Government Shutdown

Medicaid

by | Oct 9, 2025 | Medicaid, Medicare, Medicare Advantage, Regulatory

by Kristin Rowan, Editor

Government Shutdown Threatens Care at Home

Lawmakers on opposite sides of the aisle failed to come to a budget agreement by the deadline. This causes an immediate cease to all non-essential government functions and many government employees aren’t being paid. 

The Disagreement

Reporters and spokespoeople from both sides of the debate have suggested various reasons for the shutdown. Equally, both sides claim they are not the holdouts. What we do know for sure is that one of the primary points of contention is the continuation of subsidies for Affordable Care Act Marketplace Insurance plans. One group wants an extension written into the current budget while the other says it’s not necessary since the subsidies currently run through the end of the calendar year.

Push to Extend

The lawmakers who are pushing to get the subsidy issue resolved believe that marketplace users are not going to sign up for insurance in November and do it again in January when the subsidies are fixed. Instead, insurance commissioners warn that without the subsidies, many people will opt not to have insurance at all and others will select substandard plans based on affordability. They will be priced out of the plans they want without the subsidies in place.

Priced Out

In 2025, even with the subsidies, the average family was paying $800 per month on health insurance through the marketplace. When the subsidies expire, those same families will see their existing plan rates jump to $3,000 per month. KFF, the nonpartisan health research organization, estimates that most users will have a 114% rate increase. 

Government Shutdown

Photo Credit – The New York Times

Counter

According to ND insurance commissioner Jon Godfread, lawmakers who oppose the subsidies are actually opposing the cost of health care and insurance across the board. They insist the subsidies aren’t necessary if healthcare and insurance costs drop instead. Proponents of the subsidies agree, but say that is a longer discussion that will take a lot of time to resolve and the subsidies provide an immediate solution to a bigger problem. They are urging the holdouts to include the subsidies in the budget and tackle the rising cost of healthcare later.

Open Enrollment

The clock is ticking. Open enrollment for 2026 begins November first in every state except Idaho, where open enrollment starts next week. Insurers have already locked in their 2026 premium rates, which will likely cause sticker shock for most marketplace users. Most insurers have prepared subsidy and non-subsidy rates, but without the extension, we will only see the much higher non-subsidy rates. These rates are unlikely to change before enrollment starts and the only hope for marketplace buyers is for Congress to extend the subsidies.

Home Health & Hospice

Care at Home Impact

There are several ways in which the shutdown and the loss of the subsidy may impact care at home.

Payment delays are the most pressing risk. Government officials have promised no delay for some essential services like SNAP and WIC. It is likely Medicare and Medicaid payments will be delayed. While those payments will come through eventually, care at home agencies have to operate without payment or hope the

payers will process payments locally while waiting on the government to reopen. The longer the shutdown lasts, the more likely it is that payments will be delayed. The 6th Senate budget vote failed today, sending the shutdown to day 8.

The longer term impact for care at home will come if the subsidies are not renewed. If insurance rates increase by more than 100% on November 1, users will opt for lower priced coverage, which may no longer include care at home benefits. Fewer patients seeking care at home means less money for agencies. Long-term, it also means higher hospital and ER usage and costs, which increases government spending and usually leads to additional care at home cuts to offset the costs.

National Alliance for Care at Home has identifed current and potential implications of the shutdown. Read their analysis here.

This is an ongoing story and we will continue to provide additional information as it happens. 

# # #

Kristin Rowan, Editor
Kristin Rowan, Editor

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

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

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

 

MACPAC Rate Setting

CMS

by | Sep 25, 2025 | CMS, Medicaid, Medicare, Medicare Advantage, Partner News

FOR IMMEDIATE RELEASE

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

MACPAC Rate Setting

The Alliance Expresses Concerns Regarding MACPAC Approach to HCBS Rate Setting

Alexandria, VA, and Washington, DC, September 18, 2025. The National Alliance for Care at Home (the Alliance) released the following statement in response to the Medicaid and CHIP Payment and Access Commission’s (MACPAC) discussion regarding home- and community-based services (HCBS) rate-setting held during today’s September MACPAC meeting.

MACPAC Rate Setting Quote

The Alliance appreciates MACPAC’s interest in addressing issues related to worker pay in HCBS. These workers should receive higher wages and benefits as they are the backbone of the long-term care system in our country. They are dedicated professionals who provide essential services that promote the community integration, independence, and positive health and social outcomes of older adults and people with disabilities.

