What Can Providers Give to Patients, Pt 2

Admin

by Elizabeth E. Hogue, Esq. | Oct 17, 2025 | Admin, Clinical, Legal

by Elizabeth E. Hogue, Esq.

Provider Kickbacks

Exceptions

Providers, including marketers, are tempted to give patients and potential patients free items and services. While providers usually have good intentions, they must comply with applicable requirements. As Part 1 of this series indicates, there are two applicable federal statutes: the anti-kickback statute and the civil monetary penalties law. Part 1 also makes it clear that there are a number of exceptions or “safe harbors. If providers can meet the requirements of an applicable safe harbor or exception, they can give patients and potential patients free items and services that would otherwise violate applicable requirements.

Limit Increase

The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services, the primary enforcer of fraud and abuse prohibitions, announced that; effective on December 7, 2016; the limits on free items and services given to beneficiaries increased. Specifically, according to the OIG, items and services of nominal value may be given to patients or potential patients that have a retail value of no more than $15 per item or $75 in the aggregate per patient on an annual basis. The previous limits were $10 per item or $50 in the aggregate per patient on an annual basis.

Undue Influence

Under section 1128A(a)(5) of the Social Security Act, persons who offer or transfer to Medicare and/or Medicaid beneficiaries any remuneration that they know or should know is likely to influence beneficiaries’ selection of particular providers or suppliers of items or services payable by the Medicare or Medicaid Programs may be liable for thousands of dollars in civil money penalties for each wrongful act. “Remuneration” includes waivers of copayments and deductibles, and transfers of items or services for free or for other than fair market value.

In the Conference Committee report that accompanied the enactment of these requirements, Congress expressed a clear intent to permit inexpensive gifts of nominal value given by providers to beneficiaries. In 2000, the OIG initially interpreted “inexpensive” or “nominal value” to mean a retail value of no more than $10 per item or $50 in the aggregate per patient an annual basis.

Needed Items, not Cash

The OIG also expressed a willingness to periodically review these limits and adjust them based on inflation. Consequently, effective on December 7, 2016, the OIG increased the limits of items and services of nominal value that may be given by providers and suppliers to beneficiaries to a retail value of no more than $15 per item or $75 in the aggregate per patient on an annual basis.

Providers may not, however, give cash or cash equivalents.

These amounts may still seem paltry to many providers. According to the OIG, providers who see that patients need items worth more than these limits should establish relationships with charitable organizations that can provide items and/or services that are not subject to these limits. In other words, work together to meet the needs of patients!

Final Thoughts

With time and the emotional context inherent in home health and hospice, clinicians may want to offer gifts to their clients. Low reimbursement rates and workforce shortage may cause HHAs to consider gifts and incentives as a way to keep clients and get referrals to new ones. If you find yourself in this situation, make sure you’re staying under the legal threshold, and engage 3rd parties to fill larger needs.

This is part 2 of a 4-part series. Come back next week for the third installment.

# # #

Elizabeth Hogue is an attorney in private practice with extensive experience in health care. She represents clients across the U.S., including professional associations, managed care providers, hospitals, long-term care facilities, home health agencies, durable medical equipment companies, and hospices.

No portion of this material may be reproduced in any form without the advance written permission of the author.

Can This New Software Eliminate Fraud and Billing Errors?

Admin

by Tim Rowan | Oct 9, 2025 | Admin, Medicaid, Product Review

by Tim Rowan, Editor Emeritus

Software Eliminates Fraud and Errors

Like so many Home Care providers, Aspen Home Care in Kansas City, Missouri was drowning in paper. Two hundred caregivers turned in weekly timesheets every Friday. A large office staff had to go through them, looking for errors, omissions, and unauthorized visits and shifts. Submitting erroneous claims, of course, leads to payment denials, even fines. When an agency submits too many bad claims every week over a long period, a surveyor will soon be knocking at their door.

The Hurdles

On a good week, Aspen completed all necessary payroll and billing tasks and had bills ready to submit by end of business on the following Thursday. Slowing down the process were the usual errors — forgotten check-outs, more hours worked than authorized, and late timesheet submission. Caregivers grew weary of the weekly phone calls asking for clarification, even when the error was their fault. Aspen did have a basic billing system, but paper timesheets fed it too. Electronic Visit Verification was possible, but only via a patient’s landline, using punched-in identification codes.

Then... the call came

“After years of software design, we have completed our replacement for your billing and EVV system. We would like you to switch from the basic system we sold you a few years ago and beta test our better one.”

– Henry (Hank) Schwab, Owner, Compliance Plus

Beta testing is a risky venture, but both owner Ahmed Jara and Office Manager Mohammed Mohammed* trusted Hank and agreed to give it a try. After all, the agency was drowning in paper, they reminded each other.

Dramatic Process Improvements

We took part in a demo of the Compliance Plus system before speaking with Mohammed and hearing Aspen’s experience. We saw a comprehensive, user-friendly system, with a color-coded user interface, that includes scheduling, EVV, and billing for Medicaid, Managed Care, and all other payers an agency contracts with.

Time Tracking

Caregivers clock in and out with an app that is GPS-enabled down to exact longitude and latitude coordinates. Should a patient live in an internet dead zone, caregivers can use their landline. If there is no landline, Aspen will install a “smart fob” in the home. Aspen does not require specific visit start times, but once a check-in is recorded, the app knows the patient’s authorized hours and automatically alerts the caregiver when it is time to clock out.

Verification

Mistakes do happen, of course, but fixing them is not difficult. When the Compliance Plus back end sees a 14-hour visit, it assumes the caregiver forgot to check out. The visit flashes red on the screen, indicating it is not ready to bill, and displays the difference between authorized and recorded hours. The office employee managing exceptions simply calls the caregiver for verification and then manually edits the end time, and compliance is maintained.

Caregiver Feedback

Mohammed told us his caregiving staff is thrilled with the app, though he did say the transition was hard at first. “They learn to use it in about 30 minutes,” he said. “Check-in and check-in take a few seconds and now they are happy to be done with paper forever, not to mention no longer having to deliver paper timesheets to the office.” He added that fake check-ins from the car on the way to a patient’s home have been completely eliminated.

Most importantly, the three-person office staff now completes payroll and billing for 200 caregivers by midday on Tuesday instead of late on Thursday.

The "Plus" of Compliance Plus

Certainly, procedural efficiencies are important, and many scheduling and EVV systems force caregivers to check in and check out in the presence of the patient and alert office staff when a caregiver arrives late or is a no-show. What we saw during our demo, however, we have not seen elsewhere. Compliance Plus automates the tedious task of rooting out EVV, billing, and payroll errors so efficiently, payment denials, aggregator rejections, and incorrect paychecks are virtually eliminated.

Denials are Rare

Mohammed confirmed what we saw in the demo. The file that includes hours, authorizations, patient demographics, and pre-arranged pay rates is prepared and perfected in advance. Then, the system uploads the same corrected file to the aggregator and to state and other payers. “If we need to fix hours or a bill, we do it before uploading to all entities,” he said. “We rarely get rejections from the aggregator or denials from payers.”

Aggregated Data

One of the requirements of payers and EVV aggregators is that all patient and caregiver names and other information must be in their respective databases in advance. Compliance Plus finds missing data and removes a bill from the file before it is uploaded, notifying the user with a red flag. Mohammed added, “We have to make sure all patient data is in system, but that is easy to do.”

