Volume 26.07 On May 20, 2026, the “Protecting Seniors and Stopping Fraudsters Act” (“ACT”) was introduced in the House of Representatives. The proposed legislation, if enacted, would provide: Increased survey frequency for newly enrolled hospices and home health...
Volume 26.06 Effective today, May 13, 2026, the U.S. Centers for Medicare & Medicaid Services (“CMS”) has issued a Notice and imposed a national six (6) month moratorium on the Medicare enrollment of hospices. Beginning on May 13, 2026, no new hospices will be...
Volume 26.05 The Hospice Care Accountability, Reform, and Enforcement Act (“Hospice Care Act”) has been reintroduced. The Hospice Care Act contains numerous program integrity provisions and payment reforms. It would establish new safeguards to prevent fraudulent...
Volume 26.03 On March 12, 2026, the Medicare Payment Advisory Commission (“MedPAC”) issued its March 2026 Report (“Report”) to Congress. The Report includes one recommendation, “For fiscal year 2027, the Congress should eliminate the update to the 2026 Medicare base...
Volume 26.02 The U.S. Centers for Medicare & Medicaid Services (“CMS”), as well as states are actively looking at efforts to strengthen program integrity across all Medicare and Medicaid programs, including hospice. Hospice providers should be preparing for...
Volume 26.01 The California Hospice and Palliative Care Association (“CHAPCA”) and The Health Group, LLC are jointly providing the CHAPCA Hospice Financial Administration Program, scheduled for March 24-25, 2026, at California State University Northridge (Los...
Volume 25.12 The New York Assembly passed legislation in December 2025 that would have prohibited the establishment of any new for-profit hospices in the State of New York; however, the legislation has been vetoed by the Governor due to low hospice utilization in New...
Volume 25.11 Over twenty percent (20%) of hospices are now being subjected to Medicare program repayments because of the aggregate payment limitation (“CAP”). Recently, we reported that the Office of Inspector General (“OIG”) determined that the Medicaid program...
Volume 25.10 Abt Global, working on behalf of the Centers for Medicare & Medicaid Services (“CMS”), hosted a panel of technical experts to discuss hospice wage index reform. Hospices have expressed concerns regarding the use of the hospital wage index for purposes...
Volume 25.10 The Office of Inspector General, Department of Health and Human Services (“OIG”) has completed its audit of all three hospice Medicare Administrative Contractors (“MACs”) regarding the calculation of hospice CAP liabilities and the collection of monies...
Volume 25.09 MedPAC’s September 2025 public meeting will be available via live webcast on Thursday, September 4th and Friday, September 5th. The sessions are as follows: Medicare payment operations and improving payment accuracy, Oversight needed to ensure Medicare’s...
Volume 25.08 On August 1, 2025, the Centers for Medicare & Medicaid Services (“CMS”) issued a final rule (CMS-1835-F) that updates Medicare hospice payment rates and the aggregate cap amount for fiscal year (FY) 2026, which begins on October 1, 2025, in accordance...
Volume 25.07 Many hospice providers request an Extended Repayment Schedule (“ERS”) to liquidate outstanding Medicare program liabilities, which are primarily the result of a CAP overpayment. If repaying the overpayment within thirty (30) days constitutes a hardship,...
Volume 25.06 The Health Group, LLC is pleased to announce that registrations are now being accepted for the 2025 Hospice Financial Administration Conference scheduled for October 16-17, 2025. The conference will be held at the Hilton Orlando Buena Vista Lake. In...
Volume 25.05 On Friday, April 11, 2025, the U.S. Centers for Medicare & Medicaid Services (“CMS”) released the Fiscal Year (FY) 2026 Hospice Wage Index and Payment Rate Update, Hospice Conditions of Participation Updates, and Hospice Quality Reporting Program...
Volume 25.04 The Full-Year Continuing Appropriations and Extension Act of 2025 (FY 2025) “ACT”), recently passed by Congress allows for the continuation of many programs. Telehealth flexibilities for hospice have been extended through September 30, 2025. Hospices...
