Literature Review

Providers, advocates ask Senate to reject $700M in Medicaid cuts, Congress to save OAA programs McKnights Senior Living; by Kathleen Steele Gaivin; 5/27/25Providers and advocates for older adults are counting on the Senate to reject a portion of the proposed federal budget that would gut $700 million from the Medicaid program. Members of the House of Representatives passed their version of the bill late Wednesday. ... Home care advocates ANCOR and the National Alliance for Care at Home on Thursday also called on the Senate to reject the House-passed cuts to Medicaid.

‘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. 

Trump 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 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.

The ‘price’ of value-based care McKnights Long-Term Care News; by Micahel Wasserman; 5/14/25 The term “value-based care” is tossed around like a political football among healthcare policy makers. Nowhere is the meaning of this so variable as in nursing homes. The Nursing Home Value-Based Purchasing Demonstration project, completed over a decade ago, was not found to lower spending or improve quality. Webster’s Dictionary defines value as “the monetary worth of something,” “a fair return or equivalent in goods, services, or money for something exchanged” and “relative worth, utility or importance.” The government used performance measures such as hospitalization rates and quality measures as a proxy for value. Shouldn’t we be asking how clinicians, patients and their families define value?

Congress offers new plan for Medicaid cuts, raising fresh concerns among HCBS advocates McKnights Home Care; by Adam Healy; 5/13/25 House Republicans on Sunday [5/11] introduced a new budget reconciliation that outlines exactly how Medicaid cuts could take shape. Home- and community-based services advocates quickly spoke out in opposition to the bill. [Various leaders responded.]

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. 

CMS releases HOPE Guidance Manual (V. 1.01) and TablesCenters for Medicare and Medicaid Services (CMS); by CMS; 4/22/25On April 22, 2025, CMS released the HOPE Guidance Manual (V. 1.01) and connected tables. Providers can use v1.01 for HOPE planning, as this is considered final before HOPE implementation. Also note that earlier this month, the final HOPE data specs have also been released, helping software developers to finalize their HOPE software for testing in the coming months.

CMS to withdraw federal Medicaid match for workforce, social needs, and infrastructure: What states, health care providers and community organizations need to know Mondaq; by Sheppard Mullin Richter & Hampton; 4/22/25 In a move signaling a major shift in federal priorities, the Centers for Medicare & Medicaid Services ("CMS") recently announced it will limit federal funding for state Medicaid initiatives that support services beyond direct medical care. New policy guidance indicates that CMS intends to narrow the scope of the federal-state Medicaid partnership, refocusing matching funds on core healthcare services delivered to Medicaid beneficiaries. ... On April 10, CMS notified states that it will no longer approve new, or renew existing, state proposals for Section 1115(a) Demonstration Project expenditure authority to provide federal matching funds for state expenditures for designated state health programs ("DSHP") and designated state investment programs ("DSIP").

American Oncology Network achieves success in first performance period of CMMI’s enhancing oncology model Stock Titan, Globe Newswire, Fort Myers, FL; 4/22/25 American Oncology Network (AON), one of the nation’s fastest-growing community oncology networks, today announced strong results from the first performance period in the Centers for Medicare & Medicaid Innovation’s (CMMI) Enhancing Oncology Model (EOM). AON practices participating in the program—in collaboration with value-based cancer care enabler Thyme Care—achieved nearly $6M in cost savings for the Centers for Medicare & Medicaid Services (CMS). AON also earned a performance-based payment while improving patient experience and outcomes.

Supreme Court hears ‘crucial’ case today on free preventive health care KFF Health News; 4/21/25 The lawsuit, Kennedy v. Braidwood Management, could have far-reaching consequences for the health coverage of tens of millions of Americans. A ruling is expected in June. ... The Supreme Court on Monday is set to hear arguments in a case challenging a provision of the Affordable Care Act that requires private insurers to cover health care screenings, tests and checkups for free. Experts say the court’s ruling in the case, called Kennedy v. Braidwood Management, could have sweeping consequences for patient access to preventive health care across the United States.

HHS cuts pose threat to older Americans' health and safety Newsweek; by Kristin Lees Haggerty and Scott Bane - The National Collaboratory to Address Elder Mistreatment at Education Development Center (EDC); The John A. Hartford Foundation; 4/17/2 On March 27, 2025, the federal government announced major cuts to the department of Health and Human Services (HHS). ... Sounding the Alarm for Elder Justice: The population of older adults is rapidly growing, and one in 10 experience abuse, neglect, and/or exploitation—a risk that is even higher for those living with dementia. ... Cutting services to older adults will increase these risks and costs. Moreover, ... 11.5 million family and friend caregivers provide over 80 percent of help needed for people living with dementia in the U.S. Without access to services like Meal on Wheels, adult day care, and respite care, we can expect caregiver burden and strain to increase significantly and with it, rates of elder abuse, emergency department visits, hospitalizations, and nursing home placements. We know this because of the abuse spike seen clearly during the COVID-19 pandemic, which doubled to over 20 percent of older adults, as services were limited, and older adults were socially isolated. HHS cuts are also likely to result in loss of specialized expertise in identifying and addressing elder mistreatment, so that when elder abuse does occur, we won't have the services to stop it and make sure it won't happen again.