OASIS-E2

by | Aug 28, 2025 | CMS, OASIS, Regulatory

OASIS-E2

by Kristin Rowan, Editor

OASIS-E2 Instruments and Change Table draft are available from The Centers for Medicare & Medicaid Services (CMS). They are available for download here. The draft proposes an off-cycle implementation date of April 1, 2026

Change Table

Changes include:
  • Transportation listing changed from A1250 to A1255
  • Hearing (B0200) and Vision (B1000) added to ROC
  • Sex (A0810) replaces Gender (M0069)
  • COVID vaccination up to date removed
  • Language (A1110) added to ROC
  • Minor changes to replace outdated item numbers with updated ones (ex: all instances of A1250 changed to A1255)
OASIS E2 Change Table

Change Timeline

The Changes are effective April 1, 2026. However, the changes are not final pending approval from the Office of Management and Budget (OMB). Agencies are able to use the draft form for training purposes, but should look for the final form that includes the OMB control number and expiration date.

Implications

OASIS accuracy is linked to PDGM payments and quality outcomes. Prepare early for the off-cycle April 1, 2026 changes to ensure a smooth transition to E2 requirements and continued reporting accuracy. 

Resources

Draft versions of the instruments are on the CMS website in a ZIP file. You can download the file here.

The PRA package, which includes four separate documents, is available for download here.

Submit comments to CMS about OASIS-E2 or any other item in the Home Health Prospective Payment System Rate Update for CY 2026 here and here.

Quality Improvement Project

by | Aug 28, 2025 | Admin, Clinical, Home Health, Hospice

by Kristin Rowan, Editor

Quality Improvement Project

Joint two-year effort publishes results

The Quality improvement project, a joint two-year research initiative between BerryDunn, Strategic Healthcare Partners, and National Alliance for Care at Home, aimed to improve the care experience for patients and improve CAHPS scores. The study implemented best practices targeted toward the CHAPS survey to see what really was working in improving patient and family satisfaction.

“Very little research has been done in the area of home health and hospice CAHPS, and this project is helping to close that gap. By identifying and validating true best practices, we’re giving agencies actionable tools to improve patient and family experience. At the heart of care is the relationship between providers, patients, and families—and improving that experience is essential to achieving meaningful outcomes.”

Lindsay Doak

Director of Healthcare Research and Education, BerryDunn

The Quality Improvement Project

The study included 27 hospice and 36 home health agencies. It ran from October of 2023 through June of 2024. Participating agencies underwent supervisory training and support, customer service and PCC training and support, and patient-centered mentorship certification. They also participated in bimonthly review calls for performance metrics and best practices.

Data comparisons

CAHPS data collected between June 1 and December 31, 2023 served as a baseline to compare with data collected using best practices. New CAHPS data collected between June 1 and December 31, 2024 showed outcomes of the project.

Quality Improvement Project Hospice Domains
Quality Improvement Project Home Health Domains

Best Practice Findings

  • Before funding new or additional initiatives, ensure internal readiness and operational stability to ensure successful implementation
    • Customer service training improved CAHPS outcomes in communication and willingness to recommend
    • Supervisory training improved roll-up scores for hospice and both specific care issues and willingness to recommend for home health
    • Mentorship boosted overall scores in hospice, but had little impact in home health
  • Home Health agencies may benefit from mandated interdisciplinary team meetings for mentorship, peer connection, and ongoing staff education
  • Turnover rates had mixed results
    • Intentional staff changes due to performance issues increased scores
    • General high turnover disrupted continuity and long-term success

Key Takeaways/Conclusions

Implementing patient-centered care (PCC) yielded strong improvement in some areas for some organizations, but overall the project produced varied results. The project was more successful among hospices than home health agencies. PCC training will need changes to achieve measurable impact. The best results came from agencies with the highest participation rates. Further improvement efforts need to be tailored to agency types, cultures, dynamics, and internal barriers.

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This report and the information contained therein is the property of BerryDunn. For more information, contact BerryDunn directly. Download the full report here.

DOJ Settles with UnitedHealth and Amedisys

by | Aug 21, 2025 | Legal, M&A, Medicare, Medicare Advantage

by Kristin Rowan, Editor

DOJ Settles with UnitedHealth and Amedisys

Judge to Weigh In

DOJ settles with UnitedHealth and Amedisys after almost nine months of negotiations. The Department of Justice (DOJ) initially blocked the proposed merger between UnitedHealth and Amedisys, citing concerns over eliminating competition in home health and hospice services in some areas of the U.S. After the most recent settlement hearing, the merger seems to be back on track.

