WISeR Model Not so Wise

by Kristin Rowan | Apr 3, 2026 | Artificial Intelligence, CMS, Medicare, Medicare Advantage

by Kristin Rowan, Editor

WISeR Model

Dangerous and Troubling

WISeR model is not as wise as CMS had hoped. For many months, we have been reporting on the waste, fraud, and abuse initiatives from HHS and CMS. From stricter oversight to fewer new agencies to broad investigations, the crackdown on wasteful spending of the Medicare Trust Fund has increased steadily. One initiative, the Wasteful and Inappropriate Service Reduction (WISeR) model, launched in Arizona, Ohio, Oklahome, Texas, New Jersey, and Washington. As the name implies, the model aimed at reducing unnecessary services by using an AI powered prior authorization algorith.

Sounds like Medicare Advantage

The WISeR model includes a limited number of procedures that require prior authorization. Even before the model launched, some were concerned that the preauthorization requirement would delay or deny necessary care, much like the prior authorization requirements in Medicare Advantage plans. The Center for Medicare Advocacy testified in opposition to the WISeR model. The spokesperson for CMA, David Lipschutz, supported three bills discussed during that hearing, including one that would stop the WISeR model altogether and prohibit using or testing any payment models for prior authorization in traditional Medicare.

Foresight was 20/20

Three months before the WISeR model launched, CMS founder Judy Stein said the program would create barriers between physician orders and approved procedures. She cautioned:

“Adding prior authorization requirements to traditional Medicare will create costly problems and barriers to necessary care. Instead, to truly address waste and abuse in Medicare, CMS should look to the dramatic overpayments and unreasonable denials in Medicare Advantage.”

Judy Stein

Founder & Senior Advisor, Center for Medicare Advocacy

Early Reports

Physician struggles

Just three months into the WISeR model demonstration, early reports from providers and patients are discouraging. The Washington Post analysis of the model didn’t include a lot of positive feedback. Physicians report challenges with the approval process. Patients wait in pain until needed care is approved. Issues with the technology include problems with online portals as well as struggles with coordination and communication with tech firms and claims processors. Physicians also report denials for care that is within coverages guidelines and decisions that take longer than federal guidelines allow.

Unintended consequences

Part of the model intended to reduce unnecessary spending is a built-in incentive program for cost savings. The tech companies handling the AI algorithms are paid partly on the savings realized after denying medical services. This creates an inherent goal of adjusting the algorithm to deny more services, even if those services are necessary. The model supposedly balances this with pay adjustments for quality measures that include accuracy in decision-making. These tech companies are not staffed by medical professionals and it is unclear what they use as the basis for their decision-making algorithm.

Exemptions

Officials from Medicare say they intend to offer exemptions to physicians with a high authorization rate. These physicians would no longer be subject to the AI prior authorization if, over time, most of their submitted services are authorized. Taking this to its logical conclusion:

Physicians may dial back on recommended procedures until they get the exemption
Once exempt, physicians can circle back and get the procedures for their patients without prior approval
Tech companies may increase denials to ensure continued work
AI oversight of federal health spending could increase if the pilot program saves money, regardless of patient outcomes

Writing was on the Wall

Long before the WISeR model existed, AI algorithms for care authorizations had denied needed care. Insurance companies started using AI to process prior authorizations in 2020. Both UnitedHealth Group and Humana used nH Predict AI for care authorizations for Medicare Advantage. The family of an elderly couple sued UnitedHealth after their care was denied and the couple died. A class action suit against Humana claimed nH Predict AI Model predictions are highly inaccurate and are not based on patients’ medical needs. In February of 2024, CMS clarified the use of AI cautioning that “compliance is required with all of the rules at § 422.101(c) for making a determination of medical necessity, including that the MA organization base the decision on the individual patient’s circumstances.”

Unclear Future

After only a few months, officials have not indicated whether the WISeR model could expand into additional states or to cover additional procedures in the future. Beneficiaries say they stayed with the traditional Medicare plans specifically to avoid the prior authorization hurdles inherent in Medicare Advantage plans. CMS may have additional information by July, when the program has more data.

# # #

Kristin also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. She works with care at home software providers to create dynamic content that increases conversions for direct e-mail, social media, and websites. Connect with Kristin directly at kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2026 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Hospice CARE Act

by Kristin Rowan | Apr 3, 2026 | Hospice, Medicare, Regulatory

by Kristin Rowan, Editor

Hospice CARE Act

Congress breathes new life into hospice protection

In 2024, Representative Blumenauer (D-OR) introduced the Hospice Care Accountability, Reform, and Enforcement Act. The Bill, H.R. 9803, aimed “to amend title XVIII of the Social Security Act to ensure the integrity of hospice care furnished under the Medicare program.” The House referred the act to the Committee on Ways and Means and the Committee on Energy and Commerce for consideration. The Committee on Ways and Means later referred the act to the Subcommittee on Health, where it apparently remains under consideration.

