Literature Review

A proposal to remove hospice providers from a state review poses a threat to patient care The Boston Globe, Boston, MA; by Diana Franchitto; 5/16/25 The General Assembly should maintain rigorous standards and oppose rolling back Rhode Island’s Certificate of Need process, writes HopeHealth president and CEO. ... As the president and CEO of HopeHealth Hospice & Palliative Care, I am proud that Rhode Island offers some of the highest-quality hospice care in the nation. But right now, legislation before the General Assembly could put that quality at risk.A proposal in Governor Dan McKee‘s fiscal 2026 budget would eliminate the requirement that hospice providers be scrutinized by Rhode Island’s Certificate of Need (CON) process. Some may position this as an effort to streamline government, but those of us who work in hospice care know better. The CON process isn’t one of the flashier, public-facing functions of state government, but it has a direct impact on the quality of health and hospice care that Rhode Islanders receive throughout their lives. ... Exempting hospice from meeting the rigorous standards that a CON requires poses an immediate threat to the quality of patient care. ...

Medicaid hospice payments for room-and-board to resume in California Hospice News; by Jim Parker; 5/15/25 After years of nonpayment, the California Department of Health Care Services (DHCS) has instructed Medicaid managed care plans to pay hospices for nursing home room and board. The issue pertains to patients who are dually eligible for Medicare and Medicaid. When caring for patients in nursing homes, hospices typically pay for their room and board with the expectation that they will be reimbursed by Medicaid for those expenses. However, due to confusion among managed care plans that oversee Medicaid in most states, those hospices have not been receiving those payments.

Dementia patient discharged from hospice over Medicare requirement. Here’s why it happened WKMG-6, Deltona, FL; by Erika Briguglio and Louis Bolden; 5/14/25A Volusia County family is left scrambling after their loved one is abruptly dropped from hospice care. To qualify for hospice, patients must have a life expectancy of six months or less. However, for dementia patients, the prognosis can be unpredictable. Hospice care can be extended as long as the patient continues to meet Medicare requirements. Unfortunately, these requirements are why Amy Yates lost coverage for her 91-year-old grandmother. ... “I think it’s she hasn’t died fast enough, and it’s costing them money that they don’t want to spend,” Yates told News 6. ... What Yates’ family is dealing with is what Medicare calls live discharge, and they are not alone. The Hospice Foundation of America reports that 17% of people in 2022 who were admitted to hospice care were discharged; about 6% of the total caseload was discharged because they no longer met Medicare requirements for care under the hospice benefit.Editor's note: What are your hospice stats for live discharges? For Length of Stay (LOS)? This factor--with the face-to-face recertification requirement--is crucial. Unfortunately, many hospices misused President Jimmy Carter's extraordinarily long LOS with misleading information about hospice care. They watered down "end-of-life" care and never mentioned anything about a basic recertification process. Warm, user-friendly language can be used with integrity, authenticity, and patient/caregiver support.

New York bill aims to ban new for-profit hospices amid fraud concerns CBS WRGB-6, Albany, NY; by Lara Bryn; 5/14/25 A new bill awaiting the governor's signature could ban the establishment of new for-profit hospices in New York, a move lawmakers and industry experts say is necessary to improve care quality and prevent potential fraud. ... The bill has already passed in both the state Senate and House. The push for this legislation comes in part due to findings from national studies by the American Medical Association and ProPublica, which highlighted issues in for-profit hospice care. ... Jeanne Chirico, CEO of the Hospice and Palliative Care Association of New York State, said, "To try and make a quick turnaround of profit either through falsifying eligibility records or by fraudulently submitting records for individuals who never even knew they were on hospice." Chirico noted a case where a New York Medicare recipient was unknowingly enrolled in a hospice-certified program based in California. 

Downside risk, upside payment highlight new CMS innovation agendaModern Healthcare; by Bridget Early; 5/13/25The Centers for Medicare and Medicaid Services is rolling out a broad new agenda for its innovation center that could lead to requirements that participants in value-based care programs to take on downside risk, the agency announced ... The Center for Medicare and Medicaid Innovation plan prioritizes shared risk and prospective payments, streamlined quality measurement, artificial intelligence and other technologies, and Medicare Advantage payment models, Director Abe Sutton said in an interview Friday [5/9]. Notably, CMS is walking away from a goal set four years ago to have all fee-for-service Medicare beneficiaries under accountable care arrangements by 2030, Sutton said. CMS provided Modern Healthcare an advance look at the new innovation center platform. ... Designing models that require providers to accept at least some downside risk could be the most consequential action stemming from the plan. Subjecting participants to potential financial losses, not just potential benefits, is key to driving cost savings and quality improvement, Sutton said.

