Texas Has the Biggest SSVI Problem in America: 1 in 7 Hospices in CMS’s Danger Tail — and the Worst Ten All Score 14 of 16

CMS scored 998 Texas hospices on the FY2025 Service and Spending Variation Index — the second-largest cohort in the country. 140 of them (14%, roughly 1 in 7) scored 11 or higher out of 16, a tier only 6.4% of hospices reach nationally. No state puts a larger share of its hospices in CMS’s danger tail. And the raw number is the stunner: Texas has more hospices in the danger tail than 46 states have scored hospices at all.

When we published our Arizona analysis, the story was a statewide pattern of long enrollments and thin visits. Texas has the same disease — at nearly twice the intensity, and with a twist the FY2024 data makes impossible to ignore: the worst scores aren’t new.

The Ten Worst Scores in Texas Are All the Same Number: 14

Arizona’s worst ten ranged from 12 to 15. Texas’s worst ten are a wall: every single one scored 14 out of 16 — and they’re just the top of the pile, because 77 Texas hospices (7.7% of the state, vs. 3% nationally) scored 12 or higher. For calibration, the national median is 6.

Here’s the part that should end any “one bad year” defense: all ten also scored 11 or higher in FY2024 — four of them scored 14 both years. This is a stable operating pattern showing up in two consecutive years of claims data, not a statistical fluke. (As always, we publish the list with names masked and CCNs shown — verify any score in our free lookup tool.)

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

• 10 of 10 tripped skilled-nursing minutes — under ~10 minutes of nursing per routine home care day.
• 10 of 10 tripped weekend visits.
• 10 of 10 tripped skilled visits in the last days of life.
• 10 of 10 tripped long lengths of stay.
• 9 of 10 tripped no CHC/GIP and 9 of 10 tripped the live discharge rate.
• 9 of 10 landed in the top non-hospice spending bracket — the maximum 8 points on that half of the score.

Long enrollments. Minutes of care per day. No weekends, no crisis care, patients dying unattended by skilled staff — while Medicare pays other providers for the care the benefit should cover. The SSVI was built to make exactly this pattern visible, and in Texas it is visible at scale.

This Isn’t Ten Bad Actors — It’s Nearly Half the State on Two Measures

Statewide, across all 998 scored hospices:

• 46.8% tripped skilled-nursing minutes (national rate: 25%).
• 45.1% tripped weekend visits (national rate: 25%).
• 50.4% billed zero CHC and zero GIP all year (national: 45.1%).
• 18.8% sit in the top non-hospice spending bracket (national: 12.4%).
• 30.3% tripped seven-day returns after live discharge (national: 24.3%).

Two measures — nursing minutes and weekend coverage — fire at nearly double the national rate. When a percentile-based flag designed to catch the bottom 25% of the country catches 46% of your state, the state itself is the outlier.

What Texas Is Not Failing

Same as Arizona, the usual suspects don’t explain it. Nursing-facility concentration is below the national rate (6.6% vs. 9.2%) — this is not a facility-census story. And statewide, last-days-of-life visits (25.5%) and live discharges (27.9%) run only modestly above national norms — the churn narrative is a footnote, not the headline. The headline is service intensity: how few skilled minutes reach patients on ordinary days, weekends included.

Why Texas Operators Should Move Before the Final Rule

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: Texas is one of four states where CMS already applies enhanced oversight to newly enrolling hospices, and 140 in-state scores of 11+ hand regulators a ready-made targeting list the day this methodology finalizes. A Texas hospice at 11+ — or drifting toward it — should assume the score will inform who gets the records request first.

The same silver lining we found in Arizona applies double here: the measures driving Texas’s numbers are the most fixable ones on the index.

The Texas Fix List, In Order of Effort

1. Weekend visits — the cheapest point on the board. The flag line is skilled visits on just 4.8% of weekend RHC days, and LPN and MSW visits count. Nearly half the state is leaving this point on the table. The full guide.
2. Nursing minutes — know your number this week. Pull minutes-per-RHC-day from billing data against the 9.9-minute threshold, then verify actual home time reaches the claim — an unbilled visit doesn’t exist to CMS. The full guide.
3. Last-days visits — build the actively-dying watchlist. Reviewed at every IDG and stand-up, with a same-day skilled visit required on documented decline. All ten of the worst tripped this one. The full guide.
4. Seven-day returns — stop discharging around hospital stays. Texas runs 6 points above the national rate here. Coordinate the stay instead; discharge-and-readmit cycling is exactly the pattern CMS built this measure to catch. The full guide.
5. Long stays — make the 180-day recert real. Physician-led eligibility review with measurable decline data, not a restated template. The full guide.
6. Crisis care capability — the structural one. Half the state bills no CHC and no GIP all year. Start the GIP contract conversation; the flag is binary, and never escalating care is now its own signal. The full guide.

Related Reading

• Texas Hospice SSVI Scores — the full state page: all ten scores, measures tripped, and state stats
• Arizona’s SSVI Problem: 1 in 9 Hospices in CMS’s Danger Tail — the first post in this series
• SSVI Scores by State — every state’s directory page
• Decoding Your SSVI Score, Part 2: The Utilization Score — all eight measures with FY2025 thresholds
• The 10-Minute Problem: Skilled Nursing Minutes and Your SSVI

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.