HHAeXchange Features Bradley Cooper Documentary

Advocacy

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.

# # #

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

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

©2025 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Alliance to Congress: STOP CUTS

Advocacy

by Kristin Rowan | Oct 30, 2025 | Advocacy, CMS, Home Health, Medicare

by Kristin Rowan, Editor

9% Cut Proposed

CMS proposed home health rule for 2026 includes disastrous cuts. A 3.2% market basket increase, a 0.8% productivity cut, a 5% reduction to recoup prior overpayments, and a 4.1% permanent reduction to prevent further overpayments. CMS proposed an additional 0.5% cut to account for high-risk outliers. In other words, CMS wants to pay less for all patients to make up for the small percentage of patients who need more care.

Deadline Looming

The mandatory comment period ended on August 29. Next, CMS reviews the submitted comments, responds to those comments (generally explaining why they are not going to listen), and then finalizes the 2026 rule. The final rule is due November 1, 2025. Although, that falls on a Saturday, so the deadline may extend to Monday. A good many of us will be in New Orleans for the Alliance annual conference and expo by then.

Group Effort

The National Alliance for Care at Home (Alliance) joined 150+ provider, patient, community, and advocacy groups to write a letter to Congress urging them to prevent the CMS proposed cut.

“The proposed payment reductions for home health pose a serious threat to the health and safety of Medicare beneficiaries and to the broader integrity of our healthcare system. With the 2026 payment rule under review and due by November 1, we urge you to promptly intervene and press CMS to stop the cuts and realign payments.”

Pattern of Payment Reduction

The letter, addressed to Senate Majority Leader John Thune, Senate Minority Leader Chuck Schumer, Speaker Mike Johnson, and House Minority Leader Hakeem Jeffries, asks Congress to look at the consecutive years of pay reductions and how they have impacted home health. Because of the cuts, agencies have gone out of business or downsized, leaving rural areas without care.

Home Health Costs Less

The letter also explains that cutting medicare payments actually costs more. When more patients have access to home health, CMS spends less on unplanned hospital visits and ER trips. Patients have fewer falls and accidents. Risk factors are identified earlier and preventative treatments are used before a patient’s condition requires hospitalization. Home health patients stay home years longer than those not receiving home health before entering a skilled nursing or assisted living facility.

What's at Risk

The Medicare Trust Fund, funded partially by payroll taxes, includes hospital insurance that pays for hospital (Medicare Part A) services. When these costs increase, the trust fund is at risk being insolvent and taxes are increased to put money back into the fund. Lowering home health payment rates and cutting off millions of people who depend on home health will impact tax payers as well.

“The cuts currently proposed to Medicare’s home health benefit are unsustainable and would be deeply harmful to those who depend on care at home. The Alliance will continue to work with policymakers and our stakeholder allies to oppose these harmful cuts and protect access to home health services for millions of older adults, individuals with disabilities, and their families.”

Dr. Steve Landers

CEO, National Alliance for Care at Home

The Alliance issued a press release with the highlights from the letter. You can read the full letter here.

# # #

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

Bill Dombi Presents

Advocacy

by Kristin Rowan | Sep 18, 2025 | Advocacy, Home Health, Hospice, Medicaid, Medicare, Medicare Advantage, Regulatory

by Kristin Rowan, Editor

Bill Dombi Presents...

It has become almost customary for the President/CEO of The Alliance, and previously NAHC, to give the keynote address at state association and software user group meetings. The 2025 Kantime event, Passport to Success, was no exception. Dr. Steve Landers was scheduled to speak first thing Tuesday morning. But, Dr. Landers is in D.C. speaking to members of Congress and CMS for Advocacy Week, trying to convince anyone who will listen of the needed changes in Care at Home.

When Kantime asked Bill Dombi, former President of NAHC, to take Landers’s place, they asked him not to give his customary “vanilla” talk about the state of the industry. According to Dombi, Kantime gave him a bit of a license to step outside the traditional industry address. He took that license and ran with it, regaling the audience with stories of his school days, being educated (and tortured) by KCatholic nuns in full habits, his road to both the law and care at home, and his thoughts on the future of the industry.

“I shouldn’t be here. I’m retired! I should have no shoes in, wearing shorts, or maybe still sleeping, waking up just in time to catch Let’s Make a Deal or the Price is Right, have lunch, take a nap, and then watch a movie or mow my lawn. I had retirement dreams of lounging on a two-person hammock by the beach. My hammock is in the basement. And the guitar I bought myself as a retirelment present, with dreams of coming back here with my band, remains unopened in my living room. It has never been out of its case.”

Bill Dombi

President Emeritus, National Alliance for Care at Home

“But, one of my jobs is to make my successor a success. So, here I am.”

This led Bill to his first topic, Passion: Powering Health Care at Home. He invited the audience to think not of his story, but of their own what lead to their passion for care at home. If you’ve ever heard Bill Dombi speak about care at home and his wish to in his lifetime see the industry become what he has advocated for and imagined for more than 50 years, then you know how spirited and passionate he is. He has fought against injustice since the 6th grade and fought for radical improvement in care at home since college.

Bill spoke openly about the fraud, waste, and abuse that has plagued home health and hospice since before most of us knew what home care was. He lamented the continued need for advocacy at both state and federal levels with each new administration, bill, and MedPAC recommendation since before the Reagan era. He recalled the advent of Medicare and Medicaid when care at home was limited and underused. And he warned of the disasterous idea of rolling Hospice care into Medicare Advantage. In true “Bill Dombi style,” he managed to do all of this in a way that left an air of hope in the room rather than doom.