Implementation and Training

In every home care agency, there is always a measure of trepidation among the staff when switching from familiar paper to automation. Aspen Home Care was no different when owner Ahmed Jara announced that he had accepted Hank’s invitation to join a beta test. Mohammed told us that his staff’s time from implementation to software expertise took a little less than three months. Compliance Plus customer relationship manager Sara Moore conducted online training of key office staff, a service that is included in Aspen’s monthly fee. Mohammed and a couple others trained the rest of the staff on the full system and then caregivers on the use of the app.

“After a short while, the new system became our normal workflow,” Mohammed commented. “The only speed bump is when they upload new features. We need to spend a little time learning them, but ultimately, the new features improve our workflow. Our caregivers pick up the app in about 30 minutes, including new hires.”

Favorite Features

He added that his 200 caregivers like checking in and out on the app better than the legacy ANI system, which used the patient’s landline for automatic number identification. “English is a second language for some of our caregivers, and they sometimes had trouble with the ANI prompts spoken by the computerized voice,” he explained. “GPS verification is the best feature. If a caregiver checks in from too far away, we see their distance from the patient’s home on a map, and we gently ‘re-educated’ them and it does not happen again. In the past, they would sometimes get away with asking a family member to check in for them from the patient’s landline. Those days are gone.”

He also told us that Aspen does not insist on specific start times. What matters is that visit length matches authorized hours over a billing period. This is especially helpful for waiver and HCBS plans when the caregiver lives in the home. In those arrangements, checking in or out used to be easily forgotten. “I take care of her all day, how do I know when I start and stop?” The Compliance Plus app rings its cell phone loudly to remind visiting and live-in caregivers to check in and then to check out after the authorized number of hours have been reached.

Simplifying Complex Billing

Presently, Aspen exclusively serves Medicaid beneficiaries, though that can mean several managed care payers. With varying reimbursement rates from payers, combined with different caregiver hourly rates, getting a bill to match an authorization used to be a challenge for Office Manager Mohammed and his team.

It's Complicated

In the case of an agency employed family caregiver, there are often days when the family member will spend one hour toileting and feeding, the next hour doing reimbursable homemaking chores, and the third hour running care-related errands. Not only might those tasks be paid at different rates, but they can, and often are, reimbursed by different payers.

Patient Profiles

Mohammed emphasized that the way Compliance Plus handles these situations saves considerable time and reduces payer and aggregator rejections. Like in a Venn diagram, every combination of patient, payer, task type, and caregiver creates a “patient profile.” The user created most profiles in advance, based on known payer rates, etc. Occasionally, a patient’s profile is unique, but a user can easily enter the specifics into the system manually. Once a profile is built, the system calculates all of the billing accurately without additional user supervision.

Task Rates

If a payer’s rate for a task changes, Mohammed or another office staffer makes the change one time for all affected patients. In that scenario where the live-in caregiver performs three different tasks in one day, he or she checks in and out only once, before the first task and after the last, and designates each task performed. Compliance Plus does the rest.

Company Prospects

Hank Schwab told us that he is confident, after 100 successful beta customers, that Compliance Plus is ready for general release. At $10 to $12 per patient per month, he believes that supplementing word-of-mouth with a modest marketing effort will help him replace paper and strengthen the bottom line for many Medicaid and Personal Care agencies. Hank’s plan is to begin that effort as soon as he identifies an investor or two and hires a marketing director. “I already manage a team of coders and personally pay all the bills,” he laughed. “I’m ready for someone else to take on a few of my jobs.”
https://complianceplus.com/

# # #

Tim Rowan is a 30-year home care technology consultant who co-founded and served as Editor and principal writer of this publication for 25 years. He continues to occasionally contribute news and analysis articles under The Rowan Report’s new ownership. He also continues to work part-time as a Home Care recruiting and retention consultant. More information: RowanResources.com
Tim@RowanResources.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

What Can Providers Give to Patients, Pt 1

Admin

by Elizabeth E. Hogue, Esq. | Oct 9, 2025 | Admin, Legal, Marketing

by Elizabeth E. Hogue, Esq.

Providers Kickbacks

Keeping it Clean

Providers, including marketers, are tempted to give patients free items and services. But be careful! These activities may violate laws prohibiting providers that participate in state and federal health programs from giving free items and services to patients. Private insurers often impose the same prohibitions. This means that private duty agencies are not exempt from these fraud and abuse prohibitions if they participate in any state healthcare programs, such as Medicaid or Medicaid waiver programs, or accept payments from private insurers.

Provider Prohibitions

The government generally prohibits providers from giving free items and services to patients because it is concerned that such activities may:

Result in overutilization of services
Produce decisions concerning care that are not objective
Increase costs to the Medicare and Medicaid Programs and other state and federal healthcare programs

Consequences of Provider Kickbacks

Providers who violate prohibitions on what may be given to patients face criminal fines, civil money penalties, suspension or exclusion from the Medicare and Medicaid Programs and other state and federal healthcare programs, and jail time.

There are two applicable federal statutes:

The anti-kickback statute (AKS)
The civil monetary penalties law (CMPL)

Exceptions

The federal government says that providers have violated the federal False Claims Statute if referrals are obtained in a way that violates the AKS and providers submit claims for services provided to patients who were referred in violation of the AKS. Providers generally violate the False Claims Statute if they submit claims or cost reports to the government that include untrue information. When providers submit claims, they, according to enforcers, also promise that referrals were not received in ways that are prohibited. If referrals are received inappropriately by violating the anti-kickback statute, for example, then the claims are “false.” Giving free items or services to patients may also violate a federal statute: the civil money penalties law.

Promotions and Marketing

The CMPL prohibits providers from offering to give or actually giving items or services to patients or potential patients that are likely to influence receipt of services from particular providers. This prohibition is especially relevant to marketing activities. It applies to both direct and indirect promotional activities.

State-Specific Laws

Providers must also comply with applicable laws in all of the states in which they do business. State laws vary, of course, from state to state. Many states have anti-kickback statutes that are similar to the federal statute described above. State licensure statutes for physicians, nurses, therapists, social workers, and other types of providers may also include prohibitions on giving free or discounted items or services to patients, especially when they may induce patients to receive potentially unnecessary services.

Final Thoughts

Although providers may have good intentions when they give free items or services to patients and potential patients, before they are acted upon such intentions must be subjected to consideration of the prohibitions described above.

This is part 1 of a two-part series. Look for part 2 next week.

# # #

Elizabeth Hogue is an attorney in private practice with extensive experience in health care. She represents clients across the U.S., including professional associations, managed care providers, hospitals, long-term care facilities, home health agencies, durable medical equipment companies, and hospices.

No portion of this material may be reproduced in any form without the advance written permission of the author.

It’s More than Just Payroll

Admin

by Kristin | Oct 9, 2025 | Admin, Artificial Intelligence, Clinical, Product Review

by Kristin Rowan, Editor

Product Review: It's Payroll...and so Much More

Evolution into Health Care

I’m sure many of you remember the days before automated processes. Hand-written notes, paper forms, and paychecks that were filled in on a typewriter. Those days are behind us (mostly) in care at home with the alphabet soup of technology we have today: EMR, EVV, EHR, PECOS, API, EDI, UB-04, ADP

Technology evolves in unpredictable paths and patterns. And the best developers adjust to that evolution. That is the story of a software provider that we recently interviewed. What started as a general payroll and HR software evolved and steered the developers toward health care. Now, that payroll company is built for care at home and includes so much more than standard payroll. Introducing…Viventium

Home Health and Home Care Enhancements

When the Viventium team started their software, it was not industry specific. But some key clients put home care on their radar six years ago and the software development shifted to meet the unique needs of care at home agencies. Today, Viventium is a workforce management system that is built for care at home and includes features not found in general payroll software. Some of Viventium’s capabilities include:

Applicant tracking

Job board integration

Hiring data and talent recognition

Recruitment insights and analysis

Onboarding

Tax filing

Employee self-help section

Integration with Tapcheck

Time and Attendance approval

Time off requests

Scheduling and Open Shift management

Continuing education tracking

Benefits management

ACA compliance tracking and reporting

Automated blended rate payroll

Integrations and Automations

Viventium is already working with a handful of EMRs for direct integration. The system is also integrated with TapCheck for on-demand pay and with Nevvon for CEUs. For EMRs that are not fully integrated, they offer pre-built exports that can handle different export formats. Viventium can import information from virtually any patient record system.