Public Comment Period and Judicial Review

Now that the DOJ hurdle has been passed, there is a public comment period. Following the public comment period, the U.S. District Court for the District of Maryland will enter final judgement. From the Justice Department website:

As required by the Tunney Act, the proposed settlement, along with a competitive impact statement, will be published in the Federal Register. Any interested person should submit written comments concerning the proposed settlement within 60 days following the publication to Jill Maguire, Acting Chief, Healthcare and Consumer Products Section, Antitrust Division, U.S. Department of Justice, 450 Fifth Street NW, Suite 4100, Washington, DC 20530. 

Antitrust Division Statement

“In no sector of our economy is competition more important to Americans’ well-being than healthcare. This settlement protects quality and price competition for hundreds of thousands of vulnerable patients and wage competition for thousands of nurses. I commend the Antitrust Division’s Staff for doggedly investigating and prosecuting this case on behalf of seniors, hospice patients, nurses, and their families.”

Abigail Slater

Assistant Attorney General, Justice Department Antitrust Division

Divestiture Agreement

According to the new agreement, UnitedHealth will sell 164 home health and hospice locations across 19 states. In addition to the sale, the agreement provides the buyers of these locations with assets, personnel, and relationships to help them compete with remaining UnitedHealth locations. Also included are protections to deter UnitedHealth from interfering with the new owners’ ability to compete.

BrightSpring Health Services and Pennant Group will acquire the 164 locations. Slater said the settlement, which includes the largest ever divestiture of outpatient healthcare, protects quality and price competition patients as well as wage competition for nurses. However, antitrust specialist Robin Crauthers, a partner with McCarter & English, says it doesn’t go far enough. According to Crauthers, the settlement agreement does not address all of the markets that would have less competition and that the DOJ accepted less than they wanted in the agreement.

Additionally, critics argue the divestiture moves 164 home health and hospice agencies from one large player to two other large players in the space. Arguably, rather than preserve competition, this divestiture agreement will only serve to strengthen the largest players in the market, giving them a substantial advantage over smaller agencies in these areas.

UnitedHealth Amedisys divestiture locations

Not the Only Concern

Vertical Integration

Joe Widmar, Director of M&A at West Monroe consulting firm, says that the number of home health and hospice agencies is not the tipping factor in competition. Rather, it is UnitedHealth’s vertical integration. A health insurance company that also owns nearly 2,700 subsidiaries, including pharmacies, home health and hospice, behavioral health, consulting for healthcare organizations, surgery centers, hospitals, mental health, managed care for Medicaid and Medicare, and specialty care. Virtually any referral from a PCP to any other health professional puts more money into the health care giant’s pockets. The lack of competition is across all forms of healthcare, leaving patients no choice buy to support UnitedHealth Group in areas where all local healthcare providers are subsidiaries. I 2024, UnitedHealth insurance paid $150.9 million to its subsidiaries for care. These provider companies are not counted in the profit caps placed on insurance companies.

Upcoding

In addition to side-stepping profit caps, vertical integration aids in upcoding. Upcoding is the practice of digging into a patient’s life to find (or create) additional patient needs. Insurers add as many codes as possible for the greatest reimbursement rates. According to a recent study, UnitedHealthcare overbilled Medicare Advantage by $14 billion through upcoding. 

In-home health risk assessments and patient reviews, often offered to beneficiaries as a free service, result in an average risk score 7% higher than in patients seen in medical practices and hospitals. UnitedHealth generates more income from patient review diagnoses than any other MA insurer. The Department of Justice is currently investigating UnitedHealth’s Medicare billing practices.

Final Thoughts

If you own a home health, hospice, or palliative care agency in any of the states shown in the graphic above, write to Jill Maguire with comments and concerns. Our primary objective is providing quality care to patients in their homes. We know that home care is less expensive for the patient and government-funded insurance. But not when all the home care agencies in an area are owned by only a few of the largest home health agencies in the country. And not when the insurer is adding diagnostic codes to pad their bill. 

# # #

Kristin Rowan, Editor
Kristin Rowan, Editor

Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news, and speaker on Artificial Intelligence and Lone Worker Safety and state and national conferences.

She also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing.  Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2025 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

 

Medicaid Enrollees Sent to ICE

by | Aug 21, 2025 | Legal, Medicaid, Regulatory

by Kristin Rowan, Editor

UPDATE

The Rowan Report originally published this article on August 7, 2025. This update is as of August 15, 2025.

After HHS began providing access to personal data on Mediciad enrollees to the Department of Homeland Security (DHS), 20 states filed to sue the department for violating privacy laws. Shortly thereafter, CMS entered into a new agreement to give DHS daily access to view the same data.

Federal Judge Vince Chhabria of California ordered HHS to stop giving DHS access to personal information. The ruling grants a preliminary injunction, stopping HHS from sharing Medicaid data with ICE in the 20 states that participated in the lawsuit. The injunction will last until 14 days after the two agencies complete and submit a reason for the decision to share information. The reasoning must comply with the Administrative Procedure Act. The injunction can also end if litigation is concluded (a formal hearing and decision).