What's in Store for Care at Home?

Bill talked about the progress his successor has made, including his current work on The Hill for Advocacy week. According to Bill, the advocacy focus for the National Alliance for Care at Home is:

PDGM
Hospice Carve-in
HCBS OBBA Risks
HCBS 80/20 rule
Medicare Advantage
Workforce Improvement

Final Thoughts - Dombi's Care at Home Forecast

The scope of Health care at home will continue to expand. There will continue to be technology and artificial intelligence advances in care at home. The provide design and delivery of care model will evolve. Consolidation and competition are definitely in play. And the workforce is a common denominator for success.

# # #

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

Advocacy Week

Advocacy

by Rowan Report | Sep 18, 2025 | Advocacy, Home Health, Hospice, Medicaid, Medicare, Medicare Advantage, Regulatory

Advocacy Week

FOR IMMEDIATE RELEASE

Contact: Elyssa Katz
communications@allianceforcareathome.org
571-281-0220

Over 240 Advocates Rally in DC for the Future of Care at Home

National Alliance for Care at Home Hosts Inaugural Advocacy Week on Capitol Hill

Alexandria, VA and Washington, D.C., September 12, 2025.

More than 240 care at home care advocates from across the country met with over 275 congressional offices this week to discuss key legislative and regulatory priorities for expanding access to home-based care services. The meetings were part of the 2025 National Alliance for Care at Home’s inaugural Advocacy Week.

Alliance Advocacy Week brings together leaders, advocates, and supporters to unite as one voice for care at home, driving positive legislative change and shaping the future of care to ensure broader access to the life-changing home care services for all Americans.

Advocates focused on four key issues during their congressional meetings:

Protecting home health care by preventing dangerous payment cuts
Safeguarding the Medicare Hospice Benefit by ensuring hospice remains a separate holistic managed care model outside of Medicare Advantage
Expanding telehealth access across many care at home services
Supporting robust Medicaid HCBS funding to strengthen community-based care

Advocacy Week National Alliance for Care at Home

In addition to Wednesday’s congressional meetings, Alliance Advocacy Week featured strategy sessions, beginner advocate training featuring a panel discussion with Congressional staffers, and in-depth policy briefings. On Thursday, the Alliance’s Assembly of State Associations – a network of leaders of state home care and hospice organizations – came together for a robust conversation.

The Alliance celebrates the achievements of this inaugural Advocacy Week on behalf of home-based care providers nationwide and will continue engaging in critical policy dialogue to support and expand access to essential care at home services.

# # #

About the National Alliance for Care at Home

The National Alliance for Care at Home (the Alliance) is the leading authority in transforming care in the home. As an inclusive thought leader, advocate, educator, and convener, we serve as the unifying voice for providers and recipients of home care, home health, hospice, palliative care, and Medicaid home and community-based services throughout all stages of life. Learn more at www.AllianceForCareAtHome.org.

©2025. This press release originally appeared on the National Alliance for Care at Home website and is reprinted here with permission. For questions or to request permission to use, please see press contact information above.

Overtime Changes

Advocacy

by Kristin Rowan | Sep 4, 2025 | Advocacy, Regulatory

by Kristin Rowan, Editor

Overtime Changes

FLSA exemption to resume

In 1938, the Fair Labor Standards Act (FLSA) established a federal minimum wage, guaranteed overtime, and kept children out of the workforce. Exemptions to FLSA include executive, administrative, professional, computer employee, and outside sales positions. Employers did not pay minimum wage for retail workers, service workers, agricultural workers, or construction workers.

Domestic workers included

An amendment to FLSA in 1974 added domestic workers to those who must receive minimum wage and overtime. The amendment did not include “companionship services” and live-in domestic service employees. A later amendment from 2013 narrowed the definition of “companionship services.” This eliminated the exemptions for workers who provided “care.” Companions could still be exempted from overtime. This stopped home care agencies from claiming exemptions and required overtime pay for home care workers.

Rolling back the rule

The Department of Labor is considering unraveling the 2013 amendment. There is a concern that they may have misinterpretated the rule. Additionally, requiring overtime for home care workers will increase the cost of care. Supporters of the rule change believe that allowing exemptions for overtime among home care workers would make live-in care more affordable. If the 2013 amendment is removed, employers would not have to guarantee minimum wage or overtime for home care aides.

Industry impact

The DOL argues that this change will make care more affordable and expand access to care at home. However, there is already a workforce shortage in the industry. Lowering pay rates and removing overtime could cause a mass exodus from the industry. As far as we know, DOL did not discuss requiring CMS to increase reimbursements rates or covering non-medical supportive care at home as an alternative.

“Removing basic labor protections from home care workers will only exacerbate the multiple issues buffeting the home care sector, its workers and consumers: serious threats from cuts to federal Medicaid contributions, changing immigration policies and the lack of realistic long-term services and supports (LTSS) options.”

