Literature Review

What does Medicare actually cover in a best-rated memory care facility?U.S. News & World Report; by Vanessa Cacers; 7/21/26 |Memory care facilities offer a safe, supportive environment for those with Alzheimer's and other forms of dementia, but care can be costly. Learn what memory care services Medicare will pay for. |Key Takeaways

HHS pausing $1 billion in Medicaid payments to California, Minnesota over fraud LI; by Mary Chastain; 7/21/26 The U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) have paused more than $1 billion in Medicaid payments to California and Minnesota due to fraud concerns. “That includes more than $887 million for California and over $200 million for Minnesota,” HHS Secretary Robert F. Kennedy Jr. said at a press conference. “If those states want that money, they need to provide documentation that these payments are legitimate.”

H.R.9703 - Improving access to transfusion care for hospice patients act of 2026 U.S. Congress.gov, House Ways and Means Committee; sponsored by Rep. Debbie Dingell (D-MI-6); bill introduced 7/15/26 H.R. 9703: To require the Center for Medicare and Medicaid Innovation to test allowing blood transfusions to be paid separately from the Medicare hospice all-inclusive per diem payment.

MedPAC releases 2026 Medicare Data Book MedPAC - Advising the Congress on Medicare Issues; 7/16/26 The Medicare Payment Advisory Commission (MedPAC) released its 2026 data book on health care spending and the Medicare program. The publication provides data on Medicare spending, demographics of the Medicare population, beneficiaries' access to care, and quality of care in the program, among other information. You may go to the data book page on our website (www.medpac.gov) to view the data book and Excel data files.

Nurse practitioner: my patient qualified for hospice. I couldn’t get her there The Examiner News; by Diane Pagan; 7/15/26 ... I’ve been Marie’s primary care nurse practitioner for seventeen months. She was referred to me at the time by her PCP because she could no longer physically manage going into the office. She suffered from dementia and her gait was worsening ... Marie’s daughter chose a hospice agency close to her home. The agency reviewed my referral and notes and accepted Marie into their program. The next step was to send them a Certificate of Terminal Illness (CTI) stating that Marie had a terminal illness with an anticipated life expectancy of 6 months or less. Then the obstacle arose. I couldn’t sign the form. ... The inability of nurse practitioners to sign a CTI does not stem from their lack of education or clinical expertise in determining when a patient is nearing end of life. The restriction is rooted in federal Medicare law, written more than 40 years ago, when the role of nurse practitioners was very different than it is today.

Calendar Year (CY) 2027 Medicare Physician Fee Schedule Proposed Rule CMS Newsroom; Fact Sheet; 7/14/26 paired with U.S. Department of Health and Human Services, CMS CY 2027 Payment Policies under the Physician Fee Schedule, 7/16/26; summary by guest editor Judi Lund Person On July 14, 2026, the Federal Register posted the CY 2027 Medicare Physician Fee Schedule proposed rule – CMS-1848-P. The CMS Fact Sheet on the proposed rule can be found here. While the proposed rule is 1,592 pages, there are two items of note to hospice and palliative care readers: 1) Supporting Beneficiaries Planning for Future Medical Decisions.CMS is proposing to create two new HCPCS codes to describe advance care planning (ACP) services furnished by clinical staff under the direct supervision of the billing physician or other practitioner. These new codes will more accurately distinguish and value the work done by billing practitioners from time spent by their clinical staff providing ACP services. We are further proposing that the existing ACP CPT codes 99497 and 99498 would only be used to report time personally spent by the billing practitioner. 2) RFI on Community-based Palliative Care, asking questions on eligibility for serious illness care and palliative care, the future of care management services and advanced primary care management.   

Why joint ventures may outpace M&A during the CMS home health enrollment moratorium Home Health Care News; by MK Manoylov; 7/14/26 The Centers for Medicare & Medicaid Services’ (CMS) six-month moratorium on new Medicare home health enrollments limits one pathway for providers to scale, but operators can still expand organically and through M&A. Growth-minded operators can increase census, improve workforce availability, acquire other businesses and forge joint ventures, home health industry insiders said during a recent Home Health Care News webinar. Organic growth can mean improving conversion rates from referrals, expanding partnerships and developing operations, said Andwell Health Partners CEO Ken Albert.