On March 18, 2026, Congresswoman Sanchez (D-CA) and Senator Warner (D-VA) introduced, or re-introduced, the Hospice Care Accountability, Reform, and Enforcement (Hospice Care) Act. According to the joint press release from its sponsors, the act will “modernize the Medicare hospice benefit, protect patients and taxpayers from fraud, and expand access to essential services and caregiver support.”

Program Integrity and Payment Reform

The two primary foci of the act are program integrity provisions and payment reforms. The hospice benefit remains largely unchanged since it began in 1982 despite significant changes in both the providers delivering and patients receiving end-of-life care. The rise in reports of fraud and abuse puts into question whether the current system can ensure both meeting the needs of patients and families and safeguard the Medicare Trust Fund.

“Hospice should provide comfort and dignity at the end of life, yet the benefit has not evolved to meet families where there is need. This bill strengthens and enhances Medicare’s hospice benefit so it provides the critical care patients and their families need – like respite care for caregivers and coverage of palliative treatments like dialysis and radiation – all while protecting the program from those trying to exploit it.”

Linda T. Sanchez

Congresswoman, D-CA

Program Integrity

According to the sponsors, the bill “creates additional safeguards to precent fraudulent providers from enrolling in Medicare and increases oversight of hospices, especially new hospices.”

Specifically, the bill:

Temporarily prevents new hospices from enrolling in Medicare, while allowing exceptions for instances where additional access to care is needed.
Requires increased transparency of hospice ownership and managing control information, ensuring CMS’s enrollment records are up to date.
Increases survey frequency for new hospices to ensure they meet hospice health and safety standards and prohibits payments to hospices that do not submit required quality data to the Secretary, with appropriate exceptions.
Reduces the potential for inappropriate financial conflicts of interest when certifying individuals’ eligibility for hospice care, while allowing nurse practitioners and physician assistants to also certify eligibility.
Requires CMS to conduct additional oversight activities to ensure hospices are providing holistic and comprehensive care.
Provides patients with an explanation of benefits within 15 days of an individual’s hospice election to increase beneficiary awareness of hospice enrollment and prevent extended periods of fraudulent billing.

Payment Reform

The bill “ensures that providers are incentivized to deliver high-quality care to individuals and their families.”

Specifically, it:

Revises the payment structure for routine home care to reward hospices for providing in-person care.
Increases payments to hospices for furnishing palliative radiation, chemotherapy, blood transfusions, and dialysis to address access barriers for individuals that require these costly treatments under a hospice election. Additionally, it creates an outlier payment policy to provide a backstop for providers delivering care to high-cost patients.
Adds home respite care to the Medicare hospice benefit, allowing individuals to receive respite care at home rather than in a facility, which is a key benefit for families and caregivers that are taking care of loved ones at the end-of-life.
Creates a new transitional inpatient respite benefit to support patients and families through their transition from a hospital into hospice care in the setting of their choice, allowing patients to move from hospital to general inpatient care to transitional respite, when appropriate. This new transitional payment seeks to eliminate the current pattern of care whereby terminally ill individuals are discharged from the hospital and inappropriately admitted to a skilled nursing facility in lieu of electing hospice care.

“Making decisions about hospice and end-of-life care is one of the most difficult moments that families can endure, yet Medicare’s hospice benefit is out-of-touch with the needs of patients and providers. I’m proud to introduce this legislation that will prioritize patient comfort at home as well as in a health care facility, and protect patients and taxpayers from bad actors attempting to steal essential resources.”

Mark Warner

Senator, D-VA

Industry Support

The Hospice CARE Act received wide-spread industry support after its introduction to Congress.

American Academy of Hospice and Palliative Medicine

“Patients and families in need of the care, comfort and quality of life that hospice care provides need to trust that they are receiving the best possible services. We look forward to working with Representative Sánchez and Senator Warner on these important issues and to ensure that all patients have access to this vital care.”

– Kristina Newport, CMO for AAHPM

Center for Medicare Advocacy

“In addition to significant payment reforms and program integrity measures, this bill takes important steps towards improving access to care for individuals on hospice.”

-David Lipschutz, Co-Director for the Center for Medicare Advocacy

National Alliance for Care at Home

“Hospice care is one of the most profound services our healthcare system offers, providing patients and families with compassionate, dignified care during life’s most difficult moments. As the number of Americans turning to hospice continues to grow, it is critical that the benefit keeps pace with how care is delivered today and what patients, families, and providers actually need. The Alliance looks forward to working with Representative Sánchez and Senator Warner and their congressional colleagues on this legislation. We are committed to being a constructive partner in any effort to protect what’s working, address what isn’t, and modernize the Medicare hospice benefit in ways that serve patients, families, and the future of care in our country.”

