Subsidies Undecided

by Kristin Rowan | Dec 12, 2025 | Medicaid, Medicare, Regulatory

by Kristin Rowan, Editor

Subsidies Undecided

Senate cannot agree

The record-breaking government shutdown centered around one issue: extending the COVID-era Affordable Care Act supplemental subsidies. The subsidies were an additional discount for Americans within a certain income bracket. They helped make healthcare insurance through the ACA marketplace more affordable during and after COVID. The subsidies have been extended multiple times and expire at the end of the year. Senate Republicans are not willing to extend them again. Senate Democrats won’t vote in favor of any health care proposal that doesn’t include them.

Time is Running Out

Not only do the subsidies expire at the end of the year, but anyone enrolling in a marketplace plan has to apply by December 15th, leaving precious few days to find a way forward. Senate Democrats proposed a straight three-year extension of the subsidies, which failed. Senate Republicans proposed using the subsidy money to contribute to HSAs for bronze or “catastrophic” plans. That proposal also failed.

A hybrid compromise is in the works. Details have not been released but it will likely include income caps and eligibility restrictions on the subsidies as well as some HSA flexibility. Without an extension on the subsidies, premiums are expected to increase an average of 26% in 2026, although some analyses suggest premiums could go up by 73-90%.

Another Shutdown?

The 43-day shutdown that ended in November did not finalize the 2026 budget. It merely passed enough appropriations to temporarily fund some departments through January 30, 2026 and a few essential departments for longer. If the Senate and House cannot agree on the subsidy issue, we face another shutdown in February. Every shutdown impacts Medicare & Medicaid payments, approvals, and renewals.

Experts indicate nearly 50% of people buying marketplace plans are ages 50-64. Most, if not all of them, are looking at lower cost (and lower benefit) plans or dropping insurance altogether in 2026. If insurance costs remain high, this group of

people will enter Medicare with poorer health, which will cost the Medicare program and tax payers more in the long run. It will cause a vicious circle of higher Medicare costs, leading to higher taxes, lower subsidies, higher premiums, fewer people being covered, and finally higher Medicare costs again.

This is an ongoing story and The Rowan Report will continue to bring you the latest news on the subsidies and the impending expiration of the temporary government funding as we head into 2026.

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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

CMS Proposed Changes

by Kristin Rowan | Dec 12, 2025 | Advocacy, CMS, Medicaid, Medicare, Medicare Advantage, Regulatory

by Kristin Rowan, Editor

CMS is Making Changes

Good or Bad?

CMS is making changes across Medicare and Medicare Advantage. From Star Ratings to Prescription Drug Prices to the Hospice benefit, CMS is embracing Make America Healthy Again. Will these initiatives benefit Medicare and Medicare Advantage recipients or the insurance companies who provide the plans?

Drug Payment Model

In early November, CMS announced a plan to lower prescription drug costs for Medicaid recipients. State Medicaid programs can opt in to the GENErating cost Reductions fOr U.S. Medicaid Model (GENEROUS). The pilot program is using the most-favored-nation pricing that was recently negotiated and announced by President Trump. Most-favored-nation pricing requires prescription drug manufacturers to charge the same low rate paid in other countries.

Limited Pilot

Beginning in 2026, CMS will negotiate with manufacturers of select drugs for lower pricing. Participating states will start using uniform, transparent coverage criteria. This is not criteria for inital coverage in Medicaid, but for standardizing access to high-cost medications.

Manufacturers are not required to participate in the GENEROUS Model, but can voluntarily apply. Participating manufacturers agree NOT to seek additional supplemental rebates or discounts outside the model price.

New Medicare Advantage Policies

CMS has proposed updates to the Medicare Advantage and Medicare Part D programs. The new plan would begin in CY 2027 and includes major changes to the Star Ratings system. CMS is also seeking feedback on new ways to modernize MA.

Star Rating Changes

The proposed changes are supposed to incentivize plans to improve care. CMS suggests removing 12 unique measures that look at administrative processes and those that don’t highlight differences between plans. Star Rating measurements of care, outcomes, and patient experience will remain.

Request for Feedback

CMS is seeking feedback on Medicare Advantage changes, including improving competition, refining risk adjustment, and aligning quality incentives to deliver greater value. CMS is open to either a limited model test or program-wide changes. Interested parties can submit feedback through January 26, 2026. Read the Proposed Rule here. Submit your comments.

Expanding Technology-Enabled Care

CMS may finally be recognizing what we’ve been promoting for 25 years: Care improves with technology support.

CMS Proposed Changes<br />
Technology-based Care

The ACCESS model tests a new payment approach in original Medicare to expand access to technology-supported care options. CMS aims to increase technology-supported care options to improve health and prevent and manage chronic diseases. More than two-thirds of Medicare beneficiaries are dealing with high blood pressure, diabetes, chronic musculoskeletal pain, and depression.

An interest form is now available for the 10-year Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model test. The model test begins July 1, 2026. The application to participate must be received by April 1, 2026.

Impact

As these programs roll out between now and 2029, the impact on insurance plans, payors, beneficiaries, and taxpayers will unfold. Will lower cost prescriptions and technology-based care lower insurance rates? Payor reform may be necessary to change out-of-pocket costs. Regulations may have to further incentivize payors to increase care when costs go down, particularly with value-based care models.

