Abra Hospice

“Condition of Participation 418.64: Core Services not met Based on observation, record review, and interview, the hospice failed to provide all core services directed by the hospice consistent with acceptable standards of practice to include nursing services, medical social services and counseling services to any patients on services or admitted to the hospice in that, The hospice did not provide confirmation that current nurses, social workers, and counsellors were available to provide services and oversight to patients for care. The hospice failed to provide nursing care and services by a nurse under the supervision of a registered nurse and failed to ensure nursing services met the needs of the patient as identified in the patient’s initial comprehensive assessment and updated assessments. The Surveyor was unable to confirm nursing services were being provided to patients. L0591. The hospice failed to ensure medical social services were provided to patients and their families by a qualified social worker, under the direction of a physician based on the patients’ and families identified needs. The Surveyor was unable to confirm if Medical social services were being provided to patients and their families. Refer to L0594 The hospice failed to provide counseling services to the patients and patients’ families to assist the patients and their families in minimizing the stress and problems that arise from terminal illness, related conditions, and the dying process. Refer to L0595”

“Condition of Participation 418.100 Organization and Administration of Services not met. Based on records reviews and interviews, the hospice failed to organize, manage, and administer its resources to provide hospice care and services to the patients, caregivers, and families necessary for the palliation and management of the terminal illness and related conditions; in that,: The hospice Administrator and the Supervising Nurse refused the recertification survey meant to ascertain the hospice was providing care and services to its patients, caregivers, and families as required to help relieve stress associated with terminal illness and the end -of -life process. The hospice failed to be engaged in providing Nursing services, Medical social services, Physician services, Counseling services including spiritual counseling, dietary counseling, and bereavement counseling, Hospice aide, volunteer, and homemaker services, Physical therapy, occupational therapy, and speech-language pathology services, Short-term inpatient care, Medical supplies (including drugs and biologicals) and medical appliances in accordance with acceptable standards. Refer to L 652 The hospice failed to make nursing services, physician services, drugs and biologicals routinely available to patients on a 24-hour basis 7 days a week. Refer to L 653”

“Based on observation, records reviews, and interviews, the hospice failed to provide nursing care and services by a nurse under the supervision of a registered nurse and failed to ensure nursing services met the needs of the patient as identified in the patient’s initial comprehensive assessment and updated assessments. In that, an attempted visit was made on 06/02/2026 at the hospice physical location listed in IQIES with an active CCN which indicated the hospice is operational and able to bill for services rendered, the hospice Administrator and Alternate Administrator/Supervising Nurse were not available to the surveyor onsite at the time of the Surveyor’s arrival, but when the Administrator and the Alternate Administrator arrived in response to the Surveyor’s call they declined the recertification survey. The Surveyor was unable to confirm nursing services were being provided to patients. This failure hindered HHSC Survey process and placed hospice patients at risk of receiving substandard nursing services. Findings include: Review of agency’s account page in Texas Unified license information portal (TULIP – a database utilized by the State of Texas to maintain licensing, demographic information, complaints, and self-reported incidents for home health and hospice agencies) on 06/01/2026 revealed agency’s contact information as Agency’s address A. Agency’s phone Number as XXX-XXX-XXXX, agency’s operational hours as 9am – 3pm. Monday through Thursday plus 24 hours calls.Continued review of the Agency’s TULIP account revealed agency’s census was 4 as of 01/28/2024. Observation: On 06/02/2026 at 10:30am Surveyor arrived at the Agency’s location and found the door to agency’s suite locked. Surveyor knocked on the door several times with no response. Surveyor