-Jennifer Sheets, CEO for The Alliance

LeadingAge

“At its best, compassionate, high-quality, person-centered care is delivered to beneficiaries and families by ethical, forward-thinking, competent providers, in keeping with the sector’s nonprofit origins, which established a standard of quality care. Currently, however, hospice is at an inflection point. Increased scrutiny – an appropriate response to fraudulent behavior of a limited group of bad actors – highlights the need for modernization.

-Katie Smith Sloan, President and CEO for LeadingAge

National Partnership for Healthcare and Hospice Innovation

“This legislation provides an important opportunity to pursue thoughtful reforms to the Medicare hospice benefit that both preserve patient access and address ongoing concerns related to program integrity. While the bill represents meaningful progress toward modernizing the benefit and reducing incentives for fraud, waste, and abuse, NPHI believes certain provisions – particularly those related to payment reform – present opportunities for further discussion and refinement.”

– Tom Koutsoumpas, Founder and CEO of NPHI

More Information

A section-by-section analysis of the bill is available HERE
A one-pager of the bill is available HERE

Congress is on recess until the middle of April. The last few months will dictate the priorities when the next session starts, which will likely be focused on finalizing the budget and fully reopening the government. Whether the Hospice CARE Act will progress past its 2024 version is unclear. The Rowan Report will continue to monitor its progress.

# # #

Kristin Rowan is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news. She is also a sought-after speaker on Artificial Intelligence, Technology Adoption and Lone Worker Safety. She is available to speak at state and national conferences as well as software user-group meetings.

Kristin also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. She works with care at home software providers to create dynamic content that increases conversions for direct e-mail, social media, and websites. Connect with Kristin directly at kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2026 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

The Home Care Show: A Review

by Kristin Rowan | Feb 26, 2026 | Editorial, Product Review

by Kristin Rowan, Editor

The Home Care Show

We attend a lot of events. As care at home professionals, nurses, agency owners, regulatory bodies, advocacy groups, and software solutions providers, we travel sometimes more than we are at home. As a general rule, these events comprise networking opportunities, vendor displays, educational panels, and activities. Most of the events are of good quality, well organized, and informative. After a while, they all seem to blend together and we can’t remember which event we attended last or who met at each one. Every now and again, something new comes along.

Local Event Goes National

The Home Care Show started as a regional event in New York, hosted by GlattHealth. After a few years of tri-state success, the group added The Home Care National in Miami in 2025. The Rowan Report became aware of the event through some trusted colleagues who are now on the board of the national event.

Education

After a morning networking block with several options to connect with attendees, The Home Care Show kicked off with an impressive “State of the Industry” panel. The panel included Denise Bellville, Executive Director of the Home Care Association of Florida, Damon Terzaghi, Vice President of Medicaid Advocacy & Programs for the National Alliance for Care at Home, and Eric Reinarman, Vice President of Government Relations for the Home Care Association of America.

Breakout sessions ranging from marketing to IT, led by some of the brightest minds in the industry, followed the state of the industry address. Additional panel topics included AI, payer diversification, navigating risk, optimizaing growth, and mergers & acquisitions.

Growing Pains

Any event that changes its structure, location, or size will have some growing pains. The hiccups at The Home Care Show were minor and easily overcome. There was some overlap in the schedule that disrupted the flow on Tuesday. Navigating the website on a mobile device was tricky. The registration booths were strategically placed in front of the vendor hall and panel room, seemingly to keep attendees out of those rooms before they opened. But drinks and snacks were also behind registration and not obviously available to attendees. The vendor area was heavily leaning to the insurance/financial investment/consultant/advisor variety with few exceptions. Seating in the vendor hall was limited, which made lunch on Wednesday tricky.

Nailed It!

Much of this two-day conference could be considered a home run. In fact, most of it was pretty fantastic.

The education was timely, relevant, professionally moderated, well-planned, and had a mix of representation from home care agencies, consultants, software solutions partners, and investors. One attendee said, “I learned more in that session that I did in three days at the last event.”

The networking events were varied enough to appeal to everyone. After registering, attendees had the option to play pickleball at the host hotel, enjoy the beautiful pool, or relax at the coffee shop. Tuesday evening, GlattHealth and other sponsors hosted a rooftop dinner with live music.

The vendor room kept all sponsors in the same size booth, requiring them to use their product and service to woo attendees rather than the cost of their setup. The layout allowed for movement through the hall, and lunch and cocktail hours were inside the hall, giving vendors more face-time with attendees.

Final Thoughts

As Care at Home events go, this one ranks near the top. The education is well-worth the trip. The opportunities to get concrete information from industry experts to launch your agency no matter the direction you’re taking makes this event stand apart. Whether you’re near Miami or have to travel, put The Home Care Show National on your calendar for 2027.

# # #

Kristin Rowan is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news. She is also a sought-after speaker on Artificial Intelligence, Technology Adoption and Lone Worker Safety. She is available to speak at state and national conferences as well as software user-group meetings.