Please take a few minutes to read the details on each of these proposals, add your comments, and sign up to participate. The industry needs reform and our aging family members deserve better.

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MedPAC Proposes Drastic Cut

by Kristin Rowan | Dec 12, 2025 | Clinical

by Kristin Rowan, Editor

MedPAC Proposes Drastic Cuts

Five Year Decrease Not Enough

The onset of PDGM and the recalculations of payments in 2020 have led to an overall decrease in Medicare reimbursement rates for home health by approximately 12%. CMS continues to calculate budget neutrality with flawed formulas. The Alliance, along with several other advocacy groups as well as agencies and individuals, continues to fight against the formula and the pay cuts, estimating that nearly half of all home health agencies will be losing money in order to stay open.

Industry Report

Despite the continual decrease in payment rates, MedPAC recommends additional steep cuts. Highlights from the MedPAC report include:

97% of beneficiaries have access to 2 or more HHAs
The total number of HHAs declined 1% in 2024 (excluding CA)
Only 7.9% of beneficiaries used HH in 2024
Number of 30-day periods per beneficiary increased 2.6%
The overall profit margin for Traditional Medicare is 21.2%
The overall profit margin for all payers is 5%
Anticipated profit margin for 2026 is 19% for Traditional Medicare (3% overall)

Less than 0

The Traditional Medicare profit margin in 2026 is projected at 19%. This is offset by the negative profit margin from Medicare Advantage and private insurance plans. It may not be realistic or fair for the taxpayer to offset poor policies in Medicare Advantage and private insurance plans, but that has been the reality for years. Medicare Advantage plans yield high profits for insurance payors, and negative margins for HHAs. With an overall profit margin of 3%, lowering the Medicare reimbursement rate by more than 3% will put all HHAs in the red.

The Math Isn't Mathing

The numbers are there. HHAs earn 5% now, 3% next year. MedPAC recommends that CMS reduce the 2026 rate by an additional 7%.

NET PROFIT MARGIN -4%

Conclusion from MedPAC: This will not impact care; providers will still be willing to treat Traditional Medicare beneficiaries.

That statement may be true. However, in order for HHAs to survive, they will have to drop all MA plans. More than 50% of Medicare beneficiaries are on MA plans. 40% of MA patients use HH care after hospitalization. Medicare Advantage will survive through hospitals and physicians, but the Home Health benefit won’t have any providers.

Hospice Tie-In

CMS is currently weighing the option of the hospice carve-in to Medicare Advantage plans. The pilot plan failed miserably and yet rolling this out across all plans is an option, somehow. CMS and MedPAC must not be able to see what has happened to Home Health under MA plans. Hospice will suffer the same fate through the carve-in. It is irresponsible and destructive to add Hospice to MA. For that matter, it is irresponsible and destructive NOT to remove Home Health from MA. Move it all back to Traditional Medicare where at least the profit margin is above 0.

May Cooler Heads Prevail

From the proposed rule in July to the final rule in November, CMS lessened the permanent rate cut by about 5%, finally hearing the concerns of advocates who told them HHAs would go out of business. We certainly hope CMS will keep that in mind when considering the MedPAC recommendation.

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Appeals Court Filing

by Kristin Rowan | Dec 4, 2025 | Advocacy, Clinical, CMS, Hospice, Legal

by Kristin Rowan, Editor

Appeals Court Filing

Hospice ALJ

A hospice claim may fall under review either before or after the claim has been paid. A hospice agency with a denied claim must file appeals until the claim is approved or the appeals are exhausted. First, they file a written request to reconsider. Then, they file an appeal to a Qualified Independent Contractor (QIC) who employs medical professionals to assess the case. Next, they file an appeal to an Administrative Law Judge (ALJ).

The ALJ is meant to review the documentation to determine whether it satisfies Medicare requirements. That’s all. There are two sets of criteria: the Medicare requirements and the patient record. If they match, the claim is paid. However, a recent ALJ decision and subsequent challenge suggests that the ALJ ignored expert testimony and decided independently that the patient did not qualify for hospice care.

Request to File

The hospice agency in this case filed suit against the ALJ, arguing that physician expertise should be shown deference in these cases. The National Alliance for Care at Home (the Alliance), joined by the American Academy of Hospice and Palliative Medicine (AAHPM), represented by William A. Dombi of Arnall Golden Gregory (AGG), has requested the right to file an amicus brief. An amicus brief provides extra information in a court case from an individual or group that is not part of the lawsuit, but has a vested interest in the outcome.

The Dispute

The Alliance puts at the heart of the case several issues, including:

Predicting death is inherently difficult
Physicians are the experts and their opinion should carry more weight
Oversight from non-qualified third parties add confusion, increase costs, and limit care

The Argument

The wording in multiple parts of the hospice benefit recognizes the expertise and importance of the physician. It is the physician who determines terminal illness. Physicians must have a face-to-face for continued eligibility. And it is the physician’s clinical judgment makes these determinations based on a patient’s individual circumstances, not an arbitrary set of standards.

If an ALJ, or any non-medical person, can overrule the treating physician’s assessment of a patient, they are effectively usurping the role of the doctor in providing a treatment plan. Medical care is subjective, which is why CMS has repeatedly considered and rejected defined criteria that would overrule a physician.

