Home Health Integrity and Protection Bill

Advocacy

by Kristin Rowan | Oct 16, 2026 | Advocacy, CMS, Medicare, Regulatory

by Kristin Rowan, Editor

Medicare Home Health Fraud Protection Bill

Companion bills in Senate and House

In August of this year, Senator Collins (R-ME) introduced the Medicare Home Health Payment Integrity and Protection Act of 2026 (S.5250). The bill would amend title XVIII of the Social Security Act. Its proposed actions would add tougher fraud prevention, more oversight, more enforcement resources, and an adjustment to Medicare payments for 2027.

On October 13, Congresswoman Tenney (R-NY) introduced a companion bill in the House.

HHA Screening

For agencies identified as extreme fraud risk, the bill proposes:

Enhanced screening, including fingerprinting agency administrators
Proof of comprehensive liability insurance
Additional scrutiny under some circumstances, namely a marked local increase in HHAs

Scrutiny of unusual circumstances

HHAs whose actions point to potential fraud or compliance issues would see increased oversight. New agencies would see more frequent surveys. Agencies with new ownership likewise would see increased verification and inspection. The bill also proposes additional scrutiny and oversight of agencies that miss quality data reporting requirement or have unusual admission patterns.

Surveyor requirements

Accreditation bodies would have new surveyor requirements under the new law. Specifically, the survey procedures must meet or exceed state and local agency standards as agreed to with the Secretary of Health and Human Services. Surveyors must also complete CMS training courses and stay in compliance with a performance assessment that the Secretary must establish. The assessment would include remedies for accreditation bodies not in compliance including corrective plans, ongoing monitoring, and/or termination of approval.

Fraud prevention and enforcement resources

The bill proposes $550 million in additional resources allocated to:

CMS program-integrity activities
Department of Justice and HHS Inspector General fraud enforcement
Inspections, enrollment validation, and operational verification by state survey agencies

Reimbursement rate changes

The bill changes the standard payment amount and some adjustments under the PDGM. The standard prospective payment for 2027 would be $2,382.87. This is a substantial increase over the 2027 proposed base payment rate of $2,092.27.

The bill also removes all permanent and temporary adjustments for 2020 and all subsequent years. It states that the Secretary will not “impose any adjustment to offset increases or decreases in extimated expenditures attributable to the difference in assumed versus actual behavioral changes due to the implementation of the PDGM….”

Finally, the bill proposes that suspect claims and claims from fraudulent providers will not be used in calculations for payment benchmarks and value-based adjustments.

Bill endorsed by national associations

“We are grateful to Representative Tenney for leading this important effort in the House. Medicare home health payment should be built on reliable data, not on numbers distorted by fraud. This legislation fixes the flawed math behind years of compounding cuts and gives CMS the tools to stop bad actors before they receive federal funds. With bills now in both chambers, Congress has a clear path to protecting access to essential home health services.”

Jennifer Sheets

CEO, National Alliance for Care at Home

“This bill’s oversight provisions are reasonable, appropriately targeted policies that would help maintain the benefit’s integrity. Those, along with the important proposed payment changes, will help to ensure support for legitimate providers—including our nonprofit and mission-driven members. We look forward to working with Senator Collins to advance this legislation.”

Katie Smith Sloan

President and CEO, LeadingAge

Where the bills stand

Collins’s Senate bill was read twice referred to the Senate Committee on Finance on August 5, 2026. The House bill was introduced this week and has not yet been referred to a Committee.

The Rowan Report will provide updates as these bills move through the House and Senate. We don’t expect any additional action prior to the upcoming election cycle.

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Kristin also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. She works with care at home software providers to create dynamic content that increases conversions for direct e-mail, social media, and websites. Connect with Kristin directly at kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2026 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

HCAOA Announces Medicaid Advocacy

Advocacy

by Kristin Rowan | Oct 16, 2026 | Advocacy, Medicaid, Partner News, Regulatory

by Kristin Rowan, Editor

HCAOA Expands Medicaid Advocacy

Medicaid Expert Announced

The HCAOA Annual Meeting was a-buzz with rumors of a new staff member joining the team. The announcement was scheduled during the opening session with Jason Lee, but was postponed. Lee mentioned it almost as an aside in his opening address. He said, “we’ll have a new medicaid and government relations and expert on our staff. So looking forward to an exciting announcement next week.”

News Spread

Attendees noticed Lee’s statement and began speculating about who the new expert on staff would be and why Lee didn’t name them in his opening address.

An inside source told The Rowan Report that the announcement had been delayed at the insistance of the new employee’s then current employer.

By the end of the first day of the annual event, many attendees were speculating about the announcement. Some correctly guessed the identity of the new employee while others were off the mark. Either way, the delay of the announcement created anticipation better than any marketing campaign.

At Long Last

On Oct 6, more than a week after the announcement was initially scheduled, new HCAOA Senior Director of Communications, Marketing, and Education Allison Dolan sent the press release announcing the organization’s expanded Medicaid advocacy focus. The announcement named policy expert Damon Terzaghi as Vice President of Public Policy.

You can read the full HCAOA statement here.

Expertise

The press release reads, “Terzaghi brings more than two decades of experience in Medicaid, long-term services and supports (LTSS), aging, disability and home-based care policy across federal and state government, national associations and the private sector. He most recently served as vice president of Medicaid and home care policy at the National Alliance for Care at Home, and has held roles at the Centers for Medicare & Medicaid Services, Advancing States, the Marwood Group, the National Association of State Medicaid Directors and the Oregon Department of Human Services.”

In his Own Words

“We are at a crucial inflection point in long-term services and supports in our country, as demand far exceeds capacity and more participants turn to Medicaid programs to finance their care. With the enrollment and spending growth in these programs, beneficiaries and providers are facing more and more difficult questions, ranging across access, workforce, payments, quality, and program integrity. I’m eager to hear directly from HCAOA members and make sure our policy discussions reflect their experiences.”

Damon Terzaghi

Vice President of Public Policy, Home Care Association of America

Medicaid Goals

HCAOA CEO Jason Lee said, “Medicaid is core to how many of our members do business, creating a growing need for expertise and advocacy….”

The new Medicaid advocacy focus will connect federal policy developments with state-level implementations, according to the press release. The association will work on reimbursement, workforce capacity, regulatory requirements and access to care. The plan includes creating Medicaid resources for its members.