Kristin also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. She works with care at home software providers to create dynamic content that increases conversions for direct e-mail, social media, and websites. Connect with Kristin directly at kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2026 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Are Nurses Independent Contractors?

by Kristin Rowan | Feb 26, 2026 | Admin, Caring for the Caregiver, Clinical, Legal

by Kristin Rowan, Editor

Are Nurses Independent Contractors?

Jury will decide intent

After investigation, the U.S. Department of Labor (DOL) sued Amazing Care Home Healthcare Services over misclassification of workers, recordkeeping violations, damages, and unpaid overtime. The court decided the workers were misclassified.

Classification as Employee

According to the decision, the workers were employees because the company had control over the work, set wages, required workers to report absences, and evaluated their performance. The DOL provides guidance on what constitutes an employee. Prior regulations use a “totality-of-the-circumstances” approach to classification, looking at the whole picture rather than a single determining factor. Other documents rely on an “economic reality” test that examines two core factors: the nature and degree of control a worker has over the work and the worker’s opportunity for profit or loss.

Summary Judgment

The DOL called for summary judgement, in which the judge would decide the case without a trial or jury due to “overwhelming” evidence. The judge partially agreed and granted summary judgement in favor of the DOL on worker classification, recordkeeping, and damages. The court declined summary judgement on the issue of overtime and intent. There is some question as to whether the workers were paid some overtime wages during the period in question and whether the misclassification was willful. These questions will be decided by a jury at trial.

Economic Reality

The totality framework to determine worker classification came into use during the Biden administration. The DOL has recently proposed a return to the economic reality framework from 2020. Two core and three additional factors comprise the economic reality test. These two core factors are the primary determinants:

The nature of and degree of a worker’s control over their work

does the employer control scheduling, pay rates, and prices;

does the employer supervise performance and discipline workers

Opportunity for profit or loss

does the worker advertise services independently, negotiate contracts, decide when and where to work, have the ability to hire helpers to perform the work

These three additional factors are considered in classification analysis, but carry less weight than the two primary considerations:

The amount of skill required for the work

does the worker use their own specialized skills rather than relying on the company for training

–and–

does the worker use that skill to grow the business

The degree of permanence of the working relationship between company and worker

is the work sporadic, as needed, or project-based

–and–

is the company engaging in seasonal or temporary work or industry

Whether the work is part of an integrated unit of production

can the business operate without the work performed

Clear Answer

Using the economic reality test, can we classify home health nurses as independent contractors or employees without question?

Employee

Agency sets pay rate for the nurse
Supervised performance
Clients belong to the agency
Nurses do not hire and pay helpers
Nurses do not automatically make more when the agency grows
The business cannot operate without nurses

Independent Contractor

An agency could allow the worker to set their own schedule
Nurses use their own skills, degrees, and certifications
Work could be created as project-based where 1 client=1 project for 30 days

Final Thoughts

Without very careful planning and disruption of practice, it is pretty clear that home health workers are not independent contractors, but are employees. There may be significant differences in the operation of non-medical supportive care at home, but pay rates are still determined by the agency, performance is supervised, clients belong to the agency, and the business cannot operate without healthcare workers. The DOL sued for unpaid overtime amounting to $5.9 million on behalf of both LPNs and Home Health Aides.

If you do now or plan to in the future engage any worker as an independent contractor, review all current FLSA and DOL requirements to ensure you are not misclassifying your workers.

# # #

Kristin Rowan is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news. She is also a sought-after speaker on Artificial Intelligence, Technology Adoption and Lone Worker Safety. She is available to speak at state and national conferences as well as software user-group meetings.

Kristin also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. She works with care at home software providers to create dynamic content that increases conversions for direct e-mail, social media, and websites. Connect with Kristin directly at kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2026 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Enhabit Sells Out to PE

by Kristin Rowan | Feb 26, 2026 | M&A

by Kristin Rowan, Editor

Enhabit Sells Out to PE

Kinderhook proposes billion dollar deal

Enhabit Home Health & Hospice announced this week they agreed to be acquired by Private Equity company Kinderhook industries. Enhabit has 247 home health and 115 hospice locations across 34 states. Stockholders will receive $13.80 per share from the publicly traded company after the acquisition is final and the company will longer be listed on the stock exchange. The stock buyout is reportedly just shy of 25% more than the stock value as of the close of business on February 20th.

Enhabit History

Enhabit made headlines in 2025 and again earlier in February surrounding its lawsuit against Chris Walker, Vistria Group, and Nautic Partners. In 2024, Encompass and Enhabit sued the parties for breach of duty when the principles involved created VitalCaring while still serving as senior officers for Enhabit. Enhabit, the former home health and hospice division of Encompass Health, collected $43 million in attorneys’ fees and mitigation damages on February 12, 2026.