Broader Implications

The brief argues that medical professionals are better able to make care determinations. Further, the brief includes the complexity of health care prognosis, particularly in terminal illnesses. Previous court decisions have noted that “clinical judgments must be tethered to a patient’s valid medical records….” which already eliminates the need for this oversight. The Alliance stated a high probability that the decision in this case will carry substantial weight and influence both in the Sixth Circuit and in courts nationwide.

In fact, the implications may be farther reaching than that. Payors in and out of hospice deny claims deemed “unnecessary” regularly. Claims denials range from about 19% in the ACA Marketplace to as much as 49% from private payers. Even though about 80% of appeals are later accepted, only about 1% of denied claims are appealed.

Not only could this case help more patients get the hospice care they need, it could also lay the groundwork to require insurance companies to rely more heavily on the treating physician’s recommendation. We could see lower denials from prior authorization requests, unconventional treatment plans, VA benefits, and more.

Final Thoughts

The Rowan Report supports the Alliance’s efforts in this case and wholeheartedly agrees that a physician knows better the care his patient needs than a judge ever could. We are hopeful that Bill Dombi and his team at AGG will be successful in this case and that hospice providers can get back to the business of patient care. Read the statement from the Alliance here.

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BREAKING NEWS: Home Health Final Rule

by Kristin Rowan | Nov 29, 2025 | Breaking News, CMS, Home Health, Medicare, Medicare Advantage, Regulatory

by Kristin Rowan, Editor

BREAKING NEWS

Home Health Final Rule

While most of us were still recovering from our Thanksgiving feast overload, CMS quietly released the CY 2026 Home Health Prospective Payment System Final Rule (HH Final Rule). In past years, CMS published the HH Final Rule on or about November 1. The HH Final Rule was delayed this year due to the government shutdown.

Payment & Policy Updates

The payment rate for 2026 will change based on multiple factors:

HH payment update of +2.4%
The final permanent rate adjustment of -0.9%
The final temporary adjustment of -2.7%
Fixed-dollar loss ratio for outlier payments update of -0.1%

The aggregated payment update for 2026 is a net decrease of 1.3%

Read the CMS Fact Sheet

Face-to-Face

The CARES Act allows Nurse Practitioners, Certified Nurse Specialists, and Physicians Assistants to order and certify eligibility for Medicare HH and establish a plan of care. CMS has updated face-to-face encounters to now allow NPs, CNSs, PAs and physicians to perform face-to-face encounters whether or not they were the certifying practitioner or one who cared for the patient prior to home health care.

Home Health VBPM

Effective in April 2026, the HHCAHPS survey will undergo changes. CMS is removing these three survey-based measures:

Care of Patients
Communications between Providers and Patients
Specific Care Issues

CMS is adding four measures to them measure set. These include three measures related to bathing and dressing and the Medicare Spending per Beneficiary setting measure. These changes also prompted alterations to the weights of each measure and measure category.

The expanded model has built-in criteria for the removal of any quality measure. CMS is adding an additional criteria to the list of factors. Factor 9 reads that CMS may remove a quality measure if it is not feasible to implement the measure specificiations.

Medicare Provider Enrollment Revocation

Currently, any provider must enroll and be approved to become a Medicare provider. CMS has the authority to both approve and revoke provider Medicare enrollment. When CMS revokes a provider’s Medicare enrollment, the revocation is effective 30 days after CMS mails notification to the provider. In certain circumstances, CMS can revoke enrollment retroactively to the first date of non-compliance and consequently collect any money paid to that provider back to the retroactive date. CMS is adding to the allowable grounds for retroactive revocation.

If an enrolled physician or practitioner has not ordered or certified services for 12 consective months
If a beneficiary attests that a provider did not actually perform the services they billed

Additional Changes

CMS is recalibrating case-mix weights under PDGM and LUPA thresholds.

DMEPOS accreditation regulations will now require suppliers to be resurveyed and reaccredited annually. Additionally, CMS is increasing the amount and frequency of data accrediting organizations (AOs) submit, expanding their ability to monitor AOs, and strengthening their ability to address poorly performing AOs.

The DMEPOS Competitive Bidding Program will change, but we are still waiting for the finalized improvements. CMS will begin paying for all continuous glucose monitors and insulin infusion pumps.

Read the Final Rule and additional Documents

Final Thoughts

A decrease in pay of any amount is unfortunate. However, we applaud CMS for listening to the feedback. CMS stated, “…commenters raised concers that behavior change after CY 2022 might [attribute] to factors unrelated to…PDGM.” Changes since 2020 include the introduction of OASIS-E, the expansion of value-based purchasing, and the large increase in the percentage of Medicare Advantage enrollees.

Whatever the reason, The Rowan Report joins the National Alliance for Care at Home in commending CMS for adjusting its payment calculations. The permanent pay adjustment for 2026 is listed as the final adjustment, a positive for HH moving forward. The proposed rule issued mid-year had a net -6.4% decrease in payments for a net decrease of more than $1 billion dollars. The final rule payment adjustment has a net decrease of $220 million. Still a decrease, but much more palatable.