Chhabria noted that there is no formal law preventing government agencies from sharing information, he cited agency policy as his reasoning for the injunction. ICE has a well-publicized policy against using Medicaid data for immigration enforcement. Judge Chhabria wrote in his ruling:

“Given these policies, and given that the various players in the Medicaid system have relied on them, it was incumbent upon the agencies to carry out a reasoned decisionmaking process before changing them. The record in this case strongly suggests that no such process occurred.”

August 7, 2025

Associated Press Confirms

Enrollee Information Given to ICE

In a surprise announcement on July 17, 2025, investigative reporter Kimberly Kindy and reporter Amanda Seitz filed a report. They uncovered information confirming Medicaid enrollee information given to ICE from CMS. ICE will use this to find “aliens” across the country. The health and personal information disclosed includes home addresses, birth dates, Social Security numbers, and ethnicities.

Department of Homeland Security Responds

DHS Assistant Secretary Tricia McLauglin said, “…CMS and DHS are exploring an intitiative to ensure that illegal aliens are not receiving Medicaid benefits….”

DHS Spokesperson Andrew Nixon said, “With respect to the recent data sharing between CMS and DHS, HHS acted entirely within its legal authority—and in full compliance with all applicable laws….”

Opposing Viewpoints

Senator Adam Schiff (D-CA) said, “The massive transfer of the personal data of millions of Medicaid recipients should alarm every American. This massive violation of our privacy laws must be halted immediately. It will harm families across the nation and only cause more citizens to forego lifesaving access to health care.”

Similarly, CA Governor Gavin Newsom said, “This potential data transfer brought to our attention by the AP is extremely concerning, and if true, potentially unlawful….”

HHS and DHS Sued

State Attorneys General from 20 states, led by California Attorney General Rob Bonta have filed suit. They are suing the Department of Health and Human Services (HHS), the Department of Homeland Security (DHS), HHS Secretary Robert F. Kennedy Jr., and DHS Secretary Kristi Noem.

The Associated Press found a Medicaid internal memo and emails. Subsequently, the AP reported that Medicaid officials tried to stop the data transfer due to legal and ethical concerns. The objection was unsuccessful. CMS had 54 minutes to comply with an order coming from two advisors within Secretary Kennedy Jr’s camp.

Disclosure Focuses on Violation of Laws

Current laws provide that states can create their own health plans, eligibility standards, and coverage, as long as the plan follows federal criteria. Medicaid laws also provide for emergency coverage for non-citizens. Seven states and D.C. started programs that offer full Medicaid coverage to non-citizens.

Four of the seven states, New York, Oregon, Minnesota, and Colorado, never submitted identifiable information about Medicaid recipients to CMS. The data shared with ICE came from the remaining three states; California, Illinois, & Washington State; and Washington D.C.

Map of U.S. States Compromised by CMS and DHS

The Allegation

The lawsuit was filed in the U.S. District Court for the Northern District of California. It alleges that the federal government is allowing the personal data of Medicaid recipients to be used for purposes unrelated to the Medicaid program.

Further, the coalition of states alleges that the disclosures violate several federal data privacy laws. These  include Health Insurance Portability and Accountability Act (HIPAA), Federal Information Security Modernization Act (FISMA), and the Privacy Act. 

Additionally, the Attorneys General state that the disclosures are contrary to the Social Security Act and a violation of the Spending Clause.

The lawsuit calls upon the court to bar CMS from sending additional PII to DHS and to bar DHS from using any of the information it has already received.

“In the seven decades since Congress enacted the Medicaid Act to provide medical assistance to vulnerable populations, federal law, policy, and practice has been clear: the personal healthcare data collected about beneficiaries of the program is confidential, to be shared only in certain narrow circumstances that benefit public health and the integrity of the Medicaid program itself.”

Attorneys General

Coalition of States

Final Thoughts

This lawsuit is the latest of many against the current administration. The Rowan Report will continue to update this and other stories impacting care at home as the lawsuits continue.

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Kristin Rowan, Editor
Kristin Rowan, Editor

Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news, and speaker on Artificial Intelligence and Lone Worker Safety and state and national conferences.

She also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing.  Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2025 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

 

Alliance Responds to Hospice Final Rule

by | Aug 7, 2025 | Advocacy, CMS, Hospice, Medicare, Medicare Advantage, Regulatory

by Kristin Rowan, Editor

The Alliance Responds to CMS Hospice Final Rule

CMS Issues FY 2026 Hospice Final Rule

On August 1, 2026, CMS issues the FY 2026 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Programs Requirements Final Rule. Here are the high-level changes in this year’s final rule:

