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Hospice Action Network

Let the 118th Congress know: Hospice Works! With a new Congress, it is important to let your representatives know why hospice care is important to you and millions of Americans. Help your lawmakers understand the benefits of hospice care and the challenges facing the hospice community. 
Contact your members of Congress today and share your story. Educate policymakers about the positive impact hospice makes on patients, families, and communities. Tell them why hospice is an essential benefit for all Americans. We need effective policy approaches to hospice care--and it starts with you. Click 
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All You Need to Know About the Physician Certification of Terminal Illness (CTI)

May 24, 2023 11:00 am MT

For patients to receive hospice coverage under Medicare, physicians must complete a Certification of Terminal Illness or CTI. Accurate documentation by the patient’s physician(s) is critical for Medicare to pay claims. 

On May 24, 2023, at 11:00 am ET, CGS, your Medicare Administrative Contractor (MAC), will host an interactive webinar. You can learn what a CTI is, when it is needed, and the proper documentation Medicare requires to avoid claim denials. Expert speakers Kristi Spruell, RN, and Neil Sandler, MD, will also present examples of proper CTI documentation and answer questions from attendees. CGS will record the webinar for those unable to attend live. 

Sign Up to Attend


[Updated] CMS Proposes New Rule Requiring At Least 80% of HCBS Medicaid Payments To Go Toward Worker Compensation

Home Health Care News / By Robert Holly

The U.S. Centers for Medicare & Medicaid Services (CMS) [last] Thursday announced a new proposed rule that would, among its provisions, establish a strict requirement for the amount of Medicaid payment going toward home care worker compensation.

Specifically, the proposed rule from CMS would require that at least 80% of Medicaid payments for personal care, homemaker and home health aide services be spent on compensation for direct care workers. That’s opposed to expenses such as “administrative overhead or profit,” according to the agency.

“If adopted as proposed, the rules would establish historic national standards for access to care regardless of whether that care is provided through managed care plans or directly by states through fee-for-service (FFS),” the CMS announcement explains. “Specifically, they would establish access standards through Medicaid or CHIP managed care plans, as well as transparency for Medicaid payment rates to providers, including hourly rates and compensation for certain home care and other direct care workers.”

Other aspects of Thursday’s proposed rulemaking announcement include:

– Establishing national maximum standards for certain appointment wait times for Medicaid or Children’s Health Insurance Program (CHIP) managed care enrollees

– Requiring states to conduct independent secret shopper surveys of Medicaid or CHIP managed care plans

– Mandating that states report every other year on the HCBS Quality Measure Set for their HCBS program

“With the provisions we’ve outlined, we’re poised to bring Medicaid or CHIP coverage and access together in unprecedented ways – a key priority that’s long overdue for eligible program participants who still face barriers connecting to care,” CMS Administrator Chiquita Brooks-LaSure said in the announcement.

Notably for home- and community-based services (HCBS) providers, CMS is likewise attempting to create new payment transparency requirements for states by requiring disclosure of provider payment rates in both FFS and managed care.

The goal, according to the agency, is to get “greater insight into how Medicaid payment levels affect access to care.”

Currently, demand for HCBS far exceeds service supply from providers. That’s partly because many providers, especially in personal care, continue to struggle with the recruitment and retention of workers.

“Access to most HCBS generally requires hands‑on and in‑person services to be delivered by direct care workers,” a CMS fact sheet explains. “However, direct care worker shortages are impacting beneficiaries’ access to services.”

As part of the transparency efforts under the proposal, states would have to publish the average hourly rate paid to direct care workers delivering personal care, home health aide and homemaker services.

“We are also proposing to require that states report annually, in the aggregate for each service, on the percent of payments for homemaker, home health aide and personal care services that are spent on compensation for direct care workers, and separately report on payments for such services when they are self‑directed,” the fact sheet continues. “We proposed that these requirements would be effective four years after the effective date of the final rule.”

States would also need to more rigorously report on waiting lists in section 1915(c) waiver programs, along with service delivery timeliness for personal care, homemaker and home health aide services.

The National Association for Home Care & Hospice (NAHC) called the Medicaid announcement a “mixed bag” for the program.

“We are heartened and excited to see that CMS is addressing issues related to waiting lists for home- and community-based services and delays in access to care, increasing transparency around provider payment rates and managed care contracting practices, and requiring states to provide more justification around their payment rate structures,” Damon Terzaghi, NAHC’s medicaid director, said in a statement shared with Home Health Care News.