Katie Smith Sloan

President and CEO, LeadingAge

Comments from the industry

The public comments period on this proposed rule change ended on September 2, 2025. The proposed rule received roughly 5,300 comments. Some examples of feedback include:

“…reversing the 2013 protections, the DOL would undermine the wages and economic security of home care workers…exacerbate turnover and workforce shortages…[and] harm older adults and people with disabilities….” – Hand in Hand: The Domestic Employers Network

“This proposed change is a crucial step toward restoring flexibility and affordability in home care services, particularly for families relying on live-in support.” – Owner, Home Helpers Home Care of Larimer County and member of HCAOA and IFA

“…strongly support workforce development and has historically and continues to support thoughtful solutions to our workforce crisis. We strongly support the restoration of the overtime exemption.” – The Virginia Association for Home Care and Hospice and the West Virginia Council for Home Care and Hospice

“Home care workers are also strongly vital for companion care, personal care, home health, nursing, therapy, caring for the disabled and the elderly, and more. The proposed rule that was meant to strip home care workers of wage and overtime protections is absolutely cruel and harmful for home care workers…” – Derek Dinh, CA

“I am not a home care worker, but used a home care worker to take care of my mom when she was unable to do things around the home and then got progressively worse. They need to be paid a living wage and receive overtime. They are professional people who take care of those who need care.” – Wendy Peale, NY

Opposition

Among the people and organizations who have publicly expressed opposition to this change are:
LeadingAge
Autistic Self Advocacy Network
American Civil Liberties Union
Congresswoman Pramila Jayapal
The Commonwealth of Pennsylvania, California, Colorado, Connecticut, District of Columbia, Hawaii, Illinois, Massachusetts, Maryland, Maine, Michigan, Minnesota, Nevada, New Jersey, New York, Oregon, Rhode Island, Vermont, and Washington

Final Rule

The has not issued a final rule. However, neither has the DOL enforced the requirement since July 25, 2025. Home care agencies can currently claim overtime exemptions. There is no set timeline yet for a final decision. We will continue to follow updates on this topic.

# # #

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

Research Institute Joins Alliance

Advocacy

by Rowan Report | Aug 21, 2025 | Advocacy, Home Health, Hospice, M&A, Partner News

FOR IMMEDIATE RELEASE
August 20, 2025

Contact: Elyssa Katz
571-281-0220
communications@allianceforcareathome.org

Research Institute for Home Care and National Alliance for Care at Home Ink Affiliation Agreement

Alexandria, VA and Washington, DC, August 20, 2025 – The Research Institute for Home Care (the Institute) and the National Alliance for Care at Home (the Alliance) have entered into an affiliation agreement to strengthen and expand research efforts while further unifying the care at home movement. The agreement is effective immediately.

Research Institute for Home Care

Since its founding in 2008, originally as the Alliance for Home Health Quality & Innovation, the Institute has invested in research and education about home care and hospice and its ability to deliver quality, cost-effective, patient-centered care, demonstrating the value proposition for patients and the entire U.S. healthcare system. With this affiliation, the Institute will remain an independent research organization, continuing to pursue its mission of funding and promoting research to inform policy and identify best practices and care models that expand access to healthcare in the home. Its vision remains clear: promoting healthy patients and communities through home care research, education, quality, and innovation.

The Institute’s Board of Directors will continue to independently oversee its research agenda and initiatives. The Alliance will provide comprehensive management support for the Institute’s operations. At the launch of the affiliation, Dr. Steve Landers, CEO of the Alliance, will also serve as the President of the Institute. Jennifer Schiller, the former Executive Director of the Institute, has joined the Alliance leadership team and will continue to support Institute initiatives along with other Alliance leaders. Jennifer Sheets, Founder and CEO of Carezzi, will remain the Board Chairman of the Institute.

The enhanced collaboration and amplification opportunities provided by this affiliation elevate and unify the care at home movement. Together, the strengthened Alliance and Institute leadership will continue to invest in and focus on critical home care and hospice industry research and data to inform effective policy, clinical practice, and underscore the value of home-based care.

In Their Own Words

“We are thrilled to announce our affiliation with the Research Institute for Home Care. The Institute’s more than decade-long commitment to rigorous research perfectly complements our mission. This affiliation strengthens our ability to further demonstrate that care at home is the preferred choice for patients and families and the highest-value option for our healthcare system.”

Dr. Steve Landers

CEO, National Alliance for Care at Home

“This is an important milestone for the Institute that will amplify our research impact while preserving our integrity and academic rigor. By joining forces with the Alliance, we ensure that evidence-based findings continue to inform policy and best practices that benefit patients, families, and the entire healthcare system.”

Jennifer Sheets

Chairman of the Board, Research Institute for Home Care

Director Agreement

The decision, reached by both organizations’ independent Boards of Directors, reflects the shared recognition that care at home is at a pivotal juncture. By combining the Alliance’s resources with the Institute’s research expertise, the partnership positions both organizations to influence policy, strengthen clinical practice, and advance innovation in care at home.

“The timing of this affiliation reflects a shared recognition that care at home stands at a critical juncture. By bringing together the Alliance’s resources with the Institute’s research expertise, we are better positioned to navigate today’s complex healthcare landscape and drive meaningful policy change. This partnership represents a strategic investment in the future of home-based care that will benefit providers, patients, and policymakers alike,” said Ken Albert, Board Chair for the Alliance.

# # #

About the National Alliance for Care at Home

The National Alliance for Care at Home (the Alliance) is the leading authority in transforming care in the home. As an inclusive thought leader, advocate, educator, and convener, we serve as the unifying voice for providers and recipients of home care, home health, hospice, palliative care, and Medicaid home and community-based services throughout all stages of life. Learn more at www.AllianceForCareAtHome.org.

