The U.S. Centers for Medicare & Medicaid Services (CMS) recently unveiled a new payment model demonstration designed to lower medication costs and improve outcomes among Medicaid beneficiaries, including seriously ill patient populations. Through the new Generating Cost Reductions (GENEROUS) model, pharmaceutical manufacturers will provide reduced supplemental rebates on drugs to participating state Medicaid programs. Recently […]
The U.S. Centers for Medicare & Medicaid Services (CMS) has introduced a new $50 billion federal program designed to build more sustainable rural health care systems and improve outcomes. The Rural Health Transformation Program was created under the Working Families Tax Cuts Act and funding was authorized by the recently approved One Big Beautiful Bill […]
The. U.S. Centers for Medicare & Medicaid Services (CMS) has introduced a new shared savings cost containment demonstration. The Wasteful and Inappropriate Service Reduction (WISeR) Model is incentivizing the utilization of technology to help improve outcomes and curb fraud, waste and abuse in Medicare reimbursement. The WISeR Model is designed to leverage artificial intelligence (AI) […]
The U.S. Centers for Medicare & Medicaid Services (CMS) is strengthening regulatory oversight of certain state-based and pediatric programs in an effort to reduce redundant spending. CMS recently released an analysis of 2024 beneficiary enrollment data, which found that 2.8 million individuals were simultaneously enrolled in Medicaid, Children’s Health Insurance Program (CHIP) or the subsidized […]
The U.S. Centers for Medicare & Medicaid Services (CMS) recently unveiled its 2026 proposed physician fee schedule. The proposed rule introduced a new payment model designed to improve care for patients with chronic conditions. Hospices have long sought to reach terminally ill patients upstream in their disease trajectories to end-of-life experiences. CMS’ proposed physician fee […]
A joint effort by several federal agencies has resulted in the capture of parties responsible for, in aggregate, more than $14.6 billion in health care fraud. The U.S. Department of Justice (DOJ) coordinated the 2025 National Health Care Fraud Takedown in concert with the FBI, the U.S. Drug Enforcement Administration (DEA), several U.S. Attorney’s offices […]
The U.S. Centers for Medicare & Medicaid Services (CMS) Administrator Dr. Mehmet Oz has issued a public announcement warning against the most common tactics being employed by fraudulent hospice operators. Program integrity concerns heating up in the hospice space in recent years have regulators increasingly seeking avenues to safeguard patients and their families against unscrupulous […]
The U.S. Centers for Medicare & Medicaid Services’ (CMS) Innovation Center is overhauling its Kidney Care Choices (KCC) payment model. Consequently, palliative care providers could see new payment pathways in certain geographic regions. CMS is revising the financial methodology and participation options of the KCC Model while also extending its duration and geographic reach. Sunsetting […]
The Center for Medicare and Medicaid Innovation (CMMI) will implement a new, three-pronged strategic direction aimed at improving access and outcomes while reducing health care costs. More seriously ill individuals are living longer with multiple comorbidities, a trend that has increasingly overburdened and financially strained the health care system and families across the country, according […]
The U.S. Centers for Medicare & Medicaid Services (CMS) on Friday announced its proposed 2026 hospice payment rule, which includes a 2.4% base rate increase alongside changes to quality reporting measures. The increase represents an estimated $695 million rise in total hospice payments for Fiscal Year (FY) 2026. It is also lower than the 2.9% […]
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