CMS Adds Georgia and Ohio to States Requiring “Enhanced Oversight” for Hospice Providers

Key Takeaways

• CMS has announced that it is adding Georgia and Ohio to its list of states in which hospice providers are now under “enhanced oversight,” joining Arizona, California, Nevada, and Texas.
• New enrollments and certain change of ownership transactions may trigger this enhanced oversight.

The Centers for Medicare and Medicaid Services (“CMS”) announced that it has added Georgia and Ohio to its list of states in which hospice providers are now under “enhanced oversight.” As a reminder, in 2023, CMS announced a period of enhanced oversight for new hospices in Arizona, California, Nevada, and Texas.

According to the updated Medicare Learning Network (“MLN”) Fact Sheet, CMS has received several reports over the past year of hospice fraud, waste, and abuse, which CMS aims to reduce with the enhanced oversight period.¹ CMS has also identified a concern of market oversaturation due to a significant increase in enrolled hospices in the above-referenced states. Therefore, any new hospices in those states will be subject to a period of enhanced oversight, which can range from 30 days to one year. According to CMS, “The provisional period of enhanced oversight includes medical review of hospice claims, such as prepayment review.”

For purposes of CMS’ enhanced oversight period, a “new hospice” includes not only providers that are newly enrolling in Medicare, but also hospices undergoing certain ownership changes. This includes transactions where a hospice is sold, merged into a new company, consolidated with another entity to form a new corporation, or where a facility (or part of it) is leased to a different operator.

AGG’s previous bulletin related to CMS’ initial announcement in July 2023 contains additional details on which hospices may be affected and how.

For more information, please contact AGG Change of Ownership attorneys Hedy Rubinger or Maggie Callahan.

The Arnall Golden Gregory Change of Ownership (“CHOW”) team leads all regulatory aspects of healthcare transactions for investors, operators, managers, capital partners, and developers of every size in all 50 states. The team streamlines the regulatory process so that clients close their transactions on or ahead of schedule. Whether obtaining licensure and Medicare/Medicaid approvals, structuring transactions to expedite closings, anticipating issues to minimize cash flow disruption, negotiating regulatory terms in deal documents, creatively resolving diligence issues, or advising on CHOW guidelines and compliance, the team provides extensive experience and practical solutions. To date, the CHOW team has served as primary regulatory counsel in transactions valued at more than $35 billion.​​

[1] CMS MLN7867599, available at MLN7867599 – Period of Enhanced Oversight for New Hospices in Arizona, California, Nevada, Texas, Georgia & Ohio.