Medicaid Cuts Remain Unknown So Far

CMS

by Tim Rowan | May 1, 2025 | CMS, Medicaid, Regulatory

by Tim Rowan, Editor Emeritus

"Life and Death"

Medicaid Cuts are Looming

We don’t need to cut benefits, and it really infuriates me to hear people here talking about that because it stresses people out. This is life and death for them. –Senator Bernie Moreno (R-OH)

Budget Reconciliation Threatens Medicaid

After last weeks HHS purge, all of Care at Home is on edge as the U.S. House and Senate negotiate differences in each body’s budget reconciliation bill. The same jitters are found among Medicaid-eligible citizens, especially those who hear more rumors than actual progress reports from Washington. All we know for sure this week are two things: Speaker Johnson has pushed his deadline for a vote on the bill, asking for $880 billion in cuts, from Memorial Day to Independence Day; and the parallel Senate budget bill, at this date, is quite different. Watching the reconciliation talks should be nerve-wracking but entertaining.

The House Version

As of May 1, it is too early to assign a dollar amount to the FY 2026 Medicaid budget. H.B. 1968, named “Full-Year Continuing Appropriations Act of 2025,” delegates specific cut decisions to committees. It first directs the House Energy and Commerce Committee, which oversees Medicaid and part of Medicare, to reduce the federal deficit by $880 billion over ten years. The Agriculture Committee, which oversees SNAP, is ordered to cut $230 billion over the same time period.

Medicaid Cuts: Per Capita Caps

The Energy and Commerce Committee is the oldest standing legislative committee in the House. It has broad jurisdiction over our nation’s energy, health care, telecommunications, and consumer product safety policies. In the 119th Congress, it is chaired by Brett Guthrie (R-KY), a West Point graduate with a degree in Public and Private Management from Yale.

Guthrie has advocated changes to Medicaid since his days as a Kentucky state legislator. He pushed for the $880 billion in cuts that found life in H.B. 1968. Guthrie’s solution to growing Medicaid costs is “per capita caps” which would give states a fixed maximum amount of money for each person on Medicaid. According to an analysis by Axios, published after interviewing Guthrie:

“The federal government now covers a percentage of states’ Medicaid costs, so the amount reimbursed goes up or down depending on how much a state spends on the program.
Per capita caps would likely result in less money for states, forcing them to make up the difference by raising taxes or cutting spending elsewhere.”

In His Own Words

Guthrie told Axios he saw how the Medicaid program affected state budgets firsthand while serving in the Kentucky Statehouse. “I dealt with it,” he told Axios. “That is why I care about this…It just overwhelmed state budgets. What I’ve learned is, as we keep subsidizing health care, the price keeps going up. So, my idea with per capita allotments has always been that it will control costs.”

People might “fall off” Medicaid. “I’ve talked to a lot of providers, other groups, and they’re concerned. I’m not saying they’re not, but I think we can do it in a way that people get service.”
(202) 225-3501; (202) 225-3501

Brett Guthrie

Chairman, Energy and Commerce Committee

SNAP Cuts

Glenn Thompson (R-PA) chairs the Agricultural Committee, which will be asked to make cuts to SNAP. Prior to being elected to Pennsylvania’s Fifteenth District, Thompson spent 28 years as a therapist, rehabilitation services manager, and a licensed nursing home administrator.
(202) 225-5121; (814) 353-0215

Strange Bedfellows in the Senate

Along with every Democrat, at least two conservative Republicans have expressed uncertainty about putting budget savings on the backs of Medicaid beneficiaries. Senators Bernie Moreno of Ohio and Josh Hawley of Missouri both warned in interviews with newsmagazine Semafor that proposals to cut the federal government’s share of the costs in states that have expanded Medicaid, and to otherwise cap Medicaid expansion spending, could lead to coverage losses. Moreno bluntly told Semafor that both ideas amount to “cutting benefits.”

“There’s not 50 votes for any kind of cuts in benefits. That’s just a fact,” Moreno said.

Just A Skosh of A Difference to Negotiate

A detailed analysis by the Geiger Gibson Program in Community Health at the Milken Institute School of Public Health at George Washington University compares the House and Senate versions side by side. Their analysis points out that the Senate outline for its bill calls for at least $1 billion in Medicaid spending reductions over the 10-year budget window. As already noted, the House wants its committees to find at least $880 billion over the same window.

“The Senate bill also authorizes the Budget Committee to adjust the targets for the purpose of “protecting the Medicaid program,” which may include “strengthening and improving” Medicaid (undefined) in a deficit-neutral fashion. The Senate measure thus effectively prioritizes protections for Medicaid over other potential policy aims to be achieved through the reconciliation process. The House bill, by contrast, calls for scaling back tax relief if the spending reduction targets are not met, thereby placing additional pressure on the $880 billion floor.

The House and Senate now must reconcile two extremely different measures before the reconciliation process actually proceeds, the university report concludes. “Although it is unclear whether the House will proceed with a legislation to achieve reconciliation in advance of a final agreement.”

$779 billion is a lot of reconciling...

One final independent analysis may draw this discussion to a close that speaks directly to our industry’s concerns. The Commonwealth Fund, in a March 25 “Issue Briefing,” looked at the long-term consequences of deep Medicaid cuts. In its executive summary, the briefing says:

Key Findings and Conclusions

Combined losses from proposed Medicaid and SNAP cuts would reach $1.1 trillion over a decade, including a $95 billion loss of federal funding in 2026 alone. State gross domestic products (GDPs) would be $113 billion lower, exceeding federal budget savings. About 1.03 million jobs would be lost nationwide in health care, food-related industries, and other sectors. State and local governments would lose $8.8 billion in state and local tax revenues. Not extending the enhanced health insurance premium tax credits that are scheduled to expire after December 2025 would lead to an additional 286,000 jobs lost in 2026, for a combined total of more than 1.3 million jobs lost in the United States.

Stay tuned. We at the Rowan Report are committed to keeping a close eye on developments in this bi-partisan battle.

# # #

Tim Rowan is a 30-year home care technology consultant who co-founded and served as Editor and principal writer of this publication for 25 years. He continues to occasionally contribute news and analysis articles under The Rowan Report’s new ownership. He also continues to work part-time as a Home Care recruiting and retention consultant. More information: RowanResources.com
Tim@RowanResources.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Vision for CMS

CMS

by Kristin Rowan | Apr 24, 2025 | CMS, Medicaid, Medicare, Medicare Advantage, Regulatory

by Kristin Rowan, Editor

Vision for CMS from Dr. Oz

Last week, Dr. Mehmet Oz issued a statement on his vision for the future of CMS. Dr. Mehmet Oz is a cardiothoracic surgeon and former host of his own TV show. Under the Department of Health and Human Services, CMS has a $1.7 trillion budget and oversees the health outcomes of more than 160 million people.

