Last week, the Centers for Medicare & Medicaid Services (CMS) proposed new transparency measures to strengthen oversight of hospice providers.

In the FY 2027 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements Proposed Rule, CMS is introducing a new publicly available hospice scoring system that focuses on indicators of potential inappropriate utilization, quality of care, and compliance issues, holding suspicious facilities accountable while supporting legitimate hospices to succeed.

CMS stated that this scoring system is part of their larger initiative to enhance oversight, boost transparency for families, and prevent Medicare hospice benefits from being exploited by fraudsters, ensuring that beneficiaries receive proper care.

The agency has adopted a targeted, data-driven strategy to detect and combat fraudulent activities at hospices. This includes unannounced hospice site visits nationwide and the revocation or deactivation of hundreds of hospice providers involved in improper conduct. Enhanced oversight in four states with higher fraud risks—Arizona, California, Nevada, and Texas—has led to over 200 hospice Medicare enrollment revocations for non-compliance with CMS requirements. CMS has since expanded this focused oversight approach to additional states, including Georgia and Ohio.

CMS has observed that non-hospice spending for terminally ill individuals has continued to rise in recent years. CMS’s service and spending variation index (SSVI) will assign hospices a score based on various metrics CMS collects from hospice claims, including: non-hospice spending, the percentage of beneficiaries discharged with a length of stay of 180 days or more, average minutes per routine home care day, and the percentage of live discharges where beneficiaries return to the same hospice within seven days, among others. 

CMS proposes a new icon for the Medicare.gov Care Compare site to identify hospices that did not meet requirements under the Hospice Quality Reporting Program (HQRP). CMS found that in 2025, approximately 20 percent of hospices were not in compliance with HQRP reporting requirements, consistent with previous years. 

For fiscal year 2027, CMS proposes increasing the hospice payment rate by 2.4 percent, which is an estimated boost of $785 million in payments compared to 2026. This reflects the proposed 3.2 percent inpatient hospital market basket percentage increase, minus a proposed 0.8 percentage point productivity adjustment, as required by law.