Once the payroll system is set up for your agency, or agencies, many of the workflows are automated, relieving time and stress on your staff and saving you money on recruitment, retention, FTEs and missed visits. The staff responsible for new hires will experience such automations as pre-filling demographic information everywhere once it is entered once, customizable CEU requirement task assignment and reminders, tax preparation and filing, sharing job listings across multiple job boards, and payroll generation from EVV import.

Industry Differentiators

Standard payroll companies and software are perfectly capable of running weekly time cards and calculating state and federal taxes. Most of them automate direct deposit. Very few have the built-in capability to change hourly rates during a shift. Viventium allows agencies to customize visit types, names, and rates, allowing an employee to clock in at the start of a shift and adjust their job code as needed throughout the day. Even fewer calculate overtime, benefits eligibility, sick leave accrual, and daily overtime for per visit employees automatically. And Viventium is the first payroll software I’ve come across that is piece-rate compliant, calculating rest pay and non-productive time.

Customizations

HHAs are not “one size fits all” and neither is Viventium. The list of available customizations keeps growing. Agencies can apply custom parameters to:

CEU requirements based on license type, expertise, PiPs, etc.
Benefit information
Reminders for expirations and deadlines on performance reviews, licenses, certifications, and CEUs
Workflows for digital onboarding documents, progress tracking, and completion
Re-hire eligibility
Payroll and overtime calculations for one employee working across agency locations
Reporting, analytics, data, in addition to the static analytics dashboard

User Reviews

As a small business with very little need for robust HR systems, payroll software is not really on my “must have” list. Still, I’d be remiss if I didn’t consider using a system with this many “extras”. But, don’t take my word for it. Here is what Viventium customers have to say:

Hospital System with 11-50 Employees

“I enjoy the software and it beats most if not all payroll systems out there for attractiveness to use and navigate through. Very user friendly. When they update the product they always have a training associated with it. It easy to use for our employees as well.”

Home Care Agency with 51-200 Employees

“Viventium has really helped my company by providing payroll services. As a new and small business owner, the “V” team has been patient, helpful and always a pleasure to work with. In our first 2 years, the service has been very helpful and timely. I am very happy I decided to go with the “V” team. Highly recommend for payroll services.”

∼ Carlos, SYNERGY HomeCare in Palm Bay.

Health and Wellness with 1,001-5,000 Employees

“It’s not just another payroll or HR tool, it feels thoughtfully built for real people, especially those of us in healthcare….

Plus, having everything from benefits administration to compliance tracking in one place has saved me countless hours. It’s helped our team stay organized and focused on what really matters: supporting our staff and growing our business.”

Review

In the care at home industry, Viventium is relatively new in comparison with other systems. Outside of care at home, Viventium is trusted by more than 3,000 companies and has the experience and expertise to support more than just payroll, but all workforce management.

The user interface is pleasant and visually pleasing enhancing its very user-friendly, easy to use platform. 3rd party tools are fully integrated, keeping every feature under a single sign-on. Also included is an Android and iOS app for your staff to track and view hours, pay rates, benefits, and education all in one place.

The automation and customization reduces payroll prep time, improves compliance and accuracy, strengthens retention and recruitment, eliminates physical paperwork for onboarding, and much more. This part is not my opinion, but is based on this efficiency study.

Final Thoughts

If you’re not using Viventium, it is worth exploring. The potential to eliminate multiple software systems and logins is real. The savings in time, retention, and reduced errors are measurable. Viventium is the best kept secret in care at home and based on my conversations with their team, we haven’t heard the last of Viventium’s innovation and industry-specific features.

# # #

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

**Vendors never pay for product reviews nor does a vendor’s sponsor status influence the content of the review.

Quality Improvement Project

Admin

by Kristin Rowan | 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.

# # #

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

Eleos Navigates Eligibility Risk

Admin

by Rowan Report | Aug 21, 2025 | Admin, Artificial Intelligence, Clinical, Home Health, Hospice, Medicaid, Partner News

Eleos Navigates Eligibility Risk

FOR IMMEDIATE RELEASE

Contact: Amanda Wells

awells@sloanepr.com

Eleos Launches AI Scanner to Navigate Medicaid Eligibility Risk in Real Time

The new OBBBA AI scanner uses Eleos’ ambient AI technology to alert providers of patient eligibility changes, preserving revenue and ensuring care continuity amid sweeping Medicaid policy changes

BOSTON, MA, Aug. 20, 2025 — Eleos, the leading AI platform in post-acute care, today announced the launch of the OBBBA (One Big Beautiful Bill Act) AI scanner, the first real-time tool to proactively detect potential changes to Medicaid eligibility during client sessions. The OBBBA AI scanner uses Eleos’ purpose-built ambient AI scribing technology to inform providers about changes that may impact coverage, giving them time to act before Medicaid coverage lapses. The tool was launched in response to sweeping Medicaid funding cuts and eligibility rule changes.

Eligibility Check

Providers can select Medicaid-related “themes” to track such as housing status, diagnosis updates, or life events like marriage or aging out of eligibility. The OBBBA scanner captures contextual clues that could trigger changes in coverage. Providers use this information to take action to prevent eligibility loss, reduce care disruption and maintain treatment continuity. For care organizations, this means fewer denials and greater revenue stability, as well as better client support.

The OBBBA AI scanner arrives at a critical moment: new Medicaid rules introduce shorter retroactive coverage windows, semi-annual (versus annual) redeterminations and narrowed eligibility criteria — all of which lead to a higher risk of churn, especially for vulnerable groups such as people with serious mental illness and those experiencing housing instability.

“We’re hearing from leaders across the country that Medicaid redetermination changes are already causing confusion and fear among clients and providers alike. The OBBBA AI scanner gives providers the earliest possible warning via real-time insights so they can protect coverage and avoid treatment disruptions, ensuring clients continue to receive necessary and life-saving care. This kind of provider-first technology is at the core of Eleos.”

Alon Joffe

Co-founder and CEO, Eleos

Embedded seamlessly within the Eleos Documentation experience, the tracker works in tandem with providers’ existing workflows, requiring no additional software or manual data entry.

Industry leader sees Eleos scanner as critical tool

“OBBBA has created significant uncertainty for the behavioral health sector, and organizations need every possible advantage to navigate it. Properly deployed, purpose-built AI tools help organizations navigate an ever-changing landscape while also promoting the health and well-being of clients and communities.”

Chuck Ingoglia

President and CEO, National Council for Mental Wellbeing

Rationale

The OBBBA AI scanner builds on Eleos’ mission to free care providers from administrative burdens and enable better, more data-informed care. Deployed in over 200 organizations in 30-plus states, Eleos is the most-used AI solution in behavioral health, substance use disorder (SUD) treatment and post-acute care. Its suite of AI-powered documentation and compliance solutions has been proven to reduce documentation time by more than 70%, double client engagement and drive 3-4x better treatment outcomes.