Enhabit’s registered mission is A Better Way to Care®. The company purpose is to provide high-quality, compassionate care to every patient. Their core values and fundamental beliefs guide their behaviors and actions.

Deciding to Sell Out

“Following a thorough evaluation and extensive deliberations in consultation with our independent advisors, we are pleased to reach this agreement with Kinderhook. The Board evaluated the current state of the business, its outlook and opportunities, and is confident this transaction maximizes value for our stockholders and is in their best interest.”
Jeffrey W. Bolton
Chairman of the Board of Directors, Enhabit

CEO Barb Jacobsmeyer said the agreement is a “terrific outcome” for stockholders, clinicians, caregivers, patients, and families, citing resources and expertise that will come from Kinderhook. Meanwhile, Chris Michalik, Managing Director at Kinderhook said the company admires Enhabit’s leadership, patient-centered culture, and strong market position.

Pending Approval

Enhabit’s Board of Directors unanimously approved the acquisition. However, the deal still awaits approval from stockholders and regulatory bodies. Enhabit has scheduled a special meeting of stockholders for the vote. In conjunction with the SEC filing, some Enhabit executive officers filed a customary voting and support agreement, meaning they have granted proxy voting rights to Kinderhook. It is almost certain the acquisition will be approved by both companies. Only the regulatory approval is unknown.

# # #

Kristin Rowan is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news. She is also a sought-after speaker on Artificial Intelligence, Technology Adoption and Lone Worker Safety. She is available to speak at state and national conferences as well as software user-group meetings.

Kristin also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. She works with care at home software providers to create dynamic content that increases conversions for direct e-mail, social media, and websites. Connect with Kristin directly at kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2026 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

BREAKING NEWS: Dr. Landers Steps Down

by Kristin Rowan | Feb 12, 2026 | Advocacy, Breaking News, Home Health, Hospice, Partner News

by Kristin Rowan, Editor

Dr. Landers Steps Down

National Association Announces Successor

Dr. Landers steps down from his role as CEO of the National Alliance for Care at Home (the Alliance). The Alliance published news of Dr. Landers’ resignation the morning of February 11, 2026. His successor will take the CEO role on February 17th and Dr. Landers will advise on the transition through May 10th.

Achievements

Dr. Landers’ tenure at the helm of the Association was short-lived, having served as CEO for just beyond the one year mark. He was the inaugural CEO of the Alliance, taking the role officially when the merger between NAHC and NHPCO was completed. In that time, Dr. Landers effectively led the merged associations, navigating the two organizations into a harmonious. team.

Building Strength

During his tenure, Dr. Landers built a structure on which the Alliance will grow. He spurred that growth with the addition of COO Sherl Brand and Chief Government Affairs Officer Scott Levy. And he build reinforced the foundation of the industry by forging relationships with the Partnership for Quality Home Healthcare and the Research Institute for Home Care.

Standing Strong

Under Dr. Landers, the Alliance, with the support of industry leaders, advocacy groups, and organizations, aggressively and successfully fought against what would have been a disastrous 9% pay rate adjustment from CMS. The Alliance remains at the forefront of advocacy efforts, including meeting with Dr. Oz to help combat Medicare and Medicaid fraud.

In His Own Words

“Advancing home care and hospice should be amongst the highest public policy priorities for our country. I am deeply grateful and proud to have served as the inaugural CEO of the National Alliance for Care at Home and am eager to see all the great work I know is to come in the next chapter. I extend my deepest gratitude and admiration to the Alliance staff, Board of Directors, and all the amazing members of our community I have had the privilege of working with.”
Dr. Steve Landers
Inaugural CEO, National Alliance for Care at Home

New Leader

On february 17 2026, Jennifer Sheets will take the role of CEO at the Alliance. Sheets has worn multiple healthcare hats including intensive care nurse, hospital system CEO, merger & acquisition executive in private equity, senior clinical operations at Bayada, and AI technology founder. According to her LinkedIn statement, Sheets will remain at her role as Founder and CEO of her AI software company “throughout this transition.”

We have reached out to the Alliance to schedule an interview with Sheets.

# # #

Kristin Rowan is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news. She is also a sought-after speaker on Artificial Intelligence, Technology Adoption and Lone Worker Safety. She is available to speak at state and national conferences as well as software user-group meetings.

Kristin also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. She works with care at home software providers to create dynamic content that increases conversions for direct e-mail, social media, and websites. Connect with Kristin directly at kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2026 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

MedPAC Finalizes Recommendation to CMS

by Kristin Rowan | Jan 30, 2026 | Advocacy, CMS, Home Health, Hospice, Medicare, Regulatory

by Kristin Rowan, Editor

MedPAC Recommends 7% Cut

Vote Finalized

In December, MedPAC published a proposed recommendation for calendar year 2027 that included a 7% cut to home health reimbursement rates and no increase for hospice. Last week, MedPAC voted to finalize that recommendation and send it to CMS.

