Literature Review

The measure isn’t wrong. The story is incomplete. McKnights Long-Term Care News; by Steven Littlehale; 2/27/26 Not long ago, I was sitting across from a nursing home leadership team as they stared at a quality measure report that didn’t make sense to them. ... So we did what more facilities should do when a QM score feels off: We stopped looking at the rating and started looking at the math. That’s where the real story surfaced. It wasn’t about poor care, but about exclusions not captured, covariates not fully coded, and pieces of the clinical picture that never made it into the structured data fields the Centers for Medicare & Medicaid Services reads. 

Husch Blackwell’s Meg Pekarske: Hospices facing ‘huge pendulum shift' Hospice News; by Holly Vossel; 2/27/26 The hospice space has seen waves of regulatory changes in recent years that are affecting sustainable access, according to Meg Pekarske, partner at the law firm Husch Blackwell. Ensuring program integrity and quality will take an overhaul of hospice regulation. Pekarske, a hospice and health care attorney, is retiring with more than 25 years of legal experience, effective March 31. She recently sat down with Hospice News to reflect on the most significant regulatory changes impacting the future scope of hospice care delivery. Greater consideration is needed around a potential revamp of the Medicare Hospice Benefit, Pekarske said.

Medicare, Medicaid, and Children's Health Insurance Programs: Nationwide Temporary Moratoria on enrollment of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) supplier medical supply companies Federal Register; by the Centers for Medicare & Medicaid Services; 2/27/26 Summary: This notice announces the imposition of a 6-month nationwide moratorium on the Medicare enrollment of DMEPOS supplier medical supply companies. Background: ... Under the Patient Protection and Affordable Care Act (Pub. L. 111-148), as amended by the Health Care and Education Reconciliation Act of 2010 (Pub. L. 111-152) (collectively known as the Affordable Care Act), Congress provided the Secretary with new tools and resources to combat fraud, waste, and abuse in Medicare, Medicaid, and the Children's Health Insurance Program (CHIP).

Why Alivia Care is getting invested in ACO models Hospice News; by Jim Parker; 2/19/26 The senior care provider Alivia Care is going all in on high-needs Accountable Care Organization models in 2026. This includes participation in the final year of the Accountable Care Organization Realizing Equity, Access and Community Health (ACO REACH) model that the Center for Medicare & Medicaid Innovation (CMMI) is currently testing. Following that, the hospice, home health, PACE and palliative care provider plans to engage in the center’s new Long-term Enhanced ACO Design (LEAD) model. ... [Descriptions by Alivia Care CEO Susan Ponder Stansel ...]

What hospice leaders need to know about H.R.7148 - 119th Congress (2025-2026): Consolidated Appropriations Act, 2026 | Congress.gov | Library of Congress | signed by the President, 2/3/26Congress.gov; content below gleaned by Judi Lund Person, Guest Editor

Congress passes spending bill, extends telehealth flexibilities American Academy of Professional Coders (AAPC); by Renee Dustman; 2/4/26 ... Congress has extended the expiration dates for certain telehealth flexibilities from Jan. 30, 2026, to Dec. 31, 2027 (unless otherwise stated), as follows: ...

Measures that matter: How better metrics can transform end-of-life care | part one Teleios Collaborative Network (TCN); podcast hosted by Chris Comeaux with Bob Tavares, Robin Heffernan and Mindy Stewart-Coffee; 2/4/26 In Episode One of Measures That Matter: How Better Metrics Can Transform End-of-Life Care ... explores why fewer, clearer quality measures are essential for reducing variability, improving patient outcomes, and supporting value-based care at the end of life. ... Bob Tavares explains how decades of healthcare analytics revealed a fundamental problem in Hospice quality measurement: an abundance of metrics that fail to differentiate performance.  Many current measures cluster nearly all providers at the top, making it difficult for patients, payers, and value-based organizations to identify true centers of excellence or address variability that puts patients at risk.

CMS announces $50 billion Rural Health Transformation Program: What providers and states need to know JD Supra; by Margia Corner, Alexandria Foster, Kendall Kohlmeyer; 2/2/26On December 29, 2025, the Centers for Medicare & Medicaid Services (“CMS”) announced that it will distribute award amounts to all 50 states under the first year of the Rural Health Transformation Program (the “Program”). ... The Program’s $50 billion in funds will be allocated over five years, with $10 billion available each year beginning in 2026. ... Under Public Law 119-21, funding must be distributed to states as follows: ...

Healthcare leaders must confront toxicity to avoid obsolescence, SCAN Group CEO warns Time.News; by Grace Chen; 1/27/26 A new call to action from Dr. Sachin Jain emphasizes ethical leadership, honest self-assessment, and a relentless focus on patient needs as crucial for survival in a rapidly evolving healthcare landscape. Healthcare organizations face a stark choice: embrace ethical principles and actively combat internal toxicity, or risk becoming irrelevant.

HHS-OIG Semiannual Report to Congress: April 1 - September 30, 2025 HHS Office of Inspector General; by the OIG; 1/21/26 OIG publishes the Fall 2025 Semiannual Report to Congress. Also posts two enforcement actions.Fall 2025 Semiannual Report to Congress Today, OIG released its Fall 2025 Semiannual Report to Congress, summarizing its activities and accomplishments from April 1, 2025, through September 30, 2025. The report outlines OIG’s work to address fraud, waste, abuse and mismanagement across HHS programs—and driving change through oversight and accountability. OIG's efforts during this period led to a total monetary impact of $2.43 billion, demonstrating the agency’s role in protecting taxpayer funds and improving program performance. Read the full report now to understand how OIG is working to safeguard taxpayer dollars and enhance government performance. 

Dealmaking in home care slows, stabilizes in home health due to Medicare Payment Rule Home Health Care News; by Morgan Gonzales; 1/20/26 After several months of home health dealmaking uncertainty sparked by the largest-ever proposed cut to Medicare home health payments, a softer-than-anticipated final rule has paved the way for greater investor confidence in the sector in 2026. 

Kaiser Permanente affiliates settle Medicare risk adjustment fraud case for $556 million JD Supra; by Emily Ann Farmer, Lindsey Brown Fetzer, Brian Roark, Julia Tamulis - Bass, Berry & Sims PLC; 1/19/26 On January 14, the Department of Justice (DOJ) announced that five Kaiser Permanente affiliates agreed to pay $556 million to resolve allegations that they violated the False Claims Act (FCA) by submitting unsupported diagnosis codes for Medicare Advantage (MA) beneficiaries to increase reimbursement from the federal government. The relators will receive approximately $95 million as their share of the recovery. ... At $556 million, this represents the largest FCA settlement involving allegations of MA risk adjustment fraud to date, far eclipsing prior MA risk‑adjustment settlements, including Cigna ($172 million, 2023) and Independent Health ($100 million, 2024).

US health expenditures rapidly accelerating Hospice News; by Jim Parker; 1/14/26 ... Rising health care utilization is the most significant driver of the spending increases, according to CMS. One key factor is that utilization is bouncing back from declines that occurred during the COVID-19 pandemic, according to Micah Hartman, a statistician in the National Health Statistics Group with the Office of the Actuary at CMS. Population growth was also a factor. ... By payer type, private health insurance saw the largest rate of spending growth at 8.8%, followed by Medicare at 7.8% and Medicaid at 6.6%. Out-of-pocket spending rose by 5.9%. ... Hospice care saves Medicare roughly $3.5 billion for patients in their last year of life, according to a joint report from the National Hospice and Palliative Care Organization (NHPCO), the National Association for Home Care & Hospice (NAHC) and NORC at the University of Chicago.