For more information about the OBBBA AI scanner or to request a demo, visit www.eleos.health.

# # #

About Eleos

Eleos is the leading AI platform for behavioral health, substance use disorder, home health and hospice. At Eleos, we believe the path to better care is paved with provider-focused technology. Our purpose-built AI platform streamlines documentation, simplifies revenue cycle management and surfaces deep care insights to drive better client outcomes. Created using the industry’s largest database of real-world sessions and fine-tuned by our in-house clinical experts, our AI tools are scientifically proven to reduce documentation time by more than 70%, boost client engagement by 2x and improve symptom reduction by 3-4x. With Eleos, post-acute care providers are free to focus less on administrative tasks and more on what got them into this field in the first place: caring for their clients.

HIS to HOPE Help

Admin

by Rowan Report | Aug 21, 2025 | Admin, Clinical, CMS, Hospice

by Curantis Solutions

HIS to HOPE Help

HOPE visit types

The HOPE (Hospice Outcomes & Patient Evaluation) model introduces a new rhythm to hospice documentation, one that centers on the patient’s evolving experience of care. To meet HOPE’s standards with confidence, it’s critical to understand the different visit types and their timing.

Let’s break down the three visit types defined by HOPE: INV, HUV, and Symptom Follow-Ups, so your team knows exactly what’s required, when, and why it matters.

INV

Initial Nursing Visit

What it is: The first clinical touchpoint in the HOPE timeline. The INV marks the beginning of structured data collection and sets the baseline for all subsequent updates.

When it’s due: As soon as possible after admission, ideally within the first day.

What it captures:

Key demographic and clinical data
Initial symptom impact ratings
Observations that may trigger a future follow-up

HUV

HOPE Update Visits

HOPE requires two follow-up check-ins to capture how the patient’s condition is changing over time. These are called HOPE Update Visits—HUV1 and HUV2.

HUV1

When it’s due: Days 6–15 after admission
Purpose: Reassess symptoms and update the patient’s status.

HUV2

When it’s due: Days 16–30 after admission
Purpose: Continue tracking trends and changes, especially as patients stabilize or begin to decline.

Pro tip: Even if the visit wasn’t originally intended as a HOPE Update Visit, clinicians can update their response at visit close ensuring the right file is created.

Symptom Follow-Up Visits

What they are:
Special visits required when certain symptoms (e.g., pain, shortness of breath, anxiety) are rated as having a moderate or severe impact on the patient’s well-being.

When they’re due:
Time-sensitive, must occur within days of the symptom being flagged.

Why they matter:
These follow-ups are the heart of HOPE’s patient-centered approach. They ensure that care plans are adapted quickly and that patients don’t suffer in silence.

Symptom follow-ups should be:

Automatically evaluated after each visit
Clearly flagged with alerts across the system
Auto-documented into the HOPE record upon completion and QA

HOPE Hub

To support you every step of the way, Curantis Solutions has created the HOPE Hub—a dedicated resource center designed to guide your team through a seamless transition to HOPE-based documentation. For more HOPE Resources, visit here.

# # #

About Curantis Solutions

Curantis Solutions was born from a desire to put hospice and palliative care first. With a genuine culture of caring, our team is dedicated to creating a refreshingly simple software experience that utilizes emerging technology, smart design and a cloud-native/serverless architecture to create an experience that is congruent with the technology you utilize in your everyday life. It’s time for hospice and palliative care software to make life easier vs creating arduous workarounds and added frustration. It’s time you experience Curantis Solutions!

Patients’ Right to Freedom of Choice

Admin

by Elizabeth E. Hogue, Esq. | Jul 24, 2025 | Admin, CMS, Home Health, Hospice, Medicaid, Medicare, Regulatory

by Elizabeth E. Hogue, Esq.

Patient's Right to Freedom of Choice of Providers

U.S. Supreme Court Weighs In

Patient’s rights to freedom of choice of providers who will render care to them is currently based on four key sources:

Court decisions that establish the right of all patients, regardless of payor source and the setting in which services are rendered, to control treatment, including who provides it
Federal statutes for both the Medicare and Medicaid Programs that establish the right of patients whose care is paid for by these programs to choose providers to render care – Specifically, Section 1802 (42 U.S. C. 1395a) states as follows: “(a) Basic freedom of choice.- Any individual entitled to insurance benefits under this title may obtain health services from any institution, agency, or person qualified to participate under this title if such institution, agency or person undertakes to provide him such services.”
The Balanced Budget Act of 1997 (BBA), which currently requires hospitals to provide a list of home health agencies and hospices to patients. According to the BBA, the list must meet the following criteria: (a) Providers that render services in the geographic area in which patients reside, are Medicare-certified, and request to be included must appear on the list given to patients. (b) If hospitals have a financial interest in any provider that appears on the list, this interest must be disclosed on the list.
Conditions of Participation (COP’s) of the Medicare Program that are the same as the provisions of the BBA described above

Supreme Court Decision

The U.S Supreme Court has now issued a decision about the federal statute for the Medicaid Program described above in Medina v. Planned Parenthood South Atlantic, et al. [No, 23-1276 (June 26, 2025)]. This case involves the any-qualified-provider provision in the statute above that requires states to ensure that any individual eligible for medical assistance may obtain it from any provider qualified to perform the service who undertakes to provide it. The question is whether individual Medicaid beneficiaries may sue state officials under the above statute for failing to comply with the any-qualified-provider provision.

Exclusions on "any-qualified-provider" provision

The State of South Carolina excluded Planned Parenthood from the Medicaid Program. An enrollee in the Medicaid Program sued the State based on the above statute because she said that she wanted to receive Medicaid services from Planned Parenthood.

Federal enforcement; not private

The Court said that spending power statutes, such as Medicaid Programs, are especially unlikely to create the right for individuals to sue the states. The typical remedy for state noncompliance is federal funding termination. Private enforcement, such as suits by individuals, requires states to voluntarily and knowingly consent to private suits based on clear and unambiguous alerts from Congress to the states that private enforcement is a funding condition.

The Court concluded that the above statute does not permit individuals to sue the States for violation of their right to freedom of choice of providers.

# # #

Elizabeth Hogue is an attorney in private practice with extensive experience in health care. She represents clients across the U.S., including professional associations, managed care providers, hospitals, long-term care facilities, home health agencies, durable medical equipment companies, and hospices.

No portion of this material may be reproduced in any form without the advance written permission of the author.

Paul Joiner: On the Record

Admin

by Kristin Rowan | 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?

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 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

Implementing QHINs Interoperability Part 4

Admin

by Rowan Report | Jul 18, 2025 | Admin, Interoperability, Regulatory

by Ben Rosen, Sr. Client Success Manager, Netsmart

Interoperability

What You Need to Know About Interoperability and How it Affects You: Part 4

For over two decades, tech companies and government agencies have been moving toward the goal of interoperability in healthcare technology. At long last, standards and protocols are in place—and continually being improved—to support open data exchange networks. As a result, healthcare providers, including human services, post-acute providers and specialty practices, have more opportunities to participate in alternative payment models and adapt more readily to the evolving payment landscape.

This is part four of a four-part series covering the forces that are driving interoperability, as well as the future vision of open networks, and what it all could mean to your organization. Read Part One Here; Read Part Two Here; Read Part Three Here.

Interoperability in Healthcare

QHIN Implementation, Use Cases, and Benefits

Qualified Health Information Networks (QHIN) can support a range of use cases, including treatment, payment, healthcare operations, public health reporting and patient access to their records. These are referred to as Exchange Purposes (XPs), and all QHINs must facilitate a request for this data. The difference lies with how QHINs facilitate those requests and provide that information to you as a participant. The data uses the same network that all QHINs have built too, but there is value in what your current technology vendor can do with the data.

