Hospice Advocates: Better Solutions Needed for Non-Hospice Spending

The proposed 2.4% hospice payment rate increase is insufficient, and the U.S. Centers for Medicare & Medicaid Services (CMS) should reconsider regulatory changes the agency is currently mulling, according to the National Partnership for Healthcare and Hospice Innovation (NPHI).

Meanwhile, the hospice and home health tech company Axxess has raised questions about telehealth utilization and the way information is presented on CMS’ Care Compare website.

The payment increase does not keep up with rising costs of care, a competitive labor market or inflation, NPHI contended.

“While CMS proposed a 2.4% hospice payment update for FY 2027, NPHI emphasized that many nonprofit hospice providers continue to operate on exceptionally narrow margins while caring for a disproportionate share of patients with complex medical and social needs,” the organization indicated in a statement shared with Hospice News. “NPHI encouraged CMS to pursue future payment reforms that better align reimbursement with patient acuity and resource utilization.”

Another key issue addressed in NPHI’s comments includes provisions related to non-hospice spending.

Non-hospice spending refers to health care services excluded from the Medicare Hospice Benefit because they are unrelated to a patient’s terminal diagnosis. These services are billed by other Medicare providers rather than hospices, meaning hospice organizations may not know that the claims exist.

One component of this is CMS’ proposed Service and Spending Variation Index (SSVI) would use a scoring system based on nine claims-based measures that capture various aspects of hospice utilization and non-hospice spending. CMS said the index is intended to identify hospices that may warrant greater transparency and regulatory oversight.

NPHI urged CMS to provide hospices with patient-specific claims data, enhance coordination among Medicare Parts A, B and D, and defer implementation of non-hospice spending measures until providers are equipped to evaluate and respond to the underlying drivers of spending.

The organization said several SSVI measures should be adjusted to better capture the influence of patient choice, local market factors, facility-based care needs and individualized care planning.

NPHI also took issue with the CMS proposal to require hospices to provide all patients with an addendum to the election statement, saying it would create undue burden on providers and be of “limited value” to patients and families. Currently, hospices are mandated to supply this information only upon request.

“NPHI supports thoughtful program integrity solutions that protect beneficiaries and taxpayer dollars,” NPHI CEO Tom Koutsoumpas said in a statement. “However, new requirements should be carefully evaluated to ensure they meaningfully benefit patients and do not unnecessarily divert resources away from direct patient care.”

In its own comments on the proposed rule, Axxess sought greater clarity around the ways hospices can use telehealth for physician or nurse practitioner face-to-face recertification encounters. This is a pandemic-era regulatory flexibility that is currently in place through Dec. 31, 2027.

Axxess noted that CMS is implementing provisions from the Consolidated Appropriations Act of 2026 that would restrict the use of telehealth for hospice face-to-face (F2F) recertification encounters beginning Jan. 31, 2026, under certain circumstances. This includes markets that are under a targeted or regional moratorium.

Though the agency has currently implemented a six-month moratorium on hospice and home health Medicare enrollment, CMS has indicated that these telehealth encounters remain permissible. However, the discrepancy with the statue could create confusion, according to Axxess.

“MACs and audit contractors may issue claim denials creating confusion and the need for providers to resubmit claims for otherwise compliant payments,” Axxess said in its comments. “Clarification is needed that the use of telehealth for hospice face-to-face recertification encounters applies only when the individual is located in an area subject to a regional, state-, or county-specific moratorium, rather than the nationwide moratorium.”

Axxess also contended that a proposed Care Compare icon indicating non-compliance with Hospice Outcomes and Patient Evaluation (HOPE) tool reporting requirements. The company said in its comments that the icon would not provide meaningful information to patients and families and could have adverse consequences.

“From a consumer perspective, an icon signaling non-compliance may be misinterpreted as an indicator of poor quality or unsafe care, when instead it reflects administrative submission timing that is largely invisible to patients and caregivers,” Axxess noted in its comments. “The proposed icon may mislead rather than inform consumer decision-making and undermine the purpose of Care Compare as a patient-centered quality resource.”