Home health advocates accuse CMS of overreach on fraud-fighting measures McKnights Home Care; by Liza Berger; 7/10/26 While there has been much focus so far on the continuing behavioral adjustments in the recent home health proposed rule, there is another aspect of the rule that has drawn providers’ scorn — the harsh fraud measures. “The rule proposes significant expanded authority for CMS to deny or revoke Medicare enrollment,” Jennifer Sheets, CEO of the National Alliance for Care at Home, said during a webinar hosted by the Polsinelli law firm Thursday. “These enrollment provisions are a particular concern for us.” Sheets pointed out to a provision in the program integrity proposals that would expand the reapplication bar — prohibiting a provider from re-enrolling for up to 10 years — for any enrollment denial reason. “This really concerns us,” she said. “We think it is overreach from CMS, and that 10-year bar is a pretty scary thing to be looking at.”

CMS proposes significant changes to Medicare Provider Enrollment Mondaq | Legal500 | Intelligence; by Mary Beth Fortugno, Travis Lloyd, Julia Tamulis; 7/8/26On July 6, 2026, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule that would significantly expand CMS’s authority to revoke and deny Medicare enrollment and broaden disclosure obligations. Among the most significant proposals, CMS would:

CMS proposed rule: understanding palliative care in home health Hospice News; by Jim Parker; 7/10/26 While recent actions by the U.S. Centers for Medicare & Medicaid Services (CMS) could incrementally move the needle on palliative care access, they could also come with many limitations. CMS in its proposed 2027 home health rule clarified that home health providers can use certain billing codes to provide community-based palliative care to eligible patients. The agency emphasized that this palliative care would be distinct from hospice. Stakeholders in the hospice community were quick to applaud the proposal. ... However, what CMS has done falls short of a community-based palliative care benefit. For one, patients must meet the eligibility requirements for home health. This means that, among other requirements, patients must be homebound to receive this care, according to Katy Barnett, director of hospice and home health operations and policy for LeadingAge. This excludes many patients who may benefit from palliative care.

Palliative care for older adults with hip fracture: An explanatory sequential mixed-methods studyJournal of Pain & Symptom Management; by Daniel I Hoffman, Sydney Moore, Amanda J Reich, Christina Sheu, Mengyuan Ruan, Masami Tabata-Kelly, Kate Sciacca, Tamryn F Gray, Daniel Dohan, Charlotta Lindvall, Zara Cooper; 6/26After hip fracture, older adults experience burdensome treatments and high mortality; they may therefore benefit from palliative care (PC). Among 1,433 hip fracture admissions, GOCC [goals of care conversations], hospice discussions, and specialty PC were documented in view on their role in GOCC. Conclusion: Limited standardization, role uncertainty, and cultural factors limited PC documentation and delivery, highlighting opportunities to strengthen PC integration in surgical care.

Straight from the source: DOJ, OIG, and CMS on fraud and abuse enforcement in 2026 and beyond Mondaq | Legal 500 | Intelligence; by Lorel Writh and Lisa Re; 7/7/26  The American Health Law Association (AHLA) Conference wrapped up today, and its closing general session brought together three federal enforcers: Kim Brandt, Deputy Administrator and COO of Centers for Medicare & Medicaid Services (CMS); Susan Gillin, Assistant Inspector General for Legal Affairs at the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG); and Brenna Jenny, Deputy Assistant Attorney General in the U.S. Department of Justice’s (DOJ) Fraud Section. AHLA CEO David Cade moderated. Across the hour, the panel previewed how the three agencies intend to coordinate fraud and abuse enforcement in 2026 and beyond, emphasizing interagency collaboration, a shift from chasing improper payments to preventing them, and the connection between program integrity and affordability.

False Claims Act insights - how hospice fraud impacts legitimate providers  Husch Blackwell LLP; by Husch Blackwell LLP; 7/6/26 Host Jonathan Porter welcomes Bryan Nowicki, leader of Husch Blackwell’s hospice practice group and host of the Hospice Insights podcast, to discuss the recent wave of hospice fraud enforcement. With hospice fraud dominating headlines in recent months, Bryan shares insights on how massive fraud schemes are impacting the industry and why legitimate providers face collateral damage.