called the phone number listed on the door and the Administrator of the agency responded to the call and stated that she would be at the agency in 10 minutes after Surveyor informed the Administrator of the purpose of the visit. At 11:07am the Administrator arrived at the hospice location and granted Surveyor entry into the agency and immediately informed surveyor that she received a letter from CMS notifying her that the Hospice account was suspended and their NPI was deactivated for not reapplying for CMS revalidation of the Hospice enrollment with CMS in 2025. During interview with the Hospice Administrator on 06/02/2026 at 11:10am the Administrator stated that she did not know that she was to reapply to CMS to revalidate hospice CMS enrollment record information every 5 years. The Administrator further stated that as a result of the suspension, the hospice had not been able to bill CMS for hospice services rendered for a year and a half and she had contacted CMS about the issue and was in the process of resolving it. So, she was not sure how to proceed with survey without completely resolving the existing problem with CMS. Surveyor requested to see the letter from CMS. The Administrator stated that she was not sure where she kept the letter, but she would look for it. Surveyor explained that there was no notice of suspension of Hospice account in IQIES during presurvey preparation and that HHSC survey does not have anything to do with CMS re-imbursements for services rendered. Surveyor tried to refocus the Administrator’s attention back to the HHSC survey process and inquired about hospice’s current census. The Administrator stated that the agency had no active clients and had not had clients for about a year and a half. Surveyor then inquired about when the last client was discharged from the agency or when the Hospice last provided services to clients. The Administrator stated that hospice last provided services to clients in November 2025. Surveyor requested to see the list of clients the Hospice provided services to in 2025. The Administrator picked up her laptop computer to go into another room stating that she wanted to go print the list of clients the hospice agency provided services to in 2025. Surveyor requested to see the clients’ list on the Administrators laptop and then the Administrator could print it/email the list to the Surveyor later. The Administrator then suddenly changed the subject and asked the surveyor if she could refuse the survey and request to be surveyed at a later date after she had resolved the issue with CMS. Surveyor asked the Administrator if she was refusing the survey. The Administrator, replied, “Yes, I like to refuse the survey but I’m not sure what would happen if I refused the survey. What’s your advice. Surveyor informed the Administrator that she could refuse the survey if that is what she felt was best for the agency, but the Administrator had to put the agency’s refusal to be surveyed in writing. The Surveyor also informed the Administrator that the agency will be cited for refusing the survey. The Administrator asked if the Surveyor could wait for the Hospice Alternate Administrator/Director of Nursing to arrive so both of them could discuss the agency’s refusal of HHSC survey before she made her final decision. The Alternate Administrator/ Director of Nursing arrived had the discussion with the Administrator and they both decided to decline the survey. Surveyor requested the Administrator to provide a written refusal of the survey by the agency. The Administrator provided surveyor with a letter a refusal of the survey. Surveyor left the agency at 1pm unable to conduct a survey to ascertain whether hospice Nursing staff were routinely providing core services to hospice patients as required by regulations. Review of the Palmetto (CMS) revalidation request letter that was received from the Administrator via email on 06/03/2026 at 1:58am revealed that the CMS had “a Hold” on the Hospice’s Medicare enrollment records due to the Hospice’s lack of response to the Medicare revalidation request that was sent to the Hospice on March 21, 2025. The hospice’s revalidation of CMS enrollment records was due on June 30th, 2025. The letter also stated that CMS would reject Hospice’s claims for services and items furnished during the period of the Hold. However, it is clearly stated in the letter that CMS’s Hold on the Hospice account did not cancel the hospice’s contract with CMS, nor will it affect the hospice’s Medicare participation agreement or any of its conditions as the hospice is still enrolled in the Medicare program.”