About the Research Institute for Home Care

The Research Institute for Home Care (the Institute) is a non-profit, national consortium of home care providers and organizations. The Institute invests in research and education about home care and its ability to deliver quality, cost-effect, patient-centered care across the care continuum. The Institute is committed to conducting and sponsoring research and initiatives that demonstrate and enhance the value proposition that home care has to offer patients and the entire U.S. healthcare system.

Alliance Responds to Hospice Final Rule

Advocacy

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

by Kristin Rowan, Editor

The Alliance Responds to CMS Hospice Final Rule

CMS Issues FY 2026 Hospice Final Rule

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

Rate Setting Changes
- A 3.3% inpatient hospital market basket percentage increase
- A 0.7% productivity adjustment (read decrease)
- Statutory cap increases from $34,465.34 to $35,361.44
Hospice Care Admission
- The physician member of the interdisciplinary group (IDG) may recommend admission to hospice care
Face-to-Face Attestation
- Signature and date requirements restored
- Eliminated requirement for attestation to be a separate and distinct document
- Attestation requirement can be a section or addendum to recert form, or part of a signed and dated clinical note
Hospice Quality Reporting Program

The HOPE tool will replace the HIS tool on October 1, 2025, despite comments to delay implementation
CMS published a HOPE Technical Information webpage ,an HQRP training library, and a Requirements and Best Practices webpage
CMS recognized the error in their HOPE burden calculations. The burden is 21.1% higher than initially reported. The difference will be “taken into consideration” in the next PRA package submission.
The separate reporting tool (QIES) and reports tool (CASPER) will sunset and iQIES will replace both tools.

FY 2026 Hospice Quality Reporting Program

National Alliance for Care at Home Statement

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

Wage Adjustment

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

Regulatory Relief

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

HOPE Tool Implementation

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

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

Dr. Steve Landers

CEO, National Alliance for Care at Home

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

Final Thoughts

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

# # #

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

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

©2025 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Tell CMS not to Kill Home Health

Advocacy

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

by Kristin Rowan, Editor

The Alliance to Care at Home:

CMS needs your comments

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

Proposed Rule

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

The Alliance Call to Action

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

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

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

Provide good reasons for not keeping the proposed rule as is

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

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

Provide an alternative recommendation

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

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

Maintain professionalism and respect

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

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

Mention the Other Side

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

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

Hillary Loeffler

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

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

Illogical Arguments

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

Ad Hominem

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

Slippery Slope

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

Fallacy of Composition

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

Fallacy of Origin

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

CMS needs your comments now

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

# # #

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

“Planning for In-Home Care”

Advocacy

by Rowan Report | Jul 24, 2025 | Advocacy, Home Health, Hospice, Partner News

FOR IMMEDIATE RELEASE

Contact: Elyssa Katz
571-281-0220
communications@allianceforcareathome.org

The Alliance’s CaringInfo Program Launches New “Planning for In-Home Care” Section

Rebrands to Align with Expansion to Serve Full Home-Based Care Continuum

ALEXANDRIA, VA and WASHINGTON, DC – CaringInfo.org, a program of the National Alliance for Care at Home (the Alliance), is expanding its resources with a new website section – “Planning for In-Home Care” – as well as a brand refresh to align with its growing audience. CaringInfo provides free resources to educate and empower patients and caregivers to make informed decisions about home, serious illness, and end-of-life care and services.

CaringInfo

While CaringInfo began with a focus on serious illness and end-of-life care and support, the program’s content is expanding to provide information and resources on the full spectrum of home-based care services. As a first step in this expansion, CaringInfo has launched “Planning for In-Home Care,” a new section on the website focused on the various types of care available at home.

Planning for In-Home Care

The new section covers essential topics including when in-home care is needed, preparing for in-home caregivers, who provides in-home care services, how to find a caregiver, and how to pay for in-home care.

“CaringInfo is a valuable resource used widely among hospice, palliative, and advance care planning experts and professionals as well as patients and families who need help and guidance.”

Dr. Steve Landers

CEO, The National Alliance for Care at Home

Landers, continued, “The launch of ‘Planning for In-Home Care’ marks an exciting step in the continued expansion of CaringInfo to provide resources and guidance on the full continuum of home-based care and to serve as a resource to all providers under the Alliance umbrella. Finding and navigating care at home can be difficult for patients and their loved ones, especially as it is often needed during life’s most vulnerable moments. These free, accessible resources help ensure everyone seeking home-based care can make informed decisions to get the support they need.”

Visual Update

The updated CaringInfo design is intended to remain familiar for return visitors who trust the site as their go-to source for making care decisions, while aligning with the Alliance’s core brand. This visual update indicates CaringInfo’s realignment to serve the full home-based care community, including home health, home care, Medicaid HCBS, palliative care, and hospice providers.

CaringInfo’s goal is that all people are making informed decisions about their care. In addition to easy-to-understand information about caregiving, advance care planning, and the types of care available to those who need it, CaringInfo also offers a complete library of annotated advance directive forms for all 50 states, plus Washington, DC and Puerto Rico. The full site is available in both English and Spanish.

Visit CaringInfo.org, which is free and available to all, to explore the full site as well as the new content.

# # #

About the National Alliance for Care at Home

The National Alliance for Care at Home (the Alliance) is the leading authority in transforming care in the home. As an inclusive thought leader, advocate, educator, and convener, we serve as the unifying voice for providers and recipients of home care, home health, hospice, palliative care, and Medicaid home and community-based services throughout all stages of life. Learn more at www.AllianceForCareAtHome.org.

