Literature Review

ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model U.S. Centers for Medicare & Medicaid Services (CMS) The ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model tests an outcome-aligned payment approach in Original Medicare to expand access to new technology-supported care options that help people improve their health and prevent and manage chronic disease. The voluntary model focuses on conditions affecting more than two-thirds of people with Medicare, including high blood pressure, diabetes, chronic musculoskeletal pain, and depression. It will run for 10 years beginning July 5, 2026.

Hospice Coalition Questions and Answers: October 23, 2025Palmetto GBA; 12/10/2025Includes Coalition questions, Hospice Appeals Reports, and Hospice CAP Updates.

Hospice News’ 10 most-read stories of 2025 Hospice News; by Jim Parker; 12/19/25 Large acquisitions, regulatory headwinds and the fate of COVID-era telehealth flexibilities were top-of-mind issues for hospice providers in 2025, as evidenced by the 10 most-read Hospice News stories of the year. ... The following are the 10 most-read Hospice News articles of 2025.

The future of the hospice physician: HOPE, staffing & technology Maxwell TEC; podcast by Tom Maxwell with Dr. Andrew Mayo and Dr. Tiffany Richter; 12/15/25... In this episode, Tom sits down with two of the most respected clinical leaders in the country: Dr. Andrew Mayo (Chief Medical Officer, St. Croix Hospice) and Dr. Tiffany Richter (Chief Medical Officer, Agape Care Group). They break down the debate between full-time vs. contracted physicians, the "hybrid" model that is winning, and the heartbreaking regulatory gaps preventing dialysis patients from accessing hospice care. Plus, they share deeply personal stories that remind us why we do this work. 

Navigating the AI frontier: Legal guardrails for home health and hospice providers in 2025 and beyond JD Supra; by Jason Bring, Bill Dombi, Arnall Golden Gregory LLP; 12/12/25 Key Takeaways

Perceived value of transfusion access and hospice services among patients with blood cancersJAMA Network Open; by Hari S. Raman, Angel M. Cronin, Scott F. Huntington, Hajime Uno, Caitlin Brennan, Susan Lysaght Hurley, Anna Tidswell, Richard M. Kaufman, Sarah M. Lanahan,  Kimberly S. Johnson, James A. Tulsky, Gregory A. Abel, Oreofe O. Odejide; 11/25In this survey study, our analysis suggests that for many patients with advanced hematologic cancers, the ability to maintain access to blood transfusions is the primary factor in deciding whether to enroll in hospice. Given that the majority of hospices in the US do not provide transfusion access, patients with blood cancers are faced with the impossible choice of preserving access to palliative transfusions vs accessing quality home-based hospice care. This dichotomy between transfusion access and hospice care may contribute to the low rate of hospice use in this population. Our findings underscore the need to develop and test novel hospice delivery models that combine palliative transfusions with routine hospice services to effectively alleviate discomfort and optimize the QOL [quality of life] of patients with blood cancers near the EOL [end of life].Assistant Editor's note: In the calendar year 2024 data from Medicare Hospice claims indicate that only 3.0% of beneficiaries had a blood cancer diagnosis, per Hospice Analytics. This article suggests some great ideas about how hospice can address the expense of blood transfusions with CMS. But until that happens, hospices could consider approaching their local transfusion center about a contract for a reduced price for blood transfusions for patients in need. Ultimately, this will benefit the hospice, the transfusion center (potentially more patients), and most importantly, the patient.

Hospice margins dropping despite utilization gains Hospice News; by Jim Parker; 12/9/25 Hospice margins are falling despite record-high utilization, according to data from the Medicare Payment Advisory Commission (MedPAC). The commission has released its draft recommendations to Congress, repeating its annual call to eliminate hospice payment rate increases in future years. “For fiscal year, 2027, Congress should eliminate the update to the 2026 Medicare base payment rate for hospice,” MedPAC indicated in its draft recommendations. ... The average Medicare fee-for-service margin for hospices fell to 8% in 2023, down from 9.8% in 2022 and 14.2% in 2020, according to MedPAC. Among for-profit providers, the average 2023 margin was 13.7%, whereas nonprofits in aggregate showed a loss at -1.3%. These numbers exclude cap overpayments and non-reimbursible costs.