Complete Information Supports Decision-Making and Compliance

By enabling data exchange, QHINs help ensure providers have access to complete, up-to-date information that has the potential to improve decision-making and reduce redundant tests. The Trusted Exchange Framework and Common Agreement™ (TEFCA) network also supports the exchange of more robust types of data than before, offering participants more holistic views of individuals to support a whole-person care approach.

A QHIN can help your organization stay compliant with interoperability mandates designed to align technology with regulatory requirements, such as the 21st Century Cures Act and TEFCA. As the data exchange landscape shifts toward a more regulatory-based landscape with TEFCA at the core, remaining in compliance with certification requirements becomes increasingly important.

Complete Information Interoperability QHIN

Preparing for TEFCA and QHIN Participation

As outlined in Part 3 of this blog series, getting the most out of joining a QHIN starts with assessing your current interoperability capabilities:

Identify gaps in your data exchange processes and data needs
Collaborate with your EHR vendor to ensure technical readiness and ensure they can accommodate the QHIN data to be used with your EHR
Explore QHIN options and compare their offerings for your current EHR features and functionality
Understand and create a plan for your organization to use or increase the use of FHIR-based integrations

Once you’ve determined which QHIN will work best for your organization, you can begin nailing down specifics and start planning implementation.

Costs, Implementation and Onboarding

Costs vary by QHIN vendor and may include membership fees, transaction fees and additional charges for optional services.

Onboarding typically includes:

Technical integration into your EHR
Staff training
Testing and validation of data exchange
Establishing compliance with TEFCA requirements/signing agreements to participate

Joining the TEFCA network is built into some existing integration processes and capabilities. There are legal agreements specific to TEFCA to sign, but all technical implementations are much easier to facilitate as an already existing EHR client, assimilating into already existing workflows.

Security and Privacy

QHINs are required to meet strict security and privacy standards under TEFCA, including compliance with HIPAA and other relevant regulations. All QHINs are HITRUST-certified and ensure robust security backing for all network transactions and therefore must have incident response and mitigation procedures in place in case of a security incident. It’s important to understand the full enterprise security plan for the QHIN you decide to use and how they protect all of their solutions/programs, not just QHIN.

It’s important to understand the full enterprise security plan for the QHIN you choose and how they protect all their solutions/programs, not just QHIN. Choose a partner with a robust history as an ONC-certified EHR vendor so your data is protected in all facets of exchange. Verify enterprise-wide security procedures and incident response plans.

Regulatory Benefits and Use Cases

By selecting a QHIN and participating in a nationwide interoperability framework, your organization can stay ahead of regulatory changes, improve patient outcomes and reduce the administrative burden of managing multiple data exchange partners. With the changing regulatory landscape, including the HTI-1 and HTI-2 rules, all ONC-certified vendors must abide by those parameters. TEFCA is taking a more central role in helping to prep organizations and users to be compliant with those regulatory standards. For this reason, QHINs with a rich history of ONC certification and who have regulatory staff will have an advantage.

Exchange Purposes

Under TEFCA, QHINs will facilitate the exchange of multiple types of data, referred to as Exchange Purposes (XPs). Initially, there were six core XPs that were revealed for TEFCA:

Treatment –To support the provision, coordination or management of healthcare among providers
Payment–For activities related to billing, claims and reimbursement under HIPAA
Healthcare Operations–For administrative, quality improvement and other operational functions
Public Health–To support public health authorities in disease surveillance, reporting and response
Government Benefits Determination – To help determine eligibility for government programs, such as Medicaid
Individual Access Services – To empower individuals to access their own health data securely and conveniently

These XPs have now been expanded to include subtypes that can be read about here, via the RCE approved resource and SOP. As mentioned previously, all QHINs will be required to support the exchange of these XP’s, and all participants of QHINs will be required to respond to Treatment and Individual Access Services. An important deciding factor when choosing a QHIN is to understand the workflows to receive this information into your EHR, as well as the capabilities to persist and action the information.

# # #

Ben Rosen is a senior client success manager and business unit owner for the interoperability solution suite at Netsmart. With more than a decade of healthcare experience, Ben has led numerous initiatives to integrate healthcare systems and enhance data sharing across the care continuum. His dedication to advancing healthcare interoperability drives his active involvement in industry initiatives and standards organizations, where he provides insight for frameworks such as HL7 FHIR, USCDI and others. Ben holds a Bachelor of Science in kinesiology from Kansas State University and a Bachelor of Science in nursing degree from the University of Nebraska Medical Center.

©2025 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in the Netsmart blog and is reprinted here with permission. For more information or to request permission to print, please contact Netsmart.

Bill to Strengthen Hospice

Admin

by Rowan Report | Jul 18, 2025 | Admin, Hospice, Regulatory

From the office of Earl L. “Buddy” Carter (R-GA)

Carter, Bera introduce Bill to Strengthen Palliative and Hospice Care Workforce

Reps. Earl L. “Buddy” Carter (R-GA) and Ami Bera, M.D. (D-CA) today introduced the Palliative Care and Hospice Education and Training Act (PCHETA), bipartisan legislation to invest in training, education, and research for the palliative care and hospice workforce, allowing more practitioners to enter these in-demand fields.

Palliative and hospice care focus on providing comfort and quality of life improvements for those seriously ill, extending quality of life and reducing the length of hospital stays for many patients.

Earl L. "Buddy" Carter

“Caring for someone living with serious illness or at the end of their life is one of the most compassionate, selfless things one can do, and we must ensure that these heroes have the assistance, training, education, and tools available to provide the highest quality care possible. As a pharmacist, I understand the toll burnout takes on the health care industry, and I am committed to bolstering the workforce so nurses, doctors, and all health care workers can continue to pursue their passion for helping others.”

Earl L. "Buddy" Carter

(R-GA), U.S. House of Representatives

Ami Bera, M.D.

“As a doctor, I know how important it is to provide patients with comfort, clarity, and support when they’re facing serious illness,” said Rep. Bera. “The Palliative Care and Hospice Education and Training Act is a smart, bipartisan step to ensure more health care professionals are trained to deliver this kind of care. By expanding training programs and strengthening our health care workforce, we will make sure that patients and families have access to the care they need to manage pain, make informed decisions, and live with dignity.”

Workforce Shortage

In 2001, just 7% of U.S. hospitals with more than 50 beds had a palliative care program, compared with 72% in 2019. Those working in the field, 40% of whom are 56 years of age or older, report high rates of burnout, in response to the increasing number of patients requiring treatment.

Reps. Carter and Bera’s bill, which has a Senate companion led by Senators Baldwin and Capito, alleviates these strains through workforce training, education and awareness, and enhanced research.

Widespread Support

“As we face a critical shortage of health professionals with expert knowledge and skills in palliative care, AAHPM applauds Representatives Carter and Bera for their leadership in introducing the Palliative Care and Hospice Education and Training Act to ensure all patients facing serious illness or at the end of life can receive high-quality care. We urge Congress to recognize the importance of a well-trained, interprofessional healthcare team to providing coordinated, person-centered serious illness care and to act now to build a healthcare workforce more closely aligned with America’s evolving healthcare needs. Advancing PCHETA will go a long way towards improving quality of care and quality of life for our nation’s sickest and most vulnerable patients, along with their families and caregivers.”