  • Rate Setting Changes
    • A 3.3% inpatient hospital market basket percentage increase
    • A 0.7% productivity adjustment (read decrease)
    • Statutory cap increases from $34,465.34 to $35,361.44
  • Hospice Care Admission
    • The physician member of the interdisciplinary group (IDG) may recommend admission to hospice care
  • Face-to-Face Attestation
    • Signature and date requirements restored
    • Eliminated requirement for attestation to be a separate and distinct document
    • Attestation requirement can be a section or addendum to recert form, or part of a signed and dated clinical note
  • Hospice Quality Reporting Program
  • The HOPE tool will replace the HIS tool on October 1, 2025, despite comments to delay implementation
  • CMS published a HOPE Technical Information webpage ,an HQRP training library, and a Requirements and Best Practices webpage
  • CMS recognized the error in their HOPE burden calculations. The burden is 21.1% higher than initially reported. The difference will be “taken into consideration” in the next PRA package submission.
  • The separate reporting tool (QIES) and reports tool (CASPER) will sunset and iQIES will replace both tools.
FY 2026 Hospice Quality Reporting Program

National Alliance for Care at Home Statement

After CMS issued the final rule, the Alliance responds with a statement addressing the wage adjustment, HOPE tool implementation, and sttestation changes. Read the full press release here.

Wage Adjustment

The Alliance recognizes that the 2.6% wage update is higher than the proposed 2.4% adjustment issued earlier this year. However, The Alliance maintains its position that the update does not go far enough to offset the very high and very real operational costs that hospices across the country face.  

Regulatory Relief

Both the physician member of the IDG recommending hospice admission and the inclusion of a clinical note to serve as attestation of a face-to-face were welcome changes to hospice regulations. The Alliance thanked CMS for these changes.

HOPE Tool Implementation

The Alliance was among the many commenters to CMS about the October 1, 2025 implementation date for the HOPE tool. Alliance CEO Dr. Steve Landers had this to say:

Despite responsiveness in other areas, the Alliance is deeply disappointed that CMS did not heed recommendations and delay the October 1, 2025 implementation of the Hospice Outcomes and Patient Evaluation (HOPE) tool nor waive the timeliness completion requirement for HOPE record submission. We expect providers to face a burdensome transition and urge CMS to remain responsive to real-world challenges, offering flexibility as providers navigate the change.  

Dr. Steve Landers

CEO, National Alliance for Care at Home

The Alliance is committed to working with CMS to reduce spending and strengthen the Medicare hospice benefit. They also continue to support the CMS initiative to reduce fraud, waste, and abuse.

Final Thoughts

The Hospice Final Rule is not what we hoped for. The wage update was increase, but not by enough to make a real impact on the operational burden hospices face. CMS has provided technical training and education for the HOPE tool, but severely underestimated the financial burden connected to the transition. CMS continues to use outdated, incorrect, or faulty information in its calculations of wage rate updates and ignores the repeated comments from advocacy groups and hospice providers. 

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Kristin Rowan, Editor
Kristin Rowan, Editor

Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news, and speaker on Artificial Intelligence and Lone Worker Safety and state and national conferences.

She also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing.  Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2025 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

 

Tell CMS not to Kill Home Health

by | Aug 7, 2025 | Advocacy, CMS, Regulatory

by Kristin Rowan, Editor

The Alliance to Care at Home:

CMS needs your comments

CMS needs your comments on the home health proposed rule for FY 2026. Advocacy is a cornerstone of the mission of The National Alliance for Care at Home. From The Hill to the home, The Alliance fights for the future of the industry. But, they can’t do it alone. 

Proposed Rule

The CMS proposed rule for FY 2026 has a net 6.4% decrease in payments to home health providers. Industry experts warn that this change will cause home health agencies to shutter their doors and it will leave many rural areas in a home health desert.

The Alliance Call to Action

At last week’s 2025 Financial Summit in Chicago, policy and industry experts provided ways to adjust how to write comments to CMS. According to Mary Carr, Vice President for Regulatory Affairs at National Alliance for Care at Home, it’s not enough for a few agencies and organizations to advocate for home health. Everyone has to submit comments about this. Carr says if done effectively, sending comments on proposed rules is one of the most powerful ways to stop these policy changes. The way you write your comment letters is important if you want them to have an impact.

Carr provided this guidance and tips on how to right an effective comment to CMS:

Remember that CMS is not looking for an agree/disagree statement

Provide good reasons for not keeping the proposed rule as is

Address very specific reasons why any part of the proposed rule is bad

Include the direct impact the proposal will have on your business, your staff, and your patients

Provide an alternative recommendation

Mention studies on how much less home health costs compared with SNFs and ALFs

Don’t let fear, anger, and anxiety detract from your message

Maintain professionalism and respect

Mention and thank CMS for any good aspects of the proposed rule

Include impact statements on reduction in services, delays to getting care, and areas that would be without any available home health care should the proposed rule stand

Mention the Other Side

No matter what side of the aisle you are usually on, we all must agree that care at home is an industry issue, not a Democrat or Republican issue. Hillary Loeffler, Vice President of policy and regulatory affairs at the Alliance, reluctantly mentions that the clawbacks, reductions, and methodology used to determine rates were put in place by the previous administration. 

