Literature Review

Concurrent/simultaneous services from Hospice and a Home and Community Based Services waiver- UPDATED Information about claims submissionAlabama Media Portal - media.alabama.gov; by the State of Alabama Press Release - Medicaid; 1/14/25The Alabama Medicaid Agency (Medicaid) updated the policy to allow concurrent services from hospice and a Home and Community-Based Services (HCBS) Waiver. However, it is vital that the hospice and HCBS waiver case manager coordinate to avoid duplication of services.The HCBS waiver person-centered care plan (PCCP) and hospice plan of care (POC) of the recipient should be coordinated between the hospice, HCBS waiver case manager, and the recipient and his/her caregiver. A conference that includes these parties must be held before concurrent services can start. The PCCP/POC conference shall be documented in both the recipient’s hospice and waiver record. [Click on the title's link to continue reading.]

Kōkua Mau, Hawaii, Medicaid Palliative Care Services BenefitHawaiʻi is the first state to comprehensively cover palliative care services for its Medicaid beneficiaries, by adding community palliative care as a preventive service in its Medicaid state plan. Since the memo has been published we are now moving into the implementation phase. This novel SPA (State Plan Amendment) is the result of multi-stakeholder collaboration over many years. It serves as a road map for other states exploring new ways to pay for interdisciplinary, community-based palliative care.

Winter snow storm slams into over a dozen states in the East, Midwest USA Today; by Julia Gomez; 1/6/25 The Central Plains and Midwest are getting slammed by a winter storm , according to officials, and it's leaving over a dozen inches of snow in some places. Here's a look at what the storm is leaving behind. Over 60 million people in the Central Plains, Midwest and along the East Coast are being bombarded by heavy snowfall because of the "disruptive" winter storm moving through the area, according to the National Weather Service. Some areas could see snowfall anywhere between 8 to 14 inches. The storm is also expected to impact travel in Kansas City, St. Louis, Indianapolis and Cincinnati and bring the cities to a standstill.Editor's note: Are you ready for emergencies in your service areas? Click here for the CMS.gov Emergency Preparedness Rule. Click here for Wisconsin's CMS Emergency Preparedness Rule Toolkit: Hospices.

U.S. health care spending reaches $4.9 trillion Hospice News; by Jim Parker; 12/20/24 The nation’s total health expenditures rose 7.5% to $4.9 trillion in 2023, a new analysis by the U.S. Centers for Medicare & Medicaid Services (CMS) found. This growth took place at a faster pace in 2023 than prior years. In 2022, health care spending rose at a rate of 4.6%. Total Medicare hospice spending accounted for $25.7 billion last year, according to a separate report from the Medicare Payment Advisory Commission (MedPAC). ... About 21% of U.S. health care spending in 2023 was via Medicare, with private insurance representing a 30% share. Medicaid accounted for 21%, and the remaining 10% were out-of-pocket costs. “Hospital care, physician and clinical services, and nursing care facilities and continuing care retirement communities, which collectively accounted for 33% of all out-of-pocket spending in 2023, were the main contributors to the faster growth in 2023,” CMS indicated.

How the downfall of the ‘Chevron Doctrine’ could affect hospices in the courts Hospice News; by Holly Vossel; 12/16/24 Recent court rulings have the potential to make significant differences in the landscape of hospice regulatory oversight in coming years, particularly when it comes to audits and the forthcoming Special Focus Program (SFP). In June the U.S. Supreme Court overturned a ruling that in 1984 established the “Chevron Doctrine,” which instructed lower courts to defer to executive branch agencies to resolve ambiguities in laws passed by Congress. The decision marked the end of the practice known as “Chevron deference,” which required that courts must defer to regulatory agencies’ interpretations of “ambiguous” statutes within federal legislation as long as the enforcement activity is deemed “reasonable.” Hospices could potentially see a vastly different outlook in regulatory enforcement activity during a time of tremendous changes already taking place in the industry, [Bryan Nowicki, partner at the law firm Husch Blackwell] said.

What's new for Medicare in 2025? Fidelity; by Kate Ashford, Nerdwallet; 11/25/24, updated 12/11/24Each year, Medicare comes with a new set of prices, new plan ratings and sometimes new regulations. What you’ll pay may be different from last year, and your network and prescription drug coverage may change, depending on your plan. Here’s how Medicare looks in 2025. ...

