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All posts tagged with “Regulatory News | Medicare.”
Experts warn of scams during Medicare Fraud Prevention Week
06/05/25 at 03:30 AMExperts warn of scams during Medicare Fraud Prevention Week Public News Service; by Suzanne Potter; 6/4/25 Medicare loses $60 billion to $80 billion a year to fraud and this year, for Medicare Fraud Prevention Week, your local Senior Medicare Patrol has good advice on how to spot a con. There are plenty of scams to be aware of. Karen Joy Fletcher, communications director with the nonprofit California Health Advocates, said beware if a caller asks to verify your Medicare number, claiming the program needs to send out a new type of card. ... ... Caregivers can be on the lookout for medical equipment arriving at the house even though the beneficiary never ordered it. Another red flag? A stranger may approach you in a parking lot asking you to sign up for new, free Medicare services like house cleaning or meals, which are then fraudulently billed to the government. ... Another scam involves tricking people into unknowingly signing up for hospice care. It is especially dangerous, because once a person is on hospice, Medicare will only approve palliative care and could mistakenly deny an essential surgery or medication.
CMS budget puts complaint surveys over routine inspections as main nursing home oversight
06/05/25 at 03:15 AMCMS budget puts complaint surveys over routine inspections as main nursing home oversight McKnights Long-Term Care; by Kimberly Marselas; 6/2/25 A proposed 2026 Trump administration budget request would shift nursing home survey priorities, further delaying the time between standard inspections at many facilities. The Centers for Medicare & Medicaid Services budget justification published late Friday calls for a $45 million increase in survey spending across multiple sectors next fiscal year. But it also prioritizes complaint surveys in a way that would reduce the availability of surveyors to conduct routine, annual inspections mandated by law. The document from the Department of Health and Human Services shows the percentage of nursing home standard surveys completed each year would fall from 74% in fiscal year 2024 to a projected 65% completion rate in fiscal year 2026.
TCN/HPC Today: Storm clouds on the horizon for reimbursement
06/05/25 at 03:00 AMTCN/HPC Today: Storm clouds on the horizon for reimbursement - Top news stories, May 2025 Teleios Collaborative Network (TCN); podcast by Chris Comeaux with Cordt Kassner, 6/4/25 What happens when artificial intelligence meets end-of-life care? How do we reconcile private equity's profit motives with hospice's mission-driven ethos? These questions took center stage in this month's roundup of hospice news with host Chris Comeaux and guest Cordt Kassner. The May edition of TCNtalks' top news stories reveals a healthcare sector at a fascinating crossroads. AI has emerged as both a tantalizing promise and a practical challenge for hospice providers. ... In this episode of TCN Talks, hosts Chris Comeaux and Cord Kassner reflect on Memorial Day and discuss significant news stories from May, including the complexities of thanking veterans for their service, the role of artificial intelligence in hospice care, and the importance of honest conversations about racism in healthcare.Editor's note: This monthly podcast combines quantitative data and qualitative discussion from articles gleaned from the 400+ posts we provide each month. Do you seek to make sense of it all? Tune in and learn. We welcome your feedback via our newsletter's Contact page.
HHS faces $31B cuts in proposed FY ’26 budget: 6 notes
06/05/25 at 03:00 AMHHS faces $31B cuts in proposed FY ’26 budget: 6 notes Becker's Hospital Review; by Madeline Ashley; 6/2/25 President Donald Trump’s proposed fiscal 2026 budget slashes funding for the National Institutes of Health by $18 billion to $27.5 billion as part of a sweeping overhaul to realign federal healthcare spending. The NIH received $46.4 billion in program level funding in 2024 and just over $46 billion in 2025, according to the budget proposal. [Continue reading for this article's lists of (1) consolidated institutes and centers; and (2) "six things to know."]