Unfortunately, we are concerned about the draft recommendation MACPAC discussed during today’s meeting. Rather than seeking to address the root-cause of low worker wages, MACPAC’s recommendation instead focuses on collecting 

additional information that would further describe the issue. This approach increases administrative burden on states and providers without actually proposing solutions to this problem.

MACPAC Rate Setting Report

MACPAC’s report acknowledges that rate studies and wage data are insufficient to address chronically underfunded Medicaid HCBS programs. To create meaningful change, state administrations and state legislators must be held accountable to fund services at levels that enable improved wages for workers. Sixty years of Medicaid program history have demonstrated that such wholesale changes to state actions are only achieved through new and strengthened Federal requirements. We urge MACPAC and its Commissioners to be bold and recommend structural changes to Federal Medicaid law and regulations that mandate payment policies ensuring access to HCBS through livable wages for direct care workers. The Centers for Medicare & Medicaid Services (CMS) should be given the authority to require states to:

  • Perform comprehensive rate studies no less frequently than every five years that:
    • Use generally accepted accounting practices to develop a payment methodology that assures continued adequacy of each component of the rate model; and
    • Establish a rate model that includes individualized components for core provider cost drivers as well as a livable wage for workers.
  • Submit a copy of the rate review report and recommendations with any waiver renewal or state plan amendment and make the report publicly available on their website; and
  • Require states to justify any variance between the report recommendations and the actual established payment rates.

Further, CMS should be given the authority to disapprove rate methodologies that do not clearly account for all statutory and regulatory requirements of delivering services as well as demonstrating that the rates are sufficient to support a livable wage for workers.

Our members are committed to improving the lives and livelihoods of direct care workers because beneficiaries depend on them. We call on MACPAC to ensure that states and the federal government are equal partners in this critical endeavor.

MACPAC Rate Setting Quote 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.   

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

Bill Dombi Presents

Advocacy

by | 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.

Bill Dombi Presents

“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, Editor
Kristin Rowan, Editor

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

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

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

 

Advocacy Week

Advocacy

by | 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
Advocacy Week Strategy Session<br />
Advocacy Week Strategy Session

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.

BREAKING NEWS: CMS Changes AHEAD

CMS

by | Sep 4, 2025 | CMS, Medicaid, Medicare

From cms.gov

CMS Changes AHEAD

CMS Announces Changes to Achieving Healthcare Efficiency through Accountable Design (AHEAD) Model to Improve Quality, Promote Transparency, and Decrease Costs

September 2, 2025

What's New

The CMS Innovation Center announced new policy and operational changes, as well as a new end date, to the Achieving Healthcare Efficiency through Accountable Design (AHEAD) Model to help states achieve their total cost of care (TCOC) targets, while advancing the Center’s commitment to promote choice and competition, increase prevention, empower patients, and protect taxpayer dollars.

Why it Matters

Participating states now have more tools to manage Medicare costs (designed to support sustainable growth) and improve quality of care and population health outcomes

What to Expect

Changes will be implemented across all cohorts beginning in January 2026. AHEAD’s end date for all cohorts is now December 31, 2035.

The Big Picture

Changes made to the model will help to advance the CMS Innovation Center’s strategic pillars of: 1) choice and competition, with states implementing at least two policies focused on promoting choice and competition in their health care markets and 2) prevention, with a new Population Health Accountability Plan focused on preventive care, including chronic disease prevention.

CMS Change AHEAD

Additional Details

CMS is also introducing payment reforms through AHEAD for patients with Original Medicare and establishing new transparency requirements around TCOC and primary care investment targets. For the first time ever, AHEAD will bring total cost of care accountability to all Original Medicare beneficiaries in AHEAD regions through geographic attribution of beneficiaries not attributed to other CMS accountable care organization programs. This novel framework will offer risk-bearing Geographic Entities additional tools and enhanced flexibilities to improve health outcomes and lower spending for their patients while receiving shared payments (or losses) through two-sided risk arrangements. In return, patients may receive additional beneficiary incentives while enjoying existing protections under the Original Medicare program.

Total Cost of Care Model

The AHEAD Model is a state total cost of care (TCOC) model that seeks to drive state and regional health care transformation and multi-payer alignment, with the goal of improving the total health of a state population and lowering costs. Under a TCOC approach, a participating state uses its authority to assume responsibility for managing health care quality and costs across all payers, including Medicare, Medicaid, and private coverage. States also assume responsibility for ensuring health providers in their state deliver high-quality care, improve population health, offer greater care coordination, and promote healthier living for all people participating in the model. The AHEAD Model provides participating states with funding and other tools to address rising health care costs and improve health outcomes.