Volume 25.03 Hospices must generally furnish all core hospice services themselves and not by independent contractors. However, hospices may furnish noncore services under arrangements with other providers or suppliers, including nursing facilities. When hospice...
Volume 25.02 Implementation of the highly controversial hospice Special Focus Program (“SFP”) has been suspended by the Trump Administration. SFP, which was part of the 2024 home health payment rule, was intended to identify poor performing hospices and effect...
Volume 25.01 All hospices that were certified on or before October 1, 2023, are required to submit a Self-Determined Hospice CAP (“SDHC” or “CAP”) Report on or before February 28, 2025. The CAP Report will generally cover claims for the period of October 1, 2023,...
Volume 24.16 Many hospices have experienced claim rejections resulting significant cash-flow disruptions because of reporting the certifying physician which did not match information in the Provider Enrollment, Chain and Ownership System (“PECOS”) Enrolled Physicians...
Volume 24.15 HOSPICE CARE ACT OF 2024 INTRODUCED On Wednesday, Representative Earl Blumenauer introduced legislation, the Hospice Care Accountability, Reform, and Enforcement Act (“Hospice CARE Act”), which represents what would be the most significant hospice...
Volume 24.14 The Centers for Medicare & Medicaid Services (“CMS”) has announced that prepayment medical review will be expanded in California, Arizona, Texas, and Nevada. The expansion will reach existing providers; however, a small sample of claims will be...
Volume 24.13 The drafted Hospice Care Accountability, Reform, and Enforcement Act (“Hospice Care Act”) would require the U.S. Department of Health and Human Services (“DHHS”) to impose a nationwide moratorium on the enrollment of hospice programs for a five (5) year...
Volume 24.12 On August 7, 2024, the Centers for Medicare & Medicaid Services (“CMS”) issued guidance regarding the termination of the VBID Hospice Component. The guidance is available at CY2024 VBID-Hospice Technical and Operational Guidance (cms.gov). The...
Volume 24.11 While the drafted Hospice Care Accountability, Reform, and Enforcement Act (“Hospice Care Act”) is generally regarded as a continuation of efforts to target bad actors operating in the hospice space, it would not only significantly impact negligent and...
Volume 24.10 The Hospice Care Accountability, Reform, and Enforcement Act of 2024 (“Hospice CARE Act of 2024”), currently in draft form, would eliminate coverage of certain aide and homemaker services. The draft legislation would make the following changes (changes...
Volume 24.09 The two largest organizations representing home care providers, the National Association for Home Care & Hospice (“NAHC”) and the National Hospice and Palliative Care Organization (“NHPCO”), signed an affiliation agreement on June 10th, 2024 Beginning...
Volume 24.08 Yesterday, Congressman Earl Blumenauer released a discussion draft of legislation that would, if enacted, substantially modify hospice enrollment, compliance, and Medicare payments. We will be making an extensive review of the draft that attempts to deal...
Volume 24.07 The Health Group, LLC has scheduled the 2024 Hospice Financial Administration Conference for September 30 – October 1, 2024. The two-day program will be held at the Hilton Phoenix Tapatio Cliffs Resort in Phoenix, Arizona. We have negotiated very...
Volume 24.06 Hospices that have and are currently participating in the VBID Model Hospice Benefit often inquire as to the impact on their aggregate payment limitation (“CAP”) caused by patients served through the VBID contract. VBID patients and the days the patient...
Volume 24.05 The 2024 Home Health Prospective Payment System (“HH PPS”) Rate Update final rule included a provision clarifying that the definition of a Managing Employee in 42 CFR §424.502 includes the administrator and medical director of a hospice. This change was...
Volume 24.04 LeadingAge, the National Association for Home Care & Hospice (“NAHC”), the National Hospice and Palliative Care Organization (“NHPCO”), and the National Partnership for Healthcare and Hospice Innovation (“NPHI”) have released their National Hospice...
Volume 24.03 In a stunning development, yesterday the U.S. Centers for Medicare & Medicaid Services (“CMS”) announced that the hospice component of the value-based insurance design model (“VBID”) will end on December 31, 2024. The hospice component was recently...
