The Centers for Medicare & Medicaid Services (CMS) plans a new hospice scoring system in fiscal year 2027 to track “indicators of potential inappropriate utilization, quality of care, and compliance concerns, holding suspicious facilities accountable while allowing legitimate hospices to thrive.”
CMS announced the service and spending variation index (SSVI) is part of its ongoing efforts to combat fraud and strengthen program integrity. CMS said the system will increase transparency for families, ensure proper care, protect beneficiaries and support providers delivering quality end-of-life care.
Details of the proposed rule can be found on the Federal Register. The agency has also published a fact sheet on the proposed rule.
The SSVI score will be based on a variety of metrics CMS gathers from hospice claims, including:
- Non-hospice spending
- Percent of beneficiaries discharged with a length of stay of 180 days or more
- Average minutes per routine home care day
- Percent of live discharges where beneficiaries return to the same hospice in seven days
Provider-level data and each facility’s SSVI score would be posted on CMS’ Hospice Center webpage.
While a high SSVI score is not a direct indicator of fraud, waste or abuse, CMS believes it would represent cause for concern of integrity risks or inappropriate utilization, indicating a need for increased oversight, including additional review to assess potential program integrity or compliance issues.
“Hospices exist to help Americans die peaceful, dignified deaths, not to line the pockets of fraudsters,” CMS Administrator Dr. Mehmet Oz said in a press release. “These new transparency measures will make it easier for CMS and others to identify hospice providers that misuse Medicare dollars, cut off their funding, and refer them to law enforcement for criminal prosecution.”
Among other efforts to combat fraud, CMS has conducted unannounced hospice site visits nationwide and revoked the licenses of hundreds of hospice providers engaged in improper activity. In Arizona, California, Nevada and Texas, the agency has revoked more than 200 hospice Medicare enrollments for failure to comply with CMS requirements. CMS has since expanded this targeted oversight approach to additional states, including Georgia and Ohio.
Hospice providers should plan for this development and take steps to improve their metrics. This includes training rain staff on the importance of these indicators and instituting policies to ensure compliance and best practices. Consult an experienced attorney to assist with improving your SSVI score.
Harris Beach Murtha’s Government Compliance and Investigations Practice Group and Health Care Industry Team will continue following this and related issues and report out significant developments. If you are a Medicaid provider and need assistance with this or related matters, please reach out to attorney Glenn M. Jones at (516) 880-8494 and gjones@harrisbeachmurtha.com, or the Harris Beach Murtha attorney with whom you most frequently work.
This alert is not a substitute for advice of counsel on specific legal issues.
Harris Beach Murtha’s lawyers and consultants practice from offices throughout Connecticut in Bantam, Hartford, New Haven and Stamford; New York State in Albany, Binghamton, Buffalo, Ithaca, New York City, Niagara Falls, Rochester, Saratoga Springs, Syracuse, Long Island and White Plains; as well as in Boston, Massachusetts, and Newark, New Jersey.