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 […]

Hospice Advocacy Groups Call on CMS to Delay, Revise Special Focus Program

A coalition of industry groups has spoken out about the design of the U.S. Centers for Medicare & Medicaid Services (CMS) forthcoming Special Focus Program (SFP) for hospices. CMS initially pitched the idea in 2022 but instead convened a Technical Expert Panel (TEP) to further guide development. The TEP completed its work late last year, […]

CMS Proposed 2024 Physician Fee Schedule Introduces New Supports for Family Caregivers, Social Determinants

The U.S. Centers for Medicare & Medicaid Services (CMS) has proposed new pathways to support family caregivers for patients with serious illnesses. The agency’s 2024 physician fee schedule proposed rule contains a number of provisions related to caregiver assistance, health equity, interdisciplinary care and social determinants of health. “CMS is proposing coding and payment for […]

CMS: ACO REACH Will Change in 2024

The U.S. Centers for Medicare & Medicaid Services (CMS) is making significant changes in 2024 to the Accountable Care Organization Realizing Equity, Access and Community Health (ACO REACH) payment model. The updates include the introduction of a new approach to payment designed to enhance care delivery and care coordination for patients in underserved communities, according […]

CMS Unveils Dementia-Focused Payment Model with Interdisciplinary Care Approach

The U.S. Centers for Medicare & Medicaid Services (CMS) has unveiled a new payment model demonstration geared toward dementia-related illnesses, which are becoming more prevalent among hospice patients. The Guiding an Improved Dementia Experience (GUIDE) Model is designed to improve the quality of life for dementia patients and their caregivers by addressing behavioral health and […]

CMS Pilot to Conduct Medical Reviews of Hospice Stays Longer than 90 Days

The U.S. Centers for Medicare & Medicaid Services (CMS) is conducting a small pilot program for post-payment reviews of hospice stays that exceed 90 days. The agency has contracted with Noridian Healthcare Solutions, LLC as its Supplemental Medical Review Contractor (SMRC). Noridian will perform the reviews and submit findings to CMS. “CMS internal data has […]