Literature Review

Finding Medicare Fee-for-Service (FFS) Payment System Rules: schedules and resources Congressional Research Service - Informing the legislative debate since 1914; by Congressional Research Service, summary by Michele L. Malloy; updated 8/14/26 The Medicare Fee-for-Service (FFS) program pays physicians, hospitals, and other health care facilities based on statutorily established payment systems, most of which are updated annually through regulations. The publication of Medicare FFS proposed and final rules follow schedules based on requirements found in statute, regulation, or both. ... This report contains information on these payment system rules in a quick reference table. Specifically, the table compiles the payment systems; their main portals on the Centers for Medicare & Medicaid Services (CMS) website; the typical rulemaking schedule; statutory and regulatory requirements; and the most recently issued proposed rules, public comments, final rules, and subsequent corrections.

Modernizing payment integrity in an era of systemic fraud MedCityNews; by Christian Bass; 8/21/26 Across the United States, Medicaid and Medicare fraud cases are surfacing with increasing frequency — and scale. From improper billing and undocumented services to upcoding and duplicate claims, these cases span federal programs and state-administered Medicaid plans. Once perceived as isolated misconduct, these cases are now being exposed as a systemic challenge, revealing vulnerabilities in reimbursement oversight that affect payers, regulators, and ultimately taxpayers. ... Gaps in reimbursement oversight and recovery will only widen, unless plans modernize how they detect, investigate, and recoup improper payments. Organizations that respond quickly will be positioned to manage the financial and regulatory headwinds.

READOUT: FinCEN holds engagement to eliminate hospice fraud in CaliforniaU.S. Treasure Financial Crimes Enforcement Network, Los Angeles, CA; 8/19/26 On August 17, the U.S. Department of the Treasury’s Financial Crimes Enforcement Network (FinCEN) convened law enforcement and financial institutions for an engagement on health care benefits fraud, including the exploitation of hospice care services. Participants discussed new and emerging health care fraud schemes targeting federal and state health insurance programs, associated financial typologies and red flag indicators, and opportunities to boost awareness around hospice care fraud. Additionally, FinCEN held a training session for law enforcement on August 18 on how to use Bank Secrecy Act data to combat fraud. These engagements build on FinCEN’s work to counter fraud in partnership with the White House Task Force to Eliminate Fraud. 

Hospice Wage Index, the Final Rule, and the signals CMS is sending | part one Teleios Collaborative Network (TCN); pocast hosted by Chris Comeaux with Annette Kiser and Judi Lund Person The 2027 Hospice Final Rule is more than a reimbursement update—it’s a window into where Centers for Medicare & Medicaid Services (CMS) believes hospice care needs to go next. In Part One, host Chris Comeaux sits down with hospice regulatory experts Annette Kiser and Judi Lund Person to look beyond the numbers and “read the tea leaves” in CMS’s latest rule.  They unpack what hospice leaders need to understand about the Hospice Election Statement Addendum, the growing scrutiny of unrelated services and non-hospice Medicare spending, telehealth reporting, and the Service and Spending Variation Index (SSVI).  As Judi explains, CMS’s commentary and responses to industry feedback can reveal as much about the agency’s direction as the regulations themselves.

When a hospice patient comes to the hospitalICD10monitor; by Tiffany Ferguson, LMSW, CMAC, ACM; 8/17/26 A recent question was posed related to “What happens when a hospice enrolled patient returns to the hospital for emergency or hospital care?” Aside from the initial questions such as “did we even know this patient was on hospice when they roll through the emergency room, or why did they come back to the hospital? The next question may evolve to the following: is the treatment still involving care congruent with the patient’s hospice care plan or has the patient/representative elected to revoke their hospice services? Understanding these distinctions is increasingly important for case management, utilization review, registration, revenue cycle, and especially hospital clinical teams.