NAHC does have concerns about 80% of Medicaid payments going toward worker compensation, Terzaghi noted.

“We are concerned that CMS is not proactively addressing the chronically woeful state payment rates for home- and community-based services and instead is creating a new bureaucratic analysis that may or may not ever impact the wages of workers,” Terzaghi said. “We are further concerned that CMS has decided to forego ensuring adequate state payments in favor of applying an arbitrary requirement to pass through a proportion of the rates to direct care workers. This policy cannot be effective without consideration of the actual payment rates or the substantial administrative requirements that Federal and state regulations place on providers.”

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The rules are available online at:

Access rule: 2023-08959.pdf (

Managed Care Rule: 2023-08961.pdf (


Home Care Industry Touts Bipartisan Bill to Expand Medicare In-Home Benefits, Reimbursement

Fierce Healthcare / By Dave Muoio
Healthcare providers and tech companies with a stake in home health have coalesced around bipartisan legislation introduced last week that would shift care away from the hospital to patients' living rooms and bedrooms.
The Expanding Care in the Home Act sponsored by Reps. Adrian Smith, R-Nebraska, and Debbie Dingell, D-Michigan, would expand access to and reimbursement for various home care services delivered to Medicare beneficiaries. The bill proposes a baseline 12 hours per week of personal care services benefit in Medicare, which advocates say would help support a population of beneficiaries unable to afford out-of-pocket home care but not quite poor enough to qualify under Medicaid.
“As we identify opportunities to modernize the care seniors can access, we must consider the convenience and comfort home care offers them,” Smith said in a release. “The Expanding Care in the Home Act is a commonsense measure to ensure Medicare can process claims for in-home care services, and I’m proud to lead introduction of this important bill.”
Additionally, reimbursement funds and policy adjustments directed by the tentative legislation would open the door for primary care house calls; increase access to home dialysis, in-home advanced diagnostic, in-home lab testing and home infusion services; and help support the development of additional home-based care workers, according to a release.
“We know people often prefer to receive care in the comfort and security of their own homes, and the COVID-19 pandemic highlighted the importance of expanding access to health care beyond traditional doctor’s office or hospital settings,” Dingell said in a release. “I’m proud to introduce this legislation which will help remove barriers to care and increase options for patients to receive critical care in the setting of their choice.”
The proposed bill is being championed by Moving Health Home, an advocacy group comprised of DaVita Kidney Care, Ascension, Amazon, Signify Health, Current Health, Intermountain Healthcare and at least 15 other stakeholder industry groups, according to its website…

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OIG Audit Reveals Lack of Data Sharing Led to $128M in Duplicate Payments by Medicare, VA

Fierce Healthcare / By Annie Burky
Medicare paid for medical services that the Veterans Health Administration (VHA) had also paid for, resulting in duplicate payments of up to $128 million over five years, revealed an audit performed by the Office of Inspector General (OIG).
The federal oversight agency reported that Medicare could have avoided the loss if proper controls had been implemented.
The audit, performed by the Department of Health and Human Services’ OIG, reviewed Medicare and VHA benefits paid for by the VA’s community care programs. The audit covered $19.2 billion in Medicare Parts A and B payments for 36.3 million claims for individuals eligible for Medicare and VHA benefits who received services from VA’s community providers. The audit period spanned from January 2017 through December 2021 and sought to identify duplicate payments.
“These duplicate payments occurred because [the Centers for Medicare & Medicare Services (CMS)] did not implement controls to address duplicate payments for services provided to individuals with Medicare and VHA benefits,” the report said.  “Specifically, CMS did not establish a data-sharing agreement with VHA for the ongoing sharing of data between the two agencies and did not develop an interagency process to include VHA enrollment, claims and payment data in CMS’s data repository.”
VA’s community care program offers veterans who are unable to easily access a VHA facility the option to receive care through community providers. Said providers participate in Medicare and have entered into agreements with the VA.
In the years of the audit, veterans who accessed care at these facilities increased, partially due to the June 2019 expansion of eligibility in the Veterans Community Care Program. During the 2020 fiscal year, roughly 5.6 million individuals were dually eligible for Medicare and VHA benefits.
“VHA is solely responsible for paying for the community care services it authorized,” the report said. “Medicare payment for other services not authorized by VA may be made in accordance with Medicare requirements. Duplicate claims occur when a provider submits claims for the same services to both Medicare and VHA, and duplicate payments occur when both programs pay the claims.

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