Every year, Medicare updates the rules that govern hospice care: how it’s paid for, what it covers, and how quality is measured. And every year, Compassion & Choices monitors those proposed changes to be sure they strengthen patient-directed end-of-life care. When they don’t, we take action.
This spring, Compassion & Choices’ Chief Legal Advocacy Officer, Bernadette Nunley, submitted a formal comment in response to the latest rule proposal. The comment is part of our broader work advocating at the federal level for your end-of-life rights, from the reintroduction of the Compassionate Care Act to expanding end-of-life care education for all healthcare professionals and fighting to amend the ban on using federal insurance (including Medicare) to pay for medical aid in dying in authorized states.
Here’s what’s in the latest proposed rule, how we responded, and why it matters to you.
Hospice patients often need in-person visits from healthcare providers to stay enrolled in their care. During the pandemic, the Centers for Medicare & Medicaid Services (CMS) allowed these “face-to-face” recertifications to happen over telehealth, a change that’s been extended ever since. The new rule proposes extending that flexibility through the end of 2027.
We told CMS this matters. Many hospice patients are homebound, medically fragile, or in significant pain. Requiring travel or rushed in-person visits just to stay recertified can be a real burden — especially for people in rural areas, those living with advanced dementia, or anyone for whom travel is simply unsafe. We urged CMS to keep this flexibility in place so patients don’t lose access to hospice care over a scheduling technicality.
The proposed rule also asks the public for input on how Medicare could better support community-based palliative care, which is care that manages pain and improves quality of life for people with serious illness, often alongside ongoing treatment, outside of the hospital setting.
We used this opportunity to press CMS for concrete changes:
CMS also asked for public input on how medical aid in dying interacts with hospice care. Our response emphasized that hospice care and medical aid in dying are not mutually exclusive. We want to be sure that any new rule changes do not limit hospice services for patients who plan to use medical aid in dying, such as forcing hospices to terminate services immediately before a patient’s death.
We explained in our comment that in places where medical aid in dying is authorized, the evidence shows that hospice care and medical aid in dying work together, not against each other. Attending physicians are required to discuss hospice and palliative care with anyone considering medical aid in dying, and most people who use medical aid in dying are enrolled in hospice at the time of their death. Those patients considering medical aid in dying still benefit from hospice services, including pain and symptom management, nursing assessments, caregiver education and respite, spiritual care, and more.
Our point: Patients considering medical aid in dying still deserve and need full hospice support. And we’ll continue to work to protect hospice care for people who choose this option.
The public comment period on this rule has closed, and CMS will now review all submissions — including from Compassion & Choices — before issuing a final rule later this year.
Advocacy like this is behind-the-scenes, sometimes technical work, but it shapes real outcomes for real patients. Thank you for being part of a movement that shows up for people at every stage of the process.
Learn more about how we’re fighting at the federal level for patient-directed end-of-life care.
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Compassion & Choices Gift Processing Center
PO Box 485
Etna, NH 03750
Compassion & Choices is a 501 C3 organization. Federal tax number: 84-1328829