Kristina Newport, MD FAAHPM, HMDC

Chief Medical Officer, American Academy of Hospice and Palliative Medicine

“Palliative care treats the whole person, not just the disease. Ensuring health care providers can be trained in this specialized, coordinated form of care and providing funding for robust public education through the Palliative Care Education and Training Act can help increase access to palliative care for cancer patients and make their cancer journey less difficult. We commend Reps. Carter and Bera for their leadership and steadfast commitment to palliative care and to improving quality of life for patients, including those impacted by cancer.”

Lisa A. Lacasse

President, American Cancer Society Cancer Action Network

“Every person living with serious illness or facing the end of life deserves compassionate, expert care that honors their choices and helps them live comfortably on their own terms. The Alliance celebrates Representatives Carter and Bera’s leadership in introducing the Palliative Care and Hospice Education and Training Act, which will ensure families have access to the trained professionals they need during life’s most difficult moments. As our population ages, this critical investment in education and training will help us meet the growing demand for quality palliative and hospice care

Dr. Steve Landers

CEO, National Alliance for Care at Home

Supporting Organizations

Alzheimer’s Association, Alzheimer’s Disease Resource Center, Alzheimer’s Impact Movement, American Academy of Hospice and Palliative Medicine, American Academy of Pediatrics, American Academy of Physician Associates, American Cancer Society Cancer Action Network, American College of Surgeons, American Geriatrics Society, American Heart Association, American Psychological Association, American Psychosocial Oncology Society, The American Society of Pediatric Hematology/Oncology, Association for Clinical Oncology, Association of Oncology Social Work, Association of Pediatric Hematology/ Oncology Nurses, Association of Professional Chaplains, The California State University Shiley Haynes Institute for Palliative Care, Cambia Health Solutions, Cancer Support Community, CaringKind, Catholic Health Association of the United States, Center to Advance Palliative Care, Children’s National Health System, Coalition for Compassionate Care of California, Colorectal Cancer Alliance, Courageous Parents Network, The George Washington Institute for Spirituality and Health, GO2 for Lung Cancer, The HAP Foundation, HealthCare Chaplaincy Network, Hospice and Palliative Nurses Association, LEAD Coalition, LeadingAge, The Leukemia & Lymphoma Society, Motion Picture & Television Fund, National Alliance for Care at Home, National Alliance for Caregiving, National Brain Tumor Society, National Coalition for Cancer Survivorship, National Coalition for Hospice and Palliative Care, National Comprehensive Cancer Network, National Marrow Donor Program, National Palliative Care Research Center, National Partnership for Healthcare and Hospice Innovation, National Patient Advocate Foundation, National POLST Paradigm, Oncology Nursing Society, Pediatric Palliative Care Coalition, PAs in Hospice and Palliative Medicine, Prevent Cancer Foundation, Second Wind Dreams, Social Work Hospice & Palliative Care Network, Society of Pain and Palliative Care Pharmacists, St. Baldrick’s Foundation, Supportive Care Matters, Susan G. Komen, Trinity Health, West Health Institute, The Alliance for the Advancement of End-of-Life Care, Alzheimer’s Los Angeles, Alzheimer’s Orange County, Arizona Association for Home Care, Arizona Hospice & Palliative Care Organization, Association for Home & Hospice Care of North Carolina, California Association for Health Services at Home, The Center for Optimal Aging at Marymount University, Children’s Hospice and Palliative Care Coalition, Delaware Association for Home & Community Care, Florida Hospice & Palliative Care Association, Georgia Association for Home Health Agencies, Georgia Hospice and Palliative Care Organization, Granite State Home Health & Hospice Association (NH), Healthcare Association of Hawaii, Home Care Association of Florida, Home Care Association of NYS, Home Care Association of Washington, Home Care and Hospice Association of Colorado, Homecare and Hospice Association of Utah, Hospice and Palliative Care Association of Iowa, Hospice and Palliative Care Association of New York, Hospice Care and Kentucky Home Care Association, Hospice Council of West Virginia, Hospice & Palliative Care Federation of Massachusetts, Idaho Health Care Association, Illinois Hospice and Palliative Care Organization, Indiana Association for Home, Kokua Mau, LeadingAge California, LeadingAge Georgia, LeadingAge New Jersey/Delaware, LeadingAge Ohio, LifeCircle-South Dakota’s Hospice and Palliative Care Network, Louisiana Mississippi Hospice and Palliative Care Organization, Maryland-National Capital Homecare Association, Michigan HomeCare and Hospice Association, Minnesota Network of Hospice and Palliative Care, Missouri Alliance for Home Care, Missouri Hospice & Palliative Care Association, Nebraska Association for Home Healthcare and Hospice, Nebraska Home Care Association, Ohio Council for Home Care & Hospice, Ohio Health Care Association, Oklahoma Association for Home Care and Hospice, South Carolina Home Care & Hospice Association, The Oregon Hospice & Palliative Care Association, Texas Association for Home Care & Hospice, Texas ~ New Mexico Hospice and Palliative Care Organization, Virginia Association for Home Care and Hospice, VNAs of Vermont, The Washington State Hospice and Palliative Care Organization, and West Virginia Council for Home Care and Hospice.

Read full bill text here.

# # #

Earl L. “Buddy” Carter is an experienced businessman, health care professional and faithful public servant. For over 32 years Buddy owned Carter’s Pharmacy, Inc. where South Georgians trusted him with their most valuable assets: their health, lives and families. While running his business, he learned how to balance a budget and create jobs. He also saw firsthand the devastating impacts of government overregulation which drives his commitment to ensuring that the federal government creates policies to empower business instead of increasing burdens on America’s job creators.

A committed public servant, Buddy previously served as the Mayor of Pooler, Georgia and in the Georgia General Assembly where he used his business experience to make government more efficient and responsive to the people. Buddy is serving his fifth term in the United States House of Representatives and is a member of the House Energy and Commerce (E&C) Committee and the House Budget Committee. As a pharmacist serving in Congress, Buddy is dedicated to working towards a health care system that provides more choices, less costs and better services.

A lifelong resident of the First District, Buddy was born and raised in Port Wentworth, Georgia and is a proud graduate of Young Harris College and the University of Georgia where he earned his Bachelor of Science in Pharmacy. Buddy married his college sweetheart, Amy. Buddy and Amy have three sons, three daughters-in-law and eight grandchildren.

Congressman Ami Bera, M.D. has represented Sacramento County in the U.S. House of Representatives since 2013. The 6th Congressional District is located just east and north of California’s capitol city, Sacramento, and lies entirely within

Sacramento County.

During Congressman Bera’s twenty-year medical career, he worked to improve the availability, quality, and affordability of healthcare. After graduating from medical school in 1991, he did his residency in internal medicine at California Pacific Medical Center, eventually becoming chief resident. He went on to practice medicine in the Sacramento area, serving in various leadership roles for MedClinic Medical Group. Chief among his contributions was improving the clinical efficiency of the practice. He then served as medical director of care management for Mercy Healthcare, where he developed and implemented a comprehensive care management strategy for the seven-hospital system.

In Congress, Bera uses the skills he learned as a doctor to listen to the people of Sacramento County and put people ahead of politics to move our country forward. His priority is to work alongside people in both parties to address our nation’s most pressing challenges and make government work. Bera believes Congress should be a place for service, not for politicians who only look out to protect their own careers, pay, and perks.

Employee or Independent Contractor

Admin

by Elizabeth E. Hogue, Esq. | Jul 18, 2025 | Admin, Legal

by Elizabeth E. Hogue, Esq.

