The Office of Inspector General (OIG) on July 15, 2026, updated its current workplan to include a new project looking at fixed daily rates paid to Medicare hospices serving residents in nursing homes. Hospices are paid the routine home care rate, which includes personal care, for care in nursing homes, but nursing homes are also required and paid to provide these services as well. OIG will look at how this payment system undermines the efficiency of Medicare payments and adds to the incentives that bad actors have to exploit the program. This review will determine Medicare payments for routine home care provided to hospice beneficiaries in nursing homes, estimate potential cost savings from reducing the payment to address the inefficiency in the payment structure, and examine practices of hospices with a high percentage of their beneficiaries in nursing homes.

The Hospice CARE Act, legislation that LeadingAge is deeply involved in, includes consideration of differential payments for hospices serving patients in nursing homes, and the Centers for Medicare and Medicaid Services (CMS), as part of the FY2027 Hospice Wage Index Rule, proposed a measure of utilization to track hospices with significant numbers of nursing home patients.