Two-Thirds of Nevada Hospices Billed Zero Crisis Care All Year — and CMS’s SSVI Is Counting It

CMS scored 153 Nevada hospices on the FY2025 Service and Spending Variation Index, and Nevada’s median score is a 6 out of 16 — exactly the national median. So the typical Nevada hospice is not the story. This number is: 68% of the state’s scored hospices billed zero Continuous Home Care hours and zero General Inpatient Care days for the entire fiscal year. Nationally, 45% trip that flag. In Nevada, better than two in three do.

That single flag — CMS calls it No CHC and No GIP — is Nevada’s signature. It is the only SSVI measure that isn’t a percentile cutoff; it’s binary. Bill one hour of continuous home care or one day of general inpatient care all year and you clear it. Two-thirds of Nevada didn’t. It’s the fingerprint of a routine-home-care-only market: a lot of hospices that never once escalate a patient to the higher-intensity levels of care the benefit is built around. Pair that with the state’s other two elevated flags — live discharges and long stays — and you have a distinct profile, different from Texas’s thin service delivery and California’s enrollment churn.

The Ten Worst Scores in Nevada: 13s, 12, and Six 11s

The state’s ten highest FY2025 totals run from 11 to 13 out of 16 — three 13s, one 12, and six 11s (national median: 6; only about 6% of hospices nationally reach 11). Every one of the ten scored 9 or higher in FY2024, and eight of the ten were already at 10+ — established patterns, not one bad year. (Names masked, CCNs shown, as always — verify any score in our free lookup tool.)

What the ten have in common, from the CMS scoring-component files:

• 9 of 10 tripped long lengths of stay — a third or more of discharges at 180+ days.
• 8 of 10 tripped the live discharge rate — nearly half or more of their patients left hospice alive.
• 7 of 10 tripped skilled-nursing minutes.
• 6 of 10 tripped No CHC / No GIP — no crisis-level care billed all year.
• 6 of 10 maxed out non-hospice spending at the full 8 of 8 points.

Long stays, live discharges, and maxed non-hospice spending — on top of a level-of-care model that never escalates — is the low-acuity, enrollment-heavy profile: patients kept on census past 180 days, discharged alive at high rates, while Medicare pays other providers for care those patients sought elsewhere. It is precisely the pattern that put Nevada on CMS’s short list of markets to watch, now quantified per-CCN in a public file.

What Nevada Is Not Failing — and Why That Matters

Here’s the credibility check. Statewide, across all 153 scored hospices, Nevada is better than the national rate on three of the eight measures:

• Nursing-facility concentration: 0.0% flagged, vs. 9.2% nationally — literally zero Nevada hospices trip the 40%-in-a-facility flag.
• Seven-day returns: 17.0%, vs. 24.3% nationally — less discharge-readmit cycling, not more.
• Weekend visits: 19.0% flagged, vs. 25% nationally — Nevada hospices show up on weekends more reliably than the nation.

So Nevada’s problem is not where patients are cared for, and it’s not weekend coverage or churn. It concentrates in two places: the level-of-care model (a market that rarely bills CHC or GIP) and the enrollment side (who gets admitted and how long they stay). That’s a short fix list — but the items on it take real clinical governance to move, not a documentation tweak.

Nevada Is the Fourth of CMS’s Four Enhanced-Oversight States

The SSVI is still a proposed methodology (CMS-1851-P, the FY2027 Hospice Wage Index proposed rule), and CMS says plainly that a high score is not a finding of fraud, waste, or abuse. But context matters, and Nevada’s is pointed. It is one of only four states — Arizona, California, Texas, and Nevada — that CMS placed under a provisional period of enhanced oversight for newly enrolling hospices, after a surge of newly certified providers in those markets. This series has now covered all four. If you operate in Nevada and land at 11+ on a public CMS index, assume the score is being read against that backdrop, not in isolation.

The Nevada Fix List — Short, But Heavy

1. Crisis care: build the capability, then use it. Two-thirds of the state trips this flag, and it’s the cheapest one to clear on paper — sign a GIP contract with at least one hospital or SNF, train staff on the CHC 8-hour predominantly-nursing rule, and stand up a symptom-crisis protocol that triggers a level-of-care evaluation. The flag is about having and using the capability, not volume. But don’t bill CHC or GIP you can’t document — clear it by managing crises correctly, not by chasing the point. The full guide, and our deep dive on this flag.
2. Live discharges: treat every one as a case study. Pull your last 20 live discharges by reason code. Revocations usually mean an unmanaged crisis sent the patient to the hospital — which is the same gap that trips flag #1. “No longer terminally ill” discharges past 180 days usually mean the admission screen failed, not that the patient recovered. The full guide.
3. Long stays: make the 180-day recert a real clinical event. Physician-led, with measurable decline data — weight, PPS/FAST, MAC — not a restated template. Score your referral sources by their eventual live-discharge and 180+ rates and re-educate the outliers. The full guide.
4. Nursing minutes: know your number. Nevada runs modestly hot here (32.0% vs. 25%). Pull minutes-per-RHC-day from billing data against the 9.9-minute threshold and staff the visits that are being missed. The full guide.

Related Reading

• Nevada Hospice SSVI Scores — the full state page: all ten scores, measures tripped, and state stats
• The No-CHC/No-GIP Flag — deep dive on the measure two-thirds of Nevada trips
• California Has More Hospices on CMS’s SSVI Watch List Than Any State — the enrollment-churn profile
• Texas Has the Biggest SSVI Problem in America — the thin-service-delivery profile
• Arizona’s SSVI Problem: 1 in 9 Hospices in CMS’s Danger Tail
• SSVI Scores by State — every state’s directory page

Disclaimer: The SSVI is part of CMS’s FY2027 Hospice Wage Index proposed rule (CMS-1851-P) and is not finalized; the comment period closed June 1, 2026, and the methodology or thresholds could change. All figures in this article are derived from analysis of the CMS FY2024 and FY2025 SSVI score and scoring-component data files published April 2026; state assignment uses the CMS-reported facility state. A high SSVI score is not a finding of fraud, waste, or abuse. This article is informational and not legal or compliance advice; verify against the CMS source and your own counsel before acting.