“I want to thank President Trump and Secretary Kennedy for their confidence in my ability to lead CMS in achieving their vision to Make America Healthy Again. Great societies protect their most vulnerable. As stewards of the health of so many Americans – especially disadvantaged youth, those with disabilities, and our seniors, the CMS team is dedicated to delivering superior health outcomes across each program we administer. America is too great for small dreams, and I’m ready to get work on the President’s agenda.”

Dr. Mehmet Oz

Administrator of CMS, Department of Health and Human Services

Make America Healthy Again

With HHS Secretary Kennedy, Oz is throwing his support behind Make America Healthy Again, under direction from President Trump. Senator Kennedy says that, under the leadership of Dr. Oz, CMS will work to modernize Medicare, the Marketplaces, and Medicaid. The goal is to get Americans the care they want, need, and deserve. The agenda includes:

Empowering the American People with personalized solutions with which they can better manage their health and navigate the complex health care system. As a first step, CMS will implement the President’s Executive Order on Transparency to give Americans the information they need about costs.
Equipping health care providers with better information about the patients they serve and holding them accountable for health outcomes, rather than unnecessary paperwork that distracts them from their mission. For example, CMS will work to streamline access to life-saving treatments.
Identifying and eliminating fraud, waste, and abuse to stop unscrupulous people who are stealing from vulnerable patients and taxpayers.
Shifting the paradigm for health care from a system that focuses on sick care to one that fosters prevention, wellness, and chronic disease management. For example, CMS operates many programs that can be used to focus on improving holistic health outcomes.

Letter to Medicaid

Following the vision statement, Dr. Oz released a letter to state Medicaid Agencies outlining the use of Medicaid dollars during his tenure as Administrator. The two-page letter, citing recent studies on gender dysphoria, directed Medicaid agencies to eliminate gender reassignment surgery from covered procedures, opting instead for psychotherapy. Hormonal interventions will be reserved for exceptional cases.

“My top priority is protecting children and upholding the law. Medicaid dollars are not to be used for gender reassignment surgeries or hormone treatments in minors – procedures that can cause permanent, irreversible harm, including sterilization. We have a duty to ensure medical care is lawful, necessary, and truly in the best interest of patients. CMS will not support services that violate this standard or place vulnerable children at risk.”

Read the full letter here.

Final Thoughts

We believe this will be the first of many changes made to Medicare and Medicaid rules under Dr. Oz. We will continue to share updates from the CMS newsdesk.

# # #

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

Industry Update

Admin

by Kristin Rowan | Apr 24, 2025 | Admin, Advocacy, Medicaid, Medicare, Medicare Advantage, Regulatory

by Kristin Rowan, Editor

Industry Update with Dr. Steve Landers

At last week’s New England Home Care & Hospice Conference, Dr. Steve Landers, President of The National Alliance for Care at Home (The Alliance) gave the keynote address and offered some industry insights and updates.

A Heartfelt Introduction

Ken Albert, Chairman of the Board at The Alliance introduced Dr. Landers before his address. After reading Dr. Landers’s official biography, Albert offered his own thoughts on the first few months of Landers’ tenure.

Last year, five colleagues from organizations across the country sat in D.C. interviewing candidates. While interviewing Landers, I was remarkably engaged by someone who is deeply passionate about care at home. Steve describes hospice care as a national treasure, and I don’t disagree. More than just his passion for care at home, Dr. Landers is savvy in navigating the political paradigms driving policy. He artfully combines data and stories to navigate relationships with policy makers. What I see every day is someone who roles up his sleeves for the patients we take care of with tremendous respect for the caregivers who are in the patients’ homes.

Ken Albert

Chairman of the Board, The National Alliance for Care at Home

Industry Changes, Advancements, and Ongoing Advocacy Efforts

Dr. Landers attributes much of the positive changes in D.C. to the efforts of volunteer leaders looking to move the industry forward. Care at home needs to become more streamlined, more efficient, and with a better voice.

His vision for the care at home industry is an America where everyone can access high-quality care wherever they call home.

Strong Admonition for CMS

Dr. Landers noted positive movement in some areas. However, he became passionately adamant that a payment update is not an increase if it doesn’t keep up with inflation or pay increases. “The Alliance represents providers delivering high-quality, person-centered care to million of individuals in the home, and they deserve to be recognized and compensated for the work they do,” he said.

Our Aging Nation

It should come as no surprise that older adults have a strong preference for aging at home. They prioritize living where they feel in control and connected. They want to be in familiar surroundings and to maintain their routines.

The U.S. population over the age of 85 is expected to triple from 2020-2060 to more than 19 million people. Despite medical advances, only 1/3 of those over the age of 85 say they are free of disability or free of difficulty with daily living.

With the rising number of older individuals, caregiver to patient ratios are falling nearly everywhere across the country. Dr. Landers and The Alliance urge policymakers to make promoting the dignity and independence of our aging population one of their highest health policy priorities. The Alliance will continue to tell anyone and everyone who will listen that care at home offers the win-win solution that policymakers are looking for.

Changes at the Top

We’ve already seen numerous and sometimes drastic changes at the federal level. Dr. Landers points out that eight years ago the “Trump 1.0 Administration” developed the PDGM framework and signed hospice reform legislation. On the campaign trail, President Trump stated he would not be making cuts to Medicare. The “Trump 2.0” care at home priorities are not yet clear, but The Alliance will continue to emphasize cost savings and the preference to age in place.

Secretary Kennedy, head of HHS, placed his emphasis on the chronic disease epidemic, launching Making America Healthy Again. He has stated a preference for community-based solutions and patient-centered care.

New CMS Administrator Dr. Oz seems to be supportive of Medicare Advantage, but did have some critique of the program during senate hearings. Dr. Oz has a stated focus of finding and eliminating fraud, waste, and abuse.

Changes Near the Top

At the congressional level, The Alliance lost a few key supporters with the last election, but many care at home advocates remained. Of the returning members of the Senate and House, care at home advocates include:

Senators Collins (R-ME), Hassan (D-NH), Tillis (R-NC), Barrasso (R-WY), Blackburn (R-TN), CortezMasto (D-NV), and Rosen (D-NV)
Representatives: Adrian Smith (R-NE), Sewell (D-AL) Van Duyne (R-TX), Panetta (D-CA), Guthrie (RKY), and Carter (R-GA)

The support in Congress leaves us hopeful. Large Reconciliation Packages dominate the current conversation. Many questions remain as to what is at risk for care at home and what Medicaid’s future might hold.