What is compliance risk? TechTarget; by Katie Terrell Hanna and Francesca Sales; 11/26/24 Compliance risk is an organization's potential exposure to legal penalties, financial forfeiture and material loss, resulting from its failure to act in accordance with industry laws and regulations, internal policies or prescribed best practices. Compliance risk is also known as integrity risk. Organizations of all types and sizes are exposed to compliance risk, whether they are public or private entities, for-profit or nonprofit, state or federal. An organization's failure to comply with applicable laws and regulations can affect its revenue, which can lead to loss of reputation, business opportunities and valuation. Types of compliance risk ... An organization might be implicated in the following types of compliance risks:

CMS Innovation Center reimagines rural health care approaches Center for Medicare and Medicaid Innovation; 11/12/24 Re-Imagining Rural Health: Themes, Concepts, and Next steps from the CMS Innovation Center "Hackathon" Series. ... Over sixty million Americans currently live in areas identified as rural, Tribal, frontier, and geographically isolated areas, including the U.S. Territories. Compared to people living in urban areas, rural Americans are more likely to experience poverty, be older, be uninsured, and have a disability. At the same time, rural communities face unique barriers to accessing care due to more limited availability of health care providers, including primary care, specialty care and home and community-based services, and residents often have to travel long distances to obtain health care. [Click on the title's link to continue reading (and distribute) this important 20 page whitepaper.]

Palliative care, ACO collaborations fuel ‘historical savings’ in MSSP Program Hospice News; by Holly Vossel; 11/11/24 Palliative care providers that form collaborative partnerships with Accountable Care Organizations (ACOs) may be lending to a landmark downward trend in health care spending in the value-based payment landscape. The U.S. Centers for Medicare & Medicaid Services (CMS) recently announced that its Medicare Shared Savings Program (MSSP) yielded more than $2.1 billion net savings in 2023 — the largest amount in the program’s inception more than a decade ago, according to the agency. ACOs participating in MSSP earned an estimated $3.1 billion in shared savings payments during the program’s 2022 to 2023 performance year, the highest dollar amount thus far, CMS reported. [Click on the title's link to continue reading.]

Long-term care market to grow by USD 394.8 billion from 2024-2028, as aging population drives demand with AI impact on market trends - Technavio Cision; by PR Newswire; 11/8/24 Report on how AI is redefining market landscape - The global long-term care (LTC) market size is estimated to grow by USD 394.8 billion from 2024-2028, according to Technavio. The market is estimated to grow at a CAGR of over 3.21% during the forecast period. Growing demand for long-term care from aging population is driving market growth, with a trend towards expansion and growth of several healthcare domain. However, lack of skilled nursing staff for long-term care  poses a challenge.Key market players include Abri Health Care Services LLC, Amedisys Inc., Brookdale Senior Living Inc., CareOne Management LLC, Diversicare Healthcare Services Inc., Extendicare Canada Inc, FCP Live In, Genesis Healthcare Inc., Honor Technology Inc., Illumifin Corp., Kindred Health Holdings LLC, Life Care Centers of America Inc., Revera Inc., SeniorLiving.org, Sonida Senior Living Inc., Sunrise Senior Living LLC, and Wickshire Senior Living.

Top 10 Governance, Risk & Compliance (GRC) tool eSecurity Planet; by Claire dela Luna; 10/28/24 In today’s global economy, even small businesses operate across multiple regions and markets, each with its own regulatory landscape. Without effective GRC tools, organizations can quickly fall out of compliance, exposing themselves to security risks and operational disruptions. GRC software solutions enable businesses to manage these risks by automating policies, tracking controls, and providing real-time compliance monitoring across international borders. .. Here’s a guide to help you make the best choice.

Customizing a palliative program to patient, payer priorities Hospice News; by Jim Parker; 10/23/24 While some palliative care programs mirror the hospice model, more operators are working to tailor their services to patients’ specific needs, with varying intensity. This is increasingly important as payment shifts towards value-based payment models in which demonstrating cost savings is crucial to success. Providers need to demonstrate strong performance on quality scores as well as a track record of effectively preventing avoidable hospitalizations, readmissions and emergency department visits. This is particularly the case when negotiating contracts with Medicare Advantage plans, Accountable Care Organizations (ACOs) and other value-based payment arrangements, Sue Lynn Schramm, a partner of the hospice and palliative care consulting company Confidis, LLC, said in a presentation at the National Hospice and Palliative Care Organization Annual Leadership Conference. [Click on the title's link to continue reading.]

New hospice special focus programAmerican Health Association / National Center for Assisted Living; by Amy Miller; 10/22/23 ​​As required under the Consolidated Appropriations Act of 2021, CMS has established a hospice special focus program (SFP) in the Calendar Year (CY) 2024 Home Health Prospective Payment System (HH PPS) final rule (88 FR 77676). Through increased regulatory oversight and enforcement of the selected poor performing hospice programs, the SFP will address issues that could place hospice beneficiaries at risk of receiving poor quality of care. The hospice SFP is like the current Special Focus Facility (SFF) program in place for nursing homes. As many nursing homes refer residents to hospice programs and may receive questions from residents or their families, it will be important to keep informed if there are noted quality of care issues.