Literature Review

Rep. Panetta: Congress must listen to hospice providers Hospice News; by Jim Parker; 10/1/26 Though the U.S. Centers for Medicare and Medicaid Services (CMS) has regulatory authority over hospices, Congress has a role to play. To fulfill that role, they should listen to the concerns of hospice providers, according to Rep. Jimmy Panetta (D-Calif.). Panetta first took office in 2017 and currently serves on the Ways and Means Committee, which is among the most important congressional bodies for hospices to watch. ... "...  The federal government has a responsibility to get that process right by rooting out fraudsters without targeting the hardworking providers offering this critical service.” 

How CMS’ proposed rule would build palliative care into the home health system Home Health Care News; by Morgan Gonzales; 9/30/26 The U.S. Centers for Medicare & Medicaid Services’ (CMS) proposal to add palliative care as a billable service under the Medicare Home Health Benefit could expand home health agencies to develop relationships with different types of providers. However, adding palliative care as a billable service could also make it difficult for home health providers to provide palliative services as robust as those delivered through the hospice benefit. Home health providers have celebrated the inclusion of palliative care in CMS’ proposed CY2027 home health payment rule. ... The rule will not change eligibility requirements for the home health care benefit. To qualify, a patient must: ...

MA: Shared credentialing platform slated for November start LeadingAge; by Nicole Fallon; 9/28/26 Provider credentialing and recredentialing can be one of the more time-consuming aspects of contracting with Medicare Advantage (MA) and Medicaid managed care plans. Many LeadingAge members must submit the same information through separate credentialing processes for each plan they work with, often waiting months before contracts become active and negotiated rates take effect. A new national credentialing service, CertifyOS, may help streamline that process. Beginning November 1, 2026, providers participating in certain managed care plans will be able to submit credentialing information through a single online portal that can then be used by all participating health plans.

Warning: If you get a ‘new’ plastic Medicare card in the mail, do not give your Social Security number SavingAdvice.com; by James Hendrickson; 9/28/26 An official-looking Medicare card unexpectedly arrives in your mailbox, but there’s something different about it: it’s plastic, perhaps has a chip, and comes with instructions telling you to call a number to “activate” your new benefits. Don’t make that call. The Senior Medicare Patrol specifically warns beneficiaries about scams involving supposed new plastic Medicare cards, chip cards, and annual replacement cards. Scammers may use the story as an excuse to obtain your Medicare number, Social Security number, banking information, or other personal data. There’s an important 2026 wrinkle, however: receiving a new Medicare card isn’t automatically evidence of fraud. ... Here’s what to check before giving anyone information. ...

Medicare fraud crackdown: what recent enforcement actions tell providers JD Supra; by Adam Appleberry; 9/28/26 ... Over the past several months, CMS and DOJ have announced a series of enforcement actions involving billions of dollars in suspected or allegedly improper Medicare claims. Although the cases involve different types of providers and different alleged conduct, several themes are beginning to emerge. ...

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.  

Prior authorization under CMS-0057-F: how payers are rebuilding utilization management for compressed timeline The National Law Review, Tampa, FL; Press Release; 9/20/26 Prior authorization has moved to the center of healthcare payer operations. With the Centers for Medicare & Medicaid Services finalizing the Interoperability and Prior Authorization Final Rule (CMS-0057-F), health plans, managed care organizations, and third-party administrators face shorter decision windows and new transparency obligations at the same time review volumes continue to climb. For many organizations, the response has been a careful review of their prior authorization medical review services and the operational systems that support them.

National trends in types of hospice disenrollment among older adults with dementia, 2012–2019 Journal of the American Geriatrics Society; by Lauren J. Hunt, Siqi Gan, Krista L. Harrison, Melissa D. Aldridge, Claire Ankuda, W. John Boscardin, Alexandra K. Lee, and Alexander K. Smith; 9/15/26 Key Points

BPC’s comment on the CMS 2027 Physician Fee Schedule (PFS) proposed ruleBipartisan Policy Center (BPC); by Zach Gaumer; 9/15/26 [Letter to Mehmet Oz, Administrator, CMS/HHS] This letter includes BPC’s comments on select provisions of CMS’s proposed rule. The enclosed comments focus on our recent work on Medicare Part B physician payment reform and primary care payment reform, digital technology and AI, complex and long-term care, and rural health care. We offer comments on the following provisions within the proposed rule:

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.

CMS 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.

As 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.