Employee or Independent Contractor

DOL Won't Enforce Determination Standards

The U.S. Department of Labor (DOL) has announced that it will no longer enforce a rule published in 2024 that have been used to decide whether workers are employees or independent contractors. This means that while the DOL develops new standards it will no longer apply the analysis in the 2024 rule when investigating potential misclassification of workers as independent contractors instead of employees.

This decision is due, in part, to legal challenges to the rule. The classification of workers as either employees or independent contractors has been an important issue for providers of services in patients’/clients’ homes, especially for private duty or homecare providers.

Totality of Circumstances Rule

The rule that the DOL finalized in 2024 focused on the “totality of the circumstances” to determine whether workers were independent contractors or employees under the Fair Labor Standards Act. It considered factors like:

Opportunity for profit or loss based on skill level

Whether workers can:

Negotiate charges for services provided
Accept or decline work
Choose the order or time when services are performed
Engage in marketing or advertising activities
Make decisions about hiring others, purchasing materials and/or renting space

Investment by workers vs employers

Workers’ investments do not need to equal employer investments
Workers’ investments should support an independent business

Department of Labor Independent Contractor vs Employee

Degree of permanence

If work is temporary or project-based, worker is likely a contractor
If work is indefinite or continuous, worker is likely an employee

Nature and degree of control

If the employer has more control, workers are likely employees
Contractors have more control over scheduling
Contractors have less direct supervison
Contractors can work for multiple employers

Degree to which role is essential

Integral roles are filled by employees
These roles are critical, necessary, or central to employer’s principal business
Integral roles often manage other employees

Skill and Initiative

General skill and labor positions are usually filled by employees
The more specialized the skills, the more likely the worker can be an independent contractor

Trouble for Employers

This rule certainly made it harder to classify workers as independent contractors and was difficult to apply.

Although the DOL says it will stop enforcement action, providers must be aware that the rule is still in effect. Providers should remain cautious about how workers are classified. Providers must also continue to comply with applicable state and local laws.

Final Thoughts

Classification of employees will continue to be a balancing process. Opinions, especially between business owners and regulators, will undoubtedly continue to differ. In any event, this classification of workers remains an important issue for providers of services in patients’ homes.

# # #

Elizabeth Hogue is an attorney in private practice with extensive experience in health care. She represents clients across the U.S., including professional associations, managed care providers, hospitals, long-term care facilities, home health agencies, durable medical equipment companies, and hospices.

No portion of this material may be reproduced in any form without the advance written permission of the author.

©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

Hospice Hope

Admin

by Rowan Report | Jul 10, 2025 | Admin, CMS, Hospice, Outcomes, Regulatory

by Peggy Rattarree, Principle Product Manager, Curantis Solutions

Hospice HOPE

The importance of documenting symptom impact for patient-centered care

In hospice care, the focus isn’t just on treating symptoms; it’s on improving the quality of life for patients and their families. This is where Hospice HOPE takes center stage, emphasizing the importance of documenting symptom impact to deliver truly patient-centered care. By understanding how symptoms affect each patient’s physical, emotional, and psychosocial well-being, hospice teams can provide care that aligns with their unique needs and goals.

What is hospice HOPE?

Hospice HOPE stands for Hospice Outcomes and Patient Evaluation. It’s a philosophy that places the patient’s comfort, dignity, and goals at the forefront of care delivery. Documenting symptom impact is a critical part of this approach because it provides a detailed understanding of how symptoms affect the patient’s overall quality of life.

In hospice care, every patient’s journey is unique. By actively tracking and documenting symptom impact, care providers can move beyond generic treatments and embrace a truly individualized approach that prioritizes what matters most to the patient.

Why documenting symptom impact matters?

Moves us to patient-centered care

Documenting symptom impact allows hospice teams to focus on what truly matters to the patient. Instead of simply addressing symptoms like pain, nausea, or fatigue in isolation, it provides a holistic view of how these symptoms affect the patient’s daily life. For example:

Pain
- How does it limit mobility or the ability to participate in meaningful activities?
Fatigue
- Is it preventing patients from spending time with loved ones?
Nausea
- Is it reducing their ability to eat or enjoy meals?

By asking these questions and recording the answers, hospice providers can better tailor interventions to manage not just symptom management but the overall patient experience.

Improves communication across the care team

In hospice care, communication is everything. Documenting symptom impact ensures that every member of the interdisciplinary team (IDT), from nurses and physicians to social workers and chaplains, has access to the same comprehensive information.

This documentation:

Creates a shared understanding of the patient’s condition
Helps align the team’s goals with the patient’s priorities
Reduces duplication of efforts and enhances care coordination

When everyone is on the same page, patients and families receive more seamless, cohesive care.

Supports compliance and quality standards

Regulatory bodies like CMS (Centers for Medicare & Medicaid Services) require hospices to document and monitor patient symptoms to ensure care quality. But beyond compliance, tracking symptom impact demonstrates a commitment to continuous improvement.

Documenting symptom impact allows hospices to:

Identify trends and gaps in care
Measure the effectiveness of interventions
Use data to advocate for better resources or innovations in care delivery

Empowers families and caregivers

When symptom impact is documented, families and caregivers gain a clearer understanding of their loved one’s condition. This transparency fosters trust and collaboration between the hospice team and the family, ensuring everyone is working toward the same goals.

For example, a caregiver might better understand why a loved one sleeps more during the day or avoids certain foods. These insights can help families feel more prepared and supported during a challenging time.

Final Thoughts

With CMS rolling out Hospice HOPE, documenting symptom impact is no longer optional. It’s the standard for compassionate, high-quality care. This shift helps hospice organizations go beyond symptom control and into whole-person care that honors each patient’s life journey.

This is part one in a two-part series on Hospice HOPE. Check back next week for part two.

# # #

Peggy Rattarree Curantis Solutions Hospice HOPE

Peggy is an IT professional with over 30 years’ experience. She has defined and developed software products in industries such as grocery management, financial services, and reporting and analytics. In her 2.5 years with Curantis, Peggy has helped to shape the definition and delivery of the application. She brings a passion for agility and has been integral in transitioning Curantis to an environment of delivery on cadence, release on demand.

Peggy has a Bachelor of Music degree from University of North Texas.

©2025 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in the Curantis Solutions blog and is reprinted here with permission. For more information or to request permission to print, please contact Curantis Solutions.

Bill Cuts Medicaid Directly, Medicare Indirectly

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by Tim Rowan | Jul 2, 2025 | Admin, Legal, Medicaid, Medicare, Regulatory

by Tim Rowan, Editor Emeritus

Bill Cuts Medicaid Directly, Medicare Indirectly

This is what online publishers call a “living article.” With the House and Senate passing different bills, progress toward the President’s desk changes by the hour. What follows is everything we knew to be true on Tuesday evening, July 1. However, this bill will impact Home Health, Home Care, and Hospice. To keep readers informed, we will continuously update this article as need through the weekend. We will not send our usual emails to subscribers with every update, so we urge you to return here from time to time for updates to this breaking news item. We will add the date and time to each update.

July 3: Bill Passes, The Alliance Responds

Nearly as soon as House Republicans began their celebration, Alliance President Dr. Steve Landers issued a response from the National Alliance for Care at Home. We reprinted the complete statement from The Alliance here.

“As these Medicaid provisions become law, the Alliance will work tirelessly to monitor their implementation and advocate for the protection of Medicaid enrollees, families, and providers nationwide. We will continue to champion the delivery of HCBS – proven services that are preferred by beneficiaries and save the system money.”