More Information

# # #

©2025 Centers for Medicare & Medicaid Services. This announcement originally appeared on the CMS website here. For more information, please contact the CMS Innovation Center.

Medicare Prior Authorization

CMS

by | Sep 4, 2025 | CMS, Medicare, Regulatory

by Kristin Rowan, Editor

Medicare Prior Authorization

Wasteful and Inappropriate Service Reduction Model

The Centers for Medicare and Medicaid Services (CMS) is launching a pilot program in six states to combat what they deem to be unnecessary treatments. Dubbed the Wasteful and Inappropriate Service Reduction (WISeR) Model, the voluntary program will launch in New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington beginning January 1, 2026 and ending December 31, 2031. The program will use Artificial Intelligence (AI) and Machine Learning (ML) alongside human clinical review to “ensure timely and appropriate Medicare payment for select items and services.”

The Problem

According to CMS, health care waste harms patients and comprises 25% of healthcare spending. “Low-value” services provide little effectiveness, do not align with specific health conditions, and can lead to additional complications and more wasteful services.

Medicare Prior Authorization Solution

The new WISeR Model is designed to reduce unsupported care. Participating care providers will outsource authorization of a pre-selected list of services to reviewers using technology to “expedite and improve the review process.” These services are those that CMS designated as vulberable to fraud, waste, and abuse.

Reasoning

CMS suggests that the fee-for-service model used in traditional Medicare incentivizes unnecessary treatments, tests, and other care. According to CMS, these items provide little to no benefit for some patients. These include:

  • Skin and tissue substitutes
  • Electrical nerve stimulator implants for obstructive sleep apnea and incontinence
  • knee arthroscopy for knee osteoarthritis
  • Cervical fusion
  • Epidural steroid injections
  • Vertebral augmentation
  • Image-guided lumbar decompression
  • deep brain stimulation for Parkinson’s and essential tremor

Strategy and Outcomes

The WISeR Model is supposed to ensure patients get the most appropriate care for the best outcomes. It is also supposed to lower costs and administrative burden on providers. Patients are supposed to partner with their health care providers to decide on the most appropriate care plan. Eliminating “unnecessary” services and procedures is supposed to save taxpayer dollars and decrease fraud, waste, and abuse. Care providers are supposed to focus on providing care that has the most impact on the well-being of Medicare beneficiaries.

Editorial Comment

I am not a Medicare recipient, but I have many close friends and family who are. I am not a nurse or home health expert, but I am a patient and by my count, I have a PCP and 6 specialists that I see on a regular basis. However, I am now, or will be in the near future, in need of:

  • Electrical nerve stimulator
  • Cervical fusion
  • Steroid injections
  • Lumbar decompression

Personal Experiences

I am already at the mercy of my health insurance provider for pre-authorizations for everything that is not routine visits with my primary care provider. I know first-hand the hoops and red tape my provider(s) go through. Already this year, I have filed two requests to review denials, more than 10 rescheduled visits because my pre-authorization had not been received, and at least one interview that my PCP had to attend with an “expert” who had previously decided that my regularly scheduled follow-up cancer scan was unnecessary.

Predicted Results

Adding prior authorization approval requirements for care and treatment will delay beneficiaries from getting the care they need, prolong the pain they experience daily, and cost more in wasted time and money than it can possibly save in wasted procedures. I sincerely hope there are enough voluntary participants in this experiment to document the additional time, money, and resources required. I also hope these participants send regular surveys to their Medicare beneficiaries to ask whether they feel like getting pre-authorizations for routine procedures has made them feel like they are getting better care.

# # #

Kristin Rowan, Editor
Kristin Rowan, Editor

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

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

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

 

DOJ Settles with UnitedHealth and Amedisys

Legal

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

by Kristin Rowan, Editor

DOJ Settles with UnitedHealth and Amedisys

Judge to Weigh In

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

Public Comment Period and Judicial Review

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

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

Antitrust Division Statement

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

Abigail Slater

Assistant Attorney General, Justice Department Antitrust Division

Divestiture Agreement

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

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

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

UnitedHealth Amedisys divestiture locations

Not the Only Concern

Vertical Integration

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

Upcoding

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

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

Final Thoughts

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

# # #

Kristin Rowan, Editor
Kristin Rowan, Editor

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

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

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

 

Alliance Responds to Hospice Final Rule

Advocacy

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

by Kristin Rowan, Editor

The Alliance Responds to CMS Hospice Final Rule

CMS Issues FY 2026 Hospice Final Rule

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

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

National Alliance for Care at Home Statement

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

Wage Adjustment

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

Regulatory Relief

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

HOPE Tool Implementation

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

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

Dr. Steve Landers

CEO, National Alliance for Care at Home

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

Final Thoughts

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

# # #

Kristin Rowan, Editor
Kristin Rowan, Editor

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

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

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

 

Patients’ Right to Freedom of Choice

Admin

by | 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 E. Hogue, Esq.
Elizabeth E. Hogue, Esq.