“Based on observation, records reviews, and interviews, the hospice failed to ensure medical social services were provided to patients and their families by a qualified social worker, under the direction of a physician based on the patients’ and families identified needs. In that, an attempted visit was made on 06/02/2026 at the hospice physical location listed in IQIES with an active CCN that indicated the hospice is operational and able to bill for services rendered, the hospice Administrator and Alternate Administrator/Supervising Nurse were not available to the surveyor onsite at the time of the Surveyor’s arrival, but when the Administrator and the Alternate Administrator arrived in response to the Surveyor’s call they declined the recertification survey. The Surveyor was unable to confirm if Medical social services were being provided to patients and their families. This failure hindered HHSC Survey process and could place hospice Patients and their families at risk of not having their psychosocial needs identified and met by a qualified social worker. Findings include: Review of agency’s account page in Texas Unified license information portal (TULIP – a database utilized by the State of Texas to maintain licensing, demographic information, complaints, and self-reported incidents for home health and hospice agencies) on 06/01/2026 at 08:30a.m. revealed agency’s contact information as Agency’s address A. Agency’s phone Number as XXX-XXX-XXXX, agency’s operational hours as 9am – 3pm. Monday through Thursday plus 24 hours calls.Continued review of the Agency’s TULIP account revealed agency’s census was 4 as of 01/28/2024. Observation: On 06/02/2026 at 10:30am Surveyor arrived at the Agency’s location and found the door to agency’s suite locked. Surveyor knocked on the door several times with no response. Surveyor called the phone number listed on the door and the Administrator of the agency responded to the call and stated that she would be at the agency in 10minutes after Surveyor informed the Administrator of the purpose of the visit. At 11:07am the Administrator arrived at the hospice location and granted Surveyor entry into the agency and immediately informed surveyor that she received a letter from CMS notifying her that the Hospice account was suspended and their NPI was deactivated for not reapplying for CMS revalidation of the Hospice enrollment with CMS in 2025. During interview with the Hospice Administrator on 06/02/2026 at 11:10am the Administrator stated that she did not know that she was to reapply to CMS to revalidate hospice CMS enrollment record information every 5 years. The Administrator further stated that as a result of the suspension, the hospice had not been able to bill CMS for hospice services rendered for a year and a half and she had contacted CMS about the issue and was in the process of resolving it. So, she was not sure how to proceed with survey without completely resolving the existing problem with CMS. Surveyor requested to see the letter from CMS. The Administrator stated that she was not sure where she kept the letter, but she would look for it. Surveyor explained that she did not notice any documentation of suspension of Hospice account in IQIES during presurvey preparation and that HHSC survey does not have anything to do with CMS re-imbursements for services rendered. Surveyor tried to refocus the Administrator’s attention back to the HHSC survey process and inquired about hospice’s current census. The Administrator stated that the agency had no active clients and had not had clients for about a year and a half. Surveyor then inquired about when the last client was discharged from the agency or when the Hospice last provided services to clients. The Administrator stated that hospice last provided services to clients in November 2025. Surveyor requested to see the list of clients the Hospice provided services to in 2025. The Administrator picked up her laptop computer to go into another room stating that she wanted to go print the list of clients the hospice agency provided services to in 2025. Surveyor requested to see the clients’ list on the Administrators laptop and then the Administrator could print it/email the list to the Surveyor later. The Administrator then suddenly changed the subject and asked the surveyor if she could refuse the survey and request to be surveyed at a later date after she had resolved the issue with CMS. Surveyor asked the Administrator if she was refusing the survey. The Administrator, replied, “Yes, I like to refuse the survey but I’m not sure what would happen if I refused the survey. What’s your advice. Surveyor informed the Administrator that she could refuse the survey if that is what she felt was best for the agency, but the Administrator had to put the agency’s refusal to be surveyed in writing. The Surveyor also informed the Administrator that the agency will be cited for refusing the survey. The Administrator asked if the Surveyor could wait for the Hospice Alternate Administrator/ Director of Nursing to arrive so both of them could discuss the agency’s refusal of HHSC survey before she made her final decision. The Director of Nursing arrived had the discussion with the Administrator and they both decided to decline the survey. Surveyor requested the Administrator to provide a written refusal of the survey by the agency. The Administrator provided surveyor with a letter a refusal of the survey. Surveyor left the agency at 1pm unable to conduct a survey to ascertain whether hospice medical social workers were routinely providing social work services to hospice patients and families as required by regulations. Review of the Palmetto (CMS) revalidation request letter that was received from the Administrator via email on 06/03/2026 at 1:58am revealed that the CMS had “a Hold” on the Hospice’s Medicare enrollment records due to the Hospice’s lack of response to the Medicare revalidation request that was sent to the Hospice on March 21, 2025. The hospice’s revalidation of CMS enrollment records was due on June 30th, 2025. The letter also stated that CMS would reject Hospice’s claims for services and items furnished during the period of the Hold. However, it is clearly stated in the letter that CMS’ Hold on the Hospice account did not cancel the hospice’s contract with CMS, nor will it affect the hospice’s Medicare participation agreement or any of its conditions as the hospice is still enrolled in the Medicare program.”