“It’s a new administration. I hate to say it, but I’m going to say, ‘This methodology was created by the Biden administration, and the Trump administration needs to do something about this.’ So, hopefully they take a fresh look at it.”

Hillary Loeffler

Vice President of Policy and Regulatory Affairs, National Alliance for Care at Home

Loeffler also suggests going directly to Congress with comments and letters in addition to CMS. The recent trend of lowering reimbursement rates causing fewer visits, less coverage, and longer wait times is untenable and complete reform of the home health benefit at the federal level is needed to ensure its survival, added Loeffler.

Illogical Arguments

Whether you are publishing comments on the home health proposed rule or writing a letter to your senators and representatives, steer clear of logical fallacies. These errors in reasoning are easy to fall prey to when you have an emotional investment in the issue at hand.

Ad Hominem

The very common Ad Hominem fallicy happens when the argument moves from the problem to the person. Blaming your representative or accusing CMS of hating home health rather than focusing on the impact of the pay cut will weaken our standing.

Slippery Slope

This fallicy involves stretching the consequences of an action beyond reality. Cutting home health payment rates will decrease care and increase start-of-care delays. It will not cause homelessness, mass hysteria, or a small pox outbreak. 

Fallacy of Composition

If you’re familiar with standard contracts, you’ve read the clause that goes something like, “if any part of this contract is illegal, the rest is still intact.” The composition fallacy assumes that the whole of something matches its parts. The CMS proposed rule for FY 2026 has improvements, such as allowing physicians to do face-to-face appointments even if they are not the certifying physician. Don’t throw out the entire proposed rule. Rather focus on those parts that are clearly devastating to the industry.

Fallacy of Origin

Criticizing the rule based on its authors (CMS) as adversaries to care at home also negates the impact of our advocacy. CMS has been charged with maintaining government payments for health care in hospitals, physician groups, hospices, SNFs, and more. They have also been directed to cut costs, decrease spending, and maintain budget neutrality. The proposed rule is a death sentence for home health not because it came from CMS, but because of the flawed math. Address the calculations, the methodology, the assumption that care at home is more expensive than hospital or SNF care, and the number of people who will lose access to quality care.

CMS needs your comments now

Now that you know what issues to address and how to frame your argument, reach out. Contact CMS and your Congresspeople and submit your comments today. Comments are due by August 29th.

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Kristin Rowan, Editor
Kristin Rowan, Editor

Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news, and speaker on Artificial Intelligence and Lone Worker Safety and state and national conferences.

She also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing.  Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2025 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

 

Paul Joiner: On the Record

by | Jul 24, 2025 | Admin, Artificial Intelligence, Home Health, Hospice

by Kristin Rowan, Editor

Paul Joiner

On the Record

Paul Joiner, CEO of HHAeXchange, sat down with The Rowan Report Editor Kristin Rowan to discuss the company’s new headquarters in Manhattan, the company culture he’s creating, his dedication to support those helping our most vulnerable populations.

In His Own Words

The Rowan Report: Paul, thank you for taking the time to talk to us. HHAeXchange is going through some significant growth recently. And now you’ve moved your headquarters from Long Island to Manhattan, correct? How did that decision come about?

Paul Joiner: HHAeXchange has been in Manhattan for a long time. Sandata, who we acquired earlier this year, was in Long Island. But, the move was planned with or without Sandata. We needed a nice sized space to convene people. We valued a large, multi-purpose meeting space over individual office space. It’s a space where the teams can meet when they come to town, where we can host clients, and larger company meetings.

RR: How does the new space support your team?

Paul: The majority of our team is remote. I don’t think remote work is healthy for everyone. It varies from person to person. It’s not a long-term healthy option. Returning back to the office 9-5 five days a week isn’t practical and not all that healthy either. We have created policies, a workspace, and a culture where people are invited to visit. Some come 2-3 days per week. Some only once a month. We maintain flexibility for our teams to work when and where they need to work. Being a single parent, for example, is really hard, so we stay flexible to support single parents to be where they need to be.

At the same time, we’ve seen the benefit of the connection and how much more healthy it is by physically coming together. For the younger workforce, they are enjoying getting together and coming into the office. We have to support our younger employees and their professional development. How do you professionally develop via Zoom or Teams? Physically coworking and promoting good and active environments compel people to come into the office. To build connections, you have to be together, not just on video.

RR: You have workers across the country, though. How does that work?

Paul: We have the main office here in Manhattan, a large and growing office in Minneapolis, and a smaller office in Miami. We try to keep people in areas that make it easy to meet. However, we do have some roles with certain criteria that allows for mostly remote work. Those teams come to one of the offices to meet when they can. We’ve hosted team meetings here and in Minneapolis recently.

