Literature Review

Health sector answers Trump's call for deregulation ideas Modern Healthcare; by Bridget Early; 4/29/25 The Trump administration wants the healthcare industry to recommend rules and regulations to toss. Trade groups representing hospitals, health insurance companies and others have ideas. The White House, the Centers for Medicare and Medicaid Services and other parts of the federal government are seeking suggestions to guide President Donald Trump's campaign to radically restructure and diminish the federal government. ... CMS included a request for information in Medicare payment rules the agency proposed this month. Comments are due June 10.

Accountable Care Organizations join forces to protect critical Medicare programs Home Health Care News; by Audrie Martin; 4/23/25 A group of accountable care organizations (ACOs) have joined forces to advocate for the expansion of high-needs care models that improve outcomes and reduce costs for Medicare’s most vulnerable patients. The newly-formed Complex Care Alliance has taken a stand, urging the Centers for Medicare and Medicaid Services (CMS) to extend crucial Medicare initiatives beyond their slated 2026 expiration. On Tuesday [4/22], home-based primary care provider HarmonyCares announced its partnership with the Complex Care Alliance, expressing its support for the High-Needs ACO model, which helps provide care for Medicare’s sickest patients.

American Oncology Network achieves success in first performance period of CMMI’s enhancing oncology model Stock Titan, Globe Newswire, Fort Myers, FL; 4/22/25 American Oncology Network (AON), one of the nation’s fastest-growing community oncology networks, today announced strong results from the first performance period in the Centers for Medicare & Medicaid Innovation’s (CMMI) Enhancing Oncology Model (EOM). AON practices participating in the program—in collaboration with value-based cancer care enabler Thyme Care—achieved nearly $6M in cost savings for the Centers for Medicare & Medicaid Services (CMS). AON also earned a performance-based payment while improving patient experience and outcomes.

Supreme Court hears ‘crucial’ case today on free preventive health care KFF Health News; 4/21/25 The lawsuit, Kennedy v. Braidwood Management, could have far-reaching consequences for the health coverage of tens of millions of Americans. A ruling is expected in June. ... The Supreme Court on Monday is set to hear arguments in a case challenging a provision of the Affordable Care Act that requires private insurers to cover health care screenings, tests and checkups for free. Experts say the court’s ruling in the case, called Kennedy v. Braidwood Management, could have sweeping consequences for patient access to preventive health care across the United States.

Regulatory leaked HHS budget signals $40B in cuts, assumes ACA subsidies expire Fierce Healthcare; by Noah Tong; 4/17/25 Department of Health and Human Services (HHS) reorganization plans appear to have been revealed through a leaked Office of Management and Budget (OMB) document. The 64-page PDF with HHS’ plans were first reported by Inside Medicine and later reported by The Washington Post and other news publications. In an update, Inside Medicine said the entire document was authenticated by The Washington Post. ... While the restructuring was broadly announced, and individual offices have been reportedly axed in recent weeks, the leak provides greater insight into how the reorganization, firings, reductions in force and office eliminations and consolidations will fundamentally alter the agency.

8 health system CEOs on the turbulence defining 2025 Becker's Hospital Review; by Kelly Gooch and Kristin Kuchno; 4/16/25 From capacity constraints to reimbursement pressures, health system CEOs are navigating a changing healthcare landscape. One of the top concerns in 2025 is the potential for Medicaid funding cuts. A recent report estimates hospitals could face a $31.9 billion loss in revenue if federal proposals to scale back Medicaid expansion move forward. CEOs from across the country — including safety-net systems, academic medical centers and expanding regional providers — recently shared how they are preparing for continued uncertainty and what strategies they are prioritizing in response.

HHS restructuring and workforce reductions – key implications for the health care industry JD Supra; by Mintz.com; 4/15/25 ... As part of the department-wide restructuring plan, HHS is in the process of consolidating 28 different divisions into 15 divisions. As of April 4, 2025, it had also reduced the number of Regional Offices from ten to five. ... 