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HCAOA: Past, Present, Future

Advocacy

by Kristin Rowan | Oct 16, 2026 | Advocacy, Home Care, Medicaid, Regulatory

by Kristin Rowan, Editor

HCAOA: Past, Present, Future

An Interview with Jason Lee and Aaron Stapleton

During this year’s HCAOA annual meeting, The Rowan Report sat down with association CEO Jason Lee and outgoing board president Aaron Stapleton. We talked about the accomplishments during Stapleton’s tenure, this year’s annual meeting, and what’s in store for HCAOA in the coming years.

Stapleton set priorities for his term

As HCAOA board president, Aaron Stapleton set three priorities: raise the association’s visibility, strengthen membership and build strategic partnerships. Stapleton said the work is beginning to change how policymakers and the broader health care community understand home care.

CEO Jason Lee Board President Aaron Stapleton HCAOA

Visibility

Stapleton said greater recognition matters because home care remains less understood outside its own professional community. Advocates, patients, families and lawmakers need a clearer picture of what home care providers do and how their services fit into the wider health care system.

“We’re actually having conversations, not introducing who we are and what we do, but building off of previous years. I went into a legislator’s office this year and she said she remembered our conversation from last year. To me, that said these people are getting it; they’re understanding what we do.”

Aaron Stapleton

Board President, Home Care Association of America

Lee's focus on growth

Membership growth is another measure of progress. Lee said HCAOA had grown to more than 5,300 members, up from about 4,600 the previous year. He credited the association’s staff and board, as well as the value members find in advocacy, education and professional connections.

Partnership efforts

Lee and Stapleton pointed to partnerships as another way to amplify the sector’s voice. HCAOA has been building relationships with organizations including the Alzheimer’s Association and other national and state-level groups. Stapleton said the goal is not simply to announce partnerships before his term ends, but to open doors that can develop into lasting relationships.

“The more you co-brand things, the stronger the voice is,” Stapleton said.

Advocating for the caregiver profession

Another priority for both leaders is changing how the work is described. They objected to the term “unskilled” when applied to home care, saying it diminishes the training, judgment and oversight involved in supporting older adults and other people who need assistance. Stapleton said he would like the industry to use “care professional” more consistently to distinguish trained, employed caregivers from the broader category of family caregiving.

That distinction is about more than terminology, they said. Home care workers can help identify safety risks, support medication routines and reduce the likelihood that vulnerable people will need hospital care. Stapleton described home care as a proactive part of the health care continuum—one that can help people remain safely at home while easing pressure on families and the wider system.

The leaders acknowledged that training and licensing requirements vary by state. Lee said HCAOA has model legislation and regulations that can help states develop home care licensure frameworks, and that the association is considering a gradual approach to credentials and broader accreditation. The aim, he said, is to establish a meaningful baseline without creating unnecessary burdens for agencies that are already operating responsibly.

2027 and beyond

As Stapleton’s term approaches its end, he said his focus is on finishing strong: continuing to support Lee and the association, sustaining membership and partnership growth, and preparing incoming president Sarah Wilson for a smooth transition. He said the next leader should be able to build on existing work while bringing her own strengths and perspective.

For both leaders, the larger goal is to make home care more visible and better understood—not only by policymakers, but by health care partners and the public. They see stronger membership, broader partnerships and more personal stories from families and caregivers as ways to make that case.

Final Thoughts

I want to thank Jason and Aaron for sitting down with me during this year’s annual meeting for HCAOA. I also want to thank HCAOA for their continued support of The Rowan Report. The annual meeting is always educational and I enjoy reconnecting with members, vendors, and staff. Until next year.

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HCAOA Annual Event Preview

Advocacy

by Kristin Rowan | Sep 25, 2026 | Advocacy, Events, Home Care, Partner News, Regulatory

by Kristin Rowan, Editor

HCAOA Annual Event Preview

Woah!

Orlando, Florida is known for its warm weather and sunny days. But, next week, Orlando will be “cool!” The opening keynote speaker at the HCAOA National Home Care Conference is Mr. Cool himself, Arthur Fonzarelli. Henry Winkler, aka “The Fonz”, is an Emmy Award-winning actor, director, producer, and best-selling author. He is also an advocate for people who learn differently. This year’s keynote address will certainly kick things off with humor and inspiration, but “Ayyy” that’s just the beginning.

Headliners

Joining Winkler in this year’s lineup are Disney executive Louie Gravance talking about service excellence and comedian turned motivational speaker Jeff Civillico. Gravance is the featured speaker for the opening session on day 2 of the event. Civillico is the emcee on the main stage throughout the conference.

Education

If you’re heading to HCAOA next week, expect a busy schedule. The hardest part will be deciding which sessions to attend when some of the best minds in the industry have overlapping time slots.

Home Care CEOs and software solutions providers will present real-world applications and use cases for AI in home care, workforce solutions for developing caregivers and preparing for the future, operations guidance on benchmarking, cultivating cultural connections, recruitment, employment law, and finance and marketing.

For Floridians, HCAOA has a state-focused session track including regulatory and compliance updates a Florida Advocacy Forum.

Fun & Games

Some of the best networking opportunities are often accompanied by a glass of wine, a coffee, or an award. Don’t miss the vendor networking breakfast and lunch, the networking reception on Monday night, and the presentation of the Caregiver of the Year Award on Tuesday morning. And, of course, if you stick around after the reception on Monday, you’re bound to find most of us at the hotel bar.

Worth the Trip

The Home Care Association of America hosts a stellar event every year and this year is shaping up to be no different. I look forward to seeing many of you in Orlando next week. Plan your schedule here.

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The Alliance Hosts Second Annual Advocacy Week

Advocacy

by Rowan Report | Sep 25, 2026 | Advocacy, Events, Home Care, Home Health, Hospice, Regulatory

FOR IMMEDIATE RELEASE

Contact: Hannah Kristan
communications@allianceforcareathome.org
202-355-1647

Over 150 Advocates Convene on Capitol Hill to Champion Care at Home

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

Alexandria, VA and Washington, DC, Sept. 16, 2026. – This week, more than 150 care at home advocates from across the country met with 285 congressional offices to discuss key legislative and regulatory priorities for expanding and protecting access to care at home. The meetings were part of the 2026 National Alliance for Care at Home Advocacy Week, an important opportunity to unite the entire care at home continuum under one voice.

Alliance Advocacy Week, now in its second year, offers a unique opportunity to bring together leaders, advocates, and supporters to amplify that home is where care happens, driving positive change and shaping the future of care to ensure that access to these essential services is protected and expanded.