CMS will continue to assess the need for temporary payment adjustments for several more years. Additional adjustments (read decreases) to the payment rate will impact patient access to care. The Alliance will continue to advocate and educate members of Congress and HHS to lower or eliminate they reductions. Your advocacy and support is needed to ensure the future of Care at Home. The Rowan Report will continue to support the Alliance and other advocacy groups and share with you opportunities for advovacy.

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Medicare Advantage Reform

by Kristin Rowan | Nov 25, 2025 | CMS, Editorial, Medicare, Medicare Advantage, Regulatory

by Kristin Rowan, Editor

Medicare Advantage Reform

Background

Traditional Medicare is available to any U.S. citizen over the age of 65 or with a qualifying disability. Part A covers hospital care, skilled nursing facility care, hospice care, and some medically necessary home health care while Part B covers doctor visits and outpatient care. Medicare is billed through and paid by the federal government.

Medicare Advantage (originally Medicare+Choice) is Medicare coverage offered by private insurance companies who are then reimbursed by the government. The goal was to create competition and lower costs. It has done neither. Medicare Advantage plans are supposed to provide all of the coverage from Parts A, B, & D except hospice care. That is still handled by traditional Medicare.

Hospice Carve-in Plan

Despite the epic failure of the recent hospice carve-in experiment, House representative Schweikert (R-AZ) introduced H.R. 3467 to reform the Medicare Advantage program and included a requirement for hospice care. The goal, according to Schweikert, is to eliminate waste and fraud and stop MA insurance companies from making billions in profits by upcoding. The solutions, outlined in H.R.3467, include requiring MA recipients to stay on the same plan for at least three years and permanently including the hospice benefit in MA plans.

Eight New Bills

On November 19, 2025, Representative Mark Pocan (D-WI), with the support of 12 other members of the House, introduced eight separate bills aimed at Medicare Advantage reform and strengthening traditional Medicare. The eight bills include:

1. Disincentives for delaying and denying lifesaving care due to prior authorization requirements
2. Automatic appeals for any denial of care
3. Visually and audibly disclosing delay and denial rates in advertising
4. Banning participation in MA for any company convicted of defrauding the government
5. Lowering MA reimbursement rates to at or below traditional Medicare rates
6. Limiting the number of MA plans a company can offer to 3 per year
7. Prohibiting MA from being the default option
8. Creating a website listing all doctors by plan

Commentary

In addition to the package cosponsors and six endorsing organizations, Rep Pocan received industry expert support for his bill package.

“Big Insurance has long pitched Medicare Advantage as a key tool to lowering health care costs and delivering better care, but like so much of their rhetoric, this is nothing but bold-faced lies. The truth is, Medicare Advantage is neither Medicare nor an advantage. And it certainly doesn’t exist to lower costs. It exists to help Big Insurance make sky-high profits and enrich shareholders. It is long past time Congress stepped in and protected patients. The legislative package Congressman Pocan is introducing is the most comprehensive plan ever introduced to rein in Medicare Advantage and protect patients. Congress should pass these bills without delay.”

– Wendell Potter, President, The Center for Health and Democracy

“Medicare Advantage insurers profit from withholding medically necessary care, and can withhold care with near impunity. So, people enrolling in corporate MA plans are forced to gamble with their health and with their lives. They can’t avoid the bad actors. It’s time Congress protected older Americans and people with disabilities from bad actor Medicare Advantage insurers, as Congressman Pocan’s MA Bill package would do.”

– Diane Archer, President and Founder, Just Care

Rep. Pocan’s bills do not include the hospice carve-in and would leave hospice care under traditional Medicare.

Faulty Logic?

Medicare Advantage plan payors have been accused of upcoding, fraud, overbilling, delays in care, and denials that circumvent the rule that MA must cover everything traditional Medicare does. It may be naive to assume that passing these bills will force unscrupulous companies to suddenly have integrity.

MA enrollees pay the standard Part B premium and might pay an additional MA premium depending on their income, geographic locations, and/or additional plan benefits. Rep. Pocan’s bill lowers what MA charges the government (aka tax payers) but does not address what the plans charge enrollees. If MA plans are required to lower reimbursement rates by 10%, for example, won’t they just increase premiums, deductibles, and copays or remove additional benefits? Sure, the government spends less, but out-of-pocket costs increase and quality of care drops.

The “Seniors Choice” bill limiting the number of plans to three is unclear in its direction. A 2019 rule removed the meaningful difference requirement for MA plans. This bill seeks to reinstate that requirement, but changes the term to “significantly different” in premiums, benefits, and cost-sharing. There are too many variables in health insurance to limit the choices to three. Three choices per company lessens the competitive need to keep prices low.

Not so Hidden Agenda

Medicare Advantage reform is sorely needed. MA is largely fraudulent, misleading, and costly both in spending and health. Chipping away at some of these pieces is for the good of the enrollees on their surfaces. But dig just a little deeper and the goal is clear.

Overwhelmingly, the organizations in support of this bill package are proponents of a single payer system. The prior authorizations disincentive is termination of the entire contract for the year. The disallowing participation bill includes all companies and individuals convicted of any crime, misdemeanor or greater, in any way connected to healthcare, all financial misconduct in or out of healthcare, and all acts of fraud, kickbacks, and misrepresentation of material fact. Any plan charging more than its traditional Medicare counterpart will be eliminated. Given these restrictions, it will not take long for every Medicare Advantage plan to be eliminated entirely.