How SNF upper payment limits can hurt hospices Hospice News; by Brandyn Simmons; 8/17/2 When it comes to healthcare — especially if it involves Medicare or Medicaid — one solution can lead to new problems. The Upper Payment Limit (UPL) program is no exception to this rule. Across the spectrum in healthcare, Medicaid reimbursements have typically been inadequate in covering all expenses for patient care. This is where the UPL comes in. Under this initiative, providers such as skilled nursing facilities (SNF) can receive a gap payment through Medicare to make up the difference. While this is a boon for SNFs, this can become a major headache for many hospice companies across the United States. ...

New developments in exclusion enforcement: CMS gains exclusion authority Thompson Coburn LLP; by Milada R. Goturi , April R. Kirkley , Christine N. Moser; 8/14/26 Historically, the HHS Office of Inspector General (“OIG”) has been the only agency authorized to exclude individuals and entities from Federal healthcare programs. According to a recent HHS announcement, however, the Centers for Medicare & Medicaid Services (“CMS”) has also been granted exclusion authority. The exclusion authority will significantly expand CMS’s existing program-integrity powers and will allow CMS to not only deny, suspend, revoke or terminate Medicare enrollment but to also prevent healthcare providers from participating in the Federal healthcare programs altogether.

California’s new emergency hospice regulations: key requirements for providers JD Supra; by Margia Corner, Elicia Grilley Green, Lena Zinner; 8/13/26 For the first time in California’s history, hospice agencies have become subject to comprehensive hospice-specific licensing regulations adopted on an emergency basis and effective June 22, 2026. ... The new regulations apply to both existing licensees and new applicants, add significant new requirements for CDPH approval of transactions and other operational changes, such as the licensee’s physical location, and authorize CDPH to conduct unannounced inspections to verify compliance. Providers would benefit from reviewing their operations against the new requirements below.

Can a short-term moratorium strengthen the hospice sector? LeadingAge; by Katie Smith Sloan; 8/11/26 President and CEO Katie Smith Sloan explains why LeadingAge supported the six-month moratorium on Medicare enrollment of new hospice providers and what nonprofit providers can do to strengthen the hospice sector.Earlier this year, I had the opportunity to attend a community theater production of the iconic musical “Fiddler on the Roof.” In a series of unforgettable scenes, Tevye, the production’s main character, makes difficult family decisions by artfully balancing opposing views before choosing his path. “On the one hand,” he intones, then ruminates on the important role tradition must play in the life of his village and family. “On the other hand,” he counters thoughtfully, then acknowledges that the inevitability of change must be factored into every decision.I’ve recalled Tevye’s internal monologue many times since May, when the Centers for Medicare and Medicaid Services (CMS) announced a six-month national moratorium on enrolling new hospice agencies in Medicare. ...

How California’s hospice industry spiraled out of control — and cost millions in fraud Los Angeles Daily News, Los Angeles, CA; by Jason Henry; 8/9/26 A quiet change in California law in 2018 unleashed a deluge of new hospices and spurred millions of dollars in Medicare fraud that state and federal authorities are still trying to unwind. ... It all started with three paragraphs added, at the request of the California Department of Public Health, to the end of an omnibus bill in 2018. CDPH had a backlog of 72 applications for hospice licenses at the time and wanted legislators to provide an alternative to a major bottleneck: its own inspectors. Under SB 1495, hospices could choose to pay a third-party accrediting organization for the inspection needed for a license, instead of waiting weeks or months for the next available state employee. ... Unlike a restaurant, which must undergo fire, building and health inspections, the vast majority of hospices in California could suddenly obtain a license, and even approval to bill Medicare, without a public employee stepping foot on the property. ...

Home health, hospice admissions surge as Medicare Advantage growth plateausMcKnights Home Care; by Marissa Fernandez; 8/6/26  Providers could potentially have a new benchmark for fee-for-service home care admissions, according to the latest report from Trella Health. The annual interactive Post-Acute Market Intelligence Report: 2026 Edition also found increases in home health and hospice admissions, as well as other related data changes that could signal national trends.

Hospice Coalition Questions and Answers: June 25, 2026Palmetto GBA; 8/4/26Includes Coalition questions, Hospice Appeals Reports, and Hospice CAP Updates.

Additional CMS website information for the Hospice Wage Index Final RuleCMS