"Our strength has always been our unity..." Jennifer Sheets

“This is a defining moment for care at home. When more than 150 advocates walk the halls of Congress together, speaking with one voice on behalf of patients, families, and providers, we send an unmistakable message. Care at home already has bipartisan support and recognition as a cost-effective, patient-preferred solution. As demand continues to grow, we are committed to being a strong partner with Congress to help federal policy grow with it,” said Jennifer Sheets, CEO of the Alliance. “Our strength has always been our unity, and Advocacy Week proves what we can accomplish when the entire continuum stands together to protect and expand access to the care people need, where they want to receive it most.”

Alliance Hosts Second Annual Advocacy Week

Key Issues

Advocates focused on five key issues during their congressional meetings:

End the home health and hospice provider moratoria and instead focus on implementing existing mechanisms to apply targeted, risk-based enforcement that roots out bad actors while protecting patients and legitimate providers.

Ensure that Medicare and Medicaid program integrity strategies are targeted and data-driven, focused on stopping fraudsters without harming legitimate providers or access to care, and supporting the Protecting Seniors and Stopping Fraudsters Act.

Stabilize Medicare home health payment rates by supporting the Medicare Home Health Payment Integrity and Protection Act to reverse an access crisis that has already left more than one-third of patients referred for home health without the care they need.

Protect and strengthen access to Medicaid HCBS by supporting policies and funding that let people receive care in their homes and communities, and that strengthen the direct care workforce making that possible.

Expand access to home care services by supporting the Credit for Caring Act to provide a federal tax credit of up to $5,000 to support family caregivers who provide 49 billion hours of unpaid care to relatives.

Advocacy Week Activities

In addition to congressional meetings, Alliance Advocacy Week featured in-depth policy briefings, a training for first-time advocates, and a panel discussion with seasoned government affairs professionals. The Alliance celebrates another successful Advocacy Week on behalf of care at home providers across the country and looks forward to continuing its work with policymakers and key stakeholders.

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About the National Alliance for Care at Home

The National Alliance for Care at Home (the Alliance) is the leading authority in advancing care in the home. We envision an America where everyone has access to the highest quality, person-centered healthcare wherever they call home. Through advocacy, education, and convening, we connect providers and stakeholders to strengthen care delivery across the home-based care continuum — spanning home care, home health, hospice, palliative care, and Medicaid home and community-based services. Learn more at www.AllianceForCareAtHome.org.

©2026 The National Alliance for Care at Home. This press release was issued by The National Alliance for Care at Home and is reprinted here with permission. For more information, please see contact information above.

The Alliance Responds to the Integrity and Protection Act

Advocacy

by Rowan Report | Aug 14, 2026 | Advocacy, CMS, Home Health, Medicare, Regulatory

FOR IMMEDIATE RELEASE

Contact: Hannah Kristan
communications@allianceforcareathome.org
202-355-1647

The Alliance Celebrates the Introduction of the Medicare Home Health Payment Integrity and Protection Act of 2026

Alexandria, VA, August 7, 2026. Today, the Alliance applauds the introduction of the Medicare Home Health Payment Integrity and Protection Act of 2026 (S.B. 5250) by Senator Collins (R-ME) and Senator Blackburn (R-TN). This important piece of legislation will provide core payment integrity reforms by correcting the Centers for Medicare & Medicaid Services’ (CMS) flaws in calculating Medicare rate updates, while also streamlining program integrity measures to target fraud concerns early, stopping bad actors from entering the Medicare program. Critically, this legislation does not rely on sweeping enforcement strategies which risk further restricting access to care for Medicare beneficiaries and causing unintended harm to legitimate providers.

The Medicare Home Health Payment Integrity and Protect Act seeks to restore the Medicare home health rate to what it would have been without consecutive years of compounding cuts. Those cuts were built on data entirely unrelated to the payment system adopted in 2020, along with data tainted by the inclusion of fraudulent providers in the rate analysis. This is an important step in modernizing the home health benefit, ensuring that beneficiary access is not disrupted by providing payment rates that better reflect the true cost of care.

The program integrity reforms included in this legislation build on the industry supported bill from Representative Beth Van Duyne in the Protecting Seniors and Stopping Fraudsters Act (H.R. 8883), which gives CMS stronger tools to combat healthcare fraud without imposing unnecessary burdens on legitimate providers.

“The National Alliance for Care at Home applauds the introduction of the Medicare Home Health Payment Integrity and Protection Act of 2026 by Senator Collins. This bill corrects longstanding flaws in home health reimbursement and takes a meaningful step toward a home health benefit that is stable and built for how care is delivered today. We strongly support the bill for its payment reforms, as well as measures to protect patients and preserve the integrity of the Medicare home health benefit.”

Jennifer Sheets

CEO, National Alliance for Care at Home

Sheets continues, “Consistent with our community’s commitment to provide the highest-quality, person-centered care in the home, we support the bill’s goal to strengthen access while focusing on targeted oversight, protecting the legitimate providers who serve patients every day. We look forward to working with Senator Collins, a long-time champion of care at home, to build support for this important and timely legislation.”

“When billions of dollars are improperly siphoned from the Medicare home health program, this can undermine the integrity of the payment system used to reimburse legitimate providers and threaten care for the seniors who depend on it. I have long been a strong supporter of home health care, which allows millions of Americans to remain in the comfort, security, and privacy of their own homes, while helping to avoid unnecessary hospitalizations and nursing home admissions,” said Senator Collins. “Fraudulent home health providers harm beneficiaries and diminish reimbursements for honest agencies that are already confronting workforce shortages and rising costs. My legislation would give CMS stronger tools to stop fraud before payments are made and prevent fraudulent spending from distorting the data used to reimburse honest agencies for medically necessary care.”

The Alliance will continue to serve as a key partner to lawmakers and regulators working to reform and protect the Medicare home health benefit, ensuring that payment rates better reflect the true cost of care.

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About the National Alliance for Care at Home

© 2026 This press release was sent to The Rowan Report from the National Alliance for Care at Home and is reprinted with permission. For more information or to request permission to use this content, see contact information above.