Later this year, The Alliance sees opportunities for care at home outside of reconciliation. These include Home Health PDGM reform, hospice reform, the telehealth extension, revocation of the Medicaid HCBS 80/20 rule, tax credits, and long term care insurance.

Public Policy Priorities

As The Alliance moves forward, several key issues will remain priorities:

Access to Care at Home

PDGM Implementation
Telehealth Extension
Medicare Advantage Dynamics
Care for High Needs Beneficiaries

Quality Care at Home

Special Focus Program Implementation
DEA Telehealth Provisions
HOPE tool implementation?

Eliminating Fraud and Abuse in Care at Home

Hospice Concurrent Care
Hospice and Medicare Advantage
Medicaid 80/20 Rule
Caregiver Tax Credits / LTCI

Growing the Care at Home Workforce

Supply is simply not meeting demand
Strengthened rates, incentives, and educational opportunities will attract and retain a qualified workforce

Follow Up

I spoke with Dr. Landers after the keynote address to ask him why lone worker safety was not among the top priorities of The Alliance. He assured me that there is a position within The Alliance who, among other tasks, is focusing on lone worker safety. I urged him to make it a higher priority and will follow up to get the contact information for the position he mentioned.

# # #

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

That’s a No-No

Admin

by Elizabeth E. Hogue, Esq. | Apr 24, 2025 | Admin, Hospice, Medicaid, Medicare, Medicare Advantage, Regulatory

by Elizabeth E. Hogue, Esq.

No-no # 1

“No-No” may seem like something you would say to a toddler, but there is a list of things agency owners do that they should not do. Many of these are things providers may not often consider. This article focuses on the use of private duty services by hospice and home health patients, and what hospices and home health agencies cannot do with regard to aide services.

Aide Services

Both home health and hospice services are usually intermittent and provided in patients’ homes. Patients and their families may elect to utilize the services of private duty/home care companies for additional assistance. At the same time, hospice and home health patients may receive aide services from hospices and home health agencies.

Conditions of Participation

According to Medicare Conditions of Participation (CoPs), hospice and home health aides can only provide personal care services, including bathing. Aides provided by private duty/home care companies may also provide personal care. Unlike aides provided by hospices and home health agencies, however, they can provide additional services; such as laundry, food preparation, light housekeeping, shopping, and running errands.

Private Duty Services

When patients use private duty services, they are often paying for these services out of their own pockets. Even if they have long-term care insurance, patients still bear the financial burden of paying for private duty services. Longterm care insurance often costs thousands of dollars that patients probably paid for themselves. Patients usually pay by the hour for these services.

That's a No-No

Patients may, of course, utilize private duty/home care services to perform any of the services described above. It seems, however, that hospices routinely tell patients who have private duty/home care that they will not provide aide services because private duty/home care aides are able to provide personal care for patients.

Breaking it Down

Here is an example: A hospice admitted a bedridden patient with urinary and fecal incontinence. The patient and caregiver requested aide services from the hospice five days a week to bathe him. He paid for a few hours of private duty/home care services each day. The hospice refused to provide aide services five days a week to bathe him because he had private duty/home care services. No-no!

Compelled to Provide Care

ospices must provide aide services consistent with patients’ needs related to their terminal illnesses. In the example above, the patient clearly had a need for aide services five days a week. If patients and their caregivers state that they prefer to use private caregivers for personal care, then hospices must document the refusal of hospice aide services offered, consistent with applicable standards of care. Then hospices are not required to provide aide services.

Profiteering

When hospices deny aide services that are consistent with applicable standards of care and require patients and caregivers to use private duty/home care services, hospices are shifting the cost of aide services onto patients and their families. Patients and their families may have to pay for additional private duty/home care services to meet patients’ needs. The result for hospices is that they do not incur the costs of aide services, thereby increasing their profits at the expense of patients and their families.

If hospice staff members who refuse to provide aide services to patients and require patients and their families to use private duty/home care services instead are compensated in any way based on the financial performance or profitability of the hospices, let’s hope they look good in orange jumpsuits!

Intent to Defraud

If the private duty/home care services are being paid for by any federal or state health care program; such as Medicaid, Medicaid waiver, VA, or TriCare; then both home health agencies and hospices have engaged in fraudulent conduct by shifting costs that they should have incurred onto other federal government programs.

God forbid that the hospice also owns the company from which patients receive private duty/home care services! Then hospices are limiting their costs while profiting from patients and their families.

Dig Deep and Find Your No-No's

Now is the time for all home health agencies and hospices especially to audit patients’ records to make certain that all patients have been offered services that they are required to provide. If patients and their families choose to use private duty/home care aides instead, documentation must show that they were offered the services but chose to use private duty/home care aides.

No-No's Final Thoughts

The bottom line is that hospices and home health agencies must always provide services needed by patients. Patients may choose to pay for services that are paid for by the Medicare hospice or home health benefits. Patients cannot be required to pay for services privately that hospices and home health agencies must provide. Unacceptable!

This article is the first in a series of “No-no” items for agency owners.

# # #

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.

©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

Mass Layoffs in HHS “Overhaul”

CMS

by Kristin Rowan | Apr 11, 2025 | CMS, Regulatory

by Kristin Rowan, Editor

Mass Layoffs at HHS

HHS Secretary Robert F. Kennedy Jr. announced more than 10,000 position cuts within the department this week. The layoffs impact employees at the FDA, the CDC, the National Institute for Occupational Safety and Health, and CMS, among others.

The 10,000 layoffs come after 10,000 additional employees left the department this year through retirement and deferred resignation programs. The HHS overall staff is currently at around 75% of its previous numbers.

Kennedy Promises no Cuts to Essential Services

Despite the 25% reduction in workforce, Secretary Kennedy insists that no essential services will be cut. Native American tribes across the Southwest disagree with that statement and met with Kennedy to discuss the support they need. Kennedy left those meetings saying, “We are all going back with a long laundry list of tasks that we need to perform. And I’m going to give you my commitment today that I am available and listening to you.” Kennedy promised to look into cuts that disrupted scientific research and reinstate them.

Mass Layoff Impact to Care at Home

Of the 10,000 layoffs, approximately 300 of them came from within CMS. The agency lost roughly 4% of its total workforce. The administration pointed to “minor duplication” across the agency that the layoffs will eliminate.

The Administration for Children and Families (ACF), Assistant Secretary for Planning and Evaluation (ASPE), and CMS will share critical programs within the Administration for Community Living (ACL) that support older adults and people with disabilities.

