Fraud and Abuse Compliance

Admin

by Elizabeth E. Hogue, Esq. | Dec 18, 2025 | Admin, Home Health, Hospice, Legal

by Elizabeth E. Hogue, Esq.

Fraud and Abuse Compliance

Why All Providers Should Have One

Providers may have heard or read about the importance of Fraud and Abuse Compliance Programs in their organizations. Despite the wealth of available information about Compliance Programs, many providers continue to express uncertainty about their value.

Coincidentally, as we are preparing to publish this article, HHS publishes this report on the compliance audit of Guardian Home Care, LLC.

Here are some of the questions providers often ask about Compliance Programs:

Why should we have a Fraud and Abuse Compliance Program?

First

The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) has clearly stated that all providers are now required to have current Compliance Programs that are fully implemented.

As a practical matter, when providers establish and maintain Compliance Programs, it clearly discourages regulators from pursuing allegations of fraud and abuse violations. Jody Hunt, formerly of the DOJ, says providers should create robust fraud and abuse compliance programs. Then providers can argue that they shouldn’t be liable for violations because their compliance programs demonstrate that they had no intent to commit fraud.

Technically speaking, the Federal Sentencing Guidelines make it clear that establishment and implementation of Compliance Programs is considered to be a mitigating factor. That is, if accusations of criminal conduct are made, the consequences may be substantially less severe as a result of a fully implemented Compliance Program.

Additionally

Providers with Compliance Programs are more likely to avoid fraud and abuse. This is because Programs routinely establish an obligation on the part of every employee to report possible instances of fraud and abuse and include training for all employees.

Compliance Programs may also help to prevent qui tam or so-called “whistleblower” lawsuits by private individuals, rather than by government enforcers, who believe that they have identified instances of fraud and abuse. There are significant incentives to bring these legal actions since “whistleblowers” receive a share of monies recovered as a result of their efforts. Some “whistleblowers” have received millions of dollars. Compliance Programs make it clear that employees have an obligation to bring any potential fraud and abuse issues to the attention of their employers first.

Also…

The federal Affordable Care Act (ACA) requires providers to have Compliance Programs. In short, it’s the law!

Finally

The Deficit Reduction Act (DRA) requires providers who receive more than $5 million in monies from state Medicaid Programs per year to implement policies and procedures, provide education to employees and put information in their employee handbooks about fraud and abuse compliance. These requirements can be met through implementation of Fraud and Abuse Compliance Programs.

We don't receive reimbursement from the Medicare or Medicaid Programs.

Do we still need a Compliance Program?

Statutes and regulations governing fraud and abuse also apply to providers who receive payments from any federal and state healthcare programs, including Medicaid, Medicaid waiver and other federal and state health care programs, such as Tri-Care. Many private insurers have followed the federal government’s “lead” in terms of fraud and abuse enforcement. So private duty providers must have compliance programs, too.

Should we just use the model guidance that is applicable to us?

We hear that the OIG has provided guidance for various segments of the healthcare industry regarding Compliance Programs. Specifically, the OIG has already published guidance for clinical laboratories, hospitals, home health agencies, skilled nursing facilities (SMFs), hospices, physicians’ practices, third-party billing companies and home medical equipment companies. The OIG will publish updated guidance for all providers, It has already done so for SNFs.

The answer is “No!” Guidance from the OIG is not a model Compliance Program. Guidance from the OIG consists of general guidelines and does not constitute a valid Compliance Program. In addition, the OIG has made it clear that Programs must be customized for each organization.

Do we have to conduct internal audits first?

We have read that, before implementing Compliance Programs, providers must conduct expensive internal audits that can take many months to complete. Is this true?

While beginning the compliance process with an extensive internal audit is certainly one way to proceed, it is not the only viable way to work toward compliance. It is equally valid to begin with Compliance Programs that are customized for the organization that includes training for all employees about fraud and abuse and Compliance Programs. Then all staff members can subsequently participate in internal compliance activities, including audits, with a process in place to handle any issues that arise as a result of the audits.

