WASHINGTON, D.C. — Medicare hospice providers could face increased scrutiny under a proposed federal rule that introduces a new scoring system to flag questionable billing and care patterns while expanding transparency for patients and families.
What This Means for You
- Hospice providers will be scored based on billing patterns and care delivery
- Patients will receive clearer information about what hospice services are not covered
- Facilities that fail to report quality data may be publicly flagged
The proposal from the Centers for Medicare & Medicaid Services is part of a broader effort to reduce fraud, improve oversight, and ensure end-of-life care meets federal standards.
New Scoring System Targets Risk
At the center of the proposal is a new tool called the Service and Spending Variation Index, or SSVI.
In practical terms, the index assigns each hospice a score based on billing and care data, including how often patients receive services outside hospice, how long they stay in care, and patterns of discharge and readmission.
Officials said higher scores would not automatically indicate fraud but could signal potential concerns requiring further review.
The data, including provider-level scores, would be publicly available to help families compare hospice providers and to guide enforcement efforts.
Addressing Rising Non-Hospice Spending
Federal officials said the hospice benefit is designed to cover nearly all care for patients nearing the end of life.
However, CMS has observed increasing spending on services outside hospice care, raising concerns about whether providers are meeting their obligations.
The new scoring system is intended to identify patterns that may indicate inappropriate use of Medicare funds or gaps in care.
New Transparency Requirements
The proposal would require hospice providers to give all patients a written explanation of what services are not covered under their hospice benefit at the time they enroll.
Currently, this information—known as the hospice election statement addendum—is only provided upon request.
In practical terms, this change would ensure patients and families understand upfront which treatments, medications, or services they may need to pay for themselves.
Public Flags for Non-Compliant Providers
CMS is also proposing to add a visible indicator on the Medicare.gov Care Compare website to identify hospice providers that fail to meet quality reporting requirements.
About one in five hospices has not consistently submitted required data in recent years, limiting the government’s ability to assess care quality and provide reliable information to consumers.
Payment Updates and Penalties
The rule proposes a 2.4% increase in hospice payment rates for fiscal year 2027, reflecting updated costs for labor and services.
Hospices that fail to meet quality reporting requirements would face a reduction in payments, resulting in a net decrease compared to the previous year.
Medicare payments to hospices would also remain subject to an annual cap, proposed at $36,210.11 per patient for 2027.
Additional Policy Changes
The proposal includes updates to telehealth requirements, expanded flexibility in patient discharge decisions, and requests for public input on topics such as palliative care services and regulatory streamlining.
Agency Perspective
“Hospices exist to help Americans die peaceful, dignified deaths, not to line the pockets of fraudsters,” said CMS Administrator Dr. Mehmet Oz.
“These new transparency measures will make it easier … to identify hospice providers that misuse Medicare dollars,” he said.
Next Steps
The rule is currently in the proposal stage, and CMS is seeking public comment before finalizing the changes.
The full proposal is available at: https://www.federalregister.gov/d/2026-06604.
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