RR: Has this new meeting space had an impact on the company culture?

Paul: Yeah, it has improved. We are having real, honest conversations about what needs to be improved. The team effort is the way we win and our teams understand that. We also understand that working hard doesn’t mean foregoing your life and the ability to recharge.

Work hard, be passionate, and motivate people with your mission and vision. The people we serve don’t have it easy, they are supporting the most vulnerable people.

RR: In a recent statement, you said that the new location will support collaboration and innovation. Do you have new features on the horizon? Are you investing in AI capabilities?

Paul: We have a lot in the works. We have a new mobile app in the beta phase that we’ll be rolling out that I’m really excited about. It’s actually an update, but it’s so massive that it’s basically new. We’re working on data analytics and data tracking for some of our largest clients.  We’ve consolidated some screens into one spot to streamline and make the user more efficient. A lot of what we’re working on is foundational. We’re focusing on supporting companies as they scale.

RR: Are you looking into AI, either within the HHAeXchange platform, or in a partner?

Paul: Yeah, of course. AI is the future and it’s everywhere. We are looking at ways to return time to users, make it easier to train users, and make things easier on caregivers. We will try to generate more buzz around AI, but not until there’s real, tangible value. AI definitely needs to be part of our strategy, but being smart where we apply it to truly get the value-add for our clients. It has to improve the quality of life for the user. Does it improve the ability of caregivers to care for people?

Paul Joiner, CEO, HHAeXchange

RR: Do you have any additional acquisition or growth plans for the second half of 2025?

Paul: There’s a lot going on in the marketplace right now. A lot of our clients are growing really well also. So, we’re sort of in a heads-down mode. There’s a handful of things we’re looking at. Right now, I’m really excited about being a bigger participant across the full continuum of care for our populations. There are some opportunities to innovate and evolve to support integrated care over the next few years. I’ll just leave it at that…for now.

RR: Paul, thank you for joining me today. It’s always a pleasure.

# # #

About HHAeXchange

Founded in 2008, HHAeXchange is the leading technology platform for homecare and self-direction program management. Developed specifically for Medicaid home and community-based services (HCBS), HHAeXchange connects state agencies, managed care organizations, providers, and caregivers through its intuitive web-based platform, enabling unparalleled communication, transparency, efficiency, and compliance. In 2024, HHAeXchange expanded through the strategic acquisitions of Sandata, Cashé Software, and Generations Homecare System, strengthening its commitment to advancing the industry.

About Paul Joiner

Paul Joiner is an accomplished executive with extensive leadership experience in the healthcare sector. Currently serving as a Board Member at AssistRx, Joiner has held prominent positions, including Chief Executive Officer at both HHAeXchange and Kipu Health. Previous roles include Chief Operating Officer as well as Executive Vice President and General Manager at Availity, and Senior Vice President and General Manager of Health Plan. Joiner also served as Vice President of Client Engagement and Business Development at Midas+ Solutions, Xerox Healthcare Provider Solutions. Educational qualifications include a Master of Accountancy from Belmont University and a Bachelor of Accountancy from the University of Mississippi.

Kristin Rowan, Editor
Kristin Rowan, Editor

Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news, and speaker on Artificial Intelligence and Lone Worker Safety and state and national conferences.

She also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing.  Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2025 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

 

Non-Compliance Notifications & HOPE Training

by | Jul 24, 2025 | CMS, Hospice

by Kristin Rowan, Editor

Hospice Non-Compliance Notifications

On July 21, 2025, the CMS Hospice QRP Announcements page added an update titled “Hospice Quality Reporting Program: Non-Compliance Notifications.”

The Update Reads:

The Centers for Medicare & Medicaid Services (CMS) is providing notifications to hospices that were determined to be out of compliance with Hospice Quality Reporting Program (HQRP) requirements for calendar year (CY) 2024…. This will affect their fiscal year (FY) 2026 Annual Payment Update (APU). The Medicare Administrative Contractors (MACs) will distribute Non-compliance notifications and place them into hospices’ Certification and Survey Enhanced Reporting (CASPER) folders in QIES on July 21, 2025. Hospices that receive a letter of non-compliance may submit a request for reconsideration to CMS via email no later than 11:59 pm, August 26, 2025. If you receive a notice of non-compliance and would like to request a reconsideration, see the instructions in your notification and on the Reconsideration Requests webpage.

Details

Any reconsiderations containing protected health information (PHI) will not be processed. All PHI must be removed for a reconsideration to be reviewed.

Additionally, all submissions must be less than 20 MB overall (email message and attachments). Submissions that are greater than 20 MB in size cannot be processed.

HOPE Training

As the implementation date for the HOPE tool drew nearer, advocacy groups and hospice agencies expressed concern over it’s readiness. On June 6, 2025, The Rowan Report shared that three of the largest organizations urged CMS to delay the tool. The groups asked for proper information, education, and training. 