OBBB Care at Home Adjustments

Advocacy

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

by Kristin Rowan, Editor

Care at Home Through Medicare and Medicaid

Adjustments from OBBB

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

Medicaid Waivers

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

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

Rural Health Transformation Program

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

Health Savings Accounts

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

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

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

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

Final Thoughts

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

# # #

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

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

©2025 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Alliance Statement on House Passage of Reconciliation Bill

Advocacy

by Rowan Report | Jul 3, 2025 | Advocacy, Breaking News, Partner News, Regulatory

FOR IMMEDIATE RELEASE

Contact: Elyssa Katz
571-281-0220
communications@allianceforcareathome.org

Medicaid Provisions Threaten Home and Community-Based Services for Millions of Vulnerable Americans

Alexandria, VA and Washington, DC, July 3, 2025. The National Alliance for Care at Home (the Alliance) issued the following statement today in response to the House’s passage of the “One Big Beautiful Bill Act,” also known as the Reconciliation bill, which now heads to President Trump’s desk for his signature.

“The Alliance is deeply troubled by the Medicaid provisions within the One Big Beautiful Bill Act, which has passed both chambers of Congress and now awaits President Trump’s signature,” said Alliance CEO Dr. Steve Landers. “These provisions—including work requirements, reduced provider taxes, and new cost-sharing mandates—prioritize short-sighted budget savings over the health and wellbeing of our most vulnerable citizens who rely on home and community-based services (HCBS).”

Dr. Steve Landers

CEO, The National Alliance for Care at Home

The Alliance Advocates for Care at Home

The home care community advocated throughout the legislative process for Congress to mitigate these harmful Medicaid provisions. The legislation will reduce state provider tax rates, cutting funding that states rely on to support HCBS programs. New work requirements and mandatory cost-sharing will also create administrative burdens for both providers and beneficiaries, likely resulting in coverage losses that extend beyond those directly targeted by these policies. Further, new limits on home equity for long-term care recipients will force older adults to sell their homes, leading to unnecessary institutionalization.

Continued Advocacy

“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,” said Dr. Landers. “We will continue to champion the delivery of HCBS – proven services that are preferred by beneficiaries and save the system money.”

Careful Consideration Needed

Landers CEO The Alliance Reconciliation Bill

The Alliance calls on federal and state officials to implement these new requirements with careful consideration of their impact on vulnerable populations and to work collaboratively with providers to minimize disruption to essential services.

# # #

About the National Alliance for Care at Home

The National Alliance for Care at Home (the Alliance) is the leading authority in transforming care in the home. As an inclusive thought leader, advocate, educator, and convener, we serve as the unifying voice for providers and recipients of home care, home health, hospice, palliative care, and Medicaid home and community-based services throughout all stages of life. Learn more at www.AllianceForCareAtHome.org.

© 2025 The National Alliance for Care at Home. This press release originally appeared on The Alliance website and is reprinted here with permission. For additional information or to request permission to print, please see the contact information above.

Follow our continuous updates on the bill passage, what it means for Medicare and Medicaid, and how the provisions of the bill will be rolled out in our accompanying article here.

CMS Home Health Proposed Rule 2026

Advocacy

by Kristin Rowan | Jul 2, 2025 | Advocacy, CMS, Home Health, Regulatory

by Kristin Rowan, Editor

CMS Home Health Proposed Rule 2026

June 30th, 2025, the Centers for Medicare & Medicaid Services issued its proposed rule with updates to Medicare payment policies and rates for home health agencies under the Home Health Prospective Payment System Proposed Rule for calendar year 2026.

Payment Adjustments

The Facts, as Listed by CMS

A permanent prospective adjustment to home health payments of -4.059% (not applied to LUPAs)
- Reasoning: the impact of implementing PDGM
A temporary adjustment of -5.0% (not applied to LUPAs)
- Reasoning: to recoupe retrospective overpayments
Updates Fixed-Dollar Loss (FDL) adjustment of -0.5%
Payment Update Percentage of 2.4%
Quality data decrease of 2%, offset by the update percentage yields a 0.4% adjustment
Net changes in payment rate from 2025 to 2026 with quality reporting data is -6.40%

Contradictory Facts, as Listed by CMS

The finalized methodology used to calculate the impact of PDGM yielded the need for a -7.85% permanent adjustment
In CY 2023, 2024, and 2025, CMS implemented permanent adjustments of -3.925%, -2.890%, and -1.975%, respectively
The total permanent adjustment made in the last three years is -8.790% (0.940% more than the calculated adjustment need)
CMS has now determined that Medicare is still paying more under PDGM than it did under the old system and is proposing an additional permanent adjustment of -4.059%
This yields a combined -12.849% permanent adjustment over four years
The CMS analysis of estimated aggregate expenditures lead them to propose an additional temporary adjustment of -5.0%

HHCAHPS Survey Changes

Added Questions

Whether the care provided helped the patient take care of their health.
Whether the patient’s family/friends were given sufficient information and
instructions.
Whether the patient felt the staff cared about them “as a person.”

Removed Questions - Medication

Whether someone asked to see all the prescription and over-the-counter medicines
the patient was taking.
Whether the patient is taking any new prescription medicines or whether the patient’s
medicines have changed.
Whether home health providers talked to the patient about the purpose for taking new
or changed prescription medicines.
Whether home health providers talked to the patient about when to take the
medicines.