The recent government shutdown centered around the ACA subsidies that are set to expire at the end of the year. The elimination of those subsidies could push healthcare insurance premiums to a level that few can afford, furthering the need for a single payer plan.

Final Thoughts

The White House has promised a health care proposal with much speculation but no facts. The proposal has yet to be released. Congress is still negotiating the extension of Covid-era subsidy increases with only a few weeks remaining before they adjourn for the holidays. ACA participants are having to renew their health insurance without knowing what the final cost will be and many believe the number of participants will drop significantly, leaving millions uninsured.

None of the proposed solutions will fix all the problems with healthcare. But, a temporary stay is better than losing access to healthcare altogether. This is an ongoing issue and The Rowan Report will continue to bring you the latest information as it becomes available.

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Dr. Steve Landers: an Interview

by Kristin Rowan | Nov 13, 2025 | Advocacy, CMS, Home Health, Hospice, Medicare, Regulatory

by Kristin Rowan, Editor

Dr. Steve Landers

An Interview from the Alliance Annual Meeting

On the heels of the inaugural National Alliance for Care at Home Annual Meeting & Expo, I sat down with Alliance CEO Dr. Steve Landers to talk about his feelings on the event, the current state of the industry, and the future of the Alliance.

In His Own Words

The Rowan Report:

We’re just about at the end of the first annual meeting since the merger of NHPCO and NAHC. What are your thoughts on how the event was received?

Dr. Steve Landers:

Yeah, it’s been great. You know, we have, we’ve had great attendance, and the energy has been good, and we’ve got diverse participation from people all throughout the care at home community from all over the country, and I think people learned a lot and got to spend time with friends and colleagues and do business. I’m feeling good about it.

RR: I assume you’ve learned alot and we’ll see some changes next year. Where will we be in 2026?

Steve: We’ll be in Washington, D.C. next fall. Also, our summer financial summit is still on the agenda. So, we’ll be in Boston and we’re hoping to see as many people out as possible.

Alliance Annual Meeting Review Steve Landers

Alliance Outlook 2026

RR: And your new board members, who start in January, were announced earlier. Sounds like you have some great people incoming next year. What is the focus for the organization in 2026?

Steve:

We are continuing to position ourselves as strong advocates in Washington for the issues that our members are facing. The whole board and team will be very much dug in and committed to putting the best possible effort forward on the big things that our members are facing from an advocacy standpoint. Of course, we want to continue to strengthen the member programming and the educational offerings. We are going to try to build on our partnership with the research institute for home care to try and add more research activities to the to the programming.

There are some things that we’re still not sure about how next year is going to look, because on the public policy front, we still have some kind of pending issues that we’re hoping get ironed out in a positive way. Depending on how the year wraps up, we could be very much still in a bit of a firefight, whether that’s the Medicare Home Health payment system, face to face certification access for hospice and home health services, or depending on if any type of Medicare Advantage legislation comes up. So there’s still a lot unknown about how the early year looks from an advocacy standpoint, but definitely, you know, with the existing board members and new board members and our team will be leading the way on those fronts.

Medicare Home Health Proposal

RR:

There are a lot of unknowns right now with the shutdown, the hospice carve out, and other issues we’re not really seeing any movement on. Is there any one unknown that is more challenging than others?

Steve: I think the most front and center issue is the Medicare Home Health payment proposal, because it was a terrible, misguided proposal that’s going to hurt lots of people, probably cost lives, cost the system more money, and so that’s definitely so visible and acute because it’s right with us.

If we see any more movement on this issue of hospice and Medicare Advantage that will certainly become more of an acute issue. We’re already taking it very seriously and are very actively and aggressively trying to push back that bad idea.

And, of course, the longer this government shutdown, the more harm there is with things like access to telehealth, so that’s high on our mind. There are a lot of other issues we’re concerned about with the future of Medicaid HCBS and the business environment for private duty home care as well. So, the list is long.

Advocacy

RR: Very long, indeed. During the opening keynote you mentioned a call for advocacy from everyone in attendance. Specifically, you mentioned presenting “one voice.” Are there current issues that has the industry divided?

Steve: I think we’re doing a good job of keeping people together. I think there’s always a risk when people get passionate and are wanting to solve problems. If we accidentally are publicly going in different directions, that’s not productive. I wouldn’t highlit any specifics, but I think, in general, the more we can come togehter on various issues because our goals are the same. None of us want to see care at home get cut back and over regulated. Everyone involved in these issues care about the same things. But, in Washington, when attention spans are very short, you only have so much political capital so we make sure we’re pushing for the same things in those advocacy efforts.

RR: Have you gotten any indication of where CMS is landing on the final payment rule? Last I heard, they had thousands of comments and feedback on the major cut.

Final Rule

Steve: They have received an incredible amount of comments. here have been meetings at all levels of the administration on these issues. We have outlined all of the aspects of this, from the access challenges to how cutting back home health is only going to lead to lead to higher overall expenses. We’ve given them a clear outline of the methodological flaws that they made in doing their calculations and their budget neutrality calculations. We’ve been very clear as well on where they have likely baked in data from pockets of fraud that are creating disadvantages for legitimate care providers in the way that the rate system comes out, So they have everything that they should need to reset these payments to where they should be based on the law. But, it’s a scary moment because they made this proposal in the first place, and at some point, somebody thought it was a good idea.