Long-Term Goals

Multiple departments within HHS are consolidating, removing overlapping positions, research, and efforts. The stated goal of the department is to implement Make America Healthy Again, aimed at ending the chronic disease epidemic.

Make America Healthy Again

From the office of the President, Make America Healthy Again focuses on combatting rising rates of mental health disorders, obesity, diabetes, and other chronic diseases. According to the Presidential Action, agencies should prioritize gold-standard research, work with farmers to ensure food is the healthiest and most affordable possible, and ensure the availability of treatment options and the flixibility for health insurance coverage to provide benefits that support healthy lifestyles and disease prevention.

Final Thoughts

The current upheaval and overhaul within HHS does not seem to be impacting CMS or Medicare and Medicaid services at this time. The 4% reduction is staff is negligible and there have been no cuts to services or programs within CMS. Word from HHS is that no additional cuts are planned and their next focus will be on streamlining efficiency. The new Assistant Secretary for Enforcement position to combat waste, fraud, and abuse will oversee the Office of Medicare Hearings and Appeal. We will continue to follow this story as it develops.

# # #

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 .She also has a master’s degree in business administration and marketing and 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

CDPAP Overhaul Under Scrutiny

Medicaid

by Kristin Rowan | Apr 11, 2025 | Medicaid, Regulatory

by Kristin Rowan, Editor

CDPAP Overhaul in NY Medicaid Program

New York State Department of Health issued a comprehensive plan to overhaul the state’s Medicaid program. The state’s program, Consumer Directed Personal Assistance Program (CDPAP), allows patients to hire the caregiver of their choice. Eligible participants like the program for its autonomy. The redesign of the program’s execution reduces payment processors from more than 600 to just one company: Public Partnerships, LLC of Georgia.

The Need for the CDPAP Overhaul

New York Governor Kathy Hochul points to waste, fraud, and abuse in the Medicaid program as the drivers of the change. According to the Department of Health and Human Services (HHS), the cost for CDPAP rose from $2.5B in 2019 to $12B in 2025. Despite drawing national criticism, Hochul maintains that the program needs stronger oversite to ensure adequate care. Additionally, the state’s Medicaid program has recently suffered more than $143 million in clawbacks from kickbacks and improperly claimed reimbursements.

Brakes Applied

Last week, a judge issued a temporary restraining order (TRO) blocking the consolidation of the payer system down to a single entity. The TRO was issued following a lawsuit filed on behalf of individuals and independent living centers. The parties claim that the transition to Public Partnerships LLC has been delayed by technical challenges. The delays threaten to remove beneficiary access to home health services. The litigants also cited failure on the part of the state to serve notice and to allow for a fair hearing to challenge the change.

A judge has extended that TRO through April 14th, blocking additional changes. Beneficiaries who have already switched to the new payer are not impacted by the TRO. HHS Secretary Robert F. Kennedy Jr. stated there will be a 90-day review period to assess whether the change complies with federal law.

Hit From Both Sides

For or against the transition to a single payer, lawmakers on both sides of the aisle are in agreement on one thing: Public Partnership LLC should not be that single payer. The company has a history of financial mismanagement, no experience working in New York, and may have engaged in bid rigging.

Dubious Reassurances

The NY Department of Health issued a public service announcement saying access to home health care will remain intact and that members will be able to keep their current caregiver. Following the review period from HHS and the pending lawsuits, residents of New York may experience familiar disappointments.

This is an ongoing story and we will provide updates as the story develops.

# # #

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. She also has a master’s degree in business administration and marketing and 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

Relief for Providers

Admin

by Elizabeth E. Hogue, Esq. | Apr 11, 2025 | Admin, Audits, CMS, Medicare, Regulatory

by Elizabeth E. Hogue, Esq.

Relief for Providers from Devastating Penalties?

A judge in the Northern District of Texas recently decided that even the minimum penalties mandated under the False Claims Act (FCA) violate the Eighth Amendment’s Excessive Fines Clause [see U.S. ex rel. Taylor v. Healthcare Associates of Tex. (N.D. Tex. Feb. 26, 2025)]. The FCA punishes providers for submission of information that is not true in order to get paid by the federal government.

Life Threatening Penalties

The penalties assessed against providers under the FCA may be described as “life threatening.” That is, it may be difficult for providers’ businesses to survive payment of such severe penalties. The minimum penalty increased from $13,946 to $14,308 in 2025. The maximum penalty per claim increased from $27,894 to $28,619.

Ex Post Facto

These increased penalties will be assessed for violations that occurred prior to the change, but that are assessed after they are in effect. These penalties certainly make it clear why it is difficult for providers to survive violations of the FCA.

False Claims

In the Taylor case above, for example, the defendants allegedly submitted false claims as follows:

As “incident to” a physician’s care without proper documentation
For services by providers who were not eligible to bill the Medicare Program
For services performed by medical assistants instead of qualified practitioners

FCA Math Doesn't Add Up

The jury found that one of the defendants, a primary care medical group practice, submitted 21,944 false claims for $2,753,641.86 in actual damages. After trebling the damages as required by the FCA, the Court said it would enter judgement against the defendant for approximately $8 million. The Court acknowledged, however, that penalties under the FCA are fines subject to the Eighth Amendment of the U.S. Constitution.

Grossly Disproportional to the Gravity

The Court then applied the following four factors to decide whether the “fine was grossly disproportional to the gravity of the offense” under the Eighth Amendment:

The essence of the defendant’s crime and its relationship to other criminal activity
Whether the defendant was within the class of people for whom the statute of conviction was principally designed
The maximum sentence, including the fine that could have been imposed
The nature of the harm resulting from the defendant’s conduct

Fraud...or a Reporting Error?

With regard to the first factor, the Court emphasized that the defendant’s misconduct involved violations of Medicare billing rules, but did not include billing for services that were not provided. In fact, the Court said that even though the defendant violated Medicare billing rules, the misconduct was “closer in gravity to something like a ‘reporting offense.’” There was, said the Court, no evidence that the defendant’s conduct was “related to other criminal or fraudulent activity.

Magnitude of Harm

The Court also focused attention on the fourth factor. The defendant’s harm was certainly significant, but the harm, according to the Court, did not necessitate a penalty “two orders of magnitude greater than the actual financial harm,” especially when the actual damages were substantial, i.e., one hundred times the amount of actual damages. That ratio was “grossly out of alignment with the ratios in other similar cases.” The Court imposed a civil penalty of $8,260,925.58 that represents less than 3% of the statutory minimum.

Final Thoughts

Whether other Courts follow the Taylor case described above remains to be seen, but it is quite clear that providers need relief from the penalties of the FCA.