LeadingAge Reacts to the Integrity and Protection Act

CMS

by Rowan Report | Aug 14, 2026 | CMS, Home Health, Medicare, Regulatory

Leading Age React to Integrity and Protection Act

FOR IMMEDIATE RELEASE

Contact: Lisa Sanders
lsanders@leadingage.org
202-508-9407

LeadingAge Statement on the Medicare Home Health Payment Integrity and Protection Act of 2026

August 7, 2026 Washington, DC—Statement from Katie Smith Sloan, president and CEO, LeadingAge, the association of nonprofit and mission-driven providers of aging services, including home health, on the Medicare Home Health Payment Integrity and Protection Act of 2026, recently introduced by Senator Susan Collins (R-ME):

“Access to health care and services is an important benefit today, as America grows older—by 2050, adults age 65 and older will increase from 17% to nearly 25% of the population. What’s more, care at home is what people prefer and it also delivers strong patient satisfaction and quality outcomes. Yet the valuable Medicare home health benefit is under threat. Senator Collins’ bill rightly seeks to rectify two contributors to that unfortunate situation: bad actors seeking to exploit the program, and…years of reductions due to a flawed methodology. “

Katie Smith Sloan

President and CEO, LeadingAge

Sloan continued, “A longtime champion of Medicare home health, Senator Collins appreciates the shortcomings of current payment approaches; we are particularly encouraged by the bill’s recognition that the standard prospective payment amount requires a recalibration.

The Centers for Medicare and Medicaid Services’ (CMS) patient-driven groupings model (PDGM), in place since 2020, applies permanent and temporary payment adjustments, as required by Congress, premised on isolating “assumed versus actual” behavior change. The widely recognized problem is that in practice, neither CMS nor any other stakeholder, has managed to isolate the specific behavior due to PDGM from other factors that have also changed over the same time frame: patient acuity, referral patterns, staffing markets, the shift in post-acute utilization, potential fraud, and the lasting effects of the public health emergency.

LeadingAge Reacts to Integrity and Protection Act

Rather than continue use of the problematic behavioral adjustments methodology, it makes sense to set a rate that reflects the patients agencies actually serve, and pause further assumption-driven adjustments. Home health providers need this relief, and the older adults and families who depend on care at home need the stability and access sensible rate-setting would deliver.

We appreciate Senator Collins’ leadership in presenting a much-needed reset of the Medicare home health payment to promote its stability and ensure access.

In addition, we also share the desire to address fraud in this setting. LeadingAge has long expressed concern about the increase of home health providers in Los Angeles County.

This bill’s oversight provisions are reasonable, appropriately targeted policies that would help maintain the benefit’s integrity. Those, along with the important proposed payment changes, will help to ensure support for legitimate providers—including our nonprofit and mission-driven members. We look forward to working with Senator Collins to advance this legislation.”

About Leading Age

We represent more than 5,300 nonprofit and mission-driven aging services providers serving older adults and touching millions of lives every day. From our national headquarters in Washington, DC, and in collaboration with our state partners representing members active in 50 states, the District of Columbia, and Puerto Rico, we use advocacy, education, applied research, and community-building to make America a better place to grow old. Our membership encompasses the entire continuum of aging services, including skilled nursing, assisted living, memory care, affordable housing, retirement communities, adult day programs, hospice, Programs of All-Inclusive Care for the Elderly (PACE), and home-based care. We bring together the most inventive minds in the field to lead and innovate solutions that support older adults wherever they call home. For more information, visit leadingage.org.

© 2026 This press release was sent to The Rowan Report from LeadingAge and is reprinted with permission. For more information or to request permission to use this content, see contact information above.

VA Policy Causes Death of Veteran

Advocacy

by Kristin Rowan | Aug 14, 2026 | Advocacy, Regulatory, Veterans Affairs

by Kristin Rowan, Editor

VA Policy Causes Death of Veteran

For the last couple of months, we’ve been reporting on the rate and hours changes from the VA in Texas and NM. Caregivers are taking pay cuts. Agencies are operating at a loss in order to continue serving our veterans. Many veterans are losing their caregiver, losing the comfort of having a familiar person in their home, losing the progress they’ve made against depression, PTSD, and isolation. And now, we’ve heard a story that we just cannot believe.

Last week, I spoke with an agency owner operating across four states. The agency has been impacted by the rate cuts in Texas and New Mexico. His story is disturbing and highlights the darkest realities of this policy. Here is his story:

End of Care

The administration in one VA not only cut the rates and cut veteran hours, but also just ended care for some veterans and kicked them out of the program. There were no in-home visits or assessments. A member of the VA office made phone calls and asked veterans if they needed care. One of these phone calls reached a veteran with dementia. She didn’t remember the 16 to 20 hours of ADL care she was receiving to dress, eat, and bathe every day. She told the caller she did not need care and the VA dropped her from the program completely.

End of Life

Another veteran, another call to determine whether he needed care, and another drastic cut in hours. This veteran needed home visits daily. He needed supervision and check-ins. The VA didn’t see it that way and cut his care down to six hours per week. The agency shifted from regular visits to twice a week. The caregiver saw him on Friday. He fell on Friday after the visit or sometime on Saturday. He lay in his home, alone and afraid, all weekend long. He died sometime Monday. The caregiver found him when she returned to the home on Tuesday.

End of a Deadly Policy

The rate cut at the federal level, the care balance between Home Health Aide and Homemaker, the cut in hours, the end of care without an assessment, and the unwillingness of the policymakers to acknowledge the lives they have put at risk has to end. If Texas and New Mexico serve as test runs for policy change and rate cuts across the country, all our veterans could suffer like the ones in this story, and countless others. Your agency could be next. If you haven’t already, please join the fight for veteran care.

Write a letter to Secretary Collins admonishing him for the rate cut and for believing it wouldn’t impact care.
Mail to: Office of the Secretary, Department of Veterans Affairs, 810 Vermont Avenue NW, Washington, DC 20420
Send a general inquiry to Ask VA
Join the coalition with Polsinelli – PolsinelliHomeCare@polsinelli.com

Final Thoughts

These stories are not the only ones out there. Veterans across Texas and New Mexico are suffering from the loss of care. Agencies dedicated to that care are shuttering their doors from upside down reimbursements. My source said it better than I ever could.

“My hope is that by sharing some of the difficult situations we’ve encountered, the article will help shed light on the real-world consequences of these decisions. I hope it encourages meaningful discussion about how we can better support our senior veterans. I truly believe there are better ways to reduce costs than by limiting access to the care they depend on. These men and women have already sacrificed so much in service to our country. As they age, caring for them should be one of our highest priorities, and we should treat each of them with the respect and gratitude they have earned.”

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2027 Home Health Proposed Rule

CMS

by Kristin Rowan | Aug 7, 2026 | CMS, Home Health, Regulatory

by Kristin Rowan, Editor

2027 Home Health Proposed Rule

The Alliance Responds

On July 1, 2026, CMS released the 2027 Home Health Prospective Payment System proposed rule. The proposed rule includes updates to base pay, quality reporting system, value-based purchasing model, medicare provider enrollment, and DME policies. CMS is also considering ways to include palliative care. The comment period ends August 31, 2026.