We already have policies. Why do we need a Compliance Program too?

Compliance Programs are specific types of documents that routinely address issues that providers do not usually cover in internal policies and procedures. In addition, providers may not gain benefits under the Federal Sentencing Guidelines described in the first question above if there is no formal document called a Compliance Program.

We're accredited. Doesn't that mean we are in compliance?

On the contrary, Compliance Programs appropriately address potential fraud and abuse issues. They also include mechanisms for helping to ensure compliance such as processes for identification and correction of potential problems that are not addressed during the certification process. In other words, organizations may be accredited but fail to meet applicable compliance standards for fraud and abuse.

Will it help with investigations?

Will the fact that our organization has a Compliance Program make any difference with regard to the outcome of fraud and abuse investigations and the imposition of Corporate Integrity Agreements (CIA’s)?

Yes, it may make a considerable difference based on statements from the OIG. If providers have Compliance Programs in place that are current and fully implemented, the OIG may be less aggressive in pursuing potential violations. When the OIG actually discovers problems with fraud and abuse in organizations, providers are usually asked to develop and implement a Corporate Integrity Agreement (CIA). The OIG often requires CIA’s to include a process for stringent monitoring by the OIG on a continuous basis. These monitoring activities can be extremely burdensome to providers in terms of both time and money. Providers with valid Compliance Programs are not necessarily asked to develop and implement CIA’s.

Final Thoughts

Now is the time for all providers to recognize and act upon the need to establish and maintain Compliance Programs. “Working on it” is no longer good enough.

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.

BREAKING NEWS: Home Health Final Rule

Breaking News

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

by Kristin Rowan, Editor

BREAKING NEWS

Home Health Final Rule

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

Payment & Policy Updates

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

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

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

Read the CMS Fact Sheet

Face-to-Face

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

Home Health VBPM

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

Care of Patients
Communications between Providers and Patients
Specific Care Issues

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

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

Medicare Provider Enrollment Revocation

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

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

Additional Changes

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

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

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

Read the Final Rule and additional Documents

Final Thoughts

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

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

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

# # #

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

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

Alliance to Congress: STOP CUTS

Advocacy

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

by Kristin Rowan, Editor

9% Cut Proposed

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

Deadline Looming

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

Group Effort

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

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

Pattern of Payment Reduction

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

Home Health Costs Less

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

What's at Risk

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

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

Dr. Steve Landers

CEO, National Alliance for Care at Home

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

# # #

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

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

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

Bill Dombi Presents

Advocacy

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

by Kristin Rowan, Editor

Bill Dombi Presents...

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

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

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

Bill Dombi

President Emeritus, National Alliance for Care at Home

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

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

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

What's in Store for Care at Home?

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

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

Final Thoughts - Dombi's Care at Home Forecast

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

# # #

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

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

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

Advocacy Week

Advocacy

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

Advocacy Week

FOR IMMEDIATE RELEASE

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

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

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

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

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

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

Advocates focused on four key issues during their congressional meetings:

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

Advocacy Week National Alliance for Care at Home

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

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

# # #

About the National Alliance for Care at Home

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

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

Quality Improvement Project

Admin

by Kristin Rowan | Aug 28, 2025 | Admin, Clinical, Home Health, Hospice

by Kristin Rowan, Editor

Quality Improvement Project

Joint two-year effort publishes results

The Quality improvement project, a joint two-year research initiative between BerryDunn, Strategic Healthcare Partners, and National Alliance for Care at Home, aimed to improve the care experience for patients and improve CAHPS scores. The study implemented best practices targeted toward the CHAPS survey to see what really was working in improving patient and family satisfaction.

“Very little research has been done in the area of home health and hospice CAHPS, and this project is helping to close that gap. By identifying and validating true best practices, we’re giving agencies actionable tools to improve patient and family experience. At the heart of care is the relationship between providers, patients, and families—and improving that experience is essential to achieving meaningful outcomes.”

