Literature Review

Humana borrows UnitedHealth’s Medicare Advantage playbookModern Healthcare; by Nona Tepper; 8/25/25Humana's stock price is up 16.5% so far this year, a notable contrast to the [11.6%] declines the larger Medicare Advantage sector and industry leader UnitedHealth Group report. Humana's secret to success is its transparency into its focused business, experts say.

HHS launches committee to shape Medicare, MedicaidBecker's Payer Issues; by Andrew Cass; 8/22/25HHS and CMS are establishing a panel of experts tasked with providing recommendations on how to “improve how care is financed and delivered” across Medicare, Medicaid, the Children’s Health Insurance Program and the ACA’s exchanges... “This committee will help us cut waste, reduce paperwork, expand preventive care, and modernize CMS programs with real-time data and accountability, all while keeping patients at the center,” Dr. Oz said in the release.Publisher's note: Click here for additional information or to apply to particiate on this Technical Expert Panel.

Attorney General Bonta conducts first-ever review of proposed hospice affiliations, conditionally approves transactions to ensure continued access to hospice services California Department of Justice, Rob Bonta - Attorney General, Oakland, CA; Press Release; 8/20/25California Attorney General Rob Bonta today announced conditionally approving the affiliations of Chapters Health System, Inc., a Florida not-for-profit hospice provider, with two nonprofit hospice providers in California. Chapters Health System, Inc. is seeking to expand its current operations, which are largely based on the East Coast, through the creation of “Chapters West Region,” a nonprofit hospice network covering California, Nevada, and Oregon. Specifically, in California, Chapters Health System, Inc. proposed affiliations with East Bay Integrated Care, Inc. (doing business as Hospice East Bay) and Hospice of Santa Cruz County. Both Hospice East Bay and Hospice of Santa Cruz County are longstanding providers of hospice and palliative care in their respective communities. Under California law, any transaction involving the sale, or transfer of control and governance of a nonprofit health facility, must secure the approval of the Attorney General’s Office. Today’s conditional approval represents the first-ever review involving nonprofit hospice providers by the Attorney General’s Office; the overwhelming majority of hospice providers are for-profit entities.  

Aveanna beefs up advocacy efforts, leans into preferred payer strategy Home Health Care News; by Joyce Famakinwa; 8/15/25 Amid an uncertain reimbursement environment and sea of recent policy updates, Aveanna Healthcare Holdings Inc. (Nasdaq: AVAH) remains focused on the strategies that have been helping the company achieve success. ... This means ramping up the company’s efforts around advocacy, as well as actively working with various state Medicaid programs. Home Health Care News caught up with Jim Melancon at last month’s National Alliance for Care at Home Financial Summit to learn more. Melancon serves as senior vice president of government affairs at Aveanna. ... The company has 327 locations across 34 states.

Building a strong foundation for pediatric palliative care in Connecticut Solomon Center for Health Law and Policy at Yale Law School, Targeted News Service; by Wendy Jiang, Elle  Rothermich, Eugene Rusyn; 8/12/25 The Solomon Center for Health Law and Policy at Yale Law School has released a white paper outlining concrete pathways for Connecticut to guarantee pediatric palliative care (PPC) from diagnosis--not only at end of life--while building a workforce equipped to deliver it statewide. The report highlights two foundational barriers: coverage that generally triggers only when a child receives a six-month terminal prognosis, and a shortage of clinicians trained in primary palliative skills, leading to delayed referrals and fragmented support for families facing serious childhood illness. The authors recommend two primary coverage strategies for the state.Editor's Note: Though written for Connecticut, this 42-page white paper from Yale provides excellent information and recommendations to examine for one's own state. Its sub-title is "Establishing a statewide coverage pathway & expanding primary palliative care education for pediatric clinicians."

