Dr. Steve Landers: an Interview

Advocacy

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

by Kristin Rowan, Editor

Dr. Steve Landers

An Interview from the Alliance Annual Meeting

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

In His Own Words

The Rowan Report:

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

Dr. Steve Landers:

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

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

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

Alliance Annual Meeting Review Steve Landers

Alliance Outlook 2026

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

Steve:

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

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

Medicare Home Health Proposal

RR:

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

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

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

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

Advocacy

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

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

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

Final Rule

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

Keep Fighting

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

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

Commentary

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

Home Health Stabilization Act

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

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

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

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

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

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

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

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

Future Outlook

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

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

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

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

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

Steve: Absolutely. Thank you.

# # #

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

Second Longest Shutdown Since 1980

Medicaid

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

by Kristin Rowan, Editor

Second Longest Shutdown Since 1980

–As of October 30, 2025–

Shutdown day 30

Subsidy Standoff

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

Subsidy Standoff Not to Blame

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

No Reform, No Subsidy

Throughout the interview, Leader Thune would not commit to

Government Shutdown Senate Majority Leader John Thune

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

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

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

John Thune

Senate Majority Leader

(Un)lucky Number 13

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

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

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

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

When Will it End?

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

If I Were a Gambler...

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

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

# # #

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

Government Shutdown

Medicaid

by Kristin Rowan | 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.

UPDATE: Shutdown, Day 16

–As of October 16, 2025–

What it Means for Care at Home

After 10 attempts, the government is no closer to an agreement than they were on September 30th. The Senate is expected to break at the end of the day, leaving the next opportunity to negotiate until at least Monday.

Telehealth

The biggest impact on care at home during the government shut down is the ability to complete required face-to-face visits using telehealth appointments. Both home health and hospice have employed telehealth for face-to-face encounters since the COVID-era waiver, which has now been extended several times. The most recent extension, which we anticipated Congress to extend in this budget, expired on September 30th.

All face-to-face encounters occurring after October 1, 2025 must be in person.

According to home health expert Melinda A. Gaboury of Healthcare Provider Solutions says it is unlikely an extension would be retroactive even if Congress includes an extension in the finalized budget.

Payments

Conflicting information on Medicare payments leave us unsure of the actual impact. Some reports say there will be no delay while others mention 10-day holds. It is unclear whether this is in addition to the standard 14-day hold. Either way, we are anticipating (and hoping for) minimal payment disruptions.

Surveys

Initial Medicare certification for home health and hospice as well as recertifications will be delayed. If ACHA, CHAP, or another accrediting body is conducting your survey, however, there should be no delay. These accrediting bodies are continuing without interruption. State agency surbveys will be delayed until after the budget is finalized and the shutdown ends.

Look for continued updates from The Rowan Report as the shutdown and negotiations continue.

–As of October 9, 2025–

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.

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.

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 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 Rowan Report | 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.

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.

# # #

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 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.

BREAKING NEWS: CMS Changes AHEAD

CMS

by Rowan Report | 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.

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

# # #

Medicare Prior Authorization

CMS

by Kristin Rowan | 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 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 Kristin Rowan | 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 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 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

Patients’ Right to Freedom of Choice

Admin

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

by Elizabeth E. Hogue, Esq.

Patient's Right to Freedom of Choice of Providers

U.S. Supreme Court Weighs In

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

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

Supreme Court Decision

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

Exclusions on "any-qualified-provider" provision

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

Federal enforcement; not private

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

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

# # #

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

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

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

Fraud, Waste, and Abuse

Clinical

by Kristin Rowan | 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.

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

by Tim Rowan, Editor Emeritus

Bill Cuts Medicaid Directly, Medicare Indirectly

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

July 3: Bill Passes, The Alliance Responds

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

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

Dr. Steve Landers

CEO, The National Alliance for Care at Home

Final House Vote: July 3

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

As of the end of the day, July 1

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

As of the morning of July 1

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

June 29th

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

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

How the Senate Pushed the Bill Through

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

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

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

# # #

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