The U.S. Centers for Medicare & Medicaid Services (CMS) has not responded to congressional concerns about the hospice Special Focus Program (SFP).

Set for 2025 implementation, the SFP promises to identify hospices delivering poor quality care and target them for improvement remedies. However, many stakeholders, including members of Congress and hospice industry groups, have contended that the algorithm the agency plans to use to identify those hospices is deeply flawed. 

Four members of Congress led by Reps. Beth Van Duyne (R-Texas) and Earl Blumenauer (D-Oregon) have called for changes to the SFP. In Oct. 2023, they and Reps. Jimmy Panetta (D-California) and Brad Wenstrup (R-Ohio) wrote to CMS Administrator Chiquita Brooks-LaSure and White House Office of Management and Budget Director Shalanda Young. 

The four lawmakers suggested in the letter that the SFP, as currently designed, would not adequately identify poor performing hospices in need of the program. To date, CMS has not responded.

“I’m frustrated that CMS is ignoring our bipartisan concerns about the Hospice Special Focus Program,” Rep. Van Duyne told Hospice News in an email. “Vulnerable families rely on trusted hospice providers, and pushing forward with flawed data could unfairly harm them. This isn’t just about numbers — it’s about real people. I’ll continue fighting to ensure families have access to the high-quality care they deserve and that CMS fixes these issues.”

CMS did not respond to Hospice News inquiries.

Congress mandated the SFP in the Consolidated Appropriations Act of 2021, which contained language from the Helping Our Senior Population in Comfort Environments (HOSPICE) Act. The SFP program was developed in response to July 2019 reports on hospice quality from the Office of the Inspector General (OIG) in the U.S. Department of Health and Human Services (HHS).

It would have the authority to impose enforcement remedies against hospices with poor performance on regulatory or accreditation surveys, the HCI and CAHPS scores. Hospices flagged by the SFP would be surveyed every six months rather than the current three-year cycle.

Among the potential enforcement actions for the SFP are monetary fines, suspended reimbursement, appointment of temporary management to bring the hospice into compliance or revocation of a provider’s Medicare certification.

In their 2023 letter, the Congress members focused on four main concerns:

• The program would rely heavily on survey results, yet CMS has an extensive backlog for those inspections. Nearly 40% of hospices have not been surveyed within the three year timeframe, the agency reported.
• The algorithm that CMS plans to use to identify hospices for the SFP would “disproportionately disadvantage” larger hospices and fail to capture poor performers, the four legislators indicated in the letter.
• The proposed methodology places too much emphasis on data from the Hospice Care Index (HCI) and the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys data, because large numbers of hospices do not report that information.
• CMS has updated its processes for hospice surveyor training, but it remains unclear whether, at this point, a sufficient number of those personnel have received that education.

“We are committed to ensuring that the HOSPICE Act is implemented in a manner that aligns with congressional intent to improve the quality of care delivered to Medicare beneficiaries nearing the end of life,” the legislators wrote in the letter. “Unfortunately, we believe the design for the Hospice Special Focus Program (SFP) that the Centers for Medicare & Medicaid Services’ (CMS) proposed in its Calendar Year 2024 Home Health Prospective Payment System Proposed Rule (CMS-1780-P) would, if finalized, not adequately identify hospices that are truly struggling with performance.”