2 West Covina women arrested for alleged $4.8 million hospice care fraud
06/04/25 at 03:00 AM2 West Covina women arrested for alleged $4.8 million hospice care fraud CBS News KCAL, Los Angeles, CA; by Julie Sharp; 6/3/25 The U.S. Department of Justice announced that two West Covina women were arrested Tuesday for an alleged scheme to defraud Medicare of $4.8 million with false hospice care claims. One of the women who was arrested is the owner and operator of two West Covina hospices, Golden Meadows Hospice Inc., and D'Alexandria Hospice Inc., which billed Medicare for hospice services for patients who were allegedly not terminally ill. Between Sept. 2018 and Oct. 2022, owner and operator Normita Sierra, 71, and her alleged accomplice, Rowena Elegado, 55, collected more than $3.8 million from Medicare on false claims, the DOJ said.
CMS’s Hospice Star Rating System limited by missing data
06/04/25 at 03:00 AMCMS’s Hospice Star Rating System limited by missing data Health Affairs; by Amanda C. Chen and David C. Grabowski; 6/3/25 Two-thirds of US hospices were not given a star rating when the Centers for Medicare and Medicaid Services (CMS) introduced its hospice star rating system in 2022. Since then, the share of hospices without a star rating has steadily increased, including through the most recent reporting period of 2024. This suggests that the CMS hospice star rating is having limited impact. We provide recommendations for CMS and other policy makers to improve the value for hospice patients of publicly reported star ratings.
A glossary of Medicare terms
06/03/25 at 02:00 AMA glossary of Medicare termsMedicalNewsToday; by Mandy French, medically reviewed by Oluwatoyin Kuloyo, Pharm.D., BCPS; 6/2/25 When a person first signs up for Medicare, they may come across many terms and abbreviations. Learning the definitions of these terms can help make it easier to understand and navigate Medicare. Medicare information can be confusing. This A to Z glossary can help individuals understand some common terms, acronyms, and abbreviations. ... Editor's note: A must-have resource to use and distribute, with multiple links to more depth information at Medicare.gov and MedicalNewsToday.
HOPE Tool Anxiety: What are we forgetting in the rush to prepare?
06/03/25 at 02:00 AMHOPE Tool Anxiety: What are we forgetting in the rush to prepare?Teleios Collaborative Network (TCN); by Melissa Calkins and Ashley Espy; 5/30/25 Panic is in the air. With the HOPE assessment tool set to replace HIS, hospice teams are racing to prepare—scrubbing workflows, updating systems, and trying to wrap their heads around new clinical documentation demands. But amid the rush, it's easy to overlook critical gaps: non-clinical staff being left out of planning, unclear timelines, poor communication, or the complete absence of a project lead. HOPE isn't just about compliance—it's about execution. If we don't step back and ask what's missing, we risk rolling out a system that nobody is truly ready for.Steps to Operationalize the HOPE Tool:
Why CMS’ GUIDE Model could move home care from side act to main stage
06/02/25 at 03:00 AMWhy CMS’ GUIDE Model could move home care from side act to main stage Home Health Care News; by Joyce Famakinwa; 5/29/25 The Guiding an Improved Dementia Experience (GUIDE) Model might be one of the biggest steps in the right direction for recent Medicare policy. The eight-year voluntary nationwide program was launched last year by the Centers for Medicare & Medicaid Services (CMS), with the goal of supporting individuals living with dementia, as well as their unpaid caregivers. The program’s focus is more important than ever, with an estimated 6.7 million people living with dementia. This amount is expected to skyrocket to 14 million cases by 2060, according to data made available by CMS.
LeadingAge, Hospice Associations seek delay in HOPE implementation
05/30/25 at 03:05 AMLeadingAge, Hospice Associations seek delay in HOPE implementation LeadingAge; Press Release; 5/28/25 LeadingAge, along with the National Alliance for Care at Home and the National Partnership for Healthcare and Hospice Innovation, on May 19 urged the Centers for Medicare and Medicaid Services (CMS) to delay implementation of the Hospice Outcomes and Patient Evaluation, or HOPE tool. In the letter to CMS Administrator Dr. Mehmet Oz the associations outline concerns with technology implementation in preparation for the HOPE tool. The letter specifically asks CMS to waive the HOPE timeliness submission requirement for two calendar quarters post implementation. The letter further requests that CMS delay the HOPE implementation date until at least six months after CMS education, training, and final validation specifications are available and the application for iQIES access has been opened for hospices.