“Based on observation, records reviews, and interviews, the hospice failed to provide counseling services to the patients and patients’ families to assist the patients and their families in minimizing the stress and problems that arise from terminal illness, related conditions, and the dying process. In that, an attempted visit was made on 06/02/2026 at the hospice physical location listed in IQIES with an active CCN that indicated the hospice is operational and able to bill for services rendered, the hospice Administrator and Alternate Administrator were not available to the surveyor onsite, but when the Administrator and the Alternate Administrator arrived in response to the Surveyor’s call they declined the recertification survey. This failure hindered HHSC Survey process and could place hospice patients and their families at risk of enormous stress related to terminal illness, related conditions, and the dying process. Findings include: Review of agency’s account page in Texas Unified license information portal (TULIP – a database utilized by the State of Texas to maintain licensing, demographic information, complaints, and self-reported incidents for home health and hospice agencies) on 06/01/2026 at 08:30a.m. revealed agency’s contact information as Agency’s address A. Agency’s phone Number as XXX-XXX-XXXX, agency’s operational hours as 9am – 3pm. Monday through Thursday plus 24 hours calls.Continued review of the Agency’s TULIP account revealed agency’s census was 4 as of 01/28/2024. Observation: On 06/02/2026 at 10:30am Surveyor arrived at the Agency’s location and found the door to agency’s suite locked. Surveyor knocked on the door several times with no response. Surveyor called the phone number listed on the door and the Administrator of the agency responded to the call and stated that she would be at the agency in 10minutes after Surveyor informed the Administrator of the purpose of the visit. At 11:07am the Administrator arrived at the hospice location and granted Surveyor entry into the agency and immediately informed surveyor that she received a letter from CMS notifying her that the Hospice account was suspended and their NPI was deactivated for not reapplying for CMS revalidation of the Hospice enrollment with CMS in 2025. The Administrator stated that she did not know that she was to reapply for CMS revalidation every 5 years. The Administrator further stated that as a result of the suspension, the hospice had not been able to bill CMS for hospice services rendered for a year and a half and she had contacted CMS about the issue and was in the process of resolving it. So, she was not sure how to proceed with survey without completely resolving the existing problem with CMS. Surveyor requested to see the letter from CMS. The Administrator stated that she was not sure where she kept the letter, but she would look for it. Surveyor explained that she did not notice any documentation of suspension of Hospice account in IQIES during presurvey preparation and that HHSC survey does not have anything to do with CMS re-imbursements for services rendered. Surveyor tried to refocus the Administrator’s attention back to the HHSC survey process and inquired about hospice’s current census. The Administrator stated that the agency had no active clients and had not had clients for about a year and a half. Surveyor then inquired about when the last client was discharged from the agency or when the Hospice last provided services to clients. The Administrator stated that hospice last provided services to clients in November 2025. Surveyor requested to see the list of clients the Hospice provided services to in 2025. The Administrator picked up her laptop computer to go into another room stating that she wanted to go print the list of clients the hospice agency provided services to in 2025. Surveyor requested to see the clients’ list on the Administrators laptop and then the Administrator could print it/email the list to the Surveyor later. The Administrator then suddenly changed the subject and asked the surveyor if she could refuse the survey and request to be surveyed at a later date after she had resolved the issue with CMS. Surveyor asked the Administrator if she was refusing the survey. The Administrator, replied, “Yes, I like to refuse the survey but I’m not sure what would happen if I