# # #

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.

©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. Oz Nomination Advances to Full Senate

Admin

by Tim Rowan | Mar 31, 2025 | Admin, CMS, Regulatory

by Tim Rowan, Editor Emeritus

Dr. Oz Nomination Advance to Senate

“Given your close ties to the industry that you would regulate, if you are confirmed, the public would have reason to question your impartiality and commitment to serving the public’s interest.” — Senator Elizabeth Warren, letter to Dr. Mehmet Oz

Reuter’s Ahmed Aboulenein reported on March 12 that “Warren called on Oz to divest from his financial holdings related to industries regulated by the agency and commit to strong ethics safeguards.” Oz, of course, is President Donald Trump’s nominee for CMS Administrator, the agency most important to Home Health and Hospice providers.

Across the aisle, Missouri Senator Josh Hawley peppered Oz with questions about his position on transgender therapy. “You previously praised trans surgeries for minors and supported the use of puberty blockers for children. You discussed transgender therapy on your TV program and hosted transgender children.”

Hawley also questioned Dr Oz’s previous comments on abortion, adding: “I hope he’s changed his views to match President Trump! We need the Trump agenda at CMS.”

It goes without saying that a nominee who encounters challenges from the left and the right is facing an uphill battle toward Senate confirmation, especially when nominees this year can only afford to lose three votes from the majority party. What exactly has Dr. Oz said or done over his long career that may put his nomination in jeopardy?

Pulling Back the Curtain

Becker’s Hospital Review summarized Oz’s history as well as his answers to questions during his three-hour Senate hearing on March 14.

“The former TV personality answered questions about potential Medicaid cuts, the focus of the House’s February budget instruction that the Energy and Commerce Committee cut $880 billion over 10 years. Medicare and Medicaid are the largest programs under the committee’s oversight. (A March 5 Congressional Budget Office report said the only way to reach the $880 billion saving goal over the next decade, without raising taxes, would be through Medicaid or CHIP cuts.)”

While Dr. Oz did not directly respond to questions or reveal his stance regarding Medicaid cuts, he did have a prepared non-answer for the Senators. “I commit to doing whatever I can, working tirelessly to ensure that CMS provides Americans with superb care. Especially Americans who are most vulnerable. Our young, our disabled and our elderly.”

On March 25, the Senate Finance Committee voted to advance Oz’s nomination to the full Senate. The panel voted 14 to 13, along party lines.

Vision Statement

Prior to facing the challenging questions thrown at him from both sides of the aisle, Dr. Oz used his opening statement to outline a vision focused largely on modernizing CMS’s systems; addressing waste, fraud and abuse; and incentivizing Americans to make healthier lifestyle choices.

In the past, Oz had endorsed privatizing Medicare through a change that would essentially result in something that might be called “Medicare Advantage for All.” In his Senate hearing answers, Oz pivoted to the opposite argument. He cited problems of overpayments to Medicare Advantage plans, the need to limit prior authorizations, and emphasized the need to halt the practice of “upcoding” where providers or plans bill for treating patients as sicker than they actually are.

In 2010, Dr Oz hosted a 15-minute segment on his show called “Transgender Kids: Too Young to Decide?” in which he spoke to transgender children, their parents and a doctor who provided gender-affirming care.

Outlook

Considering the slim Republican majority in the Senate, Ox can afford to lose only three Republican votes in his bid to become the next CMS administrator.

# # #

Tim Rowan is a 30-year home care technology consultant who co-founded and served as Editor and principal writer of this publication for 25 years. He continues to occasionally contribute news and analysis articles under The Rowan Report’s new ownership. He also continues to work part-time as a Home Care recruiting and retention consultant. More information: RowanResources.com
Tim@RowanResources.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

MedPAC Comments on CY 2026

CMS

by Kristin Rowan | Mar 22, 2025 | CMS, Editorial, Medicare Advantage, Regulatory

by Kristin Rowan, Editor

MedPAC Comments on CY 2026

MedPac Sends Recommendations to Congress

MedPAC makes recommendations to Congress and HHS on issues affecting the Medicare program. The March report for 2025 includes recommendations for hospice, home health, and SNFs, in addition to in-patient and out-patient hospital services.

Hospice

Using the exact terminology from the 2024 report, MedPAC recommends that Congress eliminate the update to the 2025 Medicare base payment rates for hospice. MedPAC pointed to a number of statistics to support the evaluation:

The number of hospice providers increased in 2023
Some of the growth in hospice providers occurred in states where CMS has concerns over program integrity
The percentage of patients using hospice increased by .8 percent nationwide, as did the days of care and visits per week
Medicare payments exceeded marginal costs by 14 percent

Opinion

The population of the U.S. is aging as more and more Baby Boomers qualify for Medicare; there is an increased need for hospice agencies to accommodate the volume of patients
Whether there are more hospices in states where program integrity is questioned does not impact the need for hospice care; program integrity reform changes this, not reimbursement rates
The rise in use, length of stay, and days of care explain the increase in the number of hospice; need, not profitability drives this growth
The average markup in 2022 was 72 percent above marginal cost

Marginal Cost

Marginal cost is the cost of adding one more unit of production. In simple terms, that would be the overall costs of adding one hour of care for a hospice patient. This would include scheduling, hourly wage, and other operational costs. MedPAC believes that if an agency adds one hour of care and make 14 percent more than their costs, that is sufficient.

Home Health

Keeping with tradition, MedPAC used the same language again from 2024 to recommend that Congress reduce the 205 Medicare base payment rate for home health agencies by 7 percent.

The number of HHAs participating in Medicare increased by 3.4 percent.
Most of the growth in HHAs was in LA County. Outside LA County, the number of HHAs decreased by 2.8 percent.
The number of 30-day episodes per beneficiary decreased by 1.8 percent, but is still higher than in prepandemic years
MedPAC was unable to compute the marginal profit for 2023
Quality of care (percent discharged to community) increased by 1.3 percent
The all-payer margin in HHAs was 8.2 percent, attracting investors
The projected Medicare payment margin for 2025 is 19 percent

Image of letters spelling health and wealth

Opinion

LA County has more HHAs, but the rest of the country has fewer. We believe if you ask The National Alliance for Care at Home, Bill Dombi, or any number of prior HHA owners, low reimbursement rates forced them out of business

Pandemic numbers skewed the need for care at home because everyone was at home; if you only look at prepandemic numbers compared with 2023 numbers, the need for home health is increasing
HHAs keep patients out of the hospital, which accounts for more Medicare payments and higher costs
Again, the average margin across the U.S. is 72 percent, but MedPAC somehow believes 8 percent will attract investors and buyers; volume is attracting buyers, not margins
The projected 2025 margin is 19 percent and MedPAC recommends lowering it to 14 percent, matching hospice, and is 58 percent lower margins than the average industry

One Point of Parity

Surprisingly, there is an overlap in thinking between providers and MedPAC. In the February 2025 comment on the CMS notice of proposed rulemaking for 2026, MedPAC addressed the coding intensity and increased Medicare Advantage payments.

