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Payers to CMMI: We Need a Standardized Definition for Palliative Care

Hospice News

A group of health plans, policymakers, and insurance companies recently told the Center for Medicare & Medicare Innovation (CMMI) that they needed a standardized definition for palliative care in order to improve access. Centers for Medicare & Medicaid Services (CMS).

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C-TAC: CMS’ ‘Palliative’ Definition in 2025 Proposed Hospice Rule ‘Misaligned, Problematic’

Hospice News

Efforts to establish potential payment mechanisms for high-acuity palliative services within the Medicare Hospice Benefit will require greater clarity from regulators, according to the Coalition to Transform Advanced Care (C-TAC). This could result in deepening conflation of hospice and palliative care, the organization indicated. “We

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Palliative Care, Health Equity Growing in Medicare Advantage

Hospice News

Reimbursement for community-based palliative care is gaining ground in the Medicare Advantage realm. Palliative care is among the wide range of supplemental benefits that exist within the Medicare Advantage payment landscape. This is a rise from 180 MA plans in 2023 offering palliative services and 64 MA plans in 2020.

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Dynamics of Palliative Care Delivery in a Potential Medicare Benefit

Hospice News

A moving target in palliative care delivery is whether or not these services should have a dedicated benefit in the Medicare system. Most palliative care in the United States is reimbursed through fee-for-service programs, as well as Medicare Advantage, Accountable Care Organizations (ACOs) and through Medicaid in a handful of states.

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Medicare Advantage Crackdown Could Dampen Palliative Care Growth

Hospice News

Federal regulators are cracking down on the private insurers that administer Medicare Advantage (MA) plans. Centers for Medicare & Medicaid Services (CMS) began giving plans more flexibility around the definition of “primarily health-related.” based research and consulting firm ATI Advisory.

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The Nexus Between Palliative Care and PACE Programs

Hospice News

PACE programs are definitely open to capitated arrangements — per-participant, per-month. Most PACE participants are dually eligible for both Medicare and Medicaid, the U.S. Centers for Medicare & Medicaid Services (CMS) reported. PACE providers receive monthly Medicare and Medicaid capitated payments for each enrollee.

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How Palliative Care Could Help Break the SNF-to-Hospital Cycle

Hospice News

Even more so, specific Medicare and Medicaid policies perpetuate this cycle. After experiencing a functional decline at the hospital, the woman, no longer able to live at home safely, was sent to an SNF for post-acute care, covered by Medicare. Older adults frequently utilize such services, often in skilled nursing facilities (SNF).