CMS Response

As of now, CMS is not delaying the implementation of the HOPE tool. They have, however, published training tools for hospice providers. The first series of videos is Didactic Training. They cover an introduction to the tool, admin information, preferences and active diagnoses, health conditions, skin conditions, and medications.

On July 21, 2025, CMS announced the opening of registration for live HOPE training. “Hospice Outcomes and Patient Evaluation (HOPE) National Implementation Virtual Training Program Course 2: Coding Workshop.” CMS recommends completing The Didactic Training as a prerequisite to the Coding Workshop.

The Centers for Medicare & Medicaid Services (CMS) is offering a live coding workshop on August 5, 2025…. It will provide coding practice for items that are new for HOPE, as well as the existing and updated items carried over from the Hospice Item Set (HIS).

Register now at:The Hospice Outcomes and Patient Evaluation (HOPE) National Implementation Coding Workshop

Find the Didactic Recorded Training Series here.

Data Collection Starts Soon

The HOPE tool begins data collection on October 1, 2025. Key items hospice providers should understand:

  • More Frequent Assessments: HOPE introduces up to four assessment points per patient, capturing care from multiple angles during the first 30 days and at discharge.
  • Real-Time Data Capture: Unlike the retrospective nature of HIS, HOPE assessments are completed during live patient encounters, providing richer and more immediate insights.
  • Higher Stakes for Compliance: To avoid a reimbursement cut of up to 4%, agencies must ensure that at least 90% of HOPE assessments are submitted on time—a notable increase from the previous 2% penalty under HIS.
  • Public Reporting Timeline: While HIS data has been publicly available, HOPE data will not be released for public comparison until fiscal year 2028 or later, giving providers time to adapt.

*from the SimiTree blog: Understanding the Transition from HIS to HOPE

As the implementation of the HOPE tool gets closer, we will continue to share training information from CMS and other sources as it becomes available. If you need a referral to a hospice consultant to navigate the transition, please reach out to The Rowan Report.

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Kristin Rowan, Editor
Kristin Rowan, Editor

Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news, and speaker on Artificial Intelligence and Lone Worker Safety and state and national conferences.

She also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing.  Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2025 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

 

OBBB Care at Home Adjustments

by | Jul 18, 2025 | Advocacy, CMS, Medicaid, Medicare, Regulatory

by Kristin Rowan, Editor

Care at Home Through Medicare and Medicaid

Adjustments from OBBB

Despite the passing and subsequent signing of the reconciliation bill, numerous lawsuits have paused its implementation in some areas. We will continue to report on those court decisions as they arise. In the meantime, the care at home industry can look at the few adjustments that will positively impact the industry.

Medicaid Waivers

Prior to this, the HHS Secretary could only approve Medicaid waivers to cover home and community-based services for beneficiaries who already met institutional level-of-care criteria. This bill provides additional flexibility to define waiver eligibility without the institutional level-of-care criteria.

For FY 2026, CMS has an additional $50 million to oversee the new waivers. There is an additional $100 million earmarked for FY 2027 to deliver HCBS under new and existing waivers. Although the expanded waivers and additional budget will not satisfy the more 700,000 on waiting lists for HCBS, it is a start.

Rural Health Transformation Program

For five years, beginning in 2026, states can apply for a portion of a $10 billion annual fund for rural health providers. To qualify, providers must submit a rural health care plan that includes technology adoption, local partnerships, using data-driven methods, and setting strategies for financial stability. This could provide an opportunity for care at home agencies to partner with rural hospitals to help provide care in rural settings.

Health Savings Accounts

Health Savings Accounts (HSAs) allow insurance beneficiaries to save money to pay for deductibles, copays, and other services not covered by insurance (such as non-medical supportive care and home health). Currently, people can only use HSAs if they have a high deductible health plan (HDHP). The bill allows for a plan to be considered an HDHP even if it covers telehealth and remote health services prior to meeting the deductible. Insurance companies can design new HDHPs that can be used with HSAs.

Telehealth Reconciliation Bill<br />

Another change to HSAs involves the type of plan that qualifies. Currently, bronze and catastrophic plans cannot be considered HDHPs because their out-of-pocket limits exceed IRS limits for HDHPs. The bill allows bronze and catastrophic plans to qualify as HDHPs and have access to HSAs.

Additionally, current regulations prohibit anyone with a Direct Primary Care (DPC) arrangement from contributing to our using HSAs. DPC is an arrangement with a flat monthly fee for services rather than using insurance for routine care. The bill removes the limitations, allowing people with DPC arrangements to contriute to HSAs and use them for DPC arrangements.

Adding telehealth/remote plans, bronze plans, and catastrophic plans to HSA eligibility could provide opportunities for care at home agencies to connect with beneficiaries of these plans who did not have expendable funds for non-covered services before, but can now use HSAs. Allowing patients with DPCs to use HSAs could provide yet another path to increasing patients by partnering with DPC offices.