Last summer, Editor Emeritus Tim Rowan reported on the inflated health conditions filed by payers. Medicare Advantage payers also routinely deny care that traditional Medicare plans would cover. MA payers are collecting on both the front and back ends of the “Bank of CMS.” According to the Center for Economic Policy Research, upcoding by MA plans costs CMS 106 percent of traditional Medicare costs. Quality bonus payments add an additional 2 percent. Operating surplus from enrolling healthier beneficiaries adds another 11 percent. Payments to MA plans are 19 percent higher. MedPAC agrees and urges CMS to further investigate coding intensity from MA payers.

Point of Contention

Although we agree with MedPAC’s assessment of MA coding intensity, that is where the similarity ends. Let’s take that recommendation one step further and require that MA plans pay hospice and home health providers a higher percentage of their risk-assessment adjustment and let the payers make their profits elsewhere.

It Could be Worse

Given the recent upheaval in D.C. and the fear that Medicare, Medicare Advantage, Medicaid, Social Security, and other benefits would be done away with completely, we are relieved to see the House Budget Bill passing without the drastic reductions to care at home.

From the Alliance

Following the passing of the House Budget Bill, The National Alliance for Care at Home issued a response statement. We’ve published the full response here for 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. She also has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

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

Alliance Statement on Congressional Budget

Advocacy

by Rowan Report | Mar 21, 2025 | Advocacy, CMS, Partner News, Regulatory

FOR IMMEDIATE RELEASE

Contacts: Tom Threlkeld
202-547-7424
Email

Elyssa Katz
571-281-0220
Email

The Alliance Comments on Recent Congressional Budget and Reconciliation Activity

ALEXANDRIA, VA and WASHINGTON, DC, March 5, 2025 – The National Alliance for Care at Home (the Alliance) released the following statement regarding recent legislative developments that may impact the Medicaid program. These include the passage of the House Budget Bill and the reconciliation framework that includes instructions for the House Energy and Commerce Committee to find $880 billion in reductions to programs under its jurisdiction; passage of the Senate Budget framework that does not include such drastic reductions; and comments by Speaker of the House Johnson (R-LA) that any changes to Medicaid will not include caps on federal funding or changes to the state matching formulas.

“The Alliance is reassured by affirmations that the congressional majority will not pursue some of the most drastic proposals previously discussed as options for reducing federal expenditures. Our members will not support any policies that reduce access to essential home and community-based services for eligible individuals. As Congress continues to assess options to reduce federal spending, we encourage leaders to continue to look favorably on high-value services that reduce costs and improve participant satisfaction.

“Care in the home is a proven model that reduces costs and is preferred by patients and families. An independent evaluation of Money Follows the Person, a grant program that transitioned individuals from institutional settings to the community, found that total spending on older adults decreased by 20 percent during the first year and 27 percent during the second year following their move to the community.[1] If Congress wishes to seek opportunities to reduce spending, we recommend they advance care models that provide cost-effective care without limiting access to services.

“We also recognize that there are opportunities to strengthen program integrity and reduce instances of fraud, waste, and abuse in the health care sector. The Alliance supports actions that reduce fraud, waste, and abuse from bad actors without placing unnecessary burdens or unfairly punishing providers and beneficiaries who are acting in good faith. We look forward to working with Congress to advance policies that strengthen federal health care program oversight.

“Medicaid is a complex program and changes to one part of the statute may have unanticipated negative outcomes on other aspects of services, financing, or reimbursements. We encourage Congress to be extremely careful to avoid making changes that could lead to unintended outcomes. We stand ready to provide our expertise to help strengthen Medicaid for all individuals and providers.”

# # #

About the National Alliance for Care at Home

The National Alliance for Care at Home (the Alliance) is a new national organization representing providers of home care, home health, hospice, palliative care, and other health care services mainly delivered in the home. The Alliance brings together two organizations with nearly 90 years of combined experience: NAHC and NHPCO. NAHC and NHPCO have combined operations to better serve members and lead into the future of care offered in the home. Learn more at www.AllianceForCareAtHome.org.   

[1] https://www.medicaid.gov/medicaid/long-term-services-supports/downloads/mfpfieldreport21.pdf

HIPAA Compliance in Communication

Clinical

by Rowan Report | Mar 21, 2025 | Clinical, HIPAA, Regulatory

by Devin Paulin, Skyscape

The Critical Importance of HIPAA Compliance in Home Healthcare Communication

The Rise of Messaging Apps and Healthcare Communication

Nearly 44% of the global population (3.5 billion people) rely on messaging apps to communicate. Unfortunately, available consumer SMS, text, and even “secure” messaging apps like WhatsApp, Apple Message, or Google Messages do not come with safety and security features specifically required to be compliant in the healthcare industry.

Still, consumer SMS apps are quite often used for healthcare communication in which Personal Health Information (PHI) is shared, and many individuals don’t understand the level of risk or that this is a violation of the law.

HIPAA Compliance in Communication Advantages

Group and Individual texting are a proven, timesaving, real-time communication tool in healthcare, and must be done through a HIPAA-compliant messaging platform. Secure platforms can improve privacy and security while maintaining compliance in such a sensitive industry.

There are many reasons why HIPAA compliance is vital for secure communication in home healthcare.

HIPAA Compliance in Communication - Not Just for Doctors and Nurses

HIPAA compliance is not just for medical clinics and hospitals. HIPAA compliance extends to all types of services that hold healthcare information. Physical Therapy, Personal Care, Home Health, Wellness, Behavioral Health, Assisted Living, and many more all fall under HIPAA. Most importantly, ALL providers, staff members (full or part-time), contractors, and third-party partners who come in contact with PHI are subject to HIPAA law, violations, and fines.

We're too Small for Violations to be Noticed, Though

Wrong. We regularly speak to many owners and staff members of large and small Home Health Care, Assisted Living, Hospice and Palliative, Mobile Imaging, PT and Rehabilitation, and Behavioral Health across the country. Many openly operate under the false assumption that their business is too small to be noticed by the U.S. Department of Health and Human Services (HHS) and the Office for Civil Rights (OCR), who is responsible for enforcing the HIPAA Privacy and Security Rules. That is not how it works.

