Federal Home Health and Hospice Updates
(July 29, 2025) Please find the following updates for home health and hospice from LeadingAge National:
Home Health Update
July Home Health Care Compare Refresh. On July 16th, home health data was refreshed on Care Compare. The data are based on Outcome and Assessment Information Set (OASIS) quality assessment data submitted from Quarter 4, 2023 through Quarter 3, 2024. The data for the claims-based measures will display data from Quarter 1, 2022 through Quarter 4, 2023 for the Discharge to Community and Medicare Spending Per Beneficiary measures; Quarter 1, 2021 through Quarter 4, 2023 for the Potentially Preventable 30-Day Post-Discharge Readmission measure; and Quarter 1, 2023 through Quarter 4, 2023 for the Home Health Within-Stay Potentially Preventable Hospitalization measure. Additionally, the data for the Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) measures will display data from Quarter 1, 2024 through Quarter 4, 2024. LeadingAge National will be updating its member Home Health Trend Reports in the coming week and will notify members when those become available.
LeadingAge National Report Portal Now Updated. The LeadingAge National Report Portal has been updated according to the latest data from the Centers for Medicare and Medicaid Services (CMS). Home health members can access their Trend Reports based on the Care Compare quarterly refresh that includes updates to OASIS quality measures, HHCAHPS measures and Star Ratings, as well as the Quality-of-Care Star Rating. LeadingAge members can access their updated reports on the Report Portal using their LeadingAge login.
BerryDunn, LeadingAge National Launch Best Practices and Future Insights Study. On July 25th, LeadingAge National partner BerryDunn announced the launch of the National Healthcare at Home 2025 Best Practices and Future Insights Study. The study was last conducted in 2022 and provided invaluable insights to the home health and hospice sector. The study is intended to help the health care at home industry both manage and provide quality, outcome-driven care in the new health care environment. BerryDunn’s health care consulting division has partnered with the National Alliance for Care at Home, LeadingAge National, and the Council of State Home Care and Hospice Associations to launch the National Healthcare at Home 2025 Best Practices and Future Insights Study. This national study is designed to provide agency leaders with clinical and operational best practices from leading organizations across the country. LeadingAge National urges providers to participate to help advance the sector. For the initial phase of the study, BerryDunn needs your input to determine the topics that you and others in the field would like to see addressed in the study. To provide your input and register to participate, complete this form.
Medicare Advantage Update
LeadingAge National Endorses Bipartisan "Prompt and Fair Pay Act" for Medicare Advantage. LeadingAge National endorsed the bipartisan "Prompt and Fair Pay Act” (H.R. 4559) introduced by U.S. Representatives Lloyd Doggett (D-TX) and Greg Murphy (R-NC) on July 21st. This bipartisan bill would require Medicare Advantage (MA) plans to pay their contracted providers at least the current Medicare fee-for-service (FFS) reimbursement rates as the rate floor and would establish prompt pay timelines. Nothing prohibits plans from paying more than Medicare FFS rates. Establishing a rate floor that MA plans must pay has been a top advocacy priority for LeadingAge National, as it is critical to ensuring skilled nursing facility (SNF) and home health agency members' financial sustainability while also giving them some bargaining power with MA plans. The bill also establishes prompt pay timelines for in-network providers, which have been lacking, and permits interest penalties to be assessed when plans do not pay promptly. Plans would be required to pay their contracted providers within 14 calendar days of receipt of a clean claim submitted electronically and 30 days for other claims. In addition, plans would be required to notify providers within 10 days if the claim is considered not clean and explain what steps would be needed to correct it. Out-of-network providers already have regulatory protections that require MA plans to pay them at least Medicare FFS reimbursement rates and pay clean claims within 60 days. In the bill’s press release, LeadingAge National President and CEO Katie Smith Sloan said: "To Congress and to regulators, we’ve repeatedly expressed concerns that Medicare Advantage plans, by underpaying and delaying provider reimbursement, are threatening the financial stability of our nonprofit and mission-driven provider members, which jeopardizes access to necessary care and services for older adults. This legislation, which establishes a rate floor and prompt payment requirements, is a vital step toward ensuring that providers are fairly and promptly compensated for the care they deliver. It will bring much-needed financial stability to our nursing homes and home health members–particularly those located in underserved and rural communities. We strongly support this legislation and urge its swift passage." Members can access a bill fact sheet and the bill text for more details. The link to a LeadingAge National article is here. Contact Nicole Fallon with any questions.