Removed Questions - Other

Which type of staff served the patient – nurse, PT/OT, or home care aide
Whether the patient got information about what care and services they would get when they first started home health care
Removal of the proposed changes to include questions on SDOH
Minor text changes to clarfiy some existing questions and response options

Other Changes

CMS recommends additional changes in various categories:

Recalibration of the PDGM case-mix weights
- Update low utilization payment adjustment (LUPA) thresholds
- Update functional impairment levels
- Update comorbidity adjustment subgroups
- Update the fixed-dollar loss (FDL) for outlier payments
Change the face-to-face encounter policy by adding physicians to the list of who can perform the face-to-face
Removal of the “Up-to-date” on the COVID-19 vaccine percentage
Changing the Final Data Submissions Deadline Period from 4.5 months to 45 days
Adding a Termination Clause for DME, prosthetics, orthotics, and supplies competitive bidding program

Requests for Information and Feedback

CMS has issued the following RFI:

Request for Information related to Executive Order 14192 – Unleashing Prosperity Through Deregulation of the Medicare Program

CMS is seeking feedback on the proposed rule through

August 29th, 2025

Feedback on the digital quality measurement transition
Feedback on the final data submission deadline from 4.5 months to 45 days
Feedback on tools that promote healthy eating habits, exercise, nutrition, and physical activity
Feedback on the current state of health IT use, including EHRs
Feedback on the proposed changes to DMEPOS

Submit comments, feedback, and documentation to CMS

The Alliance Responds

“We are alarmed by the negligent proposed payment update, which deepens a heartless pattern of insufficient adjustments that have already led providers to close their doors and reduce services, and now threatens to further diminish care access by compelling more HHAs to take similar actions.”

Dr. Steve Landers

CEO, The National Alliance for Care at Home

You can read the entire Proposed Rule HERE. Read the Fact Sheet HERE.

# # #

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

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

©2025 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Medicaid Cuts Update: Meet the Senate Parliamentarian

Admin

by Tim Rowan | Jun 27, 2025 | Admin, Advocacy, Medicaid, Medicare

by Tim Rowan, Editor Emeritus

Medicaid Cuts Update

Senate Parliamentarian Elizabeth MacDonough

The ongoing negotiations in Congress will impact Medicaid and Medicare. There has been little movement from the Senate since we reported on this last week, but here’s what we know now:

When H.R. 1 was passed by the House of Representatives and forwarded to the Senate, it was immediately subjected to scrutiny by the Senate Parliamentarian, Elizabeth MacDonough. The job of the parliamentarian is to ensure that every proposed bill complies with Senate rules. The story of Ms. MacDonough taking her scissors to the “One Big Beautiful Bill” requires more than a little unpacking, but it is a good story.

Problem with Medicaid Cuts: "One Bill"

It appears that the idea to put all of the President’s legislative agenda into a single bill is acceptable in the House, but the Senate has different rules. The Senate forces itself to live under the filibuster system. When the filibuster is evoked, a bill must receive 60 votes to pass, but there is an exception. “Budget Reconciliation” is a rule that allows expedited passage of certain specific budget-related bills with only a simple majority, 51 votes.

The problem of the week is that H.R. 1 includes dozens of provisions that have nothing to do with spending. The Senate parliamentarian took her scissors to parts of the bill that:

change environmental regulations to pave the way to sell public lands
reduce the ability of federal judges to block Presidential orders¹
dissolve the Consumer Financial Protection Bureau
change the rules about who can be excluded from receiving Medicare benefits, even after contributing through FICA taxes

Cutting Medicaid Cuts

Parliamentarian MacDonough has also applied her scissors to the portion of the bill that would reduce Medicaid spending by nearly $800 billion over ten years. Writing for The Hill, Alexander Bolton reported on June 26:

“The Senate’s referee rejected a plan to cap states’ use of health care provider taxes to collect more federal Medicaid funding, a proposal that would have generated hundreds of billions of dollars in savings… The decision could force Senate Majority Leader John Thune (R-S.D.) to reconsider his plan to bring the Senate bill up for a vote this week.”

Alexander Bolton

Journalist, The Hill

The provision, which would have forced states to take over substantially more Medicaid costs, came under strong bipartisan opposition. Sen. Josh Hawley (R-Mo.), Susan Collins (R-Maine), Lisa Murkowski (R-Alaska) and Jerry Moran (R-Kan.) warned deep cuts to federal Medicaid spending could cause dozens of rural hospitals in their states to close. Senate Democrats, led by Jeff Merkley (D-Ore.), the ranking Democratic on the Senate Budget Committee, praised MacDonough’s exclusions.

The Hill reported, “Democrats are fighting back against Republicans’ plans to gut Medicaid, dismantle the Affordable Care Act, and kick kids, veterans, seniors, and folks with disabilities off of their health insurance – all to fund tax breaks for billionaires,” Merkley said in a statement.

The President pushed back against the parliamentarian’s rulings in a June 24 social media post:

“To my friends in the Senate, lock yourself in a room if you must, don’t go home, and GET THE DEAL DONE THIS WEEK. Work with the House so they can pick it up, and pass it, IMMEDIATELY. NO ONE GOES ON VACATION UNTIL IT’S DONE.”