Complaints logged by those within or close to your business alert the OCR to possible HIPAA violations. These can be from current and former staff, patients, clients, business partners, or anyone who claims to have witnessed a HIPAA breach. This can include disgruntled employees and whistleblowers. Even for companies that are HIPAA compliant, any breach is to be reported by an employee assigned as the security officer.

HIPAA Compliance in Home Healthcare by Type

HIPAA mandates compliance for all communications involving PHI. Some key examples include:

Provider-to-Patient Communication
- Secure platforms are necessary when caregivers contact patients outside of in-person visits.
Provider-to-Provider Communication
- Sharing PHI within or between departments must meet HIPAA standards.
Provider-to-Insurance Communication
- Insurance companies require sensitive patient data, which must be securely transmitted.
Provider-to-Third-Party Communication
- Any third-party associates handling PHI must have a signed Business Associate Agreement (BAA) and adhere to HIPAA regulations.
Provider-to-Public Health Authorities
- Reporting communicable diseases or pandemics requires secure communication.

Consequence of HIPAA Violations

HIPAA violations can have severe consequences, including:

Financial Penalties
- Fines range from $100 to $50,000 per violation, depending on the level of negligence.
Reputational Damage
- Data breaches erode patient trust, leading to a damaged reputation.
Legal Consequences
- In cases of willful neglect, organizations may face lawsuits or criminal charges.

Final Thoughts

Understanding and adhering to HIPAA regulations is crucial in home healthcare. Compliance not only safeguards sensitive information but also strengthens patient trust and ensures ethical operations.

# # #

Devin Paullin HIPAA Compliance in Home Healthcare

Devin Paullin is an award-winning innovator and executive in Healthcare Technology, having developed successful products, solutions, and partnerships in Life Sciences, Post-Acute Care, SDOH, and Long-Term industries.

He is currently Chief Growth Officer for Skyscape which provides Buzz, an all-in-one, real-time HIPAA-compliant clinical collaboration and communication platform that enables the entire staff (admins, operations, clinicians, caregivers, partners, patients, and families) with the tools to communicate securely, easily, in groups or one to one, and affordable, by any mode they choose. Visit Buzz or contact them to learn more about Buzz by Skyscape today.

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Underlying Causes of Health Issues

Advocacy

by Kristin Rowan | Mar 13, 2025 | Advocacy, CMS, Outcomes, Regulatory

by Kristin Rowan, Editor

Underlying Causes of Health Issues

Underlying causes of health issues are common. Not all health issues come directly from infections, medical conditions, or genetics. Lifestyle, environmental factors, and social determinants can cause and/or increase the severity of health issues. Beginning in the winter of 2023, the Centers for Medicare and Medicaid Services posted guidance on approving coverage for these social needs, acknowledging that they contribute to poor health outcomes. CMS named the social needs that could be covered by Medicaid, CHIP, Section 1115, and Home and Community Based Services. These include help finding new housing, one-time moving costs, eviction prevention, respite care, sober centers, home improvements, meals, and case management.

Guidance Rescinded

CMS referred to both the 2023 and 2024 documents as “Center Informational Bulletins” (CIB) meant as guidance, not rule of law. The 2024 document provided updates and clarifications to the 2023 document. According to the statement from CMS, dated March 4, 2025, they have rescinded both CIBs “to evaluate policy options consistent with Medicaid and CHIP progam requirements and objectives.” Moving forward, CMS will consider each application to cover these services on a case-by-case basis using the Social Security Act, not the HRSN Framework or the CIBs.

Opposition

Former chief medical officer of the US Medicaid program Andrey Ostrovsky, MD, FAAP said that removing coverage for social determinants of health will harm patients and taxpayers.

Sen Ron Wyden (D, Oregon) agrees, stating that addressing the underlying causes of health issues is key to keeping America healthy.

Underlying Causes of Health Issues Andrey Ostrovsky

“It’s unlikely we see an easy, smooth approval process for such services moving forward….I think that the bar to getting it approved will be higher. States are going to have to make individualized decisions around where their priorities are and where they want to continue to focus on expansion — and maybe focus a little bit more on cost constraint and financially effective services under the new administrative priorities.”

Damon Terzaghi

Senior Director of Medicaid Advocacy, National Alliance for Care at Home

On the Other Hand

Despite the opposition to this change, there does seem to be some validity to the move. There should be some discussion about where Medicaid services should end and another department begins. The question here is whether a different federal program should be providing coverage for these social determinants of health. According to Terzaghi, this could be the beginning of an improvement to the system, rather than the dismantling of it.

Final Thoughts

The changes coming out of D.C. recently seem to be coming like rapid fire. See this weeks related press release on the continuing resolution passed by Congress. As with most of these edicts, executive orders, and other changes, the long-term impact and the eventual goal remain to be seen. We will continue to follow these and other stories as new information becomes available.

# # #

Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news .She also has a master’s degree in business administration and marketing and 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 Member Testifies Before Congress

Advocacy

by Rowan Report | Mar 13, 2025 | Advocacy, Outcomes, Partner News, Regulatory

FOR IMMEDIATE RELEASE

Contacts: Elyssa Katz
571-281-0220

Tom Threlkeld
202-547-7424

communications@allianceforcareathome.org

Alliance Member, Jonathan Fleece, Testifies Before Congress on the Value of Care at Home

Ways & Means Health Subcommittee Hearing on “After the Hospital: Ensuring Access to Quality Post-Acute Care”

(Washington, DC and Alexandria, VA) – The National Alliance for Care at Home (the Alliance) released the following statement at the conclusion of a hearing conducted by the House Ways & Means Subcommittee on Health on After the Hospital: Ensuring Access to Quality Post-Acute Care:

“The Alliance thanks Chairman Vern Buchanan (R-FL), Ranking Member Lloyd Doggett (D-TX), and all members of the Health Subcommittee for convening this important discussion on post-acute care. This hearing provided an opportunity to amplify the voices of home health and hospice providers and reinforce the essential role they play in delivering high-quality, patient-centered care in the setting people prefer—at home.”

Dr. Steve Landers

CEO, The Alliance

Alliance Member Testifies: Thank you, Jonathan Fleece

“We are especially grateful to Jonathan Fleece, CEO of Empath Health, for sharing his expertise and for his service on behalf of patients and families. Empath Health has long been a leader in setting the standard for high-quality, patient-centered care, and we appreciate its commitment to advancing care at home.

“As our nation’s population rapidly ages, it is more critical than ever to get these policies right and ensure that home health and hospice remain accessible and protected from harmful cuts and unnecessary administrative burdens. Not only is care at home beloved by patients and families, but it is also cost-efficient, easing strain on the healthcare system by reducing reliance on institutional care and allowing people to heal where they feel most comfortable.”