House MA Hearing Focuses on Financial Fixes to MA Overpayments and Reducing Provider Burden. The U.S. House Ways and Means Health and Oversight Subcommittees held a joint hearing on MA on July 22nd. Witnesses included health plan representatives, rural health providers, and policy experts from the Medicare Payment Advisory Commission (MedPAC) and the Brookings Institution. Notably absent from the hearing, as Representative David Schweikert pointed out, were UnitedHealthcare, Aetna/CVS, and Humana, who control the majority of the MA market. Over the course of the first two hours of the hearing (before a recess was called for congressional members to vote), subcommittee members’ comments and questions posed to witnesses focused on delays in care and the administrative burden imposed by the MA prior authorization processes and whether some MA plan bad actors are fraudulently upcoding to receive higher payments. Of note, Representative Lloyd Doggett (D-TX) highlighted his recently introduced “Prompt and Fair Pay Act” legislation (H.R. 4559), co-sponsored with Representative Dr. Greg Murphy (R-NC), which seeks to ensure that providers are fairly compensated by MA plans and those payments are received promptly. He also publicly mentioned LeadingAge National’s endorsement of the legislation. Two other bills were discussed during the hearing including Representative Schweikert's MA reform bill (H.R. 3467), which includes an MA default enrollment and lock-in provisions, as well as a carve-in of hospice care, and the bipartisan Improving Seniors' Timely Access to Care Act (H.R. 3514/S. 1816), which seeks to standardize and speed up the prior authorization process so MA enrollees are not left waiting for needed care. When the committee returned after the recess, the discussion turned to various ways in which telemedicine, digital health devices (e.g., health watches), and technology could be used to improve health care outcomes and speed up prior authorization processes. With his time, Representative Tom Suozzi (D-NY) initiated a rapid-fire sequence of questions to witnesses about whether MA needs reforming, and if so, what aspects should be reformed. He concluded from their responses and subcommittee members' comments that there is agreement that lawmakers should seek to fix the upcoding problems and prior authorization issues in the MA program and require greater transparency about whether and how MA is delivering value. LeadingAge National has heard that there is congressional interest in an MA reform bill, which they would expect will seek to correct overpayments to MA plans, as outlined by MedPAC. Given the discussion in this hearing, such a reform bill might also serve as a vehicle to finally get the Improving Seniors’ Timely Access to Care Act (prior authorization reforms) passed. However, it also presents a vehicle for measures from Representative Schweikert's bill which LeadingAge National strongly opposes – make MA the default enrollment option for Medicare beneficiaries and lock them into one plan for three years, and/or carve hospice care into the MA program. LeadingAge National will continue to voice its concerns about the Schweikert bill and advocate for prior authorization reforms in the days and weeks ahead.
Hospice Update
Hospice Quality and Compliance Workgroup Meeting July 30th. LeadingAge National’s next Hospice Quality and Compliance Workgroup meeting is on July 30th at 1 p.m. ET. The meeting will cover the most common reasons for condition-level deficiencies in the 12 core Conditions of Participation (CoPs) that are used for survey and certification of hospice providers and how to avoid those deficiencies. These 12 core CoPs also make up how CMS determined the initial list of providers to participate in the Special Focus Program. While that program was paused in February, LeadingAge National anticipates that CMS will move forward with the program at some point in the future, focused more on CoPs. Members can register for this meeting here. PLEASE NOTE: Due to an internal scheduling conflict, this meeting will move to a new Zoom link. All current registrants should receive the updated link and a message canceling the former link. If you did not, please reach out to Katy Barnett.
Aug. 20th Webinar: Is Your Hospice Agency Prepared for HOPE? Join LeadingAge National for a 90-minute webinar on Wed., Aug. 20th at 2 p.m. to cover the practical insights to navigate the Hospice Outcomes and Patient Evaluation (HOPE) reporting requirements and prepare your team for success. Starting Oct. 1, 2025, the HOPE Tool will replace the Hospice Item Set (HIS) collection process, introducing a more comprehensive approach to patient assessments and quality reporting. This webinar is designed to provide you with the latest updates ahead of the submission deadline, along with actionable strategies to help your agency prepare for implementation and avoid a 4% cut to your Medicare rates.
CMS Announces Three-Hour HOPE Coding Workshop. CMS is offering a live, three-hour coding workshop on Aug. 5, 2025 at 1 p.m. ET. The workshop will provide coding practice for items that are new for HOPE, as well as the existing and updated items carried over from the HIS. Hospices can register now for the webinar. Hospices are encouraged to complete the brand-new Didactic Recorded Training Series as a prerequisite for the coding workshop. This course can be found here.
CMS Fact Sheet Addresses Hospice Fraud. On July 23rd, CMS posted a new Hospice Fast Facts sheet to inform the public about significant enhancements to address hospice fraud, including what hospice fraud is, how CMS is enhancing oversight of hospice providers, and what CMS is doing to stop fraud. The fact sheet includes specific numbers on hospices subject to medical review under the Provisional Period of Enhanced Oversight (PPEO) in four states including Arizona, California, Nevada, and Texas. As of June 2025, 668 hospices were subject to medical review under the PPEO, with CMS revoking the enrollment of 122 hospices. One of the major concerns with hospice fraud is the unknowing enrollment of beneficiaries in hospice which can prevent those individuals from accessing necessary treatments and services. Often when beneficiaries attempt to disenroll, they meet unresponsive, fraudulent hospice providers, which slows disenrollment. CMS has streamlined the hospice disenrollment process from 6 months to less than 12 days. Additionally, CMS's Rapid Response Team has reversed the enrollments of 358 hospice elections for Medicare beneficiaries to date.
Contact: Meg Everett, meverett@leadingageny.org, 518-867-8871