The National Alliance for Care at Home issued a press release following the proposed rule publication.

“While the proposed rate update results in increased payments relative to last year – a reflection of our continued advocacy and a much-needed reprieve for providers under the stress of increasing costs – the Alliance remains focused on working to stop unwarranted temporary adjustments that are based on a flawed methodology with underlying data integrity issues. We will continue to partner with CMS on policies that strengthen the Medicare home health benefit. Ultimately, federal policy must preserve patient access to care at home, which remains the preferred choice of care for millions of families.”

Jennifer Sheets

CEO, the Alliance

Permanent and Temporary Rate Adjustments

CMS uses data from 2020 through 2025, actual and expected behavior changes resulting from the implementation of PDGM, and calculated overpayments from prior years to determine rate adjustments.

The actual CY 2025 base rate was $2,057.35 and the recalculated rate is $1,953.60; a difference of 5.043%
Prior permanent adjustments of -1.975% in 2025 and -1.023% in 2026 are factored in, but not directly subtracted
The 2024 budget-neutral rate multiplied by case-mix weights, wage index, and payment update factors yield the 2025 budget-neutral rate of $2,036.29, a difference of 1.024%
Estimated retroactive overpayments from CY 2020 through CY 2025 of $4,9 billion to be partially collected with a -3.0% temporary adjustment to the base pay rate.
Recalibrating the case-mix weight using reporting from CY 2025, CMS calculates a budget neutrality factor for CY 2027 of +1.0045
Applying the market basket (wages across the U.S.), CMS proposes a 3.0% increase to the home health market basket, offset by a -1.0% productivity adjustment, yielding a 2.1% increase.

With these calculations, CMS proposes a -3.0% temporary adjustment to be applied for CY 2027.

The Alliance acknowledges and appreciates the headway made with CMS in understanding the true cost of delivering home health care and the value it provides to the millions of Americans who depend on it. However, the Alliance emphasizes that Medicare payment rates – with the 3% temporary adjustment applied – still do not align with the actual cost of providing comprehensive, high-quality care. In a recent letter to CMS, the Alliance encouraged CMS to eliminate all permanent and temporary adjustments due to problems in the data and analyses used to calculate payment rates.

Alignment of HH QRP and HHVBP

CMS is considering changes that would better align measure sets, reporting perioeds and assessment process between HH QRP and HHVBP. The considered changes are:

Increasing alignment in expanded HHVBP Model and HH QRP Quality of Patient Care (QoPC) Star Ratings measure sets.

Aligning HH QRP and expanded HHVBP Model measure reporting periods.

Modifying HH QRP APU and expanded HHVBP Model annual payment reporting periods.

Altering expanded HHVBP Model Interim Performance and HH QRP QoPC Star Rating Reports.

Aligning timeframe of appeals/suppression review processes for the expanded HHVBP Model and HH QRP.

Updating scoring methodology to incorporate HH QRP APU penalties in expanded HHVBP Model payment adjustments and factoring HH QRP Quality Assessments Only (QAO) values into QoPC Star Ratings scoring.

CMS is NOT asking for comments at this time. The Technical Expert Panel meeting in 2025 discussed this alignment.

Read the TEP Summary Report.

LUPA Updates

CMS proposes updates to the functional points table and the table of functional impairment levels by clinical group. The proposed updates are:

Requests for Comment

Send your comments to CMS by August 31, 2026

CMS is soliciting comments on the proposal of applying a -3.0% temporary rate adjustment instead of applying a permanent adjustment.

There are proposed changes to the criteria for selecting and prioritizing HH QRP measures, identifying measurement gaps, and measures for filling those gaps. CMS is requesting input on the measure concepts as the relate to advanced care planning.

For CY 2027, CMS is using the hospital wage index as the basis for its calculations for the home health wage index. While they believe this is the best method, they are looking for information on alternative data sources such as occupation-level wage data or other publicly available wage data. They are exploring whether such data might better reflect geographic variations in labor costs for HHAs. CMS is concurrently exploring additional wage data for hospices, SNFs, and inpatient rehab facilities.

CMS is inviting public comments on the CY 2027 proposed case-mix weights and case-mix weights budget neutrality factor.

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Kristin Rowan is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news. She is also a sought-after speaker on Artificial Intelligence, Technology Adoption and Lone Worker Safety. She is available to speak at state and national conferences as well as software user-group meetings.

Kristin also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. She works with care at home software providers to create dynamic content that increases conversions for direct e-mail, social media, and websites. Connect with Kristin directly at kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2026 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

Healthcare Workers May be Deported

Home Care
by Tim Rowan | Jul 31, 2026 | Home Care, Home Health, Regulatory

by Tim Rowan, Editor Emeritus

Author’s note: This analysis does not address the right and wrong of legal asylum status, but will focus only on the impact of deporting tens of thousands of healthcare workers.

Thousands of Healthcare Workers Could be Deported

Florida Will Be Hit Hardest

Denise Bellville is alarmed by looming unintended consequences of this administration’s border protection policy. The Executive Director of the Home Care Association of Florida has good reason. She estimates that 35,000 Haitians work in healthcare in her state, a full third of the U.S. total. Some are in-home caregivers; a few are home care agency owners.

As of last week, all are at risk of being sent back. Temporary Protected Status, given to asylum applicants from dangerous countries, has been canceled for immigrants from specific countries. Among them are 353,000 Haitians, along with applicants from eight other countries. The Supreme Court is yet to rule on four more nations named in the DHS removal request.

“Broward County is one of about six counties that will be hit especially hard and have already begun to feel the effects of the July 24 SCOTUS decision,” she told us. “Two [agencies] there have already closed. One determined that 85 of its 86 caregivers are vulnerable for deportation. The other said that Creole-speaking clients made up 80 percent of its business.”

When the Department of Homeland Security announced “Termination of Temporary Protected Status for Haiti,” the order included a little more than 353,000 Haitian asylum applicants, more than 112,000 of whom work in the U.S. healthcare system. Industry estimates indicate one-third of these healthcare workers, roughly 35,000 Haitians, live and work in Florida.

Why So Many in Florida?