Jonathan Fleece The Alliance Testifies Before Congress

Continued Advocacy from The Alliance

“Coming out of this hearing, the Alliance remains committed to working with Congress and the Administration to strengthen home health and hospice, safeguard access to these essential services, and advance policies that support their long-term sustainability. We will continue advocating against payment cuts that threaten access, promoting value-based care models, and ensuring regulatory oversight enhances—rather than hinders—the ability of providers to deliver the best possible care.”

To read the full subcommittee hearing testimony of Jonathan Fleece, CEO of Empath Health, click here.

# # #

About the National Alliance for Care at Home

The National Alliance for Care at Home (the Alliance) is a new national organization representing providers of home care, home health, hospice, palliative care, and other health care services mainly delivered in the home. The Alliance brings together two organizations with nearly 90 years of combined experience: NAHC and NHPCO. NAHC and NHPCO have combined operations to better serve members and lead into the future of care offered in the home. Learn more at www.AllianceForCareAtHome.org.   

Nursing Facility Compliance Guidance

Admin

by Elizabeth E. Hogue, Esq. | Mar 13, 2025 | Admin, Clinical, Regulatory

by Elizabeth E. Hogue, Esq.

Nursing Facility Compliance Guidance

Takeaways for Hospices

In November of 2024, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services issued revised “Nursing Facility Industry Segment-Specific Compliance Program Guidance.” This guidance describes:

Risk areas for nursing facilities
Recommendations and practical considerations for mitigating risks
Other important information that the OIG believes nursing facilities should consider when implementing, evaluating, and updating their compliance and quality programs

Guidance Extends to Post-Acute Providers

The guidance targets nursing facilities. Howeve, it also clearly states that post-acute providers other than nursing facilities should use the guidance in their compliance efforts. The OIG says: “We encourage all long-term and post-acute providers to establish and maintain effective compliance and quality programs.” Guidance for nursing facilities, for example, specifically addresses relationships between nursing facilities and hospices.

The OIG...

First...

acknowledges that nursing facilities may arrange for hospice services for patients who meet the eligibility criteria and who elect the hospice benefit.

Then...

reminds facilities and hospices that requesting or accepting remuneration from hospices may subject both parties to liability under the federal anti-kickback statute. This applies if the remuneration may influence nursing facilities’ decisions to do business with hospices or induce referrals between the parties.

Goes On...

points out that nursing facilities that refer patients for hospice services who do not qualify for the hospice benefit may be liable for submission of false claims.

Nursing Facility Compliance Guidance OIG

Additionally...

says that hospices are permitted to furnish noncore services under arrangements with other providers or suppliers, including nursing facilities. State Medicaid Programs pay hospices at least 95% of the Programs’ daily facility rate. Hospices are then responsible to pay facilities for patients’ room and board.

Finally...

provides a list of suspicious arrangements between nursing facilities and hospices, including: (1) referrals of patients to hospices to induce hospices to refer patients to facilities, and (2) solicitation or receipt of hospices of goods or services for free or below fair market value, including nurses or other staff to provide services at facilities for nonhospice patients and monetary payments for:

referrals of patients to hospices to induce hospices to refer patients to facilities
solicitation or receipt of hospices of goods or services for free or below fair market value
- solicitation of nurses or other staff to provide services at facilities for nonhospice patients
- monetary payments for:

- - Room and board for patients in excess of what nursing facilities receive directly from Medicaid if patients are not enrolled in hospices. Additional payments must represent fair market value of additional services actually provided to patients that are not included in Medicaid daily rates.
  - Additional services for residents that include room and board payments to hospices from Medicaid Programs
  - Additional services for patients that are not included in room and board payments from Medicaid Programs at rates that are above fair market value
  - Provision of services by nursing facilities to hospice patients at rates that are above fair market value

Final Thoughts

Hospices are surely under fire these days from fraud enforcers. Engaging in the practices described above is likely to draw attention by enforcers and possible enforcement action.

# # #

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.

©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

ATA Applauds Telehealth Inclusion

Advocacy

by Rowan Report | Mar 13, 2025 | Advocacy, CMS, Partner News, Regulatory, Telehealth

FOR IMMEDIATE RELEASE

Contact: Gina Cella
781-799-3137
gcella@americantelemed.org

ATA ACTION APPLAUDS INCLUSION OF MEDICARE TELEHEALTH FLEXIBILITIES IN DRAFT CONTINUING RESOLUTION, URGES CONGRESS TO REINSTATE PROVISIONS AS SOON AS POSSIBLE

WASHINGTON, D.C., MARCH 8, 2025 – ATA Action, the advocacy arm of the American Telemedicine Association, today praised Congress for including Medicare Telehealth Flexibilities and the Acute Hospital Care at Home Program in the draft Continuing Resolution (CR) released today by appropriators. These critical provisions, which were originally implemented under President Trump’s leadership in his first term, will now remain in place through September 30, 2025, ensuring that millions of Americans continue to have access to high-quality, convenient, and affordable care.

“We appreciate Congress taking action to prevent a lapse in these vital telehealth flexibilities. While we would have preferred a longer extension, this step ensures uninterrupted access to telehealth services for patients and clinicians, as we continue working toward permanent solutions that reflect the needs of modern healthcare.”

Kyle Zebley

Executive Director, ATA Action

“But there remains work to be done. The CR must still be passed by Congress, and its path forward remains uncertain,” Zebley noted. “However, we are encouraged that, this past week, we submitted a detailed letter to House and Senate Appropriations Committee leaders, expressing urgency in extending these essential provisions, and clearly Congress listened and is responding to the needs of patients and the healthcare community, for which we are deeply grateful.”

Eliminated Coverage

However, key provisions – including first-dollar coverage for High Deductible Health Plan-Health Savings Accounts (HDHP-HSA), telehealth as an excepted benefit, an expanded Medicare Diabetes Prevention Program (MDPP) that would include telehealth components, and expanded, in-home cardiopulmonary rehabilitation services – were once again left out of the final CR, as they were at the end of 2024. These essential provisions now remain expired, leaving millions of Americans without the telehealth coverage they need.

“We strongly urge Congress to reinstate these provisions as soon as possible,” Zebley said. “Every day these flexibilities remain lapsed is another day that patients cannot access the care they need, employers struggle to provide affordable coverage, and critical gaps in healthcare widen.

“Telehealth remains a bipartisan issue, and we deeply appreciate the longstanding leadership of President Trump, who put these provisions in place during his first term, as well as our policy champions in