MLN Fact Sheet: Creating an effective hospice Plan of Care
05/30/25 at 03:00 AMMLN Fact Sheet: Creating an efffective Hospice Plan of CareCenters for Medicare & Medicaid Services, Medicare Learning Network (MLN); 5/10/25 The hospice plan of care (POC) maps out needs and services given to a Medicare patient facing a terminal illness, as well as the patient’s family or caregiver. CMS data shows that some hospice POCs are incomplete or not followed correctly. This fact sheet educates on creating and coordinating successful hospice POCs. The primary goal of hospice care is to meet the holistic needs of an individual and their caregiver and family when curative care is no longer an option. To support this goal:
Door remains closed on CMS forums as new rules, requirements are phased in
05/30/25 at 03:00 AMDoor remains closed on CMS forums as new rules, requirements are phased in McKnights Long-Term Care News; by Kimberly Marselas; 5/28/25 Four months into the new presidential administration, skilled nursing leaders have had no opportunity to hear directly from Centers for Medicare & Medicaid Services staff during traditional Open Door Forums or National Stakeholder Calls. Open Door Forums have been held three-to-five times annually in a practice that started more than 20 years ago. The online meetings give providers, vendors and other stakeholders an opportunity to learn more about regulatory and logistical changes being pursued by CMS, as well as providing question-and-answer sessions with policy architects. In addition to skilled nursing forums, CMS has in the past also hosted similar events for home health, long-term care services and supports, rural health and other provider types. But CMS in January cancelled a skilled nursing forum and all others planned for February and has yet to add any new forums or stakeholder calls — which often feature the administrator discussing major policy or clinical updates — to its calendar.
Inside the Medicare Advantage Reform Act
05/29/25 at 03:00 AMInside the Medicare Advantage Reform Act Hospice News; by Jim Parker; 5/28/25 A bill currently before Congress seeks to overhaul aspects of the Medicare Advantage program. Rep. David Schweikert (R-Ariz.) recently introduced the Medicare Advantage Reform Act. If enacted, the bill, numbered H.R. 3467, would make wholesale changes to the Medicare Advantage (MA). A key provision of the bill is a proposed requirement that MA plans pay for hospice care. Hospice is currently “carved out” of Medicare Advantage. The potential impacts of moving hospice into MA at this time would be “devastating,” according to the National Alliance for Care at Home. ... [Other] changes to MA included in the text could have serious implications for hospices and other providers that also offer home health, palliative care or other services. ...
CMS: Kidney Care Choices (KCC) Model
05/29/25 at 03:00 AMCMS: Kidney Care Choices (KCC) Model CMS.gov - Centers for Medicare & Medicaid Services; 5/27/25 The Centers for Medicare & Medicaid Services (CMS) is announcing a coordinated set of changes to the Kidney Care Choices (KCC) Model starting in performance year 2026 that are expected to improve the model test by adjusting the financial methodology and participation options to improve model sustainability. In addition, the model is being extended by one year for continuation of quality care to beneficiaries through 2027. For more information, please visit KCC Model Performance Year 2026 Updates.
CMS rolls out aggressive strategy to enhance and accelerate Medicare Advantage audits
05/27/25 at 03:00 AMCMS rolls out aggressive strategy to enhance and accelerate Medicare Advantage audits CMS Newsroom; Press RElease; 5/21/25 Agency Will Begin Auditing All Eligible Medicare Advantage Contracts Each Payment Year and Add Resources to Expedite Completion of 2018 to 2024 AuditsToday, the Centers for Medicare & Medicaid Services (CMS) announced a significant expansion of its auditing efforts for Medicare Advantage (MA) plans. Beginning immediately, CMS will audit all eligible MA contracts for each payment year in all newly initiated audits and invest additional resources to expedite the completion of audits for payment years 2018 through 2024.