Volume 24.02 As a reminder, hospices must submit their self-determined CAP liability reports on or before February 29, 2024, for the 2023 CAP Year, which ended on September 30, 2023. If the report indicates a liability due to the Medicare program, the liability is to...
Volume 24.01 The U.S. Centers for Medicare and Medicaid Services (“CMS”) has released minor changes to the Hospice Cost & Data Report (“Cost Report”). The changes are as follows: The Cost Report now provides for indication that the filing is a no Medicare...
Volume 23.23 At the December meeting of the Medicare Payment Advisory Commission (“MedPAC”), the only recommendation presented was to eliminate the update to the 2024 Medicare hospice payment rates. A formal vote by MedPAC on the recommendation will occur at the...
Volume 23.22 Yesterday, CMS finalized the Home Health Prospective Payment System Rate Update which includes many provisions impacting hospices. The following provider enrollment regulations were finalized: § 424.502 Definitions. Revises the definition of managing...
Volume 23.21 CMS waived the requirement for hospices to use volunteers (42 CFR §418.78(e)) during the Public Health Emergency (“PHE”); however, the requirement is again effective January 1, 2024. Many hospices had difficulty complying with this requirement even...
Volume 23.20 Most healthcare providers are not eligible for Periodic Interim Payment (“PIP”) reimbursement; however, hospices are eligible. The beginning of a hospice’s fiscal year is the perfect time to request PIP reimbursement in lieu of being reimbursed as claims...
Volume 23.19 CMS has posted those plans that will be participating in the Medicare Advantage Value-Based Insurance Design Model in 2024, including those participating in the Hospice Benefit Component. There will be less Hospice Benefit Component participation in 2024...
Volume 23.18 The U.S. Centers for Medicare & Medicaid Services has updated Medicare hospice payment rates effective October 1, 2023. Although not consistent with Medicare payment rates, the rates are calculated based on established Medicare rates. Rates, subject...
Volume 23.17 Yesterday the Centers for Medicare and Medicaid Services (“CMS”) reported that nearly 400 hospices are being considered for potential administrative action. This is the result of site visits to numerous hospices. The site visits are the result of...
Volume 23.16 On July 28, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-1787-F) that updates Medicare hospice payments and the aggregate CAP amount for fiscal year (FY) 2024 in accordance with existing statutory and regulatory...
Volume 23.15 ]On July 20, 2023, CMS instructed the Medicare Administrative Contractors (“MACs”) to modify the calculation of hospice CAP liabilities for the 2022 CAP Year. The modified calculation will be made to appropriately apply sequestration for the 2022 CAP...
Volume 23.14 Effective today, July 13, 2023, CMS has placed new hospices, defined below, in a provisional period of enhanced oversight. A new hospice is defined as: A new enrollee in the Medicare program on or after July 13, 2023, A hospice submitting a change of...
Volume 23.13 We have been continuously reporting on the numerous hospice provider integrity measures being considered. CMS is now proposing as part of the Calendar Year (CY) 2024 Home Health (HH) Prospective Payment System Rate Update numerous hospice integrity...
Volume 23.12 In June 2023, the U.S. Department of Health and Human Services, Office of Inspector General (“OIG”) has added the “Audit of Selected, High-Risk Medicare Hospice General Inpatient Services” to the OIG Work Plan. According to the Work Plan addition, “GIP...
Volume 23.11 We previously reported on the OIG Report (2021) related to Palmetto GBA’s management of the hospice CAP report and overpayment collection activities. In that report, CMS identified CAP overpayments totaling $545,639 not collected and $17,513 of refunds...
Volume 23.10 Under the proposed hospice payment rule, payments to hospices for the year beginning October 1, 2023, will increase by only 2.8%. This increase in base rates, adjusted by geography, is not close to the overall increase in the cost of services being...
Volume 23.09 The Consolidated Appropriations Act (CAA) of 2021 authorized the Secretary of Health & Human Services to create a Special Focus Program (SFP) which aims to address issues that place hospice beneficiaries at risk for poor quality of care through...