Fun story: Years ago I did this wilderness survival training class at a camp in central Michigan. One of the things I had to do was build a shelter out of natural materials I found in my environment and sleep in it overnight.
“Sleep” may be a bit of an exaggeration. The lean-to thing I built was sturdy and effective but not very comfortable. I made it from downed branches, stones and moss. It had a small entrance hatch and a little hole at my feet for drainage in case it rained.
So, while I was lying awake in this contraption, I heard a rustling. I looked down, and I saw a face. At first, I didn’t recognize the animal that was wriggling its way into my tiny hutch, partly because its fur was so white.
I thought it might be a rabbit initially, but when it got its head through, I saw no long ears. Then I thought it might be a weasel or something. It wasn’t until it got in all the way — and its tail emerged — that I realized that I was looking at an albino skunk.
It started crawling up my legs.
I want to emphasize here that I did not freak out. I am, at least outwardly, a pretty calm bloke.
When the beast reached my lap, it actually curled up and went to sleep. I guess I was the warm thing in the forest that night. I decided my best course of action was to remain very, very still until it left, which was a little uncomfortable. But it worked. I did not get bitten, clawed, or sprayed. When it woke up, the skunk simply crawled up over my chest and tramped out through my little entrance.
Ultimately, this was a pretty cool experience. But it bears saying that a lot of people don’t like skunks. Why? Because they stink. You know what else stinks? That many people struggle to get access to hospice, home care or home health. (I am going to focus on hospice here, but this applies to virtually all home-based care.)
This was a consistent theme on Tuesday when about 160 hospice and healthcare leaders visited Capitol Hill with the National Alliance for Care at Home — protect and foster greater access to care.
Hospice “deserts” have always existed, particularly (though not exclusively) in rural areas. Many regions do not have enough quality providers to serve the population’s needs, largely due to distance, workforce constraints, economics and other factors.
To address this inequity, hospices need to grow. They must increase capacity and expand into new markets. However, recent regulatory actions threaten their ability to do so, according to the hospice executives I met in Washington, D.C., chief among them is the U.S. Centers for Medicare and Medicaid Services’ (CMS) six-month moratoria on hospice and home health enrollment in Medicare.
The moratoria hamper access to quality hospice care. This was a key message that hospices and home health providers brought to members of Congress this week.
Let’s take a brief look at the home health side of the equation. Through the third quarter of 2025, 38% of Medicare beneficiaries referred for home health care at hospital discharge did not receive those services, according to the Alliance. The gap was even wider among rural beneficiaries.
Compared with beneficiaries who received home health care, those who did not had a 36% higher 90-day mortality rate, a 33% higher hospital readmission rate and approximately 8% higher Medicare spending during the same period.
Home-based care providers could be reaching more of these patients — and reducing hospitalization costs — if the moratoria were not stymying growth.
Providers, for example, cannot expand into underserved areas through de novo operations. The moratoria have also prevented hospice and home health agencies from pursuing affiliations with health systems.
The effects could extend to hospice providers that have invested heavily in inpatient units, including facilities financed in part through community donations. If those units cannot operate, hospices could be left with unused facilities and no patients to serve, while employees hired to staff the units could face job losses.
Similarly, hospices that have invested in renovating unused wings of skilled nursing facilities to expand inpatient capacity may be unable to begin serving patients while continuing to incur substantial monthly lease costs, adding to their financial pressures.
These were some of the messages I heard on the Hill.
Hospice providers urged congressional lawmakers to call on CMS to let the moratoria expire as scheduled in November. The agency has the ability to extend them, which is something stakeholders wish to prevent. CMS had pledged to notify the public of their decision regarding an extension 60 days in advance of the expiration date. That mark passed on Sept. 14. Hospice News will keep our eyes out for the agency’s word on this.
Home-based care leaders advocated for a more targeted, data-driven approach to rooting out criminal enterprises in the hospice space. After all, we still need to deal with the fraud, which itself threatens access to quality care. A new, targeted methodology by CMS could include regional moratoria in markets that are most affected.
This is the gist of a bill that Rep. Beth Van Duyne called the Protecting Seniors and Stopping Fraudsters Act.
Among the bill’s goals is to build systems to identify bad actors earlier, particularly in geographic fraud hotspots like California, Nevada, Arizona and Texas. It would also focus regulatory action on providers with aberrant billing, discharge, enrollment, or low-quality reporting patterns rather than imposing blanket burdens across the industry, the statement indicated.
If enacted, the bill would increase survey frequency for hospices and home health agencies that are newly enrolled in Medicare, providers with ownership changes or those displaying signs of fraudulent behavior. It would also enhance screening requirements for providers considered to be at “extreme risk” of fraud, including fingerprinting administrators and medical directors and requiring proof of liability insurance.
The legislation would also take steps to improve accountability for accreditation organizations by requiring standardized survey training. It would also mandate notification requirements to alert seniors when they have been enrolled in hospice with instructions on how to disenroll if fraud or abuse occurs.
This bill was a frequent topic of conversation during the D.C. visit. Hospice and home health providers want this legislation passed. I personally endorsed the bill here on Inside Hospice back when Van Duyne introduced it in May.
Congressional staffers and lawmakers on both the House and the Senate sides appeared receptive to the hospice and home health providers concerns about the moratoria. They asked insightful questions, and a few acknowledged that the future of health care is in the home.
Lots of other issues were on the table in Washington, many adhering to the theme of access to care. Look for further coverage in Hospice News and some more analysis here in the coming days.
How about you? What do you want to see from Congress in its forthcoming “lame duck” session or post-midterms?