; 5/20/25 In this episode of "Counsel That Cares," Daniel Patten, a partner in Holland & Knight's Healthcare Regulatory & Enforcement Practice, and Spencer Freeman, chief strategy officer at Gentiva, discuss the challenges and opportunities that come with delivering integrated palliative care services, highlighting the lack of a defined Medicare benefit for palliative care compared to more established models such as hospice. Mr. Freeman shares insights on building care models that serve high-risk patient populations through coordinated interdisciplinary teams and data-driven approaches, emphasizing the importance of collaboration with risk-based primary care providers. Mr. Patten adds a legal perspective on the evolving landscape of value-based care contracts, artificial intelligence (AI) integration and regulatory compliance. Together, they explore how innovative programs can improve patient outcomes, reduce acute care utilization and facilitate payer relationships, offering a comprehensive view of the future of palliative care within value-based healthcare delivery.

HHS 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."

A proposal to remove hospice providers from a state review poses a threat to patient care The Boston Globe, Boston, MA; by Diana Franchitto; 5/16/25 The General Assembly should maintain rigorous standards and oppose rolling back Rhode Island’s Certificate of Need process, writes HopeHealth president and CEO. ... As the president and CEO of HopeHealth Hospice & Palliative Care, I am proud that Rhode Island offers some of the highest-quality hospice care in the nation. But right now, legislation before the General Assembly could put that quality at risk.A proposal in Governor Dan McKee‘s fiscal 2026 budget would eliminate the requirement that hospice providers be scrutinized by Rhode Island’s Certificate of Need (CON) process. Some may position this as an effort to streamline government, but those of us who work in hospice care know better. The CON process isn’t one of the flashier, public-facing functions of state government, but it has a direct impact on the quality of health and hospice care that Rhode Islanders receive throughout their lives. ... Exempting hospice from meeting the rigorous standards that a CON requires poses an immediate threat to the quality of patient care. ...

Medicaid 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.

The ‘price’ of value-based care McKnights Long-Term Care News; by Micahel Wasserman; 5/14/25 The term “value-based care” is tossed around like a political football among healthcare policy makers. Nowhere is the meaning of this so variable as in nursing homes. The Nursing Home Value-Based Purchasing Demonstration project, completed over a decade ago, was not found to lower spending or improve quality. Webster’s Dictionary defines value as “the monetary worth of something,” “a fair return or equivalent in goods, services, or money for something exchanged” and “relative worth, utility or importance.” The government used performance measures such as hospitalization rates and quality measures as a proxy for value. Shouldn’t we be asking how clinicians, patients and their families define value?