CMS introduced a proposed rule that would create a publicly reported hospice scoring system designed to flag providers with potential compliance, quality, or utilization concerns.

The new Service and Spending Variation Index (SSVI) would evaluate hospices using claims-based metrics such as non-hospice spending, extended lengths of stay, and discharge patterns.

Higher scores would not confirm fraud but would indicate elevated risk and trigger additional CMS oversight.

CMS also proposes adding a consumer-facing icon on Medicare’s Care Compare tool to identify hospices that fail to meet quality reporting requirements, addressing a gap affecting approximately 20% of providers.

The rule would require hospices to provide beneficiaries with a clear addendum outlining non-covered services at the time of election, improving transparency around coverage decisions.

This change is intended to reduce confusion and unexpected out-of-pocket costs during a critical stage of care.

The proposal includes a 2.4% hospice payment rate increase for FY 2027, with payment reductions for providers that do not meet quality reporting requirements.

These updates align with CMS’s broader effort to strengthen program integrity and address ongoing concerns related to hospice fraud and inappropriate utilization.
Targeted oversight efforts have already resulted in hundreds of hospice enrollment revocations in high-risk states.

If finalized, the rule would significantly expand transparency and accountability across the Medicare hospice landscape.

Source: CMS Press Release