01/08/2026
CMS Expands Enhanced Oversight to Ohio Hospices
CMS has expanded enhanced oversight and prepayment medical review to Ohio hospices, affecting both new and existing providers. Providers in other states under this oversight have reported high consequences when error thresholds are exceeded, leaving little room for error.
LeadingAge Ohio is monitoring this closely and will share updates as patterns emerge. Members with questions should reach out to Lindsey Buzzard, Director of Home Health & Hospice, at lbuzzard@leadingageohio.org.
New Hospices: Provisional Period of Enhanced Oversight (PPEO)
Hospices approved on or after December 30, 2025, are subject to PPEO if they are:
- Newly enrolling in Medicare
- Completing a CHOW under 42 CFR §489.18
- Undergoing a 100% ownership change (outside §489.18)
- Reactivating after deactivation
What PPEO means:
- Medical review, including prepayment review
- Review period of 30 days up to 1 year
- Small claim samples (often ~10)
- Very low tolerance for error (same acceptable error rate as TPE)
- No requirement for education or multiple review rounds
Notification is sent by mailed letter to the PECOS correspondence address.
Existing Hospices: Expanded Prepayment Review
CMS has also expanded prepayment review for existing hospices in Ohio.
- Low initial claim volumes
- Same acceptable error rate
- Education is not required
- CMS may impose 100% prepayment review, termination, or re-enrollment bars
What to Do Now:
- Confirm your PECOS address is current
- Be audit-ready (especially new/CHOW hospices)
- Reinforce eligibility, CTI, and admission documentation
- Prepare teams for rapid ADR response
Questions regarding this announcement may be directed to Lindsey Buzzard, Director of Home Health & Hospice at lbuzzard@leadingageohio.org.