refused the survey. What’s your advice. Surveyor informed the Administrator that she could refuse the survey if that is what she felt was best for the agency, but the Administrator had to put the agency’s refusal to be surveyed in writing. The Surveyor also informed the Administrator that the agency will be cited for refusing the survey. The Administrator asked if the Surveyor could wait for the Hospice Alternate Administrator /Director of Nursing to arrive so both of them could discuss the agency’s refusal of HHSC survey before she made her final decision. The Director of Nursing arrived had the discussion with the Administrator and they both decided to decline the survey. Surveyor requested the Administrator to provide a written refusal of the survey by the agency. The Administrator provided surveyor with a letter a refusal of the survey. Surveyor left the agency at 1pm unable to conduct a survey to ascertain whether hospice counseling staff were routinely providing core services to hospice patients and families as required by regulations. Review of the Palmetto (CMS) revalidation request letter that was received from the Administrator via email on 06/03/2026 at 1:58am revealed that the CMS had “a Hold” on the Hospice’s Medicare enrollment records due to the Hospice’s lack of response to the Medicare revalidation request that was sent to the Hospice on March 21, 2025. The hospice’s revalidation of CMS enrollment records was due on June 30th, 2025. The letter also stated that CMS would reject Hospice’s claims for services and items furnished during the period of the Hold. However, it is clearly stated in the letter that CMS’ Hold on the Hospice account did not cancel the hospice’s contract with CMS, nor will it affect the hospice’s Medicare participation agreement or any of its conditions as the hospice is still enrolled in the Medicare program.”

“Based on observation, records reviews, and interviews, the hospice failed to be engaged in providing Nursing services, Medical social services, Physician services, Counseling services including spiritual counseling, dietary counseling, and bereavement counseling, Hospice aide, volunteer, and homemaker services, Physical therapy, occupational therapy, and speech-language pathology services, Short-term inpatient care, Medical supplies (including drugs and biologicals) and medical appliances in accordance with acceptable standards. In that, an attempted visit was made on 06/02/2026 at the hospice physical location listed in IQIES with an active CCN that indicated the hospice is operational and able to bill for services rendered, the hospice Administrator and Alternate Administrator were not available to the surveyor onsite at the time of the Surveyor’s arrival. Surveyor then called the phone number listed on the agency’s door and the hospice Administrator arrived at the agency but refused the recertification survey. This failure hindered HHSC Survey process and placed hospice patients at risk of receiving substandard hospice care and services. Findings include: Review of agency’s account page in Texas Unified license information portal (TULIP – a database utilized by the State of Texas to maintain licensing, demographic information, complaints, and self-reported incidents for home health and hospice agencies) on 06/01/2026 at 08:30a.m. revealed agency’s contact information as Agency’s address A. Agency’s phone Number as XXX-XXX-XXXX, agency’s operational hours as 9am – 3pm. Monday through Thursday plus 24 hours calls.Continued review of the Agency’s TULIP account revealed agency’s census was 4 as of 01/28/2024. Observation: On 06/02/2026 at 10:30am Surveyor arrived at the Agency’s location and found the door to agency’s suite locked. Surveyor knocked on the door several times with no response. Surveyor called the phone number listed on the door and the Administrator of the agency responded to the call and stated that she would be at the agency in 10minutes after Surveyor informed the Administrator of the purpose of the visit. At 11:07am the Administrator arrived at the hospice location and granted Surveyor entry into the agency and immediately informed surveyor that she received a letter from CMS notifying her that the Hospice account was suspended and their NPI was deactivated for not reapplying for CMS revalidation of the Hospice enrollment with CMS