Literature Review

RFK Jr. continues pioid Crisis PHE into its eighth year Inside Health Policy; by Dorothy Mills-Gregg; 3/19/25 HHS Secretary Robert F. Kennedy Jr. recently renewed the department’s longest ongoing public health emergency (PHE) first declared under the first Trump administration: the opioid abuse crisis. While the Centers for Disease Control and Prevention found a 25.5% decrease in overdose deaths in 2024 compared to the previous year, HHS says the opioid PHE needs to be renewed for another 90 days so federal coordination efforts can continue and key flexibilities for HHS will be preserved.Editor's note: How recently have you reviewed your Policies & Procedures for destroying drugs in the patient's home, upon death--in accordance with state laws? For staff education and accountability? For communicating this with family? For assessing possible drug diversion of opioids, with appropriate follow-up actions? Additionally, numerous hospice bereavement programs have been flooded with grief needs of bereaved family members from opioid deaths. Click here for the U.S. Department of Justice's Drug Enforcement Administration - Diversion Control Divsion; more focused, scroll down to their "Home Disposal Methods."

OIG Nursing Facility Compliance Program Guidance: Renewed focus on fraud and abuse McDermott Will & Emery, Chicago, IL; by Gregory E. Fosheim, Monica Wallace, Dexter Golinghorst, and Brigit Dunne; 3/11/25 The US Department of Health and Human Services Office of Inspector General’s (OIG’s) release of Nursing Facility Industry Segment-Specific Compliance Program Guidance (ICPG) for the first time since 2008 reemphasizes the importance of billing and coding and fraud and abuse compliance for nursing facilities and skilled nursing facilities (SNFs). This On the Subject is the second in a two-part series summarizing highlights of the Nursing Facility ICPG. This installment focuses on OIG’s recommendation that nursing facilities comply with existing billing rules and analyze referral source arrangements for compliance with fraud and abuse laws. [Click on the title's link for this significant information.]

HHS scraps transparency practices for policymaking Modern Healthcare; by Bridget Early; 2/28/25The Health and Human Services Department is abandoning a Nixon-era practice that offered transparency into federal policymaking in a move that limits the public and the healthcare sector's ability to influence government actions. Instead, HHS intends to comply with the bare-minimum requirements of the Administrative Procedures Act of 1946, or APA, and only engage in the traditional notice-and-comment process as expressly dictated by that law, Secretary Robert F. Kennedy Jr. wrote in a policy statement published Friday [2/27]. HHS had followed the now-defunct guidelines for 54 years.

5,200 job cuts at HHS: What to know Becker's Hospital Review; by Madeline Ashley; 2/14/25 The Trump administration on Feb. 13 ordered HHS to lay off "nearly all" of its 5,200 probationary employees, The Associated Press reported Feb. 14. In a National Institutes of Health department meeting recording obtained by the AP, an NIH office director said some probationary employees with specialized skills might be retained. Affected employees were notified via email on the afternoon of Feb. 13. Many probationary employees are people who have worked for the federal government for about one to two years, before gaining civil service protections. Some probationary employees are veteran staffers who may have been recently promoted, according to the AP.

Trump freezes HHS communications: report Modern Healthcare Alert; by Bridget Early; 1/22/25 The Health and Human Services Department and its agencies are going silent for now, according to the Washington Post. On Tuesday, the day after President Donald Trump's inauguration, HHS received an order to halt all outbound communications, including health advisories, weekly reports, research, website updates and social media posts, the newspaper reported. The Washington Post reports that the pause has no definitive end date and that the decree does not specify whether exceptions will be made for disease outbreaks or other urgent situations. The directive applies to agencies such as the Centers for Medicare and Medicaid Services, the Food and Drug Administration, the Health Resources and Services Administration, the Centers for Disease Control and Prevention, the National Institutes of Health and the Substance Abuse and Mental Health Services Administration.

CMS Health Equity Data Book U.S. Centers for Medicare and Medicaid Services - Office of Minority Health; by CMS Office of Minority Health; published December 2024, email notifications 1/15/25 One of the six pillars of the Centers for Medicare & Medicaid Services (CMS) 2023 Strategic Plan is to, “Advance health equity by addressing the health disparities that underlie our health system.” The CMS Office of Minority Health (OMH) aims to advance health equity by providing broader access to data about the state of health equity across CMS’ programs. This Data Book presents summary information on disparities within CMS programs as demonstrated by data related to prevalence. ... This Data Book is intended for use as a readily-available information source on health disparities within the Medicare, Medicaid, and the Health Insurance Marketplace populations. This Data Book is organized into five key sections – CMS at a Glance, Demographics, Chronic Conditions, Behavioral Health, and Social Determinants of Health – so that Data Book users can jump to the section most relevant to their data needs. Within each section, data are presented by each population type.

ASTP Rule codifies requirements for TEFCA-Qualified health information networks McDermott Will & Emery, Washington, DC; by James A. Cannatti III, Jennifer S. Geetter, and Nathan Gray; 1/15/25 On December 16, 2024, the US Department of Health and Human Services (HHS) Assistant Secretary for Technology Policy/Office of the NationaTl Coordinator for Health Information Technology (ASTP) published the Health Data, Technology, and Interoperability: Trusted Exchange Framework and Common Agreement (TEFCA) final rule in the Federal Register as part of its continued focus on improving information sharing among healthcare stakeholders. Rather than codifying comprehensive substantive and procedural requirements for entities participating in TEFCA, the final rule provides a flexible framework establishing how such decisions will be made in current and future subregulatory documents. 

