Federal Updates for Home Health and Hospice
(Sept. 23, 2025) Please note the following home health and hospice updates from LeadingAge National:
CMS Updates Training on Achieving a Full Annual Payment Update. The Centers for Medicare and Medicaid Services (CMS) released a recorded presentation that provides the latest information about the Annual Payment Update (APU) for the Hospice Quality Reporting Program (HQRP), including what it is, the data submission requirements for Hospice Outcomes and Patient Evaluation (HOPE) and Consumer Assessment of Healthcare Providers and Systems (CAHPS®) data, how CMS determines HQRP compliance, and the steps hospices can take if they receive a non-compliance decision. As a reminder, if hospices do not submit 90% of their HOPE records within 30 days of completing the records, they risk a 4% APU reduction for Calendar Year (CY) 2027.
Hospice Quality and Compliance Workgroup Sept. 24th: Last-Chance HOPE Q&A. Do you have outstanding questions on the HOPE tool as the Oct. 1st implementation date nears? LeadingAge National is hosting a special Hospice Quality and Compliance Workgroup on Sept. 24th at 1 p.m. ET for key updates from CMS on traveling patients and symptom follow-up visits during inclement weather, followed by an open floor for participants to ask outstanding questions of LeadingAge National's experts. LeadingAge National will wrap the session with best practice sharing and crowdsource electronic medical record (EMR) questions with colleagues. And if you have thorny queries, email Workgroup leader Katy Barnett in advance; she will research answers and discuss on the call. Sign up for the call here, and check out all of the resources on LeadingAge National's Hospices and HOPE: Updates, Resources, and More or HOPE Tool: Resources and Details webpage.
HHA Review Choice Demonstration: Metrics Decreased in 2024. On Sept. 16th, CMS released updated stats on all prior authorization and pre-claim review programs, including the Review Choice Demonstration for Home Health Services, which was extended in May 2025 for an additional five years. The Fiscal Year (FY) 2024 stats found that the accuracy rates of the Medicare Administrative Contractor (Palmetto) decreased to 97.7% from 100% in FY 2023, and the number of days to process requests increased slightly from 4 to 4.7. The rate of claims overturned on level 1 appeal also jumped from 35.4% in FY 2023 to 51.6% in FY 2024. The percentage of approved requests decreased slightly from 85.5% in FY 2023 to 84.4% in FY 2024. Some of this decrease was likely caused by the addition of Oklahoma as a demonstration state starting Dec. 1, 2023. Despite the decrease in accuracy, CMS continued to see a decline in home health payments in the states covered by the demonstration.
Contact: Meg Everett, meverett@leadingageny.org