Literature Review

CMS releases RFI to overhaul Medicare claims system Inside Health Policy; by Jalen Brown; 1/9/26 CMS unveiled a request for information (RFI) Thursday (Jan. 8) aimed at replacing Medicare’s decades-old claims processing system with a modern, cloud-based platform that would be capable of adjudicating millions of claims per day in real time, which would fundamentally re-architect how Medicare pays providers. In Thursday’s RFI, dubbed “ClaimsCore,” CMS is asking large-scale technology vendors to demonstrate whether they can operate a full Medicare claims adjudication system inside a CMS-owned Amazon Web Services cloud environment.

US Department of Justice and Dr. Oz targeting California over alleged medical fraud  ABC-7 Los Angeles, CA; by Anabel Munoz The Department of Justice is investigating what it's calling medical fraud in California. First Assistant U.S. Attorney Bill Essayli and Dr. Mehmet Oz held a brief news conference in Los Angeles on Friday to say they're targeting the state of California over the alleged fraud. ... "The patients don't realize they're signing up for hospice, so they're giving up their medical ability to take care of themselves. They're moving outside the health care system, where doctors no longer will care for them because they're in hospice," Oz said. 

NPHI organizes listening tour on hospice program integrity with CMS leaders Dr. Oz and Kim BrandtNational Partnership for Healthcare and Hospice Innovation (NPHI); Press Release; 1/8/26On Thursday [1/9], Dr. Mehmet Oz, Administrator of the Centers for Medicare & Medicaid Services (CMS), and Kim Brandt, CMS Chief Operating Officer ... are visiting Nathan Adelson Hospice in Las Vegas as part of a listening session and on-site tour. On Friday, the tour continues in California, where NPHI is supporting discussions with federal leaders and providers in the state focused on fraud and abuse challenges impacting hospice care. These conversations are intended to help federal leaders better understand what providers are seeing on the ground and explore how CMS and the provider community can work together to strengthen program integrity while protecting access to high-quality, mission-driven care.

Dying with dignity - personal perspective: The sacred ending we don’t talk about enough. Psychology Today; by Cynthia Chen-Joea DO, MPH, FAAFP, DABOM; 12/24/25 In the U.S., we spend enormous amounts of energy keeping people alive, curing, fixing, and prolonging life at all costs. What we rarely talk about is how people die. And more importantly, how poorly our system supports them when the end is clearly approaching. ... [Background story about her dad's Parkinson's and eventual death] ... Then came our request for hospice. After an evaluation, we were told he didn’t “qualify” because he had gained some weight and his albumin levels were “too high.” An arbitrary checklist, based on labs values, prevented him from getting into hospice. [Keep reading] So we tried for palliative care instead. I made call after call, only to be bounced between departments, many unclear on the difference between hospice and palliative care, ... Even as a physician, I was stunned by how many barriers we encountered simply trying to do the most humane thing: to advocate for dignity, comfort, and respect at the end of my father’s life.

Hospice: Care, commerce, and the cost of a separate category The Pine Belt News, Hattiesburg, MS; by Cathy Eaker; 1/5/26 Hospice care is often presented as a compassionate alternative to aggressive medicine—a gentler path that prioritizes comfort, dignity, and peace at the end of life. In theory, it is a humane model. In practice, hospice exists at the intersection of care and commerce, and that intersection deserves far more scrutiny than it receives. ... That does not mean hospice nurses, aides, social workers, or chaplains are unethical. Quite the opposite. Most of the people providing hands-on hospice care have good hearts. They care deeply. They show up. They bathe patients gently, sit at bedsides, hold hands, and witness grief with humanity. The problem is not the caregivers—it is the structure they work within. ...

Fourth temporary extension of COVID-19 telemedicine flexibilities for prescription of controlled medications Federal Register - The Daily Journal of the United States Government; A Rule by the Drug Enforcement Administration and the Health and Human Services Department on 12/31/2025 AGENCY: Drug Enforcement Administration, Department of Justice; Substance Abuse and Mental Health Services Administration, Department of Health and Human Services. ACTION: Temporary rule. SUMMARY: The Drug Enforcement Administration (DEA) jointly with the Department of Health and Human Services (HHS) is issuing a fourth extension of telemedicine flexibilities for the prescribing of controlled medications through December 31, 2026. DATES: This rule is effective January 1, 2026 through December 31, 2026.

Hospice care for medicaid cancer patients in Puerto Rico: implications on healthcare costs and utilization JNCI Cancer Spectrum; by Karen J Ortiz-Ortiz, Marjorie Vázquez-Roldán, Axel Gierbolini-Bermúdez, María Ramos-Fernández, Carlos R Torres-Cintrón, Yisel Pagán-Santana, Tonatiuh Suárez-Ramos, Kalyani Sonawane; 12/27/25 Online ahead of print Background: ... In Puerto Rico, Medicaid had no provisions for hospice care until July 2024, representing a significant public health challenge. This study examined the association between hospice coverage policy and EoL outcomes among patients with cancer enrolled in Medicaid.Conclusion: Hospice enrollment among Medicaid enrollees was associated with lower health expenditure, lower healthcare resource utilization, and a lower likelihood of mortality in an acute setting. The recent policy change to include hospice services coverage in Puerto Rico Medicaid is a positive step that must be sustained beyond 2027.

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.

Artificial Intelligence at CMSCMS webpage; 12/19/25At CMS, Artificial Intelligence (AI) has the power to reshape the way we use data to make decisions. Given CMS' vast data resources, we have an unprecedented opportunity to drive innovation, boost productivity, and enhance service delivery through AI. This website conveys CMS' resolve to strategically leverage AI in alignment with Federal and agency values.

Countdown to 2026: New Year changes in telehealth impacting Medicare providersJD Supra; by Christopher Guthrie, Kenya Hagans, Shamika Mazyck, Aaron Sagedahl, Quarles & Brady LLP; 12/16/25 The manner in which services are provided via telehealth has the potential to look very different for healthcare providers—particularly those providing services to Medicare patients—in 2026. ...

Long-term hospice stay: New edit to prevent overpayment CMS - MLN Matters - Medicare Learning Network; by the U.S. Department of Health & Human Services; 12/5/25Related CR Release Date: December 5, 2025Effective Date: April 1, 2026Implementation Date: April 6, 2026Action Needed: Make sure your billing staff knows about a new edit that will help identify and prevent overpayments of long-term hospice care for claims submitted with matching “admission” and “from” dates.Key Updates: This new edit in the CWF will close the gap in the system that allows claims to pay at a higher rate when the “admission” and “from” dates match. MACs will reject hospice claims when the “admission” date doesn’t match the election period start date on the corresponding election period. ...

Trinity Health’s COO on getting a PACE program up and running Modern Healthcare; by Diane Eastabrook; 12/11/25 Anne Lewis calls Programs of All-Inclusive Care for the Elderly one of the “best-kept secrets” to containing rising costs for health systems. As chief operating officer of Trinity Health PACE, Lewis is helping the nonprofit Catholic health system expand the federal-state program that is expensive to launch and can take a few years to turn a profit. The program provides home care, prescriptions, meals and transportation for mostly Medicare-Medicaid dual-eligible older adults who can receive nursing home-level care in their homes.

The Medicare Advantage question hospitals want answered Becker's Hospital Review; by Alan Condon; 12/4/25 With Medicare Advantage enrollment approaching 55% of eligible beneficiaries, health systems across the country are grappling with a question that’s gone largely unaddressed in policy circles: What happens if the healthcare providers best equipped to care for seniors can no longer afford to participate?