Final Thoughts

As a whole, we are anticipating great disruption to Medicare and Medicaid stemming from the budget reconciliation bill. While we await the final word on legality from the U.S. Supreme Court on many of the provisions, we can look to the ones that may help brace the industry in the meantime.

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Kristin Rowan, Editor
Kristin Rowan, Editor

Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news, and speaker on Artificial Intelligence and Lone Worker Safety and state and national conferences.

She also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing.  Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2025 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

 

Injunctions Overturned

by | Jul 10, 2025 | CMS, Legal, Regulatory

by Kristin Rowan, Editor

District Court Injunctions Overturned

Agencies to resume layoffs.

The now infamous “Memo” from the Office of Management and Budget and the Office of Personnel Management instructed agency leaders to cut their workforce as part of the President’s DOGE Workforce Optimization Initiative. The memo from late February started with divisions and employees whose work was not mandated by law and is not considered essential during government shutdowns.

District Court Block on Workforce Downsizing

In May, District Court Judge Susan Illston ruled that the administration lacked congressional approval to make sweeping cuts, and blocked the federal workforce reductions. The order came after lawsuits from labor unions and nonprofit groups argued that the cuts would have drastic negative effects on the American people. They also posed the argument that reorganizing government functions and laying off workers en masse without congressional approval is not allowed by the Constitution. A panel of the U.S. 9th Circuit Court of Appeals voted against overturning Illston’s order. 

Supreme Court Overrules

On July 8th, the Supreme Court ruled to allow federal agencies to resume the layoff directive. The 8-1 decision lifts one block on reduction in workforce, but there are smaller injunctions across different courts that have not made it to the Supreme Court yet. The decision overturns the injunction for 17 of the 19 agencies included in the initial memo. The Department of Veterans Affairs is among those cleared to resume layoffs. The departments of Defense, Education, Homeland Security and Justice were not included in the directive.

Restructuring Not Included

The Court was careful to convey there has been no decision on whether the reorganization plan for any specific agency is legal. Each agency’s restructuring plan may eventually reach the Supreme Court.

The order also only clears the way for the reduction in workforce. It is also not a blanket green light. The administration has to provide details on how it selects the staff being laid off. In some cases, they must notify Congress and the labor unions. 

Dissent, and Agreement

The Supreme Court decision was 8-1 in favor of overturning the injunction. Only Justice Ketanji Brown Jackson dissented.

“In my view, this decision is not only truly unfortunate but also hubristic and senseless. [The] statutory shortfalls likely to result from implementation of this executive order will be immensely painful to the general public, and the plaintiffs, in the interim, causing harm that includes ‘proliferat[ing] foodborne disease,’ perpetuating ‘hazardous environmental conditions,’ ‘eviscerat[ing] disaster loan services for local businesses,’ and ‘drastically reduc[ing] the provision of healthcare and other services to our nation’s veterans.’”

Kentanji Brown Jackson

Justice, United States Supreme Court

Justice Sotomayor, who voted to overturn the injunction, wrote a one-paragraph solo opinion saying she agrees with Jackson that the administration cannot “restructure federal agencies in a manner inconsistent with congressional mandates.”

“The plans themselves are not before this Court, at this stage, and we thus have no occasion to consider whether they can and will be carried out consistent with the constraints of law,” Sotomayor warned.

Blocks Still Standing

The Supreme Court ruling overturned the injunction put in place on May 22nd by the U.S. District Court for the Northern District of California. This is the only injunction impacted by the ruling. Other injunctions remain in place.

On July 1, U.S. District Judge Melissa DuBose granted an injunction to stop the downsizing and restructuring of HHS. This injunction was not explicitly mentioned in the latest ruling, but could still be impacted.

U.S. District Judge Matthew Maddox ordered the reinstatments of AmeriCorps employees who were laid off or put on leave and blocked any additional reductions that affect union employees. 

U.S. District Judge Myong Joun indefinitely blocked the reduction of workforce of school districts in Boston. An emergency bid with the Supreme Court to lift the block could be heard and decided at any time.

A federal appeals court blocked a 90 percent reduction of the staff at the Consumer Financial Protection Bureau; federal judges reversed similar reductions at DEI foundations, and all actions under Pete Marocco are voided.

Final Thoughts

Numerous cases remain undecided in lower courts and the Supreme Court. Whether any layoffs will be finalized and whether departmental restructing is legal remain to be seen. For now, expect a reduction in personnel at the VA, but not yet at HHS or CMS. We will continue to report on updates as they occur.

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Kristin Rowan, Editor
Kristin Rowan, Editor

Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news, and speaker on Artificial Intelligence and Lone Worker Safety and state and national conferences.

She also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing.  Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2025 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