Keep Fighting

RR: What is the next step if the cuts happen?

Steve: If we don’t get what we’re hoping for, which is a real reset of these methodologies, then, the amount of teamwork and intense advocacy that’s going to have to happen to try to get Congress to fix this mistake is going to be enormous. And every one of us is going to have to put in whatever we can. Because, letting ourselves fall off of this type of cliff, letting patients and families fall off this kind of cliff, is just… it’s not… we’re gonna have to fight it every every step of the way. It’s just not right.

Commentary

The interview paused here. It was barely perceptible and nearly impossible to describe on paper. The depth of emotion conveyed in Dr. Landers’ words was palpable, sincere, and honest. In these few seconds, I was given the gift of insight on how completely Dr. Landers commits to this cause and how strong are his convictions. It was a powerful moment that I hope you all have the opportunity to witness.

Home Health Stabilization Act

RR: Both you and your predecessor, Bill Dombi, have talked about how devastating these cuts will be. Estimates of 50% of home health agencies closing, reduced access to care, loss of jobs for caregivers, and especially devastating to the patients. What if this doesn’t change? Obviously, it’s going to take everybody working together. But what’s the first step? Is there a plan?

Steve: Oh, yeah, we’ve already been working with champions in Congress to introduce H.R. 5142 the Home Health Stabilization Act of 2025. If passed into law, would halt these cuts for 2026 and 2027 and allow time to work with Congress and the administration on more comprehensive, long term fix to this total mess that’s been developed by these flawed methods and give time to really work on comprehensive solutions to some of the fraud and abuse issues and potentially other reforms that could help. Now, anytime you’re trying to get an act of Congress passed, especially with a Congress that’s not open right now, with only so many days left in the legislative calendar, that’s no guarantee either, but that is the contingency that we’ve been developing.

If they don’t fix their proposal, they’re going to march forward on January 1 with another set of cuts that are going to lead to more delays in care and more people getting referred and not getting care and more rural and high poverty communities not haveing access to care and more people going back to the hospital and costing the system more. There are life and death issues. Not just an inconvenience or a cost. People can die. It’s a big deal.

RR: I think the industry as a whole feels like CMS is only looking at the financial numbers and not the consequences of what theyre doing. There are real people who are being damaged by these decisions.

Steve: Yeah, the proposed rule did not seem to take these things into account and it was not a patient- or family-centered proposal. It’s not a final rule yet. Their final action is pending and they need to address those issues. They have a responsibility, I believe, as public servants. I believe there’s a moral obligation here to revisit what was done and get it right.

RR: And, we do have some advocates at the congressional level, correct?

Steve: Yeah, we’ve been working with members of Congress to get them to weigh in with the administration, to tell them “get your final rule right.” We have been working on a contigency that if the rule is not done correctly that Congress would force them through legislation to stop the cuts. We’re not there yet, but we could be any day now. We’ve done that work with Congress to make that progress. That amount of advocacy will require teamwork. This is one of the reasons I was trying to emphaze the importance of unity if we end up with a very short calendar and a really hard problem to solve. It’s going to be pretty intense.

RR: And we’ll be right there with you if that happens, saying “how can we help?” I know this is the most pressing issue right now, but is there anything else industry-wise that you’re looking forward to and excited about?

Future Outlook

Steve: You know, I think it’s been fun and exciting and in some ways inspiring to see this alliance community grow and build. Whether it’s all these new and innovative AI solutions that our members are getting excited about, how they can improve workflows and efficiences, or whether it’s the attention for the storytelling around the issues that our members care about on social media and earned media. There are a lot of reasons to be excited and enthusiastic about the future.

I think the AI advancements have been really exciting and interesting for the industry, because there’s so much that can be done. And certainly, regardless of how big the cuts are, any cuts are going to be difficult for home health, and especially on top of what we’ve already had, yeah, but, you know, you being able to use these AI solutions to kind of cut some of the costs and things and offset that is, is at least a silver lining in some of it, and improve the worker experience, maybe in ways that make it a little less burdensome, and you can maybe keep more people in the
workforce.

RR: Well, I want to congratulate you. You’ve made it through your firstfull year in thisposition. I think there was a sense of this event being the test, the “How did the two organizations really come together and produce this huge thing,” and, it seems likethe blending of the home health with the hospice has worked really. Attendance is high and the vibe seems to be very positive.

Steve: You know, there’s a test every day. We have to keep trying to serve our community, and it’s a journey. We’ve got a great board, and a great team. They’re focused on the mission. The team came together nicely after the merger. Now that it’s settling down, we’re just going to keep working towards a bright future. Just keep at it.

RR: I think you’ve handled it all really well and the success of this event is a testament to that, as well as the other education and advocacy you’ve accomplished in the last year. I appreciate you taking the time to talk to me today. Keep fighting the good fight.

Steve: Absolutely. Thank you.

