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A federal effort to increase oversight of hospice care has been put on hold by the Trump administration, resetting efforts to root out fraud and abuse in an industry that receives more than $25 billion from Medicare annually.

Why it matters: Federal officials in recent years have ramped up efforts to identify instances in which hospice operators fraudulently bill the government or enroll patients who aren't terminally ill. But the new administration last month halted a Biden-era plan for noncompliant hospices to take corrective action or risk being kicked out of Medicare.

The big picture: Medicare is required by law to implement some version of the targeted oversight program. But it's not clear how that will evolve in President Trump's second term. CMS didn't respond to a request for comment.

• The pause amounts to a win for the hospice industry, which said the original Biden CMS plan would penalize well-meaning operators without identifying underperforming ones.
• "What's hoped and expected at this point is the ability to refine the model," said Bill Dombi, who retired as president of the National Association for Home Care & Hospice last year.

Flashback: Congress in 2020 passed a law requiring CMS to create a program to boost oversight of underperforming hospices, including more reporting and monetary penalties for wrongdoing.

• "What was actually proposed by CMS … is a program that looked like it was penalizing rather than rehabilitating these providers," said Scott Levy, chief government affairs officer of the National Alliance for Care at Home, a trade group representing hospice organizations.

Reality check: Patient advocates worry that workforce reductions at CMS since the Trump administration took office will make it harder to improve hospice oversight.

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The Trump Medicare innovation center plans to cancel a half dozen trials to change the way health providers are paid by the end of the year as it aligns itself with the goals of the MAHA movement.

The big picture: Center for Medicare and Medicaid Innovation leadership said they want to focus on models that are likely to meet criteria for expansion and that promote the goals of HHS Secretary Robert F. Kennedy Jr.'s public health agenda, said a person with knowledge who was granted anonymity to speak freely.

What they're saying: CMMI "is committed to testing — and eventually scaling — innovative payment models that meet the statutory goals of reducing program spending while maintaining or improving quality of care," a CMS spokesperson said.

• The center has completed a data-driven review of models based on their statutory mandate and identified some that will conclude as scheduled and others that should be terminated, the spokesperson said.
• CMS estimated the changes will save taxpayers almost $750 million, though it did not specify how.

Reality check: It's common for a new administration to end or modify some Medicare payment projects early in its term.

• But the back-and-forth can make it hard for providers to fully invest in participating in these payment experiments.

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As teen tobacco use experiences historic declines, new evidence suggests vaping is giving kids the same level of nicotine exposure.

Why it matters: The findings could undercut arguments that vaping and e-cigarettes are less harmful than traditional cigarettes and can help smokers quit.

What they found: Researchers at the University of Waterloo in Canada studied 364 youths from Canada, England and the U.S. who were between 16 and 19 years old.

• Analyzing 203 urine samples, the authors found the teens who exclusively vaped had similar nicotine exposure to those who smoked cigarettes — and to those who both vaped and used cigarettes.

Adolescents using salt-based e-liquids in their vaping devices had higher nicotine biomarker levels than those using "freebase" nicotine products.

• Salt-based e-liquids may be more appealing for users because they allow higher levels of nicotine to be inhaled more easily and with less throat irritation, according to the CDC.

The bottom line: The results of the study indicate there may be essential differences in nicotine exposure based on product design.

• That difference may increase nicotine exposure among teens and prolong nicotine use, the authors wrote.

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Over 35 million Medicare beneficiaries experience health care access delays of more than one month.

The solution: Congress must act to address the flawed Medicare physician payment system to ensure physicians can keep their doors open and continue providing care to all patients.

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A Colorado program that provides taxpayer-funded health care to unauthorized immigrants is seeing costs spike more than 600% after an influx of migrants.

Why it matters: The benefits that Colorado offers to people living in the country illegally are in the spotlight amid a federal crackdown on sanctuary states and cities.

How it works: A 2022 law dubbed Cover All Coloradans provides the equivalent of Medicaid and children's health insurance coverage to those who would otherwise qualify if they were citizens.

• As of last week, enrollment topped 14,000 people.

By the numbers: The initial estimates from 2022 came before Denver received approximately 42,000 immigrants from the U.S. southern border and anticipated a $2 million price tag for discretionary spending, according to legislative budget documents.

• Officials suggest the program's costs could spike to $16 million in the current fiscal year, and costs are expected to double to $32 million next year.

What they're saying: "When people show up [without coverage] … it creates expenses that go unpaid for our providers, and it adds a burden to the entire system," Colorado House Speaker Julie McCluskie, one of the original bill sponsors, told Axios.

The other side: The two Republican lawmakers on the Joint Budget Committee balked at the cost and its purpose.

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