Disproportionate impact: Supreme Court narrows disproportionate share hospital reimbursement to Supplemental Security Income cash recipients
05/27/25 at 02:00 AMDisproportionate impact: Supreme Court narrows disproportionate share hospital reimbursement to Supplemental Security Income cash recipients The National Law Review; by Vinay Kohli, Matthew J. Westbrook, D. Austin Rettew; 5/23/25 The U.S. Supreme Court has issued a significant ruling affecting hospitals that serve low-income Medicare beneficiaries, narrowing the interpretation of the Disproportionate Share Hospital (“DSH”) payment formula. In Advocate Christ Medical Center v. Kennedy, the Court determined that only Medicare patients who were eligible to receive a cash Supplemental Security Income (“SSI”) payment during the month of their hospitalization may be included in the calculation for additional DSH reimbursement. This decision represents a setback for more than 200 hospitals that had advocated for a broader, more inclusive definition of SSI entitlement, potentially reducing the financial support available for treating Medicare’s poorest patients.
Proposed California budget calls for prior authorization for hospice in Medicaid
05/23/25 at 03:00 AMProposed California budget calls for prior authorization for hospice in Medicaid Hospice News; by Jim Parker; 5/22/25 The proposed California budget would require prior authorizations for hospice care within the state’s Medicaid program. Currently, Medicaid managed care plans who provide coverage through the state’s Medicaid system, Medi-Cal, may not perform prior authorizations for hospice. California’s Department of Health Care Services (DHCS) indicated in a 2025-2026 budget revision that this could save $25 million over the next two years and more than $50 million in the long term. If enacted, this would make California the first state in the nation to implement such a rule, according to the California Hospice & Palliative Care Association (CHAPCA). The association contends that the anticipated $25 million in cost savings is “speculative and fails to account for the downstream costs and systemic burdens this proposal would create,” according to a position paper shared with Hospice News. ... CHAPCA recommended to the state government three alternative approaches: ...
‘We need you to work with us’: Home health providers renegotiate better Medicare Advantage deals
05/22/25 at 03:00 AM‘We need you to work with us’: Home health providers renegotiate better Medicare Advantage deals Home Health Care News; by Joyce Famakinwa; 5/20/25 As Medicare Advantage (MA) enrollment continues to surge, home health providers have seen slim margins deteriorate further. Some providers have openly expressed their decision to reject financially unsustainable MA contracts. Abandoning unfavorable MA contracts may sometimes be necessary, industry executives told Home Health Care News. However, some providers have improved their MA standing by renegotiating rates or returning after walking away, leveraging data and understanding the needs of payer partners. “We have walked away, in specific states, from payers and Medicare Advantage groups because of rates and the inability to raise those rates, and pre-authorization terms,” G. Scott Herman, CEO of New Day Healthcare, told HHCN.
Navigating the Future: HOPE, Wage Index, and CMS Quality Measures
05/22/25 at 02:30 AMNavigating the Future: HOPE, Wage Index, and CMS Quality Measures Teleios Collaborative Network (TCN; podcast by Chris Comeaux with Annette Kiser and Judi Lund Person; 5/21/25 What happens when ancient philosophical questions about "the good life" collide with modern healthcare regulations? In this compelling episode of TCNtalks, host Chris Comeaux welcomes Hospice leaders Annette Kiser, Chief Compliance Officer with Teleios, and Judi Lund Person, Principal, Lund Person & Associates LLC, for a deep dive into the regulatory crossroads facing hospice providers. In this episode, we discuss the FY 2026 Proposed Rule, which focused on implementing the HOPE initiative, and two RFIs (Requests for Information) that were part of it.
Proposed bill would require MA to pay for hospice care
05/22/25 at 02:00 AMProposed bill would require MA to pay for hospice care Hospice News; by Jim Parker; 5/21/25 Rep. David Schweikert (R-Ariz.) has introduced the Medicare Advantage Reform Act, which among other provisions would require health plans to pay for hospice care. If enacted, the bill, numbered H.R. 3467, would make wholesale changes to the Medicare Advantage program. It would mandate capitated payment models, change risk adjustment methodologies and create new exemptions for physician self-referrals, among other provisions. The potential impacts of moving hospice into Medicare Advantage at this time would be “devastating,” according to the National Alliance for Care at Home.