in 2025. The Administrator stated that she did not know that she was to reapply for CMS revalidation every 5 years. The Administrator further stated that as a result of the suspension, the hospice had not been able to bill CMS for hospice services rendered for a year and a half and she had contacted CMS about the issue and was in the process of resolving it. So, she was not sure how to proceed with survey without completely resolving the existing problem with CMS. Surveyor requested to see the letter from CMS. The Administrator stated that she was not sure where she kept the letter, but she would look for it. Surveyor explained that she did not notice any documentation of suspension of Hospice account in IQIES during presurvey preparation and that HHSC survey does not have anything to do with CMS re-imbursements for services rendered. Surveyor tried to refocus the Administrator’s attention back to the HHSC survey process and inquired about hospice’s current census. The Administrator stated that the agency had no active clients and had not had clients for about a year and a half. Surveyor then inquired about when the last client was discharged from the agency or when the Hospice last provided services to clients. The Administrator stated that hospice last provided services to clients in November 2025. Surveyor requested to see the list of clients the Hospice provided services to in 2025. The Administrator picked up her laptop computer to go into another room stating that she wanted to go print the list of clients the hospice agency provided services to in 2025. Surveyor requested to see the clients’ list on the Administrators laptop and then the Administrator could print it/email the list to the Surveyor later. The Administrator then suddenly changed the subject and asked the surveyor if she could refuse the survey and request to be surveyed at a later date after she had resolved the issue with CMS. Surveyor asked the Administrator if she was refusing the survey. The Administrator, replied, “Yes, I like to refuse the survey but I’m not sure what would happen if I refused the survey. What’s your advice. Surveyor informed the Administrator that she could refuse the survey if that is what she felt was best for the agency, but the Administrator had to put the agency’s refusal to be surveyed in writing. The Surveyor also informed the Administrator that the agency will be cited for refusing the survey. The Administrator asked if the Surveyor could wait for the Hospice Alternate Administrator/ Director of Nursing to arrive so both of them could discuss the agency’s refusal of HHSC survey before she made her final decision. The Director of Nursing arrived had the discussion with the Administrator and they both decided to decline the survey. Surveyor requested the Administrator to provide a written refusal of the survey by the agency. The Administrator provided surveyor with a letter a refusal of the survey. Surveyor left the agency at 1pm unable to conduct a survey to ascertain whether hospice staff were routinely providing Nursing services, Medical social services, Physician services, Counseling services including spiritual counseling, dietary counseling, and bereavement counseling, Hospice aide, volunteer, and homemaker services, Physical therapy, occupational therapy, and speech-language pathology services, Short-term inpatient care, Medical supplies (including drugs and biologicals) and medical appliances in accordance with acceptable standards to hospice patients as required by regulations. Review of the Palmetto (CMS) revalidation request letter that was received from the Administrator via email on 06/03/2026 at 1:58am revealed that the CMS had “a Hold” on the Hospice’s Medicare enrollment records due to the Hospice’s lack of response to the Medicare revalidation request that was sent to the Hospice on March 21, 2025. The hospice’s revalidation of CMS enrollment records was due on June 30th, 2025. The letter also stated that CMS would reject Hospice’s claims for services and items furnished during the period of the Hold. However, it is clearly stated in the letter that CMS’ Hold on the Hospice account did not cancel the hospice’s contract with CMS, nor will it affect the hospice’s Medicare participation agreement or any of its conditions as the hospice is still enrolled in the Medicare program.”