CMS Refocuses on its Core Mission and Preserving the State-Federal Medicaid PartnershipCMS press release; 4/11/25The Centers for Medicare & Medicaid Services (CMS) is taking action to preserve the core mission of the Medicaid program by putting an end to spending that duplicates resources available through other federal and state programs or isn’t directly tied to healthcare services. Mounting expenditures, such as covering housekeeping for individuals who are not eligible for Medicaid or high-speed internet for rural healthcare providers, distracts from the core mission of Medicaid, and in some instances, serves as an overly-creative financing mechanism to skirt state budget responsibilities.

Closing the gap in end-of life care coverage: The role of nonprofits in policy advocacy Forbes; by James Dismond; 4/14/25... As the demand for end-of-life care grows, so will the gap between the care that patients need and what they receive. ... Workforce shortages, restrictive regulations, outdated reimbursement models and misconceptions around hospice services are keeping millions of Americans from accessing quality hospice and palliative care services. ... These barriers disproportionately affect low-income families, rural communities and communities of color. ... Unlike for-profit entities, we can prioritize community needs over shareholders. We can prioritize patient well-being over profits—or, to say it more directly, we put people over profits. And I’ve seen firsthand how advocacy can drive progress. Nonprofits must engage in:

National Alliance for Care at Home responds to the FY 2026 Hospice Proposed Rule National Alliance for Care at Home, Alexandira, VA and Washington, DC; Press Release; 4/11/25 The National Alliance for Care at Home (the Alliance) issued the following statement [Fri 4/11] in response to the Centers for Medicare & Medicaid Services (CMS) Fiscal Year (FY) 2026 Hospice Wage Index proposed rule, which proposes payment and regulatory updates under the Medicare hospice benefit. The proposed 2.4% payment update fails to adequately address the mounting financial pressures facing hospices nationwide. With escalating operational costs driven by inflation, workforce shortages, and rising expenses for supplies and services, the proposed payment increase would threaten the ability of hospices to sustainably provide quality end-of-life care. “The proposed payment update for FY 2026 falls short of what is needed to sustain high-quality hospice care,” said Dr. Steve Landers, CEO of the Alliance. “Without meaningful adjustments, hospices across the country will face serious challenges—jeopardizing access to care for terminally ill patients and placing added strain on families already facing the unimaginable. ..."

Medicare and Medicaid officials finalize rule to clarify that medical marijuana isn’t covered by federal health programsMarijuana Moment; by Kyle Jaeger; 4/8/25 The federal Centers for Medicare & Medicaid Services (CMS) has finalized a rule to clarify that marijuana products are not eligible for coverage under certain health plans for chronically ill patients because “they are illegal substances under Federal law.” In a notice set to be published in the Federal Register next week, CMS said that a series of policy and technical changes for its Medicare Advantage (MA) program and other services, including rulemaking related to cannabis products, will now take effect on June 3.[Continue reading ...]

AGG talks: Home health & hospice podcast - Episode 10: Anti-Kickback Compliance for hospice and skilled nursing providers JD Supra; by Arnall Golden Gregory, LLP; 4/3/25 In this episode, AGG Healthcare attorneys Bill Dombi and Jason Bring discuss recent OIG guidance on hospice and skilled nursing facility relationships, focusing on anti-kickback risks and fraud concerns. They cover key issues such as the importance of documenting fair market value for any services or space provided, being cautious of payments exceeding Medicaid room and board rates, and avoiding arrangements that appear to be made solely to secure referrals. Bill and Jason also touch on increased oversight and enforcement in the healthcare sector under a new presidential administration.

Dr. Oz nomination to lead CMS advances in Senate vote    Modern Healthcare; by Michael McAuliff; 4/3/25 The Senate on Thursday advanced the confirmation of former television host Dr. Mehmet Oz to lead the nation's largest healthcare agencies by serving as administrator of the Centers for Medicare and Medicaid Services. Lawmakers voted 50 to 45 to advance the nomination to a final vote, which is expected Thursday afternoon.  ... He will assume control of an agency in flux that impacts some 160 million Americans and with a budget of around $1.7 trillion. Health Secretary Robert F. Kennedy Jr. is attempting to cut some 20,000 employees across the the Health and Human Services Department while Congress is weighing budget proposals that are likely to require deep cuts in Medicaid. [Continue reading ...]