Donald Trump

President of the United States

Sorting out the Complex Immigration Question

If the above seems complicated, it becomes rudimentary compared to the background that sets the stage for the parliamentarian’s next cut. Except for emergencies, most often crisis pregnancies, persons in the country illegally cannot, and do not, receive Medicaid-reimbursed healthcare. According to a study by Kaiser Family Foundation, however, fourteen states plus the District of Columbia use state taxpayer money, not federal funds, to cover children regardless of immigration status, Seven of those fourteen, and D.C., also cover some adults with state funds regardless of immigration status.

In the bill was a provision to punish these fourteen states and D.C. by reducing their federal Medicaid payments from 90 percent to 80 percent. Though there is no accusation in the bill that these states are guilty of improper use of federal funds, the states will lose some of those funds because of the way they have chosen to use their own funds. Parliamentarian MacDonough said that is not a budget line item but an attempt by the federal government to force states to change their own healthcare policies.

Medicare Restrictions also Scrapped

Almost as a postscript, a House restriction on Medicare eligibility also fell victim to the Senate Parliamentarian’s scissors. Non-citizens who work in W-2 wage jobs pay FICA taxes, many of them for 30 years or more. When these workers turn 65, they are eligible for Medicare benefits due to their contributions, regardless of their status. Though H.R. 1, the House version, would eliminate that eligibility, Ms. MacDonough said, “Nope, this is not a budget reconciliation issue.”

Although the White House is pressuring Senators to vote quickly — so that a joint House/Senate negotiating committee can hammer out differences and send their compromise version to the President’s desk by July 4 — that self-imposed deadline is up in the air at the moment. Both President Trump and House Speaker Johnson are adamant that every spending and every non-budgetary policy change they want must be enacted in one big bill. In spite of Ms. MacDonough’s cuts, the Senate it not exactly handcuffed either. Because it makes its own rules, Senators could simply decide, with a 51-49 party-line vote, to ignore the parliamentarian.

The power, as well as the future health of Medicaid, falls into the hands of the four dissenting Republican Senators. Home Health and Home Care folks in Missouri, Maine, Alaska and Kansas take note.

____________________________________

¹ From White House correspondent Bart Jansen, writing for USA Today:

Currently, judges have discretion to set bonds on plaintiffs who file civil suits. Legal experts say judges often waive bonds in lawsuits against the government because the disputes are typically over policy rather than money.
A provision in the House-passed version of the bill would remove that discretion from federal judges and require litigants to post a bond when the issue under consideration is whether to block a Trump policy.
So far, judges have blocked Trump policies in 180 cases. All of them would have to be reviewed for bonds if the Senate approves the House provision and Trump signs it into law.
The law would effectively kill most of the limitations on Trump policies because bond amounts are determined by the dollar amount of the contested policy. In federal cases involving massive policy changes, those bonds can amount to hundreds of billions.

# # #

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

The Alliance Responds

Advocacy

by Kristin Rowan | Jun 13, 2025 | Advocacy, CMS, Hospice

by Kristin Rowan, Editor

The Alliance Responds to CMS Hospice Update

The Alliance responds to CMS-1835-P, the FY 2026 Hospice Wage Index, Conditions of Participation, and Quality Reporting Program Requirements updates. On June 10, 2025, in a 25 page letter to Dr. Mehemet Oz, CEO for The National Alliance for Care at Home Steve Landers, MD, MPH lays out the constraints and financial burdens hospice agencies will face if these updates are enacted.

Payment Rate Update

Increase Less than Inflation

In the rule for FY 2026, CMS proposes a 3.2 percent market basket increase and a .8 percent productivity decrease, yielding a 2.4 percent increase overall. According to the letter, inflation has raised medical care prices by 3.1 percent, leaving a shortfall of .7 percent. Hospices are also plagued by the same workforce shortage the rest of the medical industry faces. Workforce shortages result in fewer qualified people than there are available positions, which drives wages up. BLS data indicates the wage increase for 2025 was 4.4%. The Alliance argues that the 2.4% net increase falls well short of the actual expense increase.

Faulty Data

In a recent article, we outlined the process that CMS uses to determine the market basket update. The Alliance echos our information, showing the market basket forecast is well below actual increases. The Alliance further argues that the shortfall compounds, leaving the base rate increasingly smaller with each forecast. The current estimate is a 4.9% pay rate gap. CMS contends there is no way to adjust for forecast errors. The Alliance has a simple solution: manually adjust the payment rate every year when the finalized number are above the forecasted numbers BEFORE adding the next year’s payment rate increase.

Likewise, The Alliance concurs with The Rowan Report sentiment that productivity cannot increase in hospice like it does in less labor-intensive sectors. Landers also mentions the failure to consider travel costs, the wage differences in rural areas, and the lack of reclassification options in hospice care.

Payment Rate Recommendations

As any well-drafted response should, The Alliance provides actionable recommendations in each section. For payment rate updates, The Alliance recommends:

We recommend CMS examine closely more recent data and increase final payment rates for FY 2026.
We urge CMS to explore all available avenues to address the forecast error shortfall, such as through a one-time adjustment.
We encourage CMS to collaborate with stakeholders to address the shortcomings of relying upon hospital data to determine hospice payment rates, and ways to achieve parity across provider types with respect to geographic area wage adjustments.

HIS to HOPE Transition

Also addressed in the letter is opposition to the timeline of the HIS to HOPE transition. The Alliance restates much of what was in the joint letter to CMS urging the delay of the HOPE tool adoption. That letter was a joint venture between The National Alliance for Care at Home (The Alliance), LeadingAge, and the National Partnership for Healthcare and Hospice Innovation (NPHI).

