Federal Updates for Home Health and Hospice Providers
(May 27, 2025) Please see the following updates from LeadingAge National:
LeadingAge National and Hospice Associations Ask for CMS to Delay HOPE Implementation. LeadingAge National, along with the National Alliance for Care at Home and the National Partnership for Healthcare and Hospice Innovation, sent a letter to Dr. Mehmet Oz, Administrator of the Centers for Medicare and Medicaid Services (CMS), asking for a delay in the implementation of the Hospice Outcomes and Patient Evaluation (HOPE) tool. The May 19th letter outlines the concerns with technology implementation in preparation for the HOPE tool. The letter specifically asks CMS to waive the HOPE timeliness submission requirement for two calendar quarters post implementation. Further, the letter requests that CMS delay the HOPE implementation date until at least six months after CMS education, training, and final validation specifications are available and the application for Internet Quality Improvement and Evaluation System (iQIES) access has been opened for hospices.
CMS Publishes HHVBP TEP Report. CMS published the results of a technical expert panel (TEP) which looked at Home Health Value-Based Purchasing (HHVBP) and developing additional quality metrics to track performance in the model. The TEP provided feedback on potential development of measures targeted to underserved populations, potential development of a family caregiver measure, the addition of function measures, and the potential addition of a Medicare spending per beneficiary (MSPB) measure to the measure set for the expanded HHVBP Model. CMS did provide some of this information as a request for information in last year's calendar year (CY) rule. However, the future of measures for vulnerable populations is an uncertainty. In the Fiscal Year (FY) 2026 Skilled Nursing Rule, CMS proposed removing the Health Equity Adjustment, which was scheduled to be implemented in 2027. This is consistent with the executive orders to remove diversity, equity, and inclusion initiatives. Last month, LeadingAge National sent a letter to the Office of Management and Budget (OMB) requesting, among other things, that CMS consider some type of risk adjustment for the full program, understanding that it is still critical to prevent cherry-picking in the program. The TEP also discussed the potential use of HHVBP-based icons on Care Compare. Icons could be used, for example, to identify home health agencies with improvement or decline in performance (e.g., based on Improvement Points) or to identify agencies with a positive payment adjustment. However, there are several technical issues with this approach, including the time period used to measure change in performance.
OASIS Required for All CHHA Patients / CMS Releases April 2025 Quarterly OASIS Q&A. CMS released April 2025 Outcome and Assessment Information Set (OASIS) Questions and Answers (Q&A). This document is updated on a quarterly basis and is intended to provide guidance on OASIS questions that were received by CMS help desks. As a reminder, responses may be time-limited and may be superseded by future CMS guidance. This quarter's questions go into detail about the new requirements for all-payer OASIS collection and provides agency-specific examples of scenarios where OASIS may or may not be required. As a reminder, OASIS collection on all patients is voluntary as of Jan. 1, 2025. However, on July 1, 2025, all agencies will be required to submit OASIS documents on all patients regardless of payer except in limited circumstances. CMS previously addressed these limited circumstances in guidance; however, additional considerations are detailed in this quarterly Q&A.
Bipartisan Prior Authorization Bill Reintroduced. The Improving Seniors’ Timely Access to Care Act (H.R. 3514 / S. 1816) was officially reintroduced on May 20th by Senators Roger Marshall, MD (R-KS) and Mark Warner (D-VA) in the Senate and Representatives Mike Kelly (R-PA); Suzan DelBene (D-WA); Ami Bera, MD (D-CA); and John Joyce, MD (R-PA) in the House. The legislation already has strong bipartisan support, with over 160 endorsing organizations and 47 senators and 73 House members signed on as original co-sponsors. This bill is nearly identical (with some technical amendments made to the text) to legislation offered in the previous Congress that was not adopted in an end-of-year package in 2024, even though it received a Congressional Budget Office (CBO) score of zero in October 2024. The bill seeks to modernize the prior authorization process through standardization and electronic requests and responses. In addition, the bill codifies some important reporting requirements on prior authorization both in aggregate and also at the item and service level. This information can provide some critical transparency on what items and services incur the greatest number of requests, the frequency with which they are approved or denied, and the outcomes of appeals. The bill would also give the U.S. Department of Health and Human Services (HHS) the authority to establish timeframes for e-prior authorization requests, including real-time decisions for routinely approved items and services. LeadingAge National has lent its support to the legislation again this year.
LeadingAge National Signs Coalition Letter to Protect OAA Programs. On May 22nd, LeadingAge National joined 50 other aging services organizations calling for retention of Older Americans Act (OAA) programs in one cohesive office within HHS. Draft reorganization proposals have circulated that would administratively break OAA into pieces, with OAA-authorized programs falling in multiple offices within HHS. The letter highlights two main points: that the proposed reorganization threatens efficient and effective service delivery, and that splitting programs apart undermines legislative intent in establishing the OAA. Read the letter here.
CMS Releases New Training: Getting Started with the Hospice Quality Reporting Program and Public Reporting. CMS released a web-based training that provides an introduction to the Hospice Quality Reporting Program (HQRP) and its quality measures. The course is intended to help hospices ensure accuracy and compliance in meeting program requirements, understand their role in public reporting, and track their own metrics to improve quality.
OIG Identifies $6.6 Billion in Hospice Savings. Hospice was highlighted in a new brief from the Office of Inspector General (OIG), which overall highlights $50 billion in potential savings through the recovery of payments and program improvements. This brief is based on a select subset of OIG reports that identified significant misspent funds and opportunities for cost savings within HHS programs, including those administered by CMS. Specifically related to hospice savings, OIG calls out Medicare paying providers for services that hospices are paid to provide for their enrollees. OIG calculates this from three reports linking overpayments in Medicare Part D, Medicare Part A and B Services, and Acute Care Hospital Outpatient Services. The new administration's focus on fraud and waste within the system has already led to changes with outpatient services that LeadingAge National has been tracking. Hospices will likely see more scrutiny on outside the benefit spending in the future.
Contact: Meg Everett, meverett@leadingageny.org, 518-867-8871