Lindsay Doak

Director of Healthcare Research and Education, BerryDunn

The Quality Improvement Project

The study included 27 hospice and 36 home health agencies. It ran from October of 2023 through June of 2024. Participating agencies underwent supervisory training and support, customer service and PCC training and support, and patient-centered mentorship certification. They also participated in bimonthly review calls for performance metrics and best practices.

Data comparisons

CAHPS data collected between June 1 and December 31, 2023 served as a baseline to compare with data collected using best practices. New CAHPS data collected between June 1 and December 31, 2024 showed outcomes of the project.

Quality Improvement Project Hospice Domains

Quality Improvement Project Home Health Domains

Best Practice Findings

Before funding new or additional initiatives, ensure internal readiness and operational stability to ensure successful implementation
- Customer service training improved CAHPS outcomes in communication and willingness to recommend
- Supervisory training improved roll-up scores for hospice and both specific care issues and willingness to recommend for home health
- Mentorship boosted overall scores in hospice, but had little impact in home health
Home Health agencies may benefit from mandated interdisciplinary team meetings for mentorship, peer connection, and ongoing staff education
Turnover rates had mixed results
- Intentional staff changes due to performance issues increased scores
- General high turnover disrupted continuity and long-term success

Key Takeaways/Conclusions

Implementing patient-centered care (PCC) yielded strong improvement in some areas for some organizations, but overall the project produced varied results. The project was more successful among hospices than home health agencies. PCC training will need changes to achieve measurable impact. The best results came from agencies with the highest participation rates. Further improvement efforts need to be tailored to agency types, cultures, dynamics, and internal barriers.

# # #

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

Eleos Navigates Eligibility Risk

Admin

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

Eleos Navigates Eligibility Risk

FOR IMMEDIATE RELEASE

Contact: Amanda Wells

awells@sloanepr.com

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

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

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

Eligibility Check

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

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

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

Alon Joffe

Co-founder and CEO, Eleos

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

Industry leader sees Eleos scanner as critical tool

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

Chuck Ingoglia

President and CEO, National Council for Mental Wellbeing

Rationale

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

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

# # #

About Eleos

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

Research Institute Joins Alliance

Advocacy

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

FOR IMMEDIATE RELEASE
August 20, 2025

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

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

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

Research Institute for Home Care

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

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

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

In Their Own Words

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

Dr. Steve Landers

CEO, National Alliance for Care at Home

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

Jennifer Sheets

Chairman of the Board, Research Institute for Home Care

Director Agreement

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

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

# # #

About the National Alliance for Care at Home

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

About the Research Institute for Home Care

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

First Joint Event for NAHC & NHPCO

Events

by Rowan Report | Aug 7, 2025 | Events, Home Health, Hospice, Partner News

FOR IMMEDIATE RELEASE
July 30, 2025
PHOTO LINK

National Alliance for Care at Home Hosts Inaugural Financial Summit

Over 700 industry leaders gather in Chicago for three-day event focused on financial leadership and innovation in home-based care

(Alexandria, VA and Washington, DC) — The National Alliance for Care at Home (the Alliance) successfully hosted its inaugural event, the 2025 Alliance Financial Summit, July 27-29 in Chicago, IL. The Summit brought together financial leaders from across the care at home community, with expert-led sessions, peer collaboration, and insights into market shifts and emerging technologies.

Arrival in Chicago

Welcome

The Summit officially launched Sunday evening with an opening keynote by Wendy Sue Swanson, MD, MBE, Founder and CEO of Skin Metal and Author of “Mama Doc Medicine.” Dr. Swanson delivered a forward-looking presentation on the intersection of medicine and technological innovation. The evening concluded with a Welcome Reception in the Exhibit Hall.

Keynote

The day’s keynote session featured Alliance CEO Dr. Steve Landers alongside a panel of experts including Ken Albert, President and CEO of Andwell Health; Trisha Crissman, President and CEO of CommonSpirit Health at Home; and Hillary Loeffler, Vice President of Policy & Regulatory Affairs for the Alliance. Panel discussions addressed the potential impact of payment cuts in the Centers for Medicare & Medicaid Services Calendar Year 2026 Home Health proposed rule, hospice policy developments, workforce challenges and solutions, and actionable strategies for providers to protect the future of home-based care. Attendees then moved into a full day of concurrent sessions before an evening reception on the Chicago River.