“Based on observation, records reviews, and interviews, the hospice failed to make nursing services, physician services, drugs and biologicals routinely available to patients on a 24-hour basis 7 days a week. In that, an attempted visit was made on 06/02/2026 at the hospice physical location listed in IQIES with an active CCN that indicated the hospice is operational and able to bill for services rendered, the hospice Administrator and Alternate Administrator were not available to the surveyor onsite at the time of the Surveyor’s arrival. Surveyor then called the phone number listed on the agency’s door and the hospice Administrator arrived at the agency but refused the recertification survey. This failure hindered HHSC Survey process and could place hospice patients at risk of receiving substandard or no hospice care and services. Findings include: Review of agency’s account page in Texas Unified license information portal (TULIP – a database utilized by the State of Texas to maintain licensing, demographic information, complaints, and self-reported incidents for home health and hospice agencies) on 06/01/2026 at 08:30a.m. revealed agency’s contact information as Agency’s address A. Agency’s phone Number as XXX-XXX-XXXX, agency’s operational hours as 9am – 3pm. Monday through Thursday plus 24 hours calls.Continued review of the Agency’s TULIP account revealed agency’s census was 4 as of 01/28/2024. Observation: On 06/02/2026 at 10:30am Surveyor arrived at the Agency’s location and found the door to agency’s suite locked. Surveyor knocked on the door several times with no response. Surveyor called the phone number listed on the door and the Administrator of the agency responded to the call and stated that she would be at the agency in 10minutes after Surveyor informed the Administrator of the purpose of the visit. At 11:07am the Administrator arrived at the hospice location and granted Surveyor entry into the agency and immediately informed surveyor that she received a letter from CMS notifying her that the Hospice account was suspended and their NPI was deactivated for not reapplying for CMS revalidation of the Hospice enrollment with CMS in 2025. The Administrator stated that she did not know that she was to reapply for CMS revalidation every 5 years. The Administrator further stated that as a result of the suspension, the hospice had not been able to bill CMS for hospice services rendered for a year and a half and she had contacted CMS about the issue and was in the process of resolving it. So, she was not sure how to proceed with survey without completely resolving the existing problem with CMS. Surveyor requested to see the letter from CMS. The Administrator stated that she was not sure where she kept the letter, but she would look for it. Surveyor explained that she did not notice any documentation of suspension of Hospice account in IQIES during presurvey preparation and that HHSC survey does not have anything to do with CMS re-imbursements for services rendered. Surveyor tried to refocus the Administrator’s attention back to the HHSC survey process and inquired about hospice’s current census. The Administrator stated that the agency had no active clients and had not had clients for about a year and a half. Surveyor then inquired about when the last client was discharged from the agency or when the Hospice last provided services to clients. The Administrator stated that hospice last provided services to clients in November 2025. Surveyor requested to see the list of clients the Hospice provided services to in 2025. The Administrator picked up her laptop computer to go into another room stating that she wanted to go print the list of clients the hospice agency provided services to in 2025. Surveyor requested to see the clients’ list on the Administrators laptop and then the Administrator could print it/email the list to the Surveyor later. The Administrator then suddenly changed the subject and asked the surveyor if she could refuse the survey and request to be surveyed at a later date after she had resolved the issue with CMS. Surveyor asked the Administrator if she was refusing the survey. The Administrator, replied, “Yes, I like to refuse the survey but I’m not sure what would happen if I refused the survey. What’s your advice. Surveyor informed the Administrator that she could refuse the survey if that is what she felt was best for the agency, but the Administrator had to put the agency’s refusal to be surveyed in writing. The Surveyor also informed the Administrator that the agency will be cited for refusing the survey. The Administrator asked if the Surveyor could wait for the Hospice Alternate Administrator/ Director of Nursing to arrive so both of them could discuss the agency’s refusal of HHSC survey before she made her final decision. The Director of Nursing arrived had the discussion with the Administrator and they both decided to decline the survey. Surveyor requested the Administrator to provide a written refusal of the survey by the agency. The Administrator provided surveyor with a letter a refusal of the survey. Surveyor left the agency at 1pm unable to conduct a survey to ascertain whether hospice staff provided nursing services, physician services, drugs and biologicals routinely to patients on a 24-hour basis 7 days a week as required by regulations. Review of the Palmetto (CMS) revalidation request letter that was received from the Administrator via email on 06/03/2026 at 1:58am revealed that the CMS had “a Hold” on the Hospice’s Medicare enrollment records due to the Hospice’s lack of response to the Medicare revalidation request that was sent to the Hospice on March 21, 2025. The hospice’s revalidation of CMS enrollment records was due on June 30th, 2025. The letter also stated that CMS would reject Hospice’s claims for services and items furnished during the period of the Hold. However, it is clearly stated in the letter that CMS’ Hold on the Hospice account did not cancel the hospice’s contract with CMS, nor will it affect the hospice’s Medicare participation agreement or any of its conditions as the hospice is still enrolled in the Medicare program.”