Industry Objection

Both the proposal and final recommendation met with strong industry backlash.

“MedPAC’s dangerous and misguided recommendations to reduce the Medicare home health base payment rate by 7% for CY 2027 and eliminate the update to the 2026 Medicare base payment rate for hospice do not reflect both home health and hospice agencies’ operating realities as well as the cumulative impact of recent policy changes. For home health agencies, any cut – let alone one of such great magnitude – will threaten the ability to meet individuals’ healthcare needs. Yet again, the Commission is failing to understand the operating reality providers face and the potential patient harm that any further payment cuts pose.”
Dr. Steve Landers
CEO, National Alliance for Care at Home

Consistently Wrong

The MedPAC recommendation may not be built on solid data, use accurate calculations, consider Medicare Advantage and Medicaid rates along with Traditional Medicare FFS, consider the number of agencies that will go out of business, have any recommendations for maintaining nurse and caregiver hourly rates, or fairly distribute Medicare funds across disciplines, but, wait…where was I going with this? Oh, right! At least they’re consistent. MedPAC recommended a 7% decrease in Medicare payments for 2027, 2026, 2025, 2024, and 2023. They may be completely wrong, but they are dedicated to maintaining their wrongness.

Final Thoughts

Despite the years of 7% cut recommendations from MedPAC, the final numbers from CMS are rarely in line with those recommendations. We will, of course, know more when CMS publishes their proposal later this year. LeadingAge, National Association for Care at Home, individual and corporate HHAs and Hospices, and anyone else with a stake in the care at home industry, should contact their congressional representatives and CMS directly to voice concerns over these cuts.

# # #

Kristin Rowan is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news. She is also a sought-after speaker on Artificial Intelligence, Technology Adoption and Lone Worker Safety. She is available to speak at state and national conferences as well as software user-group meetings.

Kristin also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. She works with care at home software providers to create dynamic content that increases conversions for direct e-mail, social media, and websites. Connect with Kristin directly at kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2026 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

UnitedHealth Group Publicity Stunt

by Kristin Rowan | Jan 30, 2026 | CMS, Editorial, Medicaid, Medicare, Medicare Advantage, Regulatory

by Kristin Rowan, Editor

UnitedHealth Group Publicity Stunt

How to Distract the Public: 101

When customers and regulatory bodies start to complain about company practices, reputation management usually gets involved. An internal or external public relations, crisis communication, and/or reputation management specialist advises the company on how to overcome negative press.

Transparency & Action

When Dominos Pizza employees recorded a disturbing “hoax” video, the CEO went to the same medium (YouTube) to address the video, apologize, and reassure customers. This issue was handled so well that it is used as a teaching tool in PR classes.

In 1982, when a couple tampered with bottles of Tylenol in Chicago and seven people died, parent company Johnson & Johnson stopped advertising, recalled 31 million bottles across the country, switched to tamper-proof packaging, and personally communicated with 450,000 retailers.

Subterfuge, Smoke & Mirrors

Last week, when UnitedHealth Group, already under investigation for bribing nurses, wrongful death, and Medicare Advantage billing fraud, was called to testify before House committees about their record-high premiums, rising claims denials, and unneccessary waiting over prior approvals, UHG CEO prepared a written statement to read to the Energy & Commmerce Committee that included blaming hospital costs, pricing differences, frequency of testing, drug prices, and pharmaceutical advertising for higher premium rates; extolling the virtues of Medicare Advantage over Traditional Medicare, using incorrect and misleading information; and casually mentioning that they will “voluntarily eliminate and rebate our profits” for their ACA customers.

Gesture too Small to be Meaningful

The months long Congressional stand-off on healthcare premium subsidies continues. Affordable Care Act participants saw healthcare premiums jump over night when the subsidies expired. (Mine went up 400%).

In 2025, UnitedHealth recorded $12.1 billion in profit. But, that profit is spread out over nearly 3,000 wholly owned subsidiaries who take almost 30% of what UHG pays out in care costs. The company has increased its Medical Loss Ratio to 87% by hiring their own subsidiaries to engage in “quality improvement,” virtually eliminating ACA profit.

Of its 50 million subscribers, only about 1 million are ACA customers. Even if the company returns the ACA profits, it will return 1/50th of its profits and keep the rest. In their third quarter earnings call, UHG said it expected 2026 enrollment to be 1/3 of that in 2025. The 2026 outlook estimates an overall increase in profit to more than $14 billion, most of which will never find its way back to ACA participants.

