LeadingAge on June 1, 2026, submitted comments to the Centers for Medicare and Medicaid Services (CMS) on the Fiscal Year 2027 Hospice Wage Index Proposed Rule.

In the overall comments, LeadingAge raised concerned that the proposed 2.4% payment update fails to keep pace with the true cost of care.

“Nonprofit and mission‑driven hospices deliver high‑quality, person‑centered care that supports older adults and families through some of life’s most difficult moments,” said Katie Smith Sloan, president and CEO of LeadingAge in a press statement. “Our members consistently invest in interdisciplinary teams, bereavement services, and community‑based supports that exceed minimum requirements—yet they operate with some of the thinnest margins in the sector. As CMS considers changes via this most recent proposed rule, it is essential that regulatory updates strengthen, rather than destabilize, access to compassionate, high‑quality hospice care.”

In our analysis, there is a cumulative market basket forecasting error of -4.7% over the past five years, creating compounding financial strain on nonprofit providers and LeadingAge asks CMS to correct this forecasting error in the final rule.

The 30-page letter goes into great detail on our concerns regarding the nonhospice spending sections of the rule. LeadingAge understands CMS’s concerns with the continuing increases to nonhospice spending. Overall, LeadingAge supports the concept of the services and spending variation index (SSVI), especially the utilization measures many of which LeadingAge has previously supported and recommended CMS use in a matrix approach.

However, as LeadingAge shares in our executive summary, “we are gravely concerned that the proposals in this rule will not address the root problems of nonhospice spending and instead will add additional burden to hospices and have a chilling impact on access to services.” This direction was based on the tremendous amount of feedback received from our members who were concerned with being held accountable for other providers billing Medicare when they know a patient is on hospice.

To that end, LeadingAge offered an alternative proposal to CMS’s proposal for a universal election statement addendum for every hospice enrollee. LeadingAge recommended CMS eliminate the existing modifier loophole in the billing for services outside of the hospice benefit. This would require changes to the Common Working File to reject any claim without the GV or GW modifier and requirements that providers billing GW or GV include a copy of the addendum from the hospice, which they can obtain right now according to CMS subregulatory guidance, without requiring an addendum to be signed by every single patient.

In addition to comments on nonhospice spending, we included extensive comments on the wage index and community based palliative care RFIs based on member feedback. In general, LeadingAge is supportive of the wage index changes, however, there are many changes that need to occur in hospice data reporting prior to adopting a new wage index in part because of the failings of cost reports to collect FTE. On the palliative care RFI, LeadingAge received great feedback from our members who operate palliative programs using Part B billing and were able to make the recommendation to CMS to establish a bundled code for palliative care which is already being used in Medicaid programs in Hawaii and New Jersey. LeadingAge also offered detailed comments on how to change home health regulations to allow palliative care to be more actionable most notably by changing OASIS measures to track maintenance and not strictly improvement which is difficult in the palliative patient population.

LeadingAge also asked CMS for clear guidance on how CMS will determine the end of the hospice moratorium. On May 28, LeadingAge hosted an all member call on the new Medicare home health and hospice enrollment moratoria and what this could mean for all aging services. If you missed that call, you can access a recording, recap, and slides on our website.

LeadingAge supported the short-term moratoria with the expectation that the agency will take swift action to improve the enrollment protections for Medicare. LeadingAge has already been approached by members concerned with access issues in rural areas and we will continue to monitor the impact to access on both home health and hospice in the next six months and advocate for CMS to make this a truly short-term, six-month moratorium.