NPHI Made the Following Statement on January 16th 2025
Washington D.C. — Today, a lawsuit was filed by the Texas Association for Home Care & Hospice; Indiana Association for Home & Hospice Care; Association for Home & Hospice Care of North Carolina; South Carolina Home Care & Hospice Association; and Houston Hospice. The lawsuit challenges CMS’s implementation of the hospice Special Focus Program (SFP) as unlawful and arbitrary. We acknowledge that Houston Hospice, an NPHI member, is one of the plaintiffs in this legal action, and we are committed to supporting them and others impacted by the SFP or the accompanying excel files.
The hospice Special Focus Program (SFP), conceived and passed on a bipartisan basis as a part of the HOSPICE Act in 2021, was designed to address poor-quality hospice providers by offering them additional support and technical assistance to ensure compliance with the Medicare Hospice Conditions of Participation. NPHI is extremely disappointed that CMS has departed from that Congressional intent, transforming the hospice SFP into a burden for many well-meaning hospices, with an algorithm for identifying providers based on inaccurate data and including elements that are not referenced in the statutory language. Moreover, CMS provides no due process with no avenue for appeal or recourse for hospices targeted under the flawed SFP algorithm. This outcome was entirely predictable and one that NPHI warned would occur when CMS initially proposed and subsequently finalized a flawed algorithm to identify providers for the SFP. Over the last two years, NPHI has repeatedly conveyed these concerns to CMS directly and led efforts with a bipartisan group of lawmakers to ensure Congressional intent behind this program was appropriately translated into regulation.
NPHI fully supports the litigation filed today, which aims to direct CMS to comply with the spirit and intent of the statute and regulations. This includes ensuring that the hospice SFP measures focus solely on compliance with the Medicare Hospice Conditions of Participation. We look forward to working with Congress, CMS, the incoming Trump Administration, and others to correct these flaws and create a program that meaningfully addresses the survey process, compliance with the Conditions of Participation, and review of complaints all while safeguarding Medicare beneficiaries and well-meaning, regulatorily compliant providers.
###