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National Alliance Annual Meeting: A Review

by Kristin Rowan | Nov 13, 2025 | Editorial

by Kristin Rowan, Editor

National Alliance for Care at Home

Annual Meeting and Expo

Was anyone else waiting with great anticipation to see the first annual meeting after the merging of NAHC and NHPCO? Or was it just me? I attended the Financial Summit over the summer and didn’t sense much of a difference from the Financial Management Conference from years past. But, I had a feeling the fall event would be different.

First Impressions

Registration started early. I arrived on Saturday to experience some of New Orleans and was able to register that afternoon.

On Sunday, a full snack spread was available before the keynote address. Coffee, chips, cookies, soda. I overheard several positive comments about the snacks and drinks on my way in. There was a feeling of excitement in the air and it was instantly noticeable that attendance was up from years past.

Opening Session

Aesthetically dynamic stage backdrop. Extra large stage that rarely, if ever, had more than four people on it at a time. Acoustics in the very large room garbled some of the presentations.

Content for the opening session began with remarks from Louisiana Governor Jeff Landry. While somewhat political in nature, the address was uplifting and positive. Dr. Steve Landers, CEO of the Alliance closed the session with a brief industry update.

Perspectives From Both Sides

Interviewing several attendees, the reviews of the meeting were mixed, but predictable. Past members of NHPCO felt the educational sessions were too home health focused while past members of NAHC felt there was too much Hospice content.

Some attendees were “over” all the AI software while others were excited about where AI could help improve processes and cut expenses. For a more indepth look at the vendors, read our companion article from Editor Emeritus Tim Rowan as he highlights the companies tackling OASIS with AI.

The closing gala, hosted by National Hospice Foundation, a fundraiser reminiscent of NHPCO conferences but wholly foreign to NAHC members, sold out and the live and silent auctions gathered significant donations for the foundation. Attendees dressed to the nines for the event. Reviews following the evening were resoundingly positive.

The Best of the Best

Overwhelmingly, attendees highlighted two key features of this year’s meeting that stood out above all else.

The availability of snacks and drinks throughout the day was a welcome surprise. A variety of offerings were found outside the expo hall, outside breakout rooms, outside general session rooms, and even inside some breakout rooms. From before the opening keynote to just before the closing session, attendees never went hungry.

The coup de gras, as they say in New Orleans, was the keynote on Monday from the host of the Squeezed Podcast, Yvette Nicole Brown. Most known for her role as Shirley Bennett on Community, Yvette is a caregiver. She was the primary caregiver for her father for more than ten years as he battled Alzheimer’s. Yvette discussed how her role as a caregiver changed her, prompted her to start her podcast, and led her to champion sharing caregiver stories to strengthen organizational culture and support systems for caregivers. Her powerful story left many in tears and furthered the imperative call to advocacy echoed by the Alliance.

From the Alliance

Following the success of the inaugural annual event, the Alliance issued a press release and statement from Alliance CEO Steve Landers.

“This first annual meeting and expo as the Alliance showcased our strength as a unified organization. We were thrilled to bring together leaders in home health, hospice, and the breadth of care at home from across the nation to unite, learn, and share our commitment to creating a future where all Americans have access to high-quality, person-centered healthcare wherever they call home. We look forward to continuing to convene the care at home movement and work toward our shared purpose.”

Dr. Steve Landers

CEO, National Alliance for Care at Home

The Rowan Report sat down with Dr. Landers just before the closing session. Read the interview here.

Final Thoughts

Members of NHPCO and NAHC saw noticeable differences from their past events. This was inevitable after the merger and not unexpected. As a whole, the event was organized, well-run, enjoyable, informational, and well-received. I’d say the Alliance had a successful first run and we look forward to continued improvements in years to come.

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HHAeXchange Features Bradley Cooper Documentary

by Kristin Rowan | Oct 30, 2025 | Advocacy, Caring for the Caregiver

by Kristin Rowan, Editor

PBS/Cooper Documentary Featured

HHAExchange PA Customer Summit

HHAeXchange welcomed Pennsylvania users for a day of learning and connection this September. Led by CEO Paul Joiner, the team has grown recently with the acquisitions of Cashè, Generations Homecare, and Sandata. Joiner opened the day by sharing the company promise to put customers first and build around their core values. He also highlighted the company’s work on AI features that are coming soon.

Caregiving, the Movie

Caregiving is a documentary from Executive Producer Bradley Cooper that explores systemic issues in the US care system. Cooper cared for his dad when he had cancer and is still caring for his mom. The film follows both paid and unpaid caregivers, who share their personal stories, along with the history of caregiving. Caregiving is streaming on PBS.

HHAeXchange and Caregiving

How does a PBS documentary and 18 short films become the subject of a software user group meeting? I suspect that promoting the film using Bradley Cooper played a small role in its popularity and viewership. But, in this case, it was HHAeXchange President Stephen Vaccaro who initiated the event. Stephen watched the film and recognized its importance. He sent it to the executive team and a lot of people inside the company watched it. As they started planning the user group meeting CEO Paul Joiner suggested reaching out to the show’s producers.

Closing on a High Note

Two of the film’s principals, director Chris Durrance and caregiver Matt Cauli joined HHAeXchange CEO Paul Joiner to close out the day. The panel was extremely well-received and Matt Cauli has been hailed as a near-perfect spokesperson for caregiving (the film and the industry).

