CMS: Concurrent Hospice Care Improves Quality, Reduces Costs

Allowing patients to receive concurrent hospice and curative care reduces health care costs and improves quality. The U.S. Centers for Medicare & Medicaid Services (CMS) has released its fifth and final report on the Medicare Care Choices Model (MCCM), which studied the effects of allowing individuals to receive hospice care without foregoing other treatments.  The […]

[UPDATED] CMS Finalizes Hospice Special Focus Program, 36-Month Rule

The U.S. Centers for Medicare & Medicaid Services (CMS) has finalized its 2024 home health rule, including the implementation of a hospice Special Focus Program (SFP). The rule also finalizes the proposed “36-month”rule for hospice providers. The requirement mirrors a regulation that has existed for several years for home health agencies. The final rule forbids […]

Building a ‘More Person-Centered Health System’: Palliative Care in Value-Based Models

Forthcoming Medicare payment models will likely focus on disease-specific programs that bear similarities to palliative care. Emerging reimbursement demonstrations have placed a stronger emphasis on addressing a more diverse group of patients with high levels of care needs and complex health trajectories. Examples include the Value-Based Insurance Design (VBID) demonstration, the Accountable Care Organization Realizing […]

How CMS’ 2024 Risk Adjustment Rules May Affect Palliative Care Companies

Depending on how stakeholders play their cards, the U.S. Centers for Medicare & Medicaid Services’ (CMS) updated risk adjustment policy could lead to tightened belts — or a golden opportunity — for palliative care providers in Medicare Advantage. Much of the palliative care delivered to U.S. patients is now reimbursed through risk-based models like Medicare […]

The First Year of Hospice VBID Is the Hardest for Payers and Providers

Implementation of the Medicare Advantage hospice carve-in has been challenging for both payers and providers, though a recent analysis indicates that it may get easier over time. The U.S Centers for Medicare & Medicaid Services (CMS) commissioned the RAND Corp. to conduct the analysis of the program, formally called the hospice component of the value-based […]

Understanding CMS’ Civil Monetary Penalties for Hospices

The U.S. Centers for Medicare & Medicaid Services (CMS) has been gradually implementing changes to the hospice survey process and enforcement remedies, including civil monetary penalties in some instances. Congress approved the survey changes and enforcement actions through the Consolidated Appropriations Act of 2021, which incorporated language from the Helping Our Senior Population in Comfort […]

Health Plan Participation in Hospice VBID to Shrink in 2024

Health plan participation in the hospice component of the value-based insurance design model (VBID) will fall in 2024. For calendar year 2024, 13 Medicare Advantage Organizations (MAOs) will participate in the program’s hospice component, providing coverage through 78 health plans in 19 states. In 2023, 15 MAOs participated in hospice VBID, including 119 health plans […]

NHPCO Voices Support for CMS’ 36-Month Rule, Program Integrity Actions

The U.S. Centers for Medicare & Medicaid Services (CMS) is on the right track with several new rules designed to improve hospice program integrity, but some could use some fine-tuning, according to the National Hospice and Palliative Care Organization (NHPCO). The hospice advocacy group today issued public comments on CMS’s proposed home health rule for […]

The Strategy Behind CMS’ 2024 Updates to ACO REACH

Three principles are guiding the U.S. Centers for Medicare & Medicaid Services’ (CMS) 2024 updates to the Accountable Care Organization Realizing Equity, Access and Community Health (ACO REACH) model: care coordination, managing health equity-related risks and social determinants of health. Among a number of new requirements, the agency will also require participating organizations to develop […]

CMS: Nearly 400 Hospices Considered for ‘Administrative Action’ as Program Integrity Efforts Heat Up

The U.S. Centers for Medicare & Medicaid Services (CMS) is considering administrative action against 400 hospices, which could include revocation of their Medicare certification. The agency has been mobilizing against hospice fraud this year. In addition to new regulations and updated survey processes, CMS has been conducting unannounced onsite visits. To date, CMS personnel have […]