In addition to routine annual payment changes, the FY2024 hospice proposed rule is heavily weighted with data and insights on hospice utilization and performance in areas including non-hospice spending, live discharges and CMS concern about reports of limited availability of some palliative therapies (e.g. dialysis, radiation, etc.) signaling CMS’ intensified interest in these areas. A proposal that would require physicians who order or certify Medicare hospice services be enrolled in the Internet-based Provider Enrollment, Chain, and Ownership System (PECOS) or have a valid opt-out in order for the hospice services to be covered further shows CMS’ concerns about hospice program integrity. Beyond these concerns, CMS focused on health equity and hospice quality.