Steven Landers, CEO, The Alliance, Financial Summit

The Alliance Financial Summit Riverwalk Reception

The Alliance Financial Summit Attendee Map

Networking and Education

Tuesday featured dedicated peer-to-peer networking sessions, allowing for informal conversation and knowledge sharing, before the opportunity for more concurrent sessions. The Summit concluded with a closing keynote expert panel featuring leaders from the Alliance’s Home Health and Hospice Financial Managers Association (HHFMA).

“This first Alliance event exceeded our expectations, bringing together care at home leaders from across the nation to connect, learn, and recommit to our shared vision of an America where everyone has access to the highest quality, person-centered healthcare wherever they call home,” said Alliance CEO Dr. Steve Landers. “The content was both practical, grounded in the day-to-day challenges and successes of providers, while incorporating innovation and aspiration to drive future growth and success.”

The Alliance has announced two additional events for 2025: Alliance Advocacy Week, September 8-11 in Washington, DC, and the National Alliance for Care at Home Annual Meeting and Exposition, November 1-4 in New Orleans, LA.

# # #

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.

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

Patients’ Right to Freedom of Choice

Admin

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

by Elizabeth E. Hogue, Esq.

Patient's Right to Freedom of Choice of Providers

U.S. Supreme Court Weighs In

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

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

Supreme Court Decision

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

Exclusions on "any-qualified-provider" provision

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

Federal enforcement; not private

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

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

# # #

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

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

Paul Joiner: On the Record

Admin

by Kristin Rowan | Jul 24, 2025 | Admin, Artificial Intelligence, Home Health, Hospice

by Kristin Rowan, Editor

Paul Joiner

On the Record

Paul Joiner, CEO of HHAeXchange, sat down with The Rowan Report Editor Kristin Rowan to discuss the company’s new headquarters in Manhattan, the company culture he’s creating, his dedication to support those helping our most vulnerable populations.

In His Own Words

The Rowan Report: Paul, thank you for taking the time to talk to us. HHAeXchange is going through some significant growth recently. And now you’ve moved your headquarters from Long Island to Manhattan, correct? How did that decision come about?

Paul Joiner: HHAeXchange has been in Manhattan for a long time. Sandata, who we acquired earlier this year, was in Long Island. But, the move was planned with or without Sandata. We needed a nice sized space to convene people. We valued a large, multi-purpose meeting space over individual office space. It’s a space where the teams can meet when they come to town, where we can host clients, and larger company meetings.

RR: How does the new space support your team?

Paul: The majority of our team is remote. I don’t think remote work is healthy for everyone. It varies from person to person. It’s not a long-term healthy option. Returning back to the office 9-5 five days a week isn’t practical and not all that healthy either. We have created policies, a workspace, and a culture where people are invited to visit. Some come 2-3 days per week. Some only once a month. We maintain flexibility for our teams to work when and where they need to work. Being a single parent, for example, is really hard, so we stay flexible to support single parents to be where they need to be.

At the same time, we’ve seen the benefit of the connection and how much more healthy it is by physically coming together. For the younger workforce, they are enjoying getting together and coming into the office. We have to support our younger employees and their professional development. How do you professionally develop via Zoom or Teams? Physically coworking and promoting good and active environments compel people to come into the office. To build connections, you have to be together, not just on video.

RR: You have workers across the country, though. How does that work?

Paul: We have the main office here in Manhattan, a large and growing office in Minneapolis, and a smaller office in Miami. We try to keep people in areas that make it easy to meet. However, we do have some roles with certain criteria that allows for mostly remote work. Those teams come to one of the offices to meet when they can. We’ve hosted team meetings here and in Minneapolis recently.

RR: Has this new meeting space had an impact on the company culture?

