Literature Review

CMS cracks down on fraud, waste, and abuse in the Federal Health Insurance Marketplace® CMS Newsroom; Press Release; 9/22/26 As part of the ongoing efforts of the White House Task Force to Eliminate Fraud to crush fraud in the healthcare system and protect taxpayer dollars, the Centers for Medicare & Medicaid Services (CMS) is taking aggressive, sweeping actions within the Federal Marketplace — canceling approximately 315,000 unauthorized enrollments covering more than 760,000 individuals, which is expected to result in a return of roughly $2.2 billion in taxpayer-funded subsidies.  

CMS expands the ACCESS Model: new tracks for heart failure, COPD, substance use disorders, tobacco cessation, and extended MSK support Foley Hoag; 9/21/26 Key Takeaways:

The critical competencies hospice leaders must build for value-based care cuccess | part one Teleios Collaborative Network (TCN); podcast hosted by Chris Comeaux with Dr. Jessica Hubbs; 9/16/26 Value-based care isn’t just changing how hospice gets paid—it’s redefining what hospice leaders must be capable of delivering. In Part One of The Critical Competencies Hospice Leaders Must Build for Value-Based Care Success, host Chris Comeaux sits down with Dr. Jessica Hubbs, Chief Clinical Officer at Advanced Care Innovations, to explore the accelerating shift from fee-for-service healthcare toward models built around outcomes, total cost of care, and coordinated care delivery.  Dr. Hubbs explains why emerging models such as LEAD (Long-term Enhanced ACO Design) matter to hospice and palliative care leaders—and why the movement upstream into serious illness and home-based care could represent both a competitive headwind and an extraordinary opportunity.

The critical competencies hospice leaders must build for value-based care cuccess | part one Teleios Collaborative Network (TCN); podcast hosted by Chris Comeaux with Dr. Jessica Hubbs; 9/16/26 Value-based care isn’t just changing how hospice gets paid—it’s redefining what hospice leaders must be capable of delivering. In Part One of The Critical Competencies Hospice Leaders Must Build for Value-Based Care Success, host Chris Comeaux sits down with Dr. Jessica Hubbs, Chief Clinical Officer at Advanced Care Innovations, to explore the accelerating shift from fee-for-service healthcare toward models built around outcomes, total cost of care, and coordinated care delivery.  Dr. Hubbs explains why emerging models such as LEAD (Long-term Enhanced ACO Design) matter to hospice and palliative care leaders—and why the movement upstream into serious illness and home-based care could represent both a competitive headwind and an extraordinary opportunity.

Medicare moments: The scarcity of Medicare caregiver benefits Allied News; by Joel Mekler; 9/14/26 ... AARP and the National Alliance for Caregiving released the 2025 Caregiving in the U.S. report, their newest update since 2020. This comprehensive document offers an in-depth look at the evolving landscape of family caregiving for adults, highlighting key trends, challenges, and potential reforms. A key discovery is the swift growth in family caregiving. Almost 25% of adults — 63 million Americans — spent the last year caring for an adult (59 million) or a child (4 million) with complex medical needs or disabilities, marking a 45% increase since 2015. This trend underscores the essential role of family caregivers and exposes systemic shortcomings that place significant burdens on them, highlighting the pressing need for reforms.

NPHI urges CMS to build on hospice moratoriam with targeted enforcement Hospice News; by Jim Parker; 9/14/26 The U.S. Centers for Medicare & Medicaid Services (CMS) should follow the six-month moratoria on hospice and home health enrollment in Medicare with more pinpointed efforts to root out fraud, according to the National Partnership for Healthcare and Hospice Innovation (NPHI). The U.S. Centers for Medicare & Medicaid Services’ (CMS) implemented the moratoria in May. At the time, NPHI voiced support for the moratoria. The organization in March called for such action in a letter to CMS. Now, NPHI contends that the moratorium has “accomplished its intended purpose,” the nonprofit group said in a new letter to CMS Administrator Dr. Mehmet Oz and CMS COO Kim Brandt. The temporary moratoria is scheduled to expire in November.

Update 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. 

Don’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.

LeadingAge, 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, ...

Mercy 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. 

Hospice 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. 

Alzheimer’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.