On April 7, 2025, the United States District Court for the Northern District of Texas ruled in favor of the American Health Care Association (“AHCA”) in its lawsuit against Health and Human Services (“HHS”) Secretary Robert...more
In this episode, AGG Healthcare attorneys Bill Dombi and Jason Bring discuss the hospice special focus program and CMS’ announcement that it will cease implementing the program in the face of litigation filed by providers and...more
A group of four state associations and a hospice provider have filed a federal lawsuit in Texas challenging the Special Focus Program (“SFP”) Final Rule and the resulting list of hospices identified as poor performers. The...more
AGG’s Home Health & Hospice team publishes a quarterly newsletter covering legal and regulatory topics specific to the home and community-based healthcare industry. The fields of end-of-life and home healthcare present...more
AGG’s Home Health & Hospice team publishes a quarterly newsletter covering legal and regulatory topics specific to the home and community-based healthcare industry. The fields of end-of-life and home healthcare present...more
The US Government Accountability Office (“GAO”) issued a report on December 12, 2022, recommending that the Centers for Medicare and Medicaid Services (“CMS”) expand hospice fraud and abuse reporting requirements to make them...more
After attending the recent annual conference of the National Association for Home Care & Hospice (“NAHC”) in St. Louis, Missouri, and speaking with numerous clients, consultants, and vendors, AGG Healthcare partner, co-chair...more
An August 2020 report by the U.S. Department of Health and Human Services Office of the Inspector General recommended that the U.S. Centers for Medicare & Medicaid Services (CMS) revamp its use of the hospital wage index to...more
More than one year after two major hospice reports raised concerns ranging from billing to patient safety, the U.S. Department of Health & Human Services Office of the Inspector General (OIG) continues its review of the...more
CMS has announced a series of temporary regulatory waivers and new rules to provide hospice providers with flexibility to respond to the COVID-19 pandemic. The goals of these actions are to expand the healthcare system...more
On March 30, 2020, the U.S. Centers for Medicare and Medicaid Services (CMS) issued an Interim Final Rule (IFC) introducing temporary regulatory waivers and new rules to promote flexibility in the American health care system...more
CMS Announces Hospice Capitation Rates for Medicare Advantage -
The U.S. Centers for Medicare and Medicaid Services (CMS) recently released the capitation rates for hospice care through the value-based insurance design...more
The U.S. Centers for Medicare and Medicaid Services (CMS) recently released the capitation rates for hospice care through the value-based insurance design model (VBID), often referred to as the Medicare Advantage hospice...more
The White House presented its FY 2021 budget to Congress in early February. The budget included HHS budget provisions reflecting the Trump Administration’s views on policy areas affecting hospice. ...more
On February 10, 2020, Congressman Jimmy Panetta (D-CA) and Congressman Tom Reed (R-NY) introduced the Helping Our Senior Population in Comfort Environments Act or HOSPICE Act (H.R. 5821). ...more
The uncertainty surrounding the use of arbitration agreements in nursing homes has finally ended—at least for now. On July 16, 2019, CMS released its long-awaited final rule, which updates the requirements nursing homes must...more
Every year, health lawyers, providers, consultants, and government experts from across the country convene in Baltimore for the American Health Lawyers Association’s Institute on Medicare and Medicaid Payment Issues, the most...more
Medicare’s implementation of post-payment review through overly aggressive zone program integrity contractors (ZPICs) and unified program integrity contracts (UPICs), combined with an ineffective review process at the first...more
On August 16, 2017, the Centers for Medicare and Medicaid Services (CMS) released the Hospice Compare website. This website joins a variety of other CMS “Compare” websites – including Inpatient Rehabilitation Facility...more
People in this country have long enjoyed the right to contract. Included with that right is the ability to agree to resolve potential disputes out of court and in arbitration. The Centers for Medicare & Medicaid Services’...more
Medicare’s implementation of post-payment review through private contractors who are overly aggressive in denying payments, combined with a severe backlog of cases in queue for hearing before an Administrative Law Judge...more
11/11/2015
/ Administrative Appeals ,
Administrative Law Judge (ALJ) ,
Centers for Medicare & Medicaid Services (CMS) ,
Due Process ,
Hospice ,
Medicare ,
Medicare Provider Agreements ,
OMHA ,
RAC Audits ,
Recoupment ,
Recovery Audit Contractors (RACs)
During the 90-day public comment period on the Center for Medicare & Medicaid Services (CMS) proposed rule entitled “Reform of Requirements for Long-Term Care Facilities” which closed October 14, 2015, CMS received nearly...more
In July, the Centers for Medicare & Medicaid Services (CMS) proposed changes to the requirements for long-term care facilities, including implementation of new restrictions on the use of binding arbitration agreements between...more