The consequence of adverse outcomes cannot be understated. The risk of negative financial consequences for hospice providers is
largely dependent this year on the success of two transitions—iQIES and HOPE— neither of which are within their control.

Steve Landers, MD, MPH

CEO, National Alliance for Care at Home

HOPE Transition Recommendations

Considering the volatility inherent in a reporting transition of this magnitude and the lack of clear information provided to date, we respectfully request CMS waive the HOPE timeliness submission requirement for two calendar quarters post implementation.
We further respectfully request that CMS delay the HOPE implementation date until at least six months after CMS education and training, beyond that which is introductory and that is scheduled for spring/summer 2025, the final validation utility tool specifications are available and the application for iQIES access has been opened for hospices.

Digital and Future Hospice Measurements

Among the digital hospice measurements is an interoperability measurement. The Alliance supports interoperability and data exchange across medical care entities, but stresses to CMS that many hospices do not have digital EHR systems, cannot afford to maintain such systems, and have not received the federal financial support necessary to meet this objective.

The Alliance also objects, not in theory, but in practical application, to the nutrition measure noted in future hospice measures. Nutrition for a hospice patient is vastly different than for other patients and should be implemented as a process measure, rather than having specific goals for food intake and nutrition.

Similarly, the well-being measure is not designed for hospice care. In other sectors of healthcare, well-being incorporates measures for mental, social and physical health and focuses on curative plans. Hospice care focuses on person-centered care, emphasizing the desires of the patient as they are balanced against religious, cultural, and personal beliefs. The well-being measure must be curated to fit hospice care.

The Alliance - Conclusion

The Alliance values CMS’s ongoing commitment to enhancing hospice care quality,
ensuring program integrity, and improving patient outcomes. We appreciate your
consideration of our comments and look forward to ongoing dialogue to achieve these
shared objectives.

The Rowan Report - Conclusion

The Alliance has, as always, done an exemplary job at explaining the industry position on the CMS rule. Likewise, it has outlined each step CMS should take to view the updates through a hospice lens rather than a hospital lens. We commend and support The Alliance statement and position. As this is an ongoing topic until the final rule is implemented, we will continue to provide updates as they become available.

If you are a member of The Alliance, you can read the full 25 page letter here.

# # #

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

Delay HOPE Tool

Advocacy

by Kristin Rowan | Jun 6, 2025 | Advocacy, CMS, Hospice, Regulatory

by Kristin Rowan, Editor

Advocacy Groups to CMS:

Delay HOPE Tool Implementation

“Delay HOPE Tool Implementation,” say multiple hospice advocacy groups. LeadingAge, the National Alliance for Care at Home (The Alliance), and the National Partnership for Healthcare and Hospice Innovation (NPHI) are urging CMS to delay the transition from HIS to HOPE. The three groups sent a joint letter to Dr. Mehmet Oz, CMS Administrator, earlier this week.

“Our associations remain fully committed to the [Hospice Quality Reporting Program (HQRP)], including the payment penalties for non-compliance, and recognize the critical importance of accurate, timely data submission to inform the delivery of high-quality hospice care. However, we have serious concerns about the potential for successful implementation of the HOPE tool.”

LeadingAge, The Alliance, NPHI

Hospice Advocacy

The concerns over agency readiness to implement the new tool center on the new reporting platform. Hospice agencies state they don’t have all the necessary information to develop a workable tool for submission. Therefore, the agencies have asked CMS to delay the implementation of the HOPE tool. They have called on CMS to wait until six months after agencies have access to education, training, and final validation specifications.

Hospice Rule Penalty

The hospice program through CMS requires substantial reporting for payment. Hospices that do not submit the required 90% of records, they receive an annual payment penalty of 4%. Combined with lower than sustainable payment increases, the 4% penalty results in a lower reimbursement rate over prior years. The associations worry that the lack of information and education will lead to lower reporting. In turn, the lower reporting lowers reimbursement rates. For hospices that are already struggling to survive, the penalty is devastating. The letter to CMS asked to waive the timeliness requirement for two quarters after implementation.

HOPE Tool Lacks Validation

CMS will have a Validation Utility Tool that agencies will need to use in order to ensure their software can successfully submit their data. CMS has not released the tool and indicates they may not until sometime in September. The HOPE tool is scheduled for implementation in October. There is not enough time between release of the validity tool and implementation of the HOPE tool for proper testing.

Hospice Agencies Lack Validation

In addition to validating data submission, hospice agencies have to enroll in the new submission portal, iQUIES. Enrollment requires a privacy security official and other staff. Additionally, it requires an application to access the system, background checks, and other actions. Thus far, hospice agencies do not have access to begin this process and there is no indication of how long it will take. The associations are concerned that the process may also involve significant financial cost to hospice agencies.

Resources

CMS released the Hospice Outcomes and Patient Evaluation (HOPE) Guidance Manual v1.01, a 138 page PDF, available here. The manual includes links to other resources for hospice agencies. Namely, a webpage with information on HOPE Data Submission Specifications has a “final” version of data specs available for download. Additionally, there are links to the Main Page here and technical information and updates here. The document urges vendors to register to get updates and important announcements.

Final Thoughts

There is no information yet as to a response to the letter from CMS. Thus far, CMS is still planning on keeping the October 1, 2025 HOPE implementation date. We will continue to report on updates from CMS and the advocacy groups.

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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