[Commentary] It’s time to bring value-based care principles to hospice
05/21/25 at 03:00 AM[Commentary] It’s time to bring value-based care principles to hospice Medical Economics; by Asher Perzigian; 5/20/25 In the health care industry, the conversation around value-based care (VBC) has been abuzz for a while now. The idea is simple: pay for outcomes, not for services, and shift our mindset from volume to value as we reduce unnecessary care, improve outcomes and bend the cost curve. However, when we talk about VBC, we often overlook a critical part of the health care continuum: hospice care. And when it comes to end-of-life care, traditional measures like survival rates and reduced readmissions lose their relevance. Hospice embodies some of the deepest principles of VBC: aligning care with patient goals, avoiding unneeded interventions and supporting the person as a whole. Here’s what primary care physicians need to know about the integration of value-based principles in hospice care.
Medicare Program: Fiscal Year 2026 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements
05/21/25 at 03:00 AMMedicare Program: Fiscal Year 2026 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program RequirementsFederal Register - the Centers for Medicare & Medicaid Services; retrieved from the internet 5/20/25 Public Inspection Document: [On 5/20/25 this webpage reads:] This document is unpublished. It is scheduled to be published on 05/21/2025. Once it is published it will be available on this page in an official form. Until then, you can download the unpublished PDF version.Editor's note: This post has been prepared on Tuesday, 5/20/25, with the hope that--per the notification on this page--it will be available in its official form from this same link/webpage on Wednesday, 5/21/25. Our email delivery time is 6:00 am EDT. If this has not populated yet, please check back later in the day.
Podcast: Innovations and insights in the palliative care space
05/21/25 at 03:00 AMPodcast: Innovations and insights in the palliative care space Holland & Knight; podcast by Daniel Patten and Spencer Freeman; 5/20/25 In this episode of "Counsel That Cares," Daniel Patten, a partner in Holland & Knight's Healthcare Regulatory & Enforcement Practice, and Spencer Freeman, chief strategy officer at Gentiva, discuss the challenges and opportunities that come with delivering integrated palliative care services, highlighting the lack of a defined Medicare benefit for palliative care compared to more established models such as hospice. Mr. Freeman shares insights on building care models that serve high-risk patient populations through coordinated interdisciplinary teams and data-driven approaches, emphasizing the importance of collaboration with risk-based primary care providers. Mr. Patten adds a legal perspective on the evolving landscape of value-based care contracts, artificial intelligence (AI) integration and regulatory compliance. Together, they explore how innovative programs can improve patient outcomes, reduce acute care utilization and facilitate payer relationships, offering a comprehensive view of the future of palliative care within value-based healthcare delivery.
Trump Administration Executive Order Tracker
05/20/25 at 03:00 AMTrump Administration Executive Order TrackerMcDermott+Consulting; by McDermott+; 5/19/25 [This article] is a tracker of healthcare-related executive orders (EOs) issued by the Trump administration, including overviews of each EO and the date each EO was signed. We will regularly update this tracker as additional EOs are published. It is important to note that EOs, on their own, do not effectuate policies. Rather, in most cases, they put forth policy goals and call on federal agencies to examine old or institute new policies that align with those goals. ...
A dozen seniors at risk of being evicted from assisted living facilities in Stanislaus County
05/19/25 at 03:00 AMA dozen seniors at risk of being evicted from assisted living facilities in Stanislaus County NBC KCRA-3, Newman, CA; by Andres Valle; 5/15/25 The closure of two senior residential care facilities in Stanislaus County has left over a dozen older residents, including hospice patients, scrambling to find new homes with just days' notice. This decision comes after the passing of Kelsy Ramos, the licensee of Golden Age Living facilities in Turlock and Newman. Ramos, a Turlock native reported missing earlier this month, was found dead last Monday in Selma. The California Department of Social Services ordered the closure with no licensed manager in place, citing the absence of regulatory oversight.