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.

©2025 Elizabeth E. Hogue, Esq. All rights reserved.

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. 

OBBB Care at Home Adjustments

Advocacy

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

by Kristin Rowan, Editor

Care at Home Through Medicare and Medicaid

Adjustments from OBBB

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

Medicaid Waivers

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

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

Rural Health Transformation Program

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

Health Savings Accounts

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

Telehealth Reconciliation Bill<br />

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

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

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

Final Thoughts

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

 # # #

Kristin Rowan, Editor
Kristin Rowan, Editor

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

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

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

 

Fraud, Waste, and Abuse

Clinical

by | Jul 10, 2025 | Clinical, CMS, Home Health, Legal, Medicare, Medicare Advantage, Regulatory

by Kristin Rowan, Editor

Fraud, Waste, and Abuse

DOJ, HHS False Claims Act

Fraud, Waste, and Abuse has become something of a mantra within the Department of Health and Human Services (HHS). Secretary Kennedy has committed to combatting fraud, waste, and abuse within the federal healthcare system. The Department of Justice (DOJ) and HHS have a long history of working together to combat healthcare frauding under the False Claims Act (FCA).

Working Group

In furtherance of their goal to combat healthcare fraud, HHS and DOJ have formed the DOJ-HHS False Claims Act Working Group. The Working Group will include leadership from the HHS Office of General Counsel, CMS Center for Program Integrity, the Office of Counsel for the OIG, and the DOJ Civil Division.

Working Group Priorities to Combat Fraud, Waste, and Abuse

1. HHS will refer potential False Claims Act violations to the DOJ that are in line with the Working Group priority enforcement areas:

  • Medicare Advantage
  • Drug, device, or biologics pricing
    • arrangements for discounts, rebates, service fees, and formulary placement and pricing reporting
  • Barriers to patient access to care
    • violations of network adequacy requirements
  • Kickbacks related to drugs, medical decives, DME, and other products paid for by federal healthcare programs
  • Materially defective medical devices that impact patient safety
  • Manipulation of Electronic Health Records systems to drive inappropriate utilization of Medicare covered products and services

2. The Working Group will maximize collaboration to expedite investigations and identify new leads. They will leverage HHS resources using data mining and assessment of findings.

3. The Working Group will discuss implementing payment suspension according to the CMS Medicare Program Code of Federal Regulations¹

4. The Working Group will discuss whether DOJ will dismiss a whistleblower case under the U.S. Code for Civil actions for False Claims, pursuant to the DOJ Manual for Civil Fraud Litigation²

Report Fraud, Waste, and Abuse

The Working Group encourages whistleblowers to report violations of the False Claims Act within the priority areas. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement can be reported to HHS at 800-HHS-TIPS (800-447-8477). Similarly, the Working Group encourages healthcare companies to identify and report such violations.

Fraud, Waste, and Abuse

²DOJ Dismissal of a Civil Qui Tam Action. When evaluating a recommendation to decline intervention in a qui tam action, attorneys should also consider whether the government’s interests are served, in addition, by seeking dismissal pursuant to 31 U.S.C. § 3730(c)(2)(A).

¹Suspension of payment. The withholding of payment by a Medicare contractor from a provider or supplier of an approved Medicare payment amount before a determination of the amount of the overpayment exists, or until the resolution of an investigation of a credible allegation of fraud.

# # #

Kristin Rowan, Editor
Kristin Rowan, Editor

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

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

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

 

Bill Cuts Medicaid Directly, Medicare Indirectly

Admin

by | 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.

Senate passes bill

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.