The Truth Behind the Curtain

On January 27, 2026, just one week after the profit-sharing announcement, UnitedHealth Goup addressed shareholders in its Q4 and 2025 Earnings Call. During that call, newly appointed UnitedHealthcare CEO Tim Noel said:

“Nearly all of our employer Group and fully insured pricing align with continued increases in care activity for 2026. In the Individual ACA market, we repriced nearly all states in response to higher medical trends and the elevated needs of ACA beneficiaries in 2025…. These actions should expand operating earnings margins for UnitedHealthcare by 40 basis points, and are expected to result in membership contraction of 2.3 to 2.8 million.”
Tim Noel
CEO, UnitedHealthcare

Other statements during the call reinforced the company’s drive toward profit.

They are focusing attention in markets where they have “complimentary wrap-around services” already in place. Which means they have owned subsidiaries to shift money to instead of lowering premium rates. Additionally, they have “narrowed [their] affiliated network…with the goal of having a more optimal alignment of physicians….”

New Speak

Throughout the earnings call, company spokespeople used terms like repositioned, streamlined, aligned, membership contraction, and repriced. They carefully avoided saying that they dropped physician services outside those they owned, removed plans that paid out too much, consolidated businesses to increase profits, lost millions of members due to price increases and other plan problems, and raised prices across the board, even on plans that were already profitable.

Final Thoughts

UHG CEO Hemsley made a few statements to Congress I agree with. Drug prices are too high. Hospital and Ambulance prices are too high. Pharmaceutical companies advertise too much and use the cost to offset tax liability.

There were also some statements Hemsley almost got right.

He said small businesses should be allowed to join AHPs with fewer restrictions. There should be no restrictions on industry or geography.

He said HSA thresholds should be lowered for HDHPs. HSAs should be available to everyone, regardless of plan, deductible, payer, or whether they are on a group, individual, or ACA plan.

Hemsley thinks broker compensation should be standardized in the ACA market. If payers want broker compensation, standardized or not, ACA or Medicare Advantage, the compensation should come from the payer and not be included in premiums.

He wants consumers to have expanded access to catastrophic plans and to allow the use of premium tax credits. All plans and payers should be available to everyone, everywhere. Increasing competition in plans and players will drive down costs.

I applaud Congress for bringing the large payers in to discuss exhorbitant premium rates, but I’m still waiting on them to take action based on the information they received.

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Kristin Rowan is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news. She is also a sought-after speaker on Artificial Intelligence, Technology Adoption and Lone Worker Safety. She is available to speak at state and national conferences as well as software user-group meetings.

Kristin also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. She works with care at home software providers to create dynamic content that increases conversions for direct e-mail, social media, and websites. Connect with Kristin directly at kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2026 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

VA Updates Community Cares Contracts

by Kristin Rowan | Jan 23, 2026 | Admin, CMS, Regulatory

by Kristin Rowan, Editor

VA Issues RFP

Updates to Community Care Contracts

Some Veterans receive care from VA providers. Non-VA providers can still provide care for Veterans through a Community Care contract with the U.S. Department of Veterans Affairs (VA). In late 2025, the VA released a Request for Proposal (RFP) for new CC contracts. The new contracts are designed to substantively change non-VA provider care to Veterans.

According to the VA, the new contracts are intended to:

Increase choice through an IDIQ model that allows multiple health plans to compete to serve Veterans

Raise quality of care by requiring plans to follow broad standards of care adopted by major health systems

Improve oversight and quality of care using better data, technology, and real-time management

Add flexibility so the VA can issue competitive task orders and remove underperforming contractors

How Does This Impact Care at Home?

The primary contractor, and therefore the ones responsible for bidding and ensuring quality of care are the health plans. So, how does this change impact home care and home health providers? Here’s how:

Fast changes in network participation along with sudden shifts will inevitably come as a result of plans competing and task orders changing

Plans will need to align with VA targets, so expect waves of onboarding, recurring pushes for credentialing, and increased local networking

Because the plans will be held to quality standards, you can expect that those standards will flow through provider documentation, timeliness, claims accuracy, and EVV and FWA compliance

IDIQ is specifically designed to allow changes in the middle of care, which means the VA and health plans can add or change rules or portal, and make revisions to edit sets during the contract

Get Ahead of the Changes

Plan to make some changes before these new Community Care contracts come to your local health plans. In order to comply with the contract requirements, your credentialing packets need to be updated to include up-to-date CAQH, insurance, licenses, and compliance. This will help minimize the lag-time before getting paid.

Anticipate Expectations

The health plans will be competing for contracts, so they will expect you to compete as well. Awarded contracts will likely be fulfilled by agencies who have a high clean claim rate and quick response to edits and denials. Whatever you are using for coding, documentation, and rules need to be validated before the new care contracts start. Complete documentation will comply with the VAs focus on better data and real-time management. Make sure your team is executing precise reports; centralize your records, documentation, and audits to prove performance records and decrease issue resolution time.

Final Thoughts

Non-VA providers who want to be considered to provide care to Veterans need to show alignment with the VA’s goals to expand choice, raise quality, and increase oversight. Planning ahead by meeting those standards early will make the transition process smoother one the new contracts roll out. We will continue to provide resources and information on these Community Care contracts as they are available.