Paul: Yeah, it has improved. We are having real, honest conversations about what needs to be improved. The team effort is the way we win and our teams understand that. We also understand that working hard doesn’t mean foregoing your life and the ability to recharge.

Work hard, be passionate, and motivate people with your mission and vision. The people we serve don’t have it easy, they are supporting the most vulnerable people.

RR: In a recent statement, you said that the new location will support collaboration and innovation. Do you have new features on the horizon? Are you investing in AI capabilities?

Paul: We have a lot in the works. We have a new mobile app in the beta phase that we’ll be rolling out that I’m really excited about. It’s actually an update, but it’s so massive that it’s basically new. We’re working on data analytics and data tracking for some of our largest clients. We’ve consolidated some screens into one spot to streamline and make the user more efficient. A lot of what we’re working on is foundational. We’re focusing on supporting companies as they scale.

RR: Are you looking into AI, either within the HHAeXchange platform, or in a partner?

Paul: Yeah, of course. AI is the future and it’s everywhere. We are looking at ways to return time to users, make it easier to train users, and make things easier on caregivers. We will try to generate more buzz around AI, but not until there’s real, tangible value. AI definitely needs to be part of our strategy, but being smart where we apply it to truly get the value-add for our clients. It has to improve the quality of life for the user. Does it improve the ability of caregivers to care for people?

RR: Do you have any additional acquisition or growth plans for the second half of 2025?

Paul: There’s a lot going on in the marketplace right now. A lot of our clients are growing really well also. So, we’re sort of in a heads-down mode. There’s a handful of things we’re looking at. Right now, I’m really excited about being a bigger participant across the full continuum of care for our populations. There are some opportunities to innovate and evolve to support integrated care over the next few years. I’ll just leave it at that…for now.

RR: Paul, thank you for joining me today. It’s always a pleasure.

# # #

About HHAeXchange

Founded in 2008, HHAeXchange is the leading technology platform for homecare and self-direction program management. Developed specifically for Medicaid home and community-based services (HCBS), HHAeXchange connects state agencies, managed care organizations, providers, and caregivers through its intuitive web-based platform, enabling unparalleled communication, transparency, efficiency, and compliance. In 2024, HHAeXchange expanded through the strategic acquisitions of Sandata, Cashé Software, and Generations Homecare System, strengthening its commitment to advancing the industry.

About Paul Joiner

Paul Joiner is an accomplished executive with extensive leadership experience in the healthcare sector. Currently serving as a Board Member at AssistRx, Joiner has held prominent positions, including Chief Executive Officer at both HHAeXchange and Kipu Health. Previous roles include Chief Operating Officer as well as Executive Vice President and General Manager at Availity, and Senior Vice President and General Manager of Health Plan. Joiner also served as Vice President of Client Engagement and Business Development at Midas+ Solutions, Xerox Healthcare Provider Solutions. Educational qualifications include a Master of Accountancy from Belmont University and a Bachelor of Accountancy from the University of Mississippi.

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

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

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

“Planning for In-Home Care”

Advocacy

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

FOR IMMEDIATE RELEASE

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

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

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

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

CaringInfo

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

Planning for In-Home Care

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

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

Dr. Steve Landers

CEO, The National Alliance for Care at Home

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

Visual Update

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

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

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

# # #

About the National Alliance for Care at Home

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

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

CMS Home Health Proposed Rule 2026

Advocacy

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

by Kristin Rowan, Editor

CMS Home Health Proposed Rule 2026

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

Payment Adjustments

The Facts, as Listed by CMS

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

Contradictory Facts, as Listed by CMS

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

HHCAHPS Survey Changes

Added Questions

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

Removed Questions - Medication

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

Removed Questions - Other

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

Other Changes

CMS recommends additional changes in various categories:

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

Requests for Information and Feedback

CMS has issued the following RFI:

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

CMS is seeking feedback on the proposed rule through

August 29th, 2025

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

Submit comments, feedback, and documentation to CMS

The Alliance Responds

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

Dr. Steve Landers

CEO, The National Alliance for Care at Home

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

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

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

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