There is a large population of Haiti-born U.S. citizens in Florida. Some have been there for generations. They still speak a unique version of French and hold onto ancient Creole culture. “Caregivers from their own country, who understand both the language and the traditions of these now-elderly citizens are the only ones who can effectively care for them in all settings: home, hospital, and skilled nursing facility,” Bellville said. “When these 35,000 healthcare workers are gone, there are no others who can provide that level of care,” she asserted. “The problem will exacerbate what was already our critical in-home caregiver shortage.” She referred to a disturbing Florida reality:

Florida’s population is over 23.5 million

22.8 percent are over 65 years of age, roughly 5.35 million residents

The national average is 18.9 percent

The state has 16 caregivers per thousand residents

The national average is 65 caregivers per thousand

When asked what recourse is available, Ms. Bellville said an association cannot do much. “We even talked with Hospital and LTC associations about working together,” she said. “All of them responded that, sadly, even if we work together, we do not have sufficient clout to make a difference.”

Legal Battle Background

How Asylum Became Expulsion

The U.S. welcomed Haitians when life became dangerous in their home country. Gang violence, a problem for decades, led to the assassination of President Jovenel Moïse in 2021. In the absence of leadership, street gangs took over. Life became cheap. Good people, even if unrelated to any gang, were murdered at random. Due to the rampant violence, the U.S. State Department maintains a Level 4 “Do Not Travel” warning for Haiti. Unemployment is 15 percent; among youth, it is more 37 percent.

The Biden administration processed asylum applications by the thousands. Border Patrol accepted most claims of danger back home. For four years, hopeful applicants, including Haitians, waited for their court asylum hearings. While they were waiting, they legally sought jobs in various sectors, more than a third of them in healthcare.

Decades into a seemingly unsolvable, unending caregiver shortage, Home Care agency owners welcomed these new arrivals, trained them, and sent them out to care for the elderly in their homes, skilled nursing facilities, and rehab hospitals. Their fluency in Creole French and familiarity with Haitian culture made them invaluable in those communities.

On June 24, 2026, the Supreme Court issued a 6-3 ruling in Mullin v. Doe, denying a challenge to the terminations of TPS for Haiti and Syria. The decision granted DHS permission to move forward with implementing the terminations of TPS for those countries and eight others. Four more countries on the DHS list are expected to follow.

Epilogue

The $tats

The eventual loss of 112,000 healthcare workers will create a gaping hole in the availability of services. It will also have an impact on the U.S. Treasury and the overall economy. According to a report from Fwd.us, Haitian TPS holders contribute $5.9 billion to the U.S. economy annually. In Springfield, Ohio, where Haitian refugees were invited by the city to live and work, they added $91 million to that town’s economy. They pay over $1.5 billion per year in federal, payroll, state, and local taxes.

Based on DHS published estimates of the cost of deportation ($17,121 per person), sending 353,000 Haitians back to their island will require an expenditure of $6.04 billion. Some of that cost may be reduced by voluntary deportations that do not involve the cost of law enforcement.

Anyone choosing to self deport may have to hurry. Enforcement has already begun. HCAF Director Denise Bellville told us that some of her member agencies have reported ICE agents have started knocking on their doors unannounced, demanding to conduct I-9 audits.

# # #

Tim Rowan is a 33-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

©2026 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

Fight Loss of Rural Veteran Care: An Interview with Angelo Spinola

Advocacy
by Kristin Rowan | May 29, 2026 | Advocacy, Regulatory

by Kristin Rowan, Editor

Fight Against the Loss of Rural Veteran Care

Deep Cuts Impact All

Last November, the U.S. Department of Veterans Affairs (VA) announced the 2026 VA Fee schedule, which became effective January 1st. There were significant changes to the fee schedule compared with previous years. By far the most concerning, though, was the “rate restructuring” for Home Health Aide and Homemaker codes in Texas and New Mexico.

Rate Restructure

Prior to 2026, Texas VA had a tiered fee structure. The tiered structure applied different rates for geographical areas based on _____. The restructure for 2026 applied a single statewide rate. This gave a slight increase in rate for some urban and suburban areas. However, the change created a drastic drop in rates for rural areas. For most Texas rural areas, it is a 43% reduction for Home Health Aides. The restructing results in a 19% decrease in New Mexico.

Tiered Rates

2025 VAFS rates were as high as $67 per hour in some rural areas. The hourly rate covered the time spent in the home, greatly increased travel time compared to urban visits, and differential incentives to entice caregivers to take these shifts that are often short and spread apart. The new statewide rate is $38 per hour. For the highest paying rural areas, this is a 43% rate cut.

Hours per Veteran

In addition to the rate cut, the number of hours per veteran has also dropped to an average 3.4 hours per shift. Some veterans are seeing their monthly hours cut by more than 30%.

Advocating for Change

State and national associations and advocacy groups reached out to the VA. Six senators and congresspeople reached out Doug Collins, secretary of the VA, to express their concerns. The VA has largely not responded to inquiries about the validity of the rate reduction and has not provided the analysis used to decide the new rate.

Notice and Comment Period

Most rate changes like this require advanced notice for agencies to adjust as well as a comment period when interested and impacted parties can contact lawmakers to provide feedback and ask questions. The announcement about these rate changes came in December and went into effect in January. The VA provided almost no notice and did not entertain comments or questions.

Collins Responds

“[The rate reductions] reflect our assessment that prior rates for these areas significantly exceeded prevailing market rates. Aligning these rates with market conditions is not expected to affect veteran care.”
Doug Collins
Secretary, U.S. Department of Veterans Affairs

Defying His Objective

When Collins accepted the role of Secretary of the VA, he thanked President Trump for the assignment and asked him, “What would you like me to do?” The President answered, “Take care of my Veterans.” In a statement to the press, Collins outlined how he would accomplish that mission. Second on his list is to “put Veterans as the center of everything VA does, focusing relentlessly on customer service and convenience.”

Fail

Creating care deserts in rural areas and forcing veterans to travel up to an hour to get care is not convenient. Reducing home care hours and raising the probability of veterans having to move to care facilities is not service. Secretary Collins is failing in his objective and failing his directive from the President. More importantly, he is failing our veterans.

Coalition with Polsinelli

The Rowan Report spoke with Angelo Spinola and Heather Looby of Polsinelli. Polsinelli has been actively working on getting the rate changes reversed. Spinola, an employment litigator with a special interest in home care, explained the situation in more detail. According to Spinola there has been little information from the VA and what communication exists has been inconsistent. Many of the letters sent to the VA get no response at all. Spinola says there are legal remedies available, but they are challenging and expensive. In a letter to the VA, Polsinelli outlined the risks and consequences of these actions and gave the VA 30 days to respond.

