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Savings in Medicare Hospice Payments for Care Provided in Nursing Homes

Announced on  | Last Modified on  | Project Number: OEI-02-26-00180
Status
Active
Agency
Centers for Medicare and Medicaid Services

OBJECTIVE

The fixed daily rates that Medicare pays hospices for routine home care provided in a nursing home include personal care services.  However, nursing homes are already required to provide personal care services to their residents.  Paying the hospice the full routine home care rate that covers personal care services when these services are already required from the nursing home can undermine the efficiency of Medicare payments and add to the incentives that bad actors have to exploit the program.  This review will determine Medicare payments for routine home care provided to hospice beneficiaries in nursing homes, estimate potential cost savings from reducing the payment to address the inefficiency in the payment structure, and examine practices of hospices with a high percentage of their beneficiaries in nursing homes.

TIMELINE

  • July 15, 2026
    Announced
Work Plan Type
Office of Evaluation and Inspections
HHS Agencies
Centers for Medicare and Medicaid Services
Issue Areas
Financial Stewardship Nursing Homes, Nursing Facilities, and Assisted Living Facilities
Target Groups
Elderly
Financial Groups
Medicare A