The U.S. Centers for Medicare & Medicaid Services (CMS) has made public its first cohort for the hospice Special Focus Program (SFP). 

Finalized in the 2024 home health payment rule, the program is designed to identify poor performing hospices, mandate quality improvement and in some cases impose additional penalties. However, stakeholders in the hospice space have contended that the agency’s methodology for selecting hospices for the program is deeply flawed.

For this reason, they have argued that the list of operators should not be made public. Though CMS published the list, it delayed the release of a second that would point to future candidates for the program.

“CMS has also generated a list of future SFP candidates. We are not publishing the candidate list at this time, but we are sharing the underlying data used to create both lists to allow for external review, thereby ensuring transparency in the process by which low-performing hospices are identified,” the agency indicated on its website. “We will continue to work with providers, patients and their families, and industry, to improve hospice care across the nation.”

Stakeholders applauded the delay, including the National Alliance for Care at Home (the Alliance).

“The Alliance remains committed to improving the Hospice Special Focus Program to hold providers accountable while promoting meaningful quality improvement,” Alliance CEO Dr. Steven Landers said in a statement emailed to Hospice News. “We look forward to working with the new administration and the 119th Congress on refining the hospice evaluation system to ensure it is based on reliable and complete data, ultimately protecting access to the highest-quality care wherever patients call home.”

The SFP was among the requirements established by the Consolidated Appropriations Act of 2021. Congress included the language in response to July 2019 reports on hospice quality from the Office of the Inspector General (OIG) at the U.S. Department of Health and Human Services (HHS). CMS expects that implementation of these proposals would cost an estimated $5.5 million annually.

The SFP would have the power to impose enforcement remedies against hospices with poor performance on regulatory or accreditation surveys. Hospices flagged by the SFP would be surveyed every six months rather than the current three-year cycle.

The program would have the authority to impose fines, suspend reimbursement, appoint temporary management to bring the hospice into compliance or revoke a provider’s Medicare certification altogether.

While the hospice community has been supportive of the SFP in concept, concerns have mounted about the algorithm the agency will use to identify hospices for the program, which would purportedly be the lowest 10% of hospices in terms of quality, based on surveys and other metrics.

Members of Congress have also voiced concerns about the implementation of the SFP, but to date CMS has not responded to their inquiries.

“I’m frustrated that CMS is ignoring our bipartisan concerns about the Hospice Special Focus Program,” Rep. Beth Van Duyne (R-Texas) 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.”