Join the Fight

Next week, we will bring you real stories of agencies and veterans impacted by the changes in Texas and New Mexico. Their stories are powerful and moving. Even still, you may think this isn’t your fight because

A small enough percentage of your business is impacted

You have agencies in other states making up the difference

You don’t operate in Texas or New Mexico

Angelo cautions:

If they can do it in TX and NM, they can do it anywhere

“They” might be the VA changing rates that are unsubstantiated and contrary to the Administrative Procedure Act.

“They” might be CMS following suit and arbitrarily changing rates without analysis, notice, or comment.

“[Whether you are currently impacted by these changes or not,] the industry needs to get together to address this and join the fight before it’s too late; before it becomes the norm. “
Angelo Spinola
Home Health, Home Care & Hospice Chair, Polsinelli

How You Can Help

Write to your congressperson and senator and urge them to push Collins and the VA to reverse this change

Write to Collins and the VA directly with impact statements and concerns

Join the coalition with Polsinelli – PolsinelliHomeCare@polsinelli.com

Final Thoughts

We have interviews scheduled with providers and veterans to bring you real stories of how this is impacting our industry. We will also continue our discussions with Polsinelli to get additional information and keep you updated on the progress of the 30-day deadline and additional action the coalition will take.

Honor our Veterans

It was just a few days ago that our nation celebrated Memorial Day in honor of the ultimate sacrifice made by so many. There are too many service men and women who never came home. The ones who did risked everything for you, for me, for this country, and for the ideals that make the United States what it is. They deserve to come home after that service and age with dignity and grace in their homes for as long as they can. We owe them at least that. We all have our own stories and paths that led us to care at home, but at the core of each of those stories is care. Our veterans need that care now. Reach out, write, advocate, join. Whatever you are able to do, now is the time for action.

# # #

Kristin Rowan is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news. She is also a sought-after speaker on Artificial Intelligence, Technology Adoption and Lone Worker Safety. She is available to speak at state and national conferences as well as software user-group meetings.

Kristin also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. She works with care at home software providers to create dynamic content that increases conversions for direct e-mail, social media, and websites. Connect with Kristin directly at kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2026 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 CMS

Advocacy
by Rowan Report | May 14, 2026 | Advocacy, CMS, Medicare, Regulatory, Waste Fraud and Abuse

FOR IMMEDIATE RELEASE

Contact: Hannah Kristan
communications@allianceforcareathome.org
202-355-1647

The Alliance Responds to CMS’s Announcement of Nationwide Enrollment Moratoria on Hospice and Home Health Providers

Washington, D.C, May 13, 2026. On May 13, the Centers for Medicare & Medicaid Services (CMS) announced a six-month national moratorium on hospice and home health enrollment in response to program integrity concerns within the Medicare programs. While the National Alliance for Care at Home (the Alliance) strongly supports efforts to root out bad actors who exploit these essential programs, undermine confidence in care at home, and threaten the patients and families who depend on it, the Alliance has long advocated for targeted strategies that distinguish between high-fraud markets and communities where fraud is not an identified problem and patients already face shortages of providers.

Concerns

The Alliance welcomes the Administration’s focus on combatting fraud, waste, and abuse and appreciates that CMS has indicated providers will still be able to conduct face-to-face recertification visits via telehealth during the enrollment moratorium, which will help avoid unnecessary care disruptions for patients and families. However, an enrollment moratorium does not distinguish between bad actors and compliant providers and will ultimately reduce competition and slow innovation. More importantly, an enrollment moratorium raises serious access-to-care concerns in areas where patient demand is growing or existing capacity is already strained, leading to longer wait times, reduced service availability, and fewer choices for patients – particularly in rural or underserved communities.

Less Severe Recommendations

Public reports show that fraud is concentrated in specific geographies and among specific actors, signaling that targeted reforms and oversight strategies are needed to identify and remove fraudulent entities from the Medicare program. The Alliance and other national organizations have repeatedly provided CMS with recommendations that focus on preventing bad actors from entering the Medicare and Medicaid programs and better leveraging existing tools to fight fraud without creating unnecessary burden for good-faith providers who are already meeting program requirements.

From the Alliance CEO

“The majority of home health and hospice providers deliver compliant, patient-centered, and clinically appropriate care to individuals with complex needs, often in their most vulnerable moments. CMS must use data-driven, risk-based program integrity measures and focus resources on boots-on-the-ground surveys and enforcement of existing oversight mechanisms that root out the blatantly bad actors without potentially limiting patient access to care or punishing high quality providers operating in good faith.”
Jennifer Sheets
CEO, National Alliance for Care at Home

Final Thoughts

This moratorium, effective May 13, applies only to new providers and certain changes of ownership, and may be extended if CMS deems it necessary.

The Alliance has been and will remain a proactive, constructive partner to Congress and federal regulators on program integrity efforts. The Alliance will continue to engage with the Administration on a path forward that holds bad actors accountable while protecting patient access to the safe, high-quality care at home they need and deserve.

# # #

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. 

©2026 by the National Alliance for Care at Home. For more information or to request permission to reprint, please see contact information above.

Medicare Moratoria

Breaking News
by Kristin Rowan | May 14, 2026 | Breaking News, Medicare, Regulatory, Waste Fraud and Abuse

by Kristin Rowan, Editor

Medicare Moratoria

CMS Halts All New Home Health & Hospice Agencies

As part of it’s ongoing efforts to curb Medicare waste, fraud, and abuse, the Centers for Medicare and Medicaid Services (CMS) is taking a bold step. On Wednesday, May 13, 2026, CMS announced a 6-month moratoria on home health and hospice agency enrollment. Aimed at protecting Medicare beneficiaries and taxpayer dollars, the moratoria will temporarily stop new enrollment of providers in home health and hospice, which CMS calls “high-risk” categories and key sources of fraudulent activity. CMS states this effort builds on additional fraud prevention initiatives, including enhanced screening, site visits, and expanded oversight activities across the hospice and home health sectors

More Investigations

Together with Vice President JD Vance’s Anti-Fraud Task Force, CMS will increase its targeted investigations of hospice and home health agencies that are suspected of fraud. CMS promises to use advanced data analytics and to accelerate the removal of fraudulent hospice and home health agencies.

Skirting Authority

CMS investigations revealed that some agencies intent on committing fraud are closing their businesses and reopening under different names in different states to perpetrate additional fraud. The moratoria will prevent these agencies from skirting authority in this manner. Additionally, the moratoria applies to some changes in ownership, which is a common technique used to hide these “bad actors.”

