On March 13, 2025, the Medicare Payment Advisory Commission (MedPAC) published the March 2025 Report to Congress: Medicare Payment Policy, a congressionally-mandated report providing analysis and recommendations on Medicare programs.

The MedPAC commissioners unanimously approved the recommendations for both home health and hospice. However, it is important to note that MedPAC is an advisory body to Congress and even with a unanimous vote in favor of any recommendation, no changes will be made unless Congress makes the necessary legislative changes to implement these recommendations.

Below are highlights from the Report to Congress: 

Home Health 

Final recommendation: For calendar year 2026, the Congress should reduce the 2025 Medicare base payment rates for home health care services by seven percent. 

• Beneficiaries Access to Care: According to MedPAC, this indicator was mostly positive: 

• 98% live in a ZIP code with 2 or more HHAs 

• FFS Medicare per capita volume decreased 

• Share of hospital discharges to home health higher than pre-pandemic level 

• Quality of Care: According to MedPAC, this indicator was positive: 

• FFS Medicare beneficiaries’ risk-adjusted discharge to community rate improved slightly 

• Patient experience measures remained high and were stable 

• Access to Capital: According to MedPAC, this indicator was positive: 

• 2023 all-payer margin: 8.2% 

• HHAs’ acquisition efforts have slowed, but firms have continued to acquire HHAs 

• Medicare Payments and Costs: According to MedPAC, this indicator was positive: 

• FFS Medicare margin in 2023: 20.2% 

• Projected FFS Medicare margin for 2025: 19% 

Hospice  

Final recommendation: For fiscal year 2026, the Congress should eliminate the update to the 2025 Medicare base payment rates for hospice. 

• Beneficiaries Access to Care: According to MedPAC, this indicator was positive: 

• Increase in provider supply (6535 providers) 

• Increase in share of decedents using hospice (51.7%), number of hospice users (1.74 million), total days of care (137.7 million) 

• Increased average length of stay (96.2 days) and stable median length of stay (18 days)  

• Stable average visits per week (3.9) 

• Quality of Care: According to MedPAC, this indicator was stable: 

• CAHPS® quality scores were stable 

• Composite process measure increased slightly but generally topped out 

• Number of visits at the end of life was stable or increased slightly, but nurse visits below 2019 

• Access to Capital: According to MedPAC, this indicator was positive: 

• Continued entry of for-profit providers 

• Sector viewed favorably by investors 

• Provider-based hospices have access via parent provider 

• Medicare Payments and Costs: According to MedPAC, this indicator was positive: 

• Provider costs per day increased by 3.0% 

• 2022 FFS Medicare margin: 14.0% 

• 2025 projected margin: 8% 

The National Alliance for Care at Home (Alliance) has serious concerns over the potential negative impact these recommendations would have on care access and quality and will continue to strongly advocate for payments that ensure the sustainable delivery of high-quality care in the home. If you have questions about MedPAC or the report, please reach out to the Alliance team at regulatory@allianceforcareathome.org.  

This report follows MedPAC’s January meeting when it finalized its recommendations on Medicare payment adequacy for various service lines, including home health and hospice services. The Commission’s decisions focused on payment adequacy, access to care, quality, financial performance, and projections for 2025 and beyond. The Alliance has covered the December 2024 meeting discussing the recommendations as well as the January 2025 meeting finalizing the recommendations.