National Alliance: Medicaid cuts would adversely impact home-, community-based services Hospice News; by Jim Parker; 5/12/25 A tax bill currently before Congress could lead to Medicaid cuts that would inhibit access to home- and community-based services (HCBS). The bill, which promises sweeping tax and spending cuts, currently is undergoing a reconciliation process. The amount of tax cuts could reach $4.5 trillion, with spending cuts in the area of $4.5 billion, with a significant portion coming from Medicaid. However, the bill remains a work in progress for now with some resistance to the proposed cuts from both Democrats and a contingent of Republicans. The National Alliance for Care at Home released a statement Monday opposing the Medicaid reductions.

CMS Proposed Rules and Comment Deadlines HealthIT Answers; by HHS/ONC/CMS Communications; 5/5/25 Center for Medicare & Medicaid Services have issued the following proposed rules and have opened comment periods.

Courts diverge in challenges to CMS's minimum staffing requirements for LTC facilities JD Supra; by Kayla Stachniak Kaplan, Scott Memmott, Sydney Menack, Jonathan York, Howard Young; 4/30/25On May 10, 2024, the Centers for Medicare and Medicaid Services (CMS) published its Final Rule to implement minimum staffing standards for long-term care (LTC) facilities in the United States. However, as discussed in our prior blog post, the Final Rule was immediately challenged under the Administrative Procedure Act (APA) in two major lawsuits. These cases have resulted in divergent rulings, injecting more uncertainty across the LTC industry about the future of the application and validity of the Final Rule. ... This and further developments in these cases will have significant impact on the future of CMS’s oversight of the country’s nursing homes.

Administration to close HHS Civil Rights office Newsmax; by Brian Freeman; 4/28/25 As part of massive cutbacks at the Department of Health and Human Services, the Centers for Medicare & Medicaid Services will shut down their civil rights office in June, according to an email sent to staff on Monday and viewed by Politico. HHS has already been reduced by some 20% as part of overall downsizing, with Secretary Robert F. Kennedy Jr. and President Donald Trump focusing on eliminating those programs and agencies they say promote diversity, equity, and inclusion. ... Complaints that are nearing completion connected to workplace harassment and discrimination will be closed out in the coming weeks, and remaining complaints will be "transferred to an appropriate entity," the email stated.Editor's note: Data from the 2024 NHPCO Facts and Figures Report states: "In CY 2022, 51.6% of White Medicare decedents used the Medicare Hospice Benefit. 38.1% of Asian American Medicare decedents and 37.4% of Black Medicare decedents enrolled in hospice. 38.3% of Hispanic and 37.1% of North American Native Medicare decedents used hospice in 2022." The discrepancies between white and non-white decedents demonstrate double-digit differences. Extensive evidence-based research validates wide gaps in hospice/healthcare for persons whom the HHS Civil Rights office is charged with protecting. For more, visit Office of Civi Rights Home | HHS.gov and Office of Civil Rights About Us. 

Trends, patterns, and key comparisons related to new Medicare Hospice Provider Enrollments may indicate the need for further oversight HHS Office of Inspector General; 4/29/25 Federal requirements state that hospices must be certified by CMS and be licensed as required by State and local law. Medicare also requires that hospices meet its Conditions of Participation to receive payment. Our objective is to identify trends, patterns, and key comparisons that indicate potential vulnerabilities related to new Medicare hospice provider enrollments. The data brief may help CMS evaluate the need for additional monitoring and program integrity efforts to ensure that hospices meet all the requirements. ... 

Health sector answers Trump's call for deregulation ideas Modern Healthcare; by Bridget Early; 4/29/25 The Trump administration wants the healthcare industry to recommend rules and regulations to toss. Trade groups representing hospitals, health insurance companies and others have ideas. The White House, the Centers for Medicare and Medicaid Services and other parts of the federal government are seeking suggestions to guide President Donald Trump's campaign to radically restructure and diminish the federal government. ... CMS included a request for information in Medicare payment rules the agency proposed this month. Comments are due June 10.

Accountable Care Organizations join forces to protect critical Medicare programs Home Health Care News; by Audrie Martin; 4/23/25 A group of accountable care organizations (ACOs) have joined forces to advocate for the expansion of high-needs care models that improve outcomes and reduce costs for Medicare’s most vulnerable patients. The newly-formed Complex Care Alliance has taken a stand, urging the Centers for Medicare and Medicaid Services (CMS) to extend crucial Medicare initiatives beyond their slated 2026 expiration. On Tuesday [4/22], home-based primary care provider HarmonyCares announced its partnership with the Complex Care Alliance, expressing its support for the High-Needs ACO model, which helps provide care for Medicare’s sickest patients.