Medicare's AI prior authorization pilot sparks backlash over incentives to deny care Complete AI Training | Insurance; by Joren Erne; 12/7/25 CMS will pilot AI prior auth in traditional Medicare across AZ, NJ, OH, OK, TX, WA through 2031. Expect tougher reviews, vendor incentives, and pushback on denials and delays. ... For insurance professionals, this is a signal: CMS is importing private-plan utilization tactics into fee-for-service Medicare, with financial incentives tied to denial-driven cost savings. Expect policy, operations, and provider relations to feel it. 

MedPAC to recommend 7% cut to 2027 home health payment rate Home Health Care News; by Morgan Gonzales; 12/8/25 Just over a week after home health providers were hit with the announcement that their 2026 Medicare payment rates would be reduced by a 1.3% aggregate cut, the Medicare Payment Advisory Commission (MedPAC) agreed to recommend a significantly more drastic cut for the following year. On Friday, MedPAC released a draft report recommending that Congress reduce the Medicare base payment rate for home health care services for calendar year 2027 by 7%. 

The complex quandary over hospice relatedness Hospice News; by Jim Parker; 12/5/25 Questions over which services are deemed related to patients’ terminal diagnosis in hospice care are crucial, and physicians’ determinations of those factors may be growing more complex. ... CMS has taken a stance that essentially all the care needed by a terminally ill patient should be covered through the benefit. However, that is not always what happens in practice. ...  When considering relatedness, physicians must take a holistic approach, according to Dr. Lauren Templeton, hospice physician consultant at Weatherbee Resources and Physician Council member at The Pennant Group. ... In most cases, hospices should err on the side of considering conditions related, when possible, for the sake of their patients, Templeton indicated. “If it’s impacting the plan of care for our patients, that would make it related for us,” Templeton said.

GUIDE and beyond: Strategies for comprehensive dementia care integrationJournal of the American Geriatrics Society; by Kristin Lees Haggerty, David B Reuben, Rebecca Stoeckle, David Bass, Malaz Boustani, Carolyn Clevenger, Ian Kremer, David R Lee, Madelyn Johnson, Morgan J Minyo, Katherine L Possin, Quincy M Samus, Lynn Spragens, Lee A Jennings, Gary Epstein-Lubow; 10/25The Centers for Medicare & Medicaid Services' (CMS) Guiding an Improved Dementia Experience (GUIDE) Model represents a landmark opportunity to improve outcomes for persons with dementia and their caregivers and scale comprehensive dementia care through a structured service delivery and alternative payment approach.  Drawing from the experiences of six previously tested programs ... we describe a four-step approach to enable successful adoption and implementation: identifying key leaders and partners, preparing a tailored value proposition, initiating program start-up, and ensuring sustainable implementation. We highlight practical tools and resources to address operational challenges, including electronic health record integration, reimbursement strategies, and staff training. By focusing on evidence-based models, health systems and other providers can accelerate implementation, reduce costly emergency and institutional care, and deliver high-quality, person-centered support. This approach can help to empower GUIDE participants and others to build effective, durable, scalable comprehensive dementia care systems, ultimately advancing the goal of establishing such care as a permanent Medicare benefit.

BULLETIN: HHS repeals nursing home staffing rule provisions McKNights Long-Term Care News; by Kimberly Marselas; 12/2/25 The Department of Health and Human Services today repealed key provisions of the minimum staffing standards for long-term care facilities finalized in 2024. The move follows months of legal and legislative challenges, which had already rendered hourly staffing and registered nurse requirements moot. HHS said it was repealing provisions in alignment with the One Big Beautiful Bill Act, which imposed a nine-year moratorium on the rule’s staffing measures. ... Notice of the appeal was posted in the Federal Register Tuesday morning. Editor's Note: Click here for the official publication of this repeal, scheduled to be published on 12/3/25.

'It has made my life a lot easier': New Ohio program pays people to care for their loved ones at homeWTOL-11, Columbus, OH; by Kevin Landers; 11/24/25 Mark Straub, of Delaware County, started caring for his 93-year-old mother about two years ago. As much as he loves to have his mother at home instead of a nursing home, caring for a loved one 24/7 brings with it stress, both emotional and financial. ... The average cost of in-home care in Ohio is $60,238, according to CareScout. The average cost of nursing home care is $108,500 a year, or about $9,000 per month. Thanks to a new program in Ohio, those who care for a loved one at home are about to get financially easier. It’s called Structured Family Caregiving, or SFC. Currently, at least 11 states have formal Medicaid SFC programs that pay family members. “I didn’t believe it at first, until I got that first paycheck and I really wanted to cry, “ said Tsavaris.