MA Special Needs Beneficiaries more likely to receive lower quality hospice care Hospice News; by Jim Parker; 1/2/25 Medicare Advantage special needs plan (SNP) beneficiaries were more likely to use lower-quality hospices than those enrolled in fee-for-service Medicare. Researchers from the Perelman School of Medicine at University of Pennsylvania in Philadelphia examined Medicare enrollment and claims data for 4.2 million decedents and 2.2 million hospice enrollees from Jan 1, 2018 to Dec. 31, 2019. Among other findings, results indicated that MA SNP beneficiaries were more likely to receive care from hospices with lower Hospice Quality Reporting Program (HQRP) scores. “These results suggest that policymakers should consider incentivizing referrals to high-quality hospices and approaches to educating beneficiaries on identifying high-quality hospice care,” researchers wrote in the study, published in JAMA Network Open. Editor's note: Click here for the CMS.gov Special Needs Plans webpage.

Quality of hospices used by Medicare Advantage and traditional fee-for-service beneficiariesJAMA Network Open; Lindsay L. Y. White, PhD, MPH; Chuxuan Sun, MPA; Norma B. Coe, PhD; 12/24In this cross-sectional study including 4 215 648 decedents and 2 211 826 hospice enrollees, regular Medicare Advantage and fee-for-service beneficiaries enrolled in hospices of similar quality. However, beneficiaries in Medicare Advantage special needs plans were significantly more likely than fee-for-service beneficiaries to use hospices of inferior quality, with referral networks playing an important role in hospice quality choice. These results suggest that policymakers should consider incentivizing referrals to high-quality hospices and approaches to educating beneficiaries on identifying high-quality hospice care. 

Agency Information Collection Activities: Proposed collection; Comment request Federal Register - United States Government; A Notice by the Centers for Medicare & Medicaid Services, Health  and Human Services; 12/16/24 The Centers for Medicare & Medicaid Services (CMS) is announcing an opportunity for the public to comment on CMS' intention to collect information from the public. Under the Paperwork Reduction Act of 1995 (PRA), Federal agencies are required to publish notice in the Federal Register concerning each proposed collection of information (including each proposed extension or reinstatement of an existing collection of information) and to allow 60 days for public comment on the proposed action. Interested persons are invited to send comments regarding our burden estimates or any other aspect of this collection of information, including the necessity and utility of the proposed information collection for the proper performance of the agency's functions, the accuracy of the estimated burden, ways to enhance the quality, utility, and clarity of the information to be collected, and the use of automated collection techniques or other forms of information technology to minimize the information collection burden.

HHS OIG's Fall 2024 Semiannual Report to CongressU.S. Department of Health and Human Services [HHS] - Office of Inspector General [OIG]; by OIG; issued on 12/4/24, posted on 12/4/24 The Fall 2024 Semiannual Report to Congress highlights OIG's work focusing on the most significant and high-risk issues in health care and human services related to HHS programs and operations during the semiannual reporting period of April 1 through September 30, 2024. The semiannual reports are intended to keep the HHS Secretary and Congress informed of OIG’s crucial findings and recommendations.  ...

Hospice Oversight: 2024’s most impactful regulatory action Hospice News; by Jim Parker; 11/27/24 The past year has seen a slew of regulatory developments aimed at improving quality and combatting fraud in the hospice industry. The drive by regulators and members of Congress to strengthen oversight is fueled by two main factors. The first was two July 2019 reports on hospice quality from the Office of the Inspector General (OIG) in the U.S. Department of Health and Human Services (HHS). These spurred passage of the Helping Our Senior Population in Comfort Environments (HOSPICE) Act, which mandated the establishment of a hospice Special Focus Program (SFP), among other actions. The second driving force was the emergence of fraudulent actors in the space in relatively large numbers, particularly concentrated in California, Nevada, Arizona and Texas. [Click on the title's link to continue reading this important information.]

OIG issues nursing facility industry segment-specific Compliance Program Guidance; first in a series in Furtherance of its Modernization Initiative Butzel - Attorneys and Counselors Client Alerts; 11/22/24 On November 20, 2024, the U.S. Department of Health & Human Services, Office of Inspector General (“OIG”) issued the first Industry Segment-Specific Compliance Program Guidance (“ICPG”), which applies to the Nursing Facility Industry. This follows from the OIG’s Modernization Initiative to update publicly available resources for the healthcare industry first announced in September 20211 and finalized in April 2023. This ICPG comes just over a year after the OIG issued the General Compliance Program Guidance (“GCPG”) that kicked off the OIG’s efforts to modernize and consolidate numerous Compliance Program Guidance documents issued between 1998 and 2008. Editor's note: Click here to download the U.S. HHS OIG's 59-page November 2024 "NURSING FACILITY Industry Segment-Specific Complicance Program Guidance." A word search finds 30 references to "hospice."