Important Updates: CMS + CDPH 2025 Final Rules for hospices

Medicare Updates:

1. Special Focus Program (SFP):

• CMS finalized the SFP, targeting the lowest-performing 10% of hospices based on specific quality metrics. These hospices will face increased inspections every six months and potential penalties like fines or loss of Medicare certification. The program aims to ensure better compliance with Conditions of Participation (CoPs), though concerns have been raised about the algorithm used for hospice selection.

2. Higher Penalties for Noncompliance:

• Hospices that fail to submit data to the Hospice Quality Reporting Program (HQRP) will face a 4% payment reduction, up from 2%. This aims to increase transparency and patient choice but may strain providers already grappling with rising costs.

3. Health Equity Initiatives:

• CMS is seeking ways to enhance health equity by collecting data on underserved populations and integrating measures addressing social determinants of health. Providers are encouraged to support equitable access to hospice care through tools like the upcoming Hospice Outcomes & Patient Evaluation (HOPE) tool.

CDPH Updates:

1. License Moratorium Extension:

• California extended its moratorium on new hospice licenses until emergency regulations are established. This action responds to concerns over fraud and abuse within the state’s hospice system, following audits revealing significant deficiencies in oversight.

2. Stronger Licensing Standards:

• New legislation requires caps on staff travel time, stricter caseload standards, mandatory hospice-specific training for management, and enhanced reporting protocols. The CDPH will also validate 5% of licenses issued through accreditation agencies each year.

These measures reflect a broader push for accountability and quality in hospice care, addressing gaps in oversight while promoting access to equitable, patient-centered care.