This test tells you more about your heart attack risk KFF Health News; by Paula Span; 8/1/25 A long list of Lynda Hollander’s paternal relatives had heart disease, and several had undergone major surgeries. ... A cardiologist told Hollander that based on factors like age, sex, cholesterol, and blood pressure, she faced a moderate risk of a major cardiac event, like a heart attack, within the next 10 years. ... Her doctor explained that a coronary artery calcium test, ... could provide a more precise estimate of her risk of atherosclerotic heart disease. “The test is used by more people every year,” said Michael Blaha, co-director of the preventive cardiology program at Johns Hopkins University. Calcium scans quadrupled from 2006 to 2017, his research team reported, and Google searches for related terms have risen even more sharply. Yet “it’s still being underused compared to its value,” he said. One reason is that although the test is comparatively inexpensive ...Editor's Note: Good news. This test predicts and protects heart health, potentially providing extra years of good (or at least better) quality of life. Bad news. It is "being underused compared to its value," partly because "the test is comparatively inexpensive"? Bad news. What does the low-cost factor say ethics, choices, and quality of life? Good news. Because of my family's cardiac history, my physician recently recommended I take this test. I did, and received great results! I move into the future with greater confidence, less fear, and more gratitude for the some 100,00 heartbeats we each experience, each day.

The state of pediatric concurrent hospice care in the United States American Academy of Pediatrics; by Meaghann S. Weaver, MD, PhD, MPH, HEC-CCorresponding Author; Steven M. Smith, MD; Christy Torkildson, PhD, RN, PHN; Deborah Fisher, PhD, RN, PPCNP; Betsy Hawley, MA; Alix Ware, JD, MPH; Holly Davis, MS, APRN; Conrad S. P. Williams, MD; Lisa C. Lindley, PhD, RN, FPCN, FAAN; 8/1/25 The Patient Protection and Affordable Care Act (ACA) required all state Medicaid programs to pay for both curative and hospice services for children and adolescents. The purpose of this Special Article report is to quantify and describe the use of concurrent care for children, including a depiction of the barriers and benefits according to community-based hospice organizations in the United States. A total of 295 hospice organizations from 50 states and Washington, DC responded to the National Alliance for Care at Home call for engagement.

Glendale woman sentenced to 9 years in federal prison for $10.6 million hospice fraud scheme involving kickbacks for patients United States Attorney's Office - Central District of California, Los Angeles, CA; Press Release; 8/5/25 A Glendale woman was sentenced today to 108 months in federal prison for participating in a scheme in which hundreds of thousands of dollars in illegal kickbacks were paid and received for patient referrals that resulted in the submission of approximately $10.6 million in fraudulent claims to Medicare for purported hospice care. Nita Almuete Paddit Palma, 75, of Glendale, was sentenced by United States District Judge Dolly M. Gee, who also ordered her to pay $8,270,032 in restitution. 

Hospice Honors 2025 - 2025 CAHPS Honors and Honors Elite Award winnersMatrixCare by ResMed; retrieved from the internet 7/29/25 214 CAHPS Honors and 53 Elite Award Winners are listed. These national recognitions are presented by HealthCare First, a part of MatrixCare. These awards are based on satisfaction scores from the Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. "Honors Elite" status is awarded to those hospices that score above the national performance score on 100%, or all twenty four, of the evaluated questions. Editor's Note: We celebrate these significant achievements and thank you for the quality, expert care you provide each day! 

Breaking News: Various posts about the CMS FY26 Wage Index Final RuleCompiled by Hospice & Palliative Care Today; Joy Berger; 8/2/25Finally. The financial Final Rule arrived. What do you need to know and do? How are hospice leaders responding? We've compiled these for you to go directly to various sources to find what you need.

CMS FY 2026 Hospice Wage Index FINAL Rule posted in Federal Register

Medicare and Medicaid: 60 years of health care reform Medicare Rights Center; by Jisoo Choi; 7/30/25 On this day 60 years ago, Medicare and Medicaid were signed into law, creating a national health insurance program for older adults, people with disabilities, and people with limited incomes. In the first three years, Medicare and Medicaid enrolled nearly 20 million beneficiaries; today, Medicare has an enrollment of over 68 million and Medicaid, over 71 million. The programs, established amidst sustained public pressure and organizing by labor unions and older adults, have been and remain very popular: recent polling shows 82% of American adults hold a generally favorable view of Medicare, and 97% consider Medicaid to be important to people in their local communities.