Comments from HHAeXchange and the customer summit describe the film as “instrumental in bringing caregiving into the national conversation, shining a light on the critical role caregivers play every day and they challenges they navigate.”

Meet EP Tom Chiodo

Joined by HHAeXchange President Stephen Vaccaro, one of the film’s Executive Producers sat down with The Rowan Report to discuss Caregiving and Wellbeings.org. Tom Chiodo is the executive producer of special projects, national productions at WETA the PBS station in D.C. Tom develops documentaries, orginal digital content, and engagement campaigns for more than 330 PBS stations. Wellbeings is a campaign from public media to address critical health needs in America. Wellbeing currently has 18 short films that include additional history and information on caregiving in the U.S. that didn’t fit inside the 2-hour time constraint of the documentary. The channel has 2 million subscribers.

Not Done Yet

Speaking with Tom, it was immediately clear the passion and devotion he has for the caregiving industry.

“Caregiving is struggling. It’s not just family members, but caregiving as an industry. They don’t get paid enough, even though they’re dealing with quality of life. The job is physically and emotionally demanding, and mentally draining.”

Tom Chiodo

Executive Producer, WETA/PBS

According to Tom, the caregiver shortage pushed Medicaid to promote self-directed care as an alternative. Now, there are an estimated 53 – 105 million unpaid adult family caregivers in the U.S. with $600 billion in lost income annually. Shining a light on the changes that need to be made, Caregiving has been viewed thousands of times, but more work needs to be done. Tom is currently working on a film on defeating dementia and another with filmmaker Ken Burns on adult mental health.

Understanding for All Ages

An estimated 5.4 million children and adolescents provide direct care for a family member. Wellbeing partnered with Fred Rogers Productions for Many Ways to Show You Care, coming to Wellbeings and PBS Kids on November 7. The series shows kids and teens engaged in caregiving with siblings, parents, and grandparents who suffer from various disabilities.

Watch the Film

If you haven’t already, I encourage you to take the time to watch Caregiving and the supporting short films from Wellbeing.

# # #

Second Longest Shutdown Since 1980

by Kristin Rowan | Oct 30, 2025 | Medicaid, Medicare, Medicare Advantage, Regulatory

by Kristin Rowan, Editor

Second Longest Shutdown Since 1980

–As of October 30, 2025–

Shutdown day 30

Subsidy Standoff

Senate Majority Leader John Thune spoke with MSNBC about the shutdown and the subsidy expiration. “Shouldn’t people who are signing up during open enrollment know what they’re signing up for?,” MSNBC asked. Thune said the first step has to be opening the government before that conversation happens, not in the context of the budget talks. According to Thune, the Republican party objects to the current operation of the subsidy program and the incentive structure needs reform.

Subsidy Standoff Not to Blame

Current estimates show insurance premiums rising by 18% – 22% in 2026. Leader Thune suggests that only a “tiny percentage” of that increase is due to the expiration of the enhanced subsidies and the rest is coming from the insurance companies. He says premiums should not being going up by this much and the extreme rate increase is because of waste, fraud, and abuse, and the lack of incentives for insurance companies to lower costs.

No Reform, No Subsidy

Throughout the interview, Leader Thune would not commit to

Government Shutdown Senate Majority Leader John Thune

negotiating with Democrats, would not guarantee subsidies would be saved, and would not commit to voting for any extension without at least lowering income caps back to pre-COVID levels.

After the Senate session today, Thune spoke to reporters, indicating there was a “higher level of communication” happening. He went on to repeat his earlier statement to MSNBC.

“…there are a lot of rank-and-file members that continue, I think, to want to pursue solutions and to be able to address the issues they care about, including health care, which … we’re willing to do, but it obviously is contingent upon them opening up the government.”

John Thune

Senate Majority Leader

(Un)lucky Number 13

October 28th marked the 13th vote put to the Senate to reopen the government in 28 days. The Senate reconvened yesterday and plan to vote again today, October 30th. Senators have mixed opinions about the likelihood of an agreement now that deadlines for military pay, SNAP benefits, and other programs close in.

Senate Minority Leader Chuck Schumer (D) said negotiations were “occasional” and that Republicans haven’t offered anything different from the original House-passed budget.

Senator Lindsey Graham (R) said resolving the differences on health care would come after the government reopens. “I’m hoping next week, hopefully after the election, that we can get the government back open, talking about our differences on health care.”

Senator Thom Tillis (R) states there is no evidence that formal negotiations are happening, just discussions.

When Will it End?

The Senate is expected to vote today, October 30th. The measure needs 60 affirmative votes to pass. The vote to automatically continue without discussion failed 37-61. The subsequent votes to temporarily fund the government through November 21st failed 55-45 on October 1 and 54-45 on October 28. Senator Jim Justice (R-WV) voted yes in the first vote, but did not vote yesterday.

If I Were a Gambler...

The rumors and accusations fly on both sides about who is to blame for the shutdown. There are betting sites placing odds on the date the standoff will end. I’m no political expert, but I think there’s something else going on. I believe both sides are playing risky games and that neither side knows the rules to the other’s game. I think both sides know the exact date they will each agree to end this standoff. And I’m sure there are underlying motives that have nothing to do with what they’re telling us.

We will continue to report on this ongoing story as more information becomes available.

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