Literature Review

CMS finalizes 2027 Home Health Rule with sweeping regulatory changes Hospice News; by Jim Parker; 11/4/26 The U.S. Centers for Medicare & Medicaid Services (CMS) has finalized its 2027 home health rule, which contains significant regulatory updates that affect all healthcare providers. In addition to those provisions, the agency implemented an aggregate payment increase of 2.4%, or approximately $420 million, a departure from recent years in which home health providers have faced reimbursement reductions. CMS is adopting new measures to strengthen oversight of Medicare providers and combat fraud, waste and abuse under its calendar year 2027 home health payment rule. 

Behind the scenes: how CMS combats hospice fraud Hospice News; by Jim Parker; 11/4/26 The U.S. Centers for Medicare & Medicaid Service (CMS) is locking horns with scammers, and hospices need a transparent view into the agency’s methods. CMS routinely monitors billing activity, beneficiary complaints and other indicators that may signal potential fraud, an agency spokesperson told Hospice News. When suspicious activity is identified, the agency can take several actions, including suspending payments, revoking Medicare billing privileges and referring cases to law enforcement.

Ills of Medi­care Advant­age plans are becom­ing clearer and clearer PressReader | The Boston Globe; by Renee McInnes; 11/3/26 As a pro­vider of home care and hos­pice care, we identify with the struggles of Sarah Iselin, chief exec­ut­ive of Blue Cross Blue Shield of Mas­sachu­setts (“Blue Cross elim­in­ates sev­eral Medi­care Advant­age plans, affect­ing 20,000 seni­ors”). Health care lead­ers in every sec­tor are cop­ing with the chal­lenges of our failed sys­tem. But it must be made expli­cit that Medi­care Advant­age is a ter­rible product for patients — as it is now, appar­ently, for the bot­tom line of the state’s largest insurer. A total of $275 mil­lion in losses with these plans in 2024 and 2025 is a remark­able num­ber for Blue Cross to report. However, I would remind the health care com­munity that the home care and hos­pice space is being gut­ted, and the ulti­mate loser in this equa­tion is our patients.

How Medicare Advantage and traditional Medicare influence palliative and hospice care implementation: a conversation with Xin Hu, PhD The ASCO Post; by Jo Cavallo; 10/29/26 In 2024, ASCO updated its guideline for the integration of palliative care in oncology, ... However, despite ASCO’s recommendations, utilization of palliative care in the oncology setting remains low, with about one-third of patients globally receiving this service, with the highest utilization rate of nearly 56% in Africa and the lowest, 30%, in the United States. The results from two studies by Xin Hu, PhD, MSPH, and her colleagues evaluating the use of early palliative care among traditional Medicare and Medicare Advantage beneficiaries with advanced cancers find that systemic and structural barriers in the health-care system are contributing to the underuse of palliative care among these patients.

Medicare freeze on new hospice and home health agencies expires November 13 as CMS stays silent Medical Daily; by Joseph James; 10/29/26 A Deadline Two Weeks Away and No Word From CMS: A nationwide freeze that has blocked new hospices and home health agencies from enrolling in Medicare since May is set to expire on Nov. 13, and the federal government has not said whether it will keep the freeze in place. The Centers for Medicare & Medicaid Services told providers it would give at least 60 days' notice before the moratoria expire, according to Home Health Care News. As of Oct. 30, no extension notice had been published, leaving hospitals, discharge planners, and families without a clear picture of what the end-of-life and in-home care market will look like in two weeks.

[Australia] Home care fraud, waste and abuse: Australia’s lessons for the U.S. FTI Consulting; 10/27/26 Key Takeaway: Australia’s home care model offers U.S. providers and policymakers a practical lesson: Strengthen payment integrity through accountable providers, coordinated care and transparent billing that helps consumers flag irregularities, while preserving access to essential services. ...

Patients with suboptimal discharges – a follow-up (and rescinding hospice billing)RACmonitor; by Ronald Hirsch, MD, FACP, ACPA-C, CHCQM, CHRI; 10//28/26 Let me start with an update on my project to get a way to indicate on a hospital claim that a patient has discharged to a less-than-optimal location. ... [That began] with a push to use the “against medical advice” designation for such patients. But the stigma behind that term led me to adopt the suggestion of Valerie Rinkle, a nationally known revenue integrity expert, who proposed adoption of a condition code instead of using a discharge status code. Last week I once again presented to the National Uniform Billing Committee (NUBC), asking for such a code to be established. During that meeting, one of the members came up with an even better idea: establishing two condition codes, one for when the patient chooses a less-than-optimal location, and a different condition code for when the payer refuses to approve the suggested post-acute care.

CMS COO: hospice, home health moratoria a successful approach Hospice News; by Jim Parker; 10/29/26 The U.S. Centers for Medicare & Medicaid Services’ (CMS) temporary moratoria on hospice and home health provider enrollment in Medicare has been working, according to Kimberly Brandt, the agency’s deputy administrator and COO. To date, during the six-month enrollment freeze, CMS has denied 50 hospice and 250 home health applications. Also, CMS has seen “huge drops” in billing, particularly in geographic areas known to be rife with fraud. This includes states like California, Texas, Nevada, Ohio, Georgia and Arizona.

HHS drops expired 2025 Alzheimer's treatment goal in new dementia plan focused on prevention and early detection Medical Daily; by Cole Mercer; 10/27/26 The federal government has rewritten its national dementia strategy, shifting the focus toward prevention and earlier detection. HHS Secretary Robert F. Kennedy Jr. announced the updated national plan on Alzheimer's and related dementias on Oct. 22 at Broward Health Medical Center in Fort Lauderdale, Florida. The new plan replaces six long-standing goals with four. ...

Free webinar for physicians and healthcare professionals: Reducing hospital readmissions and reducing Hospital Readmissions and Length of stay in advanced illness patients VITAS Healthcare; Press Release; 9/14/26

CMS and states launch $275 million initiative to recruit and retain nurses in nursing homes CMS Newsroom; Press Release; 10/23/26 The new Nurses for Nursing Homes initiative is expected to support more than 4,000 nurses and nursing students nationwide, including those serving rural communities. Nursing students and licensed nurses interested in working in a nursing home may now qualify for up to $40,000 in student loan repayment and/or a $10,000 stipend in exchange for a three-year commitment to serve in a qualifying nursing home in a rural or higher labor-shortage area through a new $275 million nationwide initiative announced today by the Centers for Medicare & Medicaid Services (CMS). 

Feds hold back an additional $1.2 billion in California Medicaid reimbursements ArcaMax; by Ana Ceballos, Los Angeles Times; 10/20/26 The Trump administration is deferring an additional $1.2 billion in Medicaid reimbursements to California, citing concerns about potential fraud in a state program that helps older adults and people with disabilities with everyday tasks. Dr. Mehmet Oz, the administrator for the Centers for Medicare and Medicaid Services, said federal officials took action after they grew concerned about the rapid expansion of California's personal care services program in recent years. State officials were notified of the decision Tuesday, he said.