# # #

Tim Rowan The Rowan Report
Tim Rowan The Rowan Report

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

Medicaid Cuts Update: Meet the Senate Parliamentarian

Admin

by | 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
Medicaid Cuts

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 The Rowan Report
Tim Rowan The Rowan Report

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

UnitedHealth Bribes Nurses

Medicaid

by | Jun 13, 2025 | Medicaid, Medicare, Medicare Advantage, Other Sites, Regulatory

United Health Bribery Update

In the weeks since the below article revealed allegations against UnitedHealth, members of Congress are calling for action. At least one US Senator and two Representatives are engaged in the allegations. Senator Wyden (D-OR) announced that his office is launching its own investigation. Senator Hawley (R-MO), who is on the investigations subcommittee said it was “alarming to hear these serious allegations. I look forward to securing justice for patients, policyholders, and whistleblowers alike who’ve been harmed by insurance companies.” Other Senators expressed similar sentiments.

“If these allegations are true, UnitedHealth must be held responsible for their gross abuse of patients. Patients should always come before profits.”

Buddy Carter

Chair of the House subcommittee on health, U.S. Representative, (R-GA)

Three U.S. Representatives, coming from both sides of the aisle, are calling on the DoJ to investigate. A letter to the DoJ reads:

“The Guardian’s findings reveal the need for a wide-ranging investigation by the Department of Justice into years, if not decades, of potential waste, fraud, and abuse at UnitedHealth.”

Here is another take on the breaking news story, published by whistlebloweraid.org

The Guardian has uncovered some truly disturbing information about UnitedHealth Group. As the investigation and reporting belongs to them, I have reprinted the first part of the article here. Read the full article here.

by George Joseph, The Guardian
Wed May 21, 2025

Revealed: UnitedHealth secretly paid nursing homes to reduce hospital transfers

A Guardian investigation finds insurer quietly paid facilities that helped it gain Medicare enrollees and reduce hospitalizations. Whistleblowers allege harm to residents

UnitedHealth Group, the nation’s largest healthcare conglomerate, has secretly paid nursing homes thousands in bonuses to help slash hospital transfers for ailing residents – part of a series of cost-cutting tactics that has saved the company millions, but at times risked residents’ health, a Guardian investigation has found.

UnitedHealth paid nursing homes

Those secret bonuses have been paid out as part of a UnitedHealth program that stations the company’s own medical teams in nursing homes and pushes them to cut care expenses for residents covered by the insurance giant.

In several cases identified by the Guardian, nursing home residents who needed immediate hospital care under the program failed to receive it, after interventions from UnitedHealth staffers. At least one lived with permanent brain damage following his delayed transfer, according to a confidential nursing home incident log, recordings and photo evidence.

“No one is truly investigating when a patient suffers harm. Absolutely no one,” said one current UnitedHealth nurse practitioner who recently filed a congressional complaint about the nursing home program. “These incidents are hidden, downplayed and minimized. The sense is: ‘Well, they’re medically frail, and no one lives for ever.’”

Confidential Investigation

The Guardian’s investigation is based on thousands of confidential corporate and patient records obtained through sources, public records requests and court files, interviews with more than 20 current and former UnitedHealth and nursing home employees, and two whistleblower declarations submitted to Congress this month through the non-profit legal group Whistleblower Aid.

The documents and sources provide a never-before-seen window into the company’s successful effort to insert itself into the day-to-day operations of nearly 2,000 nursing homes in small towns and urban commercial strips across the nation – an approach which has helped UnitedHealth secure a vast stream of federal dollars from Medicare Advantage plans that cover more than 55,000 long-term nursing home residents.

UnitedHealth Responds

UnitedHealth said the suggestion that its employees have prevented hospital transfers “is verifiably false”. It said its bonus payments to nursing homes help prevent unnecessary hospitalizations that are costly and dangerous to patients and that its partnerships with nursing homes improve health outcomes.

Long-Term Profit

UnitedHealth Profit over Patients

Under Medicare Advantage, insurers collect lump sums from the federal government to cover seniors’ care. But the less insurers spend on care, the more they have for potential profit – an opportunity that UnitedHealth higher-ups have systematically sought to exploit when it comes to long-term nursing home residents.

To reduce residents’ hospital visits, UnitedHealth has offered nursing homes an array of financial sweeteners that sounded more like they came from stockbrokers than medical professionals.

Seven Years of Bribery and Threats

Over the past seven years, the company has shelled out “Premium Dividend” and “Shared Savings” payments that boosted nursing homes’ bottom lines. Through its “Quality and Shared Risk” program, UnitedHealth offered an even bigger cut to nursing homes that drove down medical spending, but threatened to claw back money from those that didn’t, according to former employees and internal corporate documents.

