CMS announced on February 14, 2025, that it had ceased implementation of the Hospice Special Focus Program (SFP) in order to “further evaluate the program.” The purpose of the SFP is to identify and strengthen oversight of poorly-performing hospice agencies, and to improve quality, including by imposing additional penalties. Congress required the program as part of the Hospice ACT of 2020, which was enacted in the wake of a concerning 2-part report by the Office of the Inspector General (OIG) at the U.S. Department of Health and Human Services. Examining state agency and accreditor surveys, as well as complaint data covering a 5-year period, OIG found that about 20% of hospice agencies had deficiencies posing serious safety risks to patients.
Although the major hospice industry groups supported the intent of the SFP, they objected to CMS’ finalized design of the program, in particular the algorithm, survey data and quality metrics used to determine the bottom 10 percent of low-performing providers. These stakeholders expressed concern that flaws in the methodology would misclassify high-quality hospices and unduly impact agencies operating in underserved communities. Legislation was introduced last year seeking to delay implementation of the program. After CMS released its initial list of 50 hospices selected for the SFP beginning in 2025, a group of state hospice associations filed a lawsuit in January challenging CMS’ implementation of the program. Shortly afterward, CMS suspended the program’s implementation.
The Center for Medicare Advocacy strongly urges the Trump Administration to prioritize and protect the care and safety of hospice patients by ensuring CMS has sufficient staff and resources to meet its statutory obligations for hospice oversight. CMS must expeditiously continue its important work with stakeholders on honing SFP methodology that will best identify providers that must be held accountable for resolving deficiencies that risk harm to patients, and those providers with a history of serious deficiencies that should be terminated from the Medicare program. CMS must also address overdue hospice inspections and inconsistent standards across state and accrediting survey agencies, as recommended by the Government Accounting Office. As a practical matter, though, major federal funding cuts would simply exacerbate the staffing shortages that have hindered state survey agencies from completing timely on-site inspections.
Resources for Individuals Considering Hospice Care
For individuals who have elected or are considering hospice care, we highlight the following resources. The Center has put out a Quick Guide with basic information about hospice coverage under Medicare. In collaboration with the National Alliance for Care at Home (formerly, the National Association for Home Care & Hospice), the Center developed “Questions to Ask When Choosing a Hospice,” a guide for beneficiaries and their families on options and considerations when selecting a qualified hospice provider. CMS has published “Safeguards for Medicare Beneficiaries in Hospice Care,” a Fact Sheet that discusses patients’ basic rights in hospice care to be free from abuse, neglect, mistreatment, and to have their personal property kept safe. Additionally, OIG has issued a one-page “Know Your Rights, Take Action” flyer.
February 27, 2025 – W. Kwok