What it Means for You

The moratoria do not apply to existing providers with current enrollments. You can continue to deliver services to Medicare beneficiaries as long as your enrollment is current and in good standing.

Statement from CMS

“We’ve seen systemic and deeply troubling fraud in the hospice and home health space, with bad actors exploiting some of our most vulnerable Medicare patients and stealing money from the American taxpayer. Today we’re shutting the door on fraud—preventing new bad actors from entering Medicare while we aggressively identify, investigate, and remove those already exploiting them. This is about protecting patients, restoring integrity, and safeguarding taxpayer dollars.”
Dr. Mehmet Oz
Administrator, Centers for Medicare and Medicaid Services

More Information

The administration’s anti- fraud, waste, and abuse efforts are ongoing.

Read the CMS Press Release

Full text of the Home Health Moratorium

Full text of the Hospice Moratorium

# # #

Kristin Rowan is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news. She is also a sought-after speaker on Artificial Intelligence, Technology Adoption and Lone Worker Safety. She is available to speak at state and national conferences as well as software user-group meetings.

Kristin also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. She works with care at home software providers to create dynamic content that increases conversions for direct e-mail, social media, and websites. Connect with Kristin directly at kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2026 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

Private Payors Against Fraud

Admin
by Elizabeth E. Hogue, Esq. | Apr 17, 2026 | Admin, CMS, Home Health, Hospice, Medicaid, Medicare, Regulatory, Waste Fraud and Abuse

by Elizabeth E. Hogue, Esq.

Private Payors Against Fraud

Join Enforcement Efforts

There seems to be a persistent myth among providers of private duty/homecare services that the federal anti-kickback statute applies to Medicare-certified providers only. On the contrary, the anti-kickback statute applies to providers who receive funds from any state or federal healthcare program; including the Medicaid Program, VA, TRICARE, etc. Private duty providers: This means many of you! Lately it has become clear that private payors have joined fraud enforcement efforts.

Guilty

In a recent case, a provider in Detroit pled guilty to conspiring to commit health care fraud. The conspiracy resulted in losses totaling $1.9 million to Medicare, Medicaid, and Blue Cross Blue Shield of Michigan. The investigation was conducted by the FBI and the Office of Inspector General of the U.S. Department of Health and Human Services, the primary enforcer of fraud and abuse prohibitions.

Ghost Services

At the plea hearing, the provider admitted to creating and operating a scheme to submit false and fraudulent claims that were medically unnecessary or not actually provided. In some instances, services billed were not ordered by physicians. The scheme continued for over five years. The provider used the proceeds of fraud for his personal use and to benefit others.

Consequences

After a presentence report is prepared, the provider faces a possible maximum sentence of ten years in prison, a fine of up to $250,000 and up to three years of supervised release following any term of imprisonment.

Federal and Private Prosecution

It is important to note that the provider was criminally prosecuted not only for fraud with regard to claims submitted to Medicare and Medicaid Programs, but also fraud committed against a private payor, Blue Cross Blue Shield.

Your Payor Could Report You

It now appears that providers who receive payments from third party payors must be concerned about fraud enforcement. Consequently, providers of private duty/home care services must develop, implement, and update Compliance Programs.

Compliance Programs

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 related to fraud enforcement if there is no formal document called a Compliance Program.

More than Accreditation

Some providers think that accreditation means they are in compliance. On the contrary, providers may be accredited but fail to meet applicable compliance standards for fraud and abuse. 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.

It Could Save You

Providers also need to know that developing, implementing, and updating Compliance Programs may make a considerable difference during fraud enforcement actions. If providers have Compliance Programs in place that are current and fully implemented, enforcers may be less aggressive in pursuing potential violations.

Corporate Integrity Agreement

When enforcers discover problems with fraud and abuse in organizations, providers are usually asked to develop and implement a Corporate Integrity Agreement (CIA). This type of agreement is likely to include processes for stringent monitoring 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, including private duty/home care companies, 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.

©2026 Elizabeth E. Hogue, Esq. All rights reserved.
No portion of this material may be reproduced in any form without the advance written permission of the author.

©2026 by The Rowan Report, Peoria, AZ. All rights reserved.

Medicaid Reform

Home Health
by Kristin Rowan | Apr 17, 2026 | Home Health, Medicaid, Regulatory, Waste Fraud and Abuse

by Kristin Rowan, Editor

Medicaid Reform

New Efforts to Stop Fraud Before it Happens

As auditors continue to investigate fraudulent activity, new initiatives through Medicare reform aim to stop fraud before it happens. The new initiative, the Combating Deceptive Practices in Assistance Programs Act adds oversight to the Medicaid program.

Preserve Medicaid through Reform

Chairman of the Joint Economic Committee and Chairman of the House Ways and Means Oversight Subcommittee, Rep. David Schweikert, announced the legislation that would tighten eligibility requirements for home health services through Medicaid. The bill requires Medicaid recipients to prove they are unable to perform three or more ADL’s without assistance.

If we seriously want to preserve Medicaid, and provide for the people most in need, we must crack down on fraud. Reaching people that need these services the most should be the top priority of these programs, not growing one of the largest jobs corps in the state. With the U.S. adding almost $87,000 per second to our national debt, making commonsense reforms can save tens of billions of dollars while protecting the truly vulnerable.”
Rep. David Schweikert
Chairman, Joint Economic Committee and House Ways and Means Oversight Subcommittee

Medicaid Waiver Programs

According to the statement from the Joint Economic Committee, the federal waiver programs that allow states to provide at home care for Medicaid beneficiaries are lacking guardrails and oversight. The state policies are “egregious” and lead to waste, fraud, and abuse.

For example, the New York State Medicaid program includes the Consumer Directed Personal Assistance Program (CDPAP) which allows beneficiaries to choose their caregiver. This broad eligibility program allows enrollees to choose friends or family members with no caregiving experience. New York’s Medicaid spending jumped from $2.5 billion in 2019 to more than $9 billion in 2023 with estimates of $12 billion in 2025.

More Information

Read H. R. 7713

Read the accompanying brief from the Joint Economic Committee: From Care to Cash: Correting Misaligned Incentives in Home Health

# # #

Kristin Rowan is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news. She is also a sought-after speaker on Artificial Intelligence, Technology Adoption and Lone Worker Safety. She is available to speak at state and national conferences as well as software user-group meetings.

Kristin also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. She works with care at home software providers to create dynamic content that increases conversions for direct e-mail, social media, and websites. Connect with Kristin directly at kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2026 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

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