Dr. Steve Landers

CEO, The National Alliance for Care at Home

Final House Vote: July 3

In spite of a couple of Republican holdouts, H.R. 1 passed the House on a 2018-2014 vote on Thursday afternoon. All of the Senate’s changes were approved, meaning the bill does not have to go back to Senate for re-approval. Now begin final assessments of the impact on Medicaid and SNAP. Changes made in the Senate, approved by the House, increased the size of spending cuts for those two programs. As analysts inside and away from our home care community weigh in, we will post them here.

As of the end of the day, July 1

It appears as though the stalemate, if there is to be one, will center around Medicaid and SNAP cuts. There are some House Republicans who are upset that the Senate increased their H.R. 1 proposed cuts to nearly $1 Trillion. Contrarily, other House Republicans threaten to vote no because cuts are not deep enough. They point to the predicted $3.3 trillion addition to the national debt over ten years. As of the evening of July 1, the House Rules Committee continues the debate. We will update this page as often as possible for you.

As of the morning of July 1

Early Tuesday morning, the Senate passed its version of Donald Trump’s bill. Among its changes are increased cuts to Medicaid. The Congressional Budget Office calculated that the House version would have resulted in $700 billion in spending reductions. It would also have removed health insurance from 10.9 million people over 10 years. The version the Senate sent back to the House Tuesday, according to the CBO, increases those cuts to $930 billion and 11.8 million people.

June 29th

The Senate reconciliation bill would cut gross federal Medicaid and Children’s Health Insurance Program (CHIP) spending by $1.02 trillion over the next ten years. These cuts are $156.1 billion (18%) larger than even the House-passed bill’s draconian cuts of $863.4 billion over ten years.

These larger gross Medicaid and CHIP cuts are driven by changes to the House-passed bill that would:
- further restrict state use of provider taxes to finance Medicaid
- eliminate eligibility for many lawfully present immigrants
- cut federal funding for payments to hospitals furnishing emergency Medicaid services
- further reduce certain supplemental payments to hospitals and other providers (known as state-directed payments)
The spending effect of these additional cuts is modestly offset by increased Medicaid and CHIP spending from provisions not in the House-passed bill
- a rural health transformation program
- increased federal Medicaid funding for Alaska and Hawaii (Already ruled out by the parliamentarian)
- expanded waiver authority for home- and community-based services
Overall, the Senate Republican reconciliation bill’s Medicaid, CHIP, Affordable Care Act marketplace, and Medicare provisions would increase the number of uninsured by 11.8 million in 2034, relative to current law
- In comparison, the House-passed bill would increase the number of uninsured by 10.9 million in 2034.
- More detailed CBO estimates of the specific Medicaid health coverage effects under the Senate Republican reconciliation bill are not yet available
- CBO estimates the House-passed bill’s Medicaid and CHIP provisions would cut Medicaid enrollment by 10.5 million by 2034 and by themselves, increase the number of uninsured by 7.8 million by 2034

How the Senate Pushed the Bill Through

Majority leader Thune could only afford to lose three Republican votes. With GOP Senators Thom Tillis (N.C.), Rand Paul (Ky.) and Susan Collins (Maine) voting against the measure, along with every Democrat, centrist Lisa Murkowski of Alaska became the sole target of Republican pressure. The tactic used to get the vote close enough for VP Vance to cast the deciding vote is disturbing.

First, leadership wrote an amendment that would have exempted Alaska from Medicaid and SNAP cuts. The parliamentarian killed that idea, saying it violated the Senate’s “Byrd Rule.” Next, marathon negotiations brought Murkowski and Parliamentarian MacDonough together to appease both. The compromise became exceptions to Medicaid and SNAP cuts that had less of an appearance of a bribe. They devised a formula that delayed cuts to states with a history of high error rates in calculating who is entitled to benefits. The CBO said that would cover as many as 10 states. The parliamentarian decided this did not violate Senate rules because it did not specifically benefit one state. They also increased the federal subsidy for rural hospitals that will be harmed by the bill from $25 billion to $50 billion.

In agreeing to vote ‘yes,’ Murkowski essentially declared that she knows the cuts will be bad for most states but will be good for her state. With the Alaska Senator’s vote secured, the final count was 50-50, leaving the final decision up to the vice president.

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Tim Rowan is a 30-year home care technology consultant who co-founded and served as Editor and principal writer of this publication for 25 years. He continues to occasionally contribute news and analysis articles under The Rowan Report’s new ownership. He also continues to work part-time as a Home Care recruiting and retention consultant. More information: RowanResources.com
Tim@RowanResources.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

HIPAA Compliance Voice Activation

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by Rowan Report | Jun 27, 2025 | Admin, Artificial Intelligence, Regulatory

by Curantis Solutions

HIPAA Compliance for Voice Activated Technology

HIPAA (Health Insurance Portability and Accountability Act) compliance is critical in the healthcare field, particularly regarding any technology that handles patient information, including HIPAA-compliant voice technology. Understanding the implications of HIPAA is essential for ensuring that innovations in healthcare technology do not compromise patient data privacy regulations.

Patient Privacy Protection

HIPAA enforces strict privacy protections for all patient data, including voice recordings and summaries. Voice recognition technology in healthcare must ensure that data is only accessible to authorized personnel. Any voice-activated system must adhere to HIPAA security measures for handling Protected Health Information (PHI).

Data Security Requirements

Voice-activated systems must implement safeguards to protect patient information from unauthorized access and breaches. This includes both physical and electronic security measures, such as:

Encryption
- Data should be encrypted both in transit and at rest to prevent unauthorized access.
Access Controls
- Systems must restrict access to only those who need to know, using multi-factor authentication and role-based permissions.
Audit Trails
- Voice-activated technologies should log all access activity, tracking who accessed data, when, and what specific information was retrieved.

HIPAA Training Requirements for Voice-Activated Systems

HIPAA emphasizes the need for staff training and awareness regarding handling PHI in voice-recognition software. Training programs should cover:

Best Practices
- Staff should be instructed on correct voice command usage to minimize accidental PHI disclosures in public or unsecured environments.
Identifying PHI
- Employees should learn to recognize and protect sensitive patient data when interacting with voice-activated systems.

Data Minimization Principles

Under HIPAA, organizations should limit data collection to only what is necessary for specific tasks. This includes:

Minimal Data Handling
- Only essential PHI should be processed and stored.
Anonymization Processes
- Voice-activated systems should anonymize data when full patient identification is unnecessary, reducing security risks.

Incident Response Protocol

In the event of a data breach involving voice-activated patient summaries, organizations must follow HIPAA-compliant response steps:

Incident Reporting
- Immediate breach investigation and reporting per HIPAA timelines.
Notification Requirements
- Patients must be notified if their PHI has been compromised, along with steps taken to mitigate risks.

Summary

HIPAA compliance directly impacts how voice-activated patient summaries are implemented in healthcare. Ensuring compliance requires:

Robust data security measures
Thorough staff training
Strict vendor agreements
Comprehensive privacy protections

By aligning voice-activated patient summaries with HIPAA regulations, healthcare organizations can enhance patient care, safeguard sensitive information, and build trust with patients and families.

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About Curantis Solutions

Curantis Solutions was founded on a desire to put hospice and palliative care first. We are dedicated to radically transforming standard electronic health records into a refreshingly simple and intuitive experience so that providers can keep their focus where it matters most – on the patients and families they serve.

With a genuine culture of caring, we have assembled a team of highly talented individuals who are passion-driven and feel connected to their role in supporting the bigger mission of enabling high-quality end-of-life care. From forward-thinking technologists to hospice and palliative care experts, and every role in between, our team works with great integrity, accountability and responsiveness to bridge the latest technology with smart design to keep patient care at the center of what we do.