# # #

Kristin Rowan is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news. She is also a sought-after speaker on Artificial Intelligence, Technology Adoption and Lone Worker Safety. She is available to speak at state and national conferences as well as software user-group meetings.

Kristin also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. She works with care at home software providers to create dynamic content that increases conversions for direct e-mail, social media, and websites. Connect with Kristin directly at kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2026 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Home Care 100 Sneak Preview

by Kristin Rowan | Jan 23, 2026 | Advocacy, Artificial Intelligence, Events, Partner News, Regulatory

by Kristin Rowan, Editor

Home Care 100 Sneak Preview

An Interview with Jeanette Lynn

In a few days, care at home leaders, influencers, educators, and solutions providers are set to descend on Scottsdale, AZ for the 2026 winter edition of the Home Care 100 Leadership Conference. I had the opportunity to speak with Managing Director Jeanette Lynn about this year’s theme, some of the events, and her outlook for 2026.

Home Care 100 Theme

The Rowan Report:

Jeanette, thank you for taking some time to chat today. I know how busy the week before an event is. Can you tell our readers about some of the agenda highlights for Home Care 100?

Jeanette Lynn:

The theme is the data imperative. The future will rely on becoming a data-centric organization.

“We impact patients, partners, referral sources, payers, policy makers, and all stakeholders. We have to come to the table with the right data in the right way.”
Jeanette Lynn
Managing Director, Home Care 100

I’m very excited about the keynote address from a former employee of Pixar talking about storytelling. When we’re talking with policymakers, providers, payers, we have to tell a story and find the connection with the audience. There is also an opportunity to do a follow-up workshop with him.

Other Key Topics and Sessions

Other sessions to anticipate next week:

Panels of providers sharing case studies

Six round-table facilitated discussions that are specific to home care, home health, or hospice. Those topics are listed on the event website

A showcase on new approaches to being a CEO of a data-driven organization including tangible and practical takeaways on how to do it. Where is the data? Where can I find it and how do I use it?

State of the Industry

RR:

What is your industry outlook?

Jeanette

There is so much that is changing so fast. Look at the conversations around AI technology just in the last year or so. The technology is opening doors that didn’t previously exist. I’m reminded of what I recently heard from Judy Faulkner from EPIC. This is a company that has been ridiculed for some time for having closed systems, following regulations but sharing information as limited as possible; it has taken them awhile to be more patient and physician-friendly. A recent announcement said patients could now access all medical information in one MyChart system across the country.

This will shift interoperability – from patients to nurses to agencies. The demand to fix this is getting higher; we’ve been sitting on the excuse of not being able to influence reimbursement rates; but MA coming out and saying the rates are going to get lower requires that we increase efficiency and the data will help get you there.

One Answer is Interoperability

When you order food online, that company can tell you that Kathy picked up your food at 7:03 p.m., is riding a bicycle, has two stops before she gets to you, and show you the route she’s taking. We can certainly provide more information, more data, and better data for our patients.

We have to supplement existing Medicare product with other services, other approaches, that get the financial lever pulled a different way. The product is too defined, coded, and reimbursed; we need a bundled care product. It’s time everyone else sees that we have more data, information, and influence.

There are multiple opportunities and pathways. Our goal is to guide our members toward the ones that will work for each organization.

The Year Ahead

RR:

You’ve been at the helm long enough now that you’ve had a chance to get your feet wet. What have been your observations and what does that mean for Home Care 100 and Lincoln Healthcare Leadership for 2026?

Jeanette:

My biggest observations at Home Care 100 and Lincoln Healthcare Leadership: HC100 is a group of diverse leaders who can drive and influence change; there will be continued consolidation and the big players influence everyone else.

For me, the biggest win is after the conference hearing that one of our members initiated a new program, new deal, new partnership. We want that on steroids. We want to exponentially expand those wins.

The Intelligence group pairs advisors with intelligence group members to figure out how to put into action what you learned at the conference. We align experts to supercharge members. So we’ve relaunched the Intelligence Group as an offering year-round.

The subsets of members in the intelligence group are doing smaller in-person meetings covering particular topics. We’re looking for more organizations joining the group and expanding those events, not hosting more HC 100 events.

Final Thoughts

Speaking with Jeanette, it was so easy to see her passion and excitement for the industry, for the upcoming event, and for the members who benefit from the event. I am looking forward to the sessions she mentioned, seeing old friends and making new ones, and, of course, a little dancing and revelry after the hard work is done.

# # #

Kristin Rowan is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news. She is also a sought-after speaker on Artificial Intelligence, Technology Adoption and Lone Worker Safety. She is available to speak at state and national conferences as well as software user-group meetings.

Kristin also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. She works with care at home software providers to create dynamic content that increases conversions for direct e-mail, social media, and websites. Connect with Kristin directly at kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2026 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

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