“You gain profitability by denying care, and when profitability suffers for the shareholders, that’s when people get crazy and do things that are not appropriate.”

Anonymous

Former National Executive, United Health

# # #

© 2025 This article is reprinted from The Guardian. The full article can be accessed here. For more information or for permission to reprint, please contact The Guardian directly.

BREAKING NEWS: Intrepid USA Files Bankruptcy

Breaking News

by | Jun 6, 2025 | Breaking News, Home Health, Hospice, Legal, M&A, Medicaid, Medicare

by Kristin Rowan, Editor

*Editor’s note: This article has been updated to remove inaccurate information from the Intrepid USA website.

Intrepid USA Files Bankruptcy

Intrepid USA, once among the largest providers of home health and hospice services, files bankruptcy in Texas. With more than $90 million in revenue in 2023, Intrepid operated more than 60 home health and hospice locations in 17 states. The Chapter 7 filing leaves no road to recovery. Chapter 7 allows the company to liquidate assets and distribute the proceeds. According to the Texas Southern Bankruptcy Court, Intrepid USA filed a voluntary petition for Chapter 7 bankruptcy on May 29, 2025.

Troubled History Plagues Company

Intrepid USA has a troubled past that it seems may have caught up with them. The U.S. Department of Justice (DoJ) alleges that between 2016 and 2021, Intrepid home healthcare agencies engaged in fraud. In violation of the False Claims Act, Intrepid filed Medicare claims for patients who did not qualify for home health, services that were not medically necessary, services provided by untrained staff, and services that were never provided. In August, 2024, Intrepid agreed to pay $3.85 million to resolve the allegations. The allegations were brought to the DoJ by two former employees of Intrepid under whistleblower provisions.

This is not the first DoJ lawsuit against Intrepid USA. In 2006, when Intrepid owned 150 agencies across the country, the company entered into an $8 million settlement agreement to resolve similar allegations. The DoJ alleged that from 1997 to 2004 Intrepid violated the False Claims Act by billing Medicare and TRICARE for services not provided by a qualified person, failing to maintain complete documentation for its claims, and other violations of Medicare regulations. Additionally, the DoJ alleged that Intrepid, in 2002 and 2003, fraudulently billed Medicaid for home care services provided to patients who were hospitalized at the time of the supposed care.

Private Equity Backing

Sometime around Q3 of 2006, Intrepid USA received financial backing from Patriarch Partners, led by Lynn Tilton. In August of 2020, Patriarch filed a notice of removal with the Supreme Court of New York. In 2021, Intrepid announced it was gearing up for rapid growth fueled by new private equity investors. Then CEO John Kunysz indicated the infusion of capital would fund opportunities for growth through acquisition.

Divest, not Acquire

Despite the influx of capital and the plan to grow through acquisition, by 2024, Intrepid was selling its assets. In August of 2024, Humana acquired 30 Intrepid branch locations and rebranded them under the CenterWell Home Health brand. The sale was part of Patriarch Partners’s Zohar Funds bankruptcy case. In November of 2024, New Day Healthcare acquired Intrepid’s hospice locations in Missouri and Texas.

$0 Revenue; 0 Value

The bankruptcy filing shows that Intrepid USA had $90 million in revenue in 2023, $50 million in revenue in 2024, and $0 in revenue so far in 2025. Chapter 7 bankruptcy is usually supervised by the court, allowing the filing company to sell assets without having to use the revenue generated by the sale to pay off debts. Intrepid listed $1 to $10 million in assets and $88 million in debts at the time of the filing. 

Intrepid USA files bankruptcy
Intrepid USA Files Chapter 7 Bankruptcy

Who will take the loss?

The Intrepid USA website still lists 55 active home health and hospice locations in 11 states. However, 30 of those locations are now listed on the CenterWell website and at least 5 other locations were part of the sale to New Day Healthcare. It is unknown if Intrepid has any locations still in operation. The company did not respond to our request for a statement.

The website also has a list of partners and investors. The Rowan Report reached out to the partners with whom we are familiar for more information. We will provide updates from them once we reach them.

Final Thoughts

The recent divestiture of home health and hospice locations to New Day and CenterWell will hopefully minimize the number of patients who are losing their home health or hospice provider. Millions of dollars in future fraudulent claims will remain in the Medicare, TRICARE, and Medicaid coffers. Conversely, the partners and investors in Intrepid USA may face some loss. We will provide any important updates and comments from the impacted companies as available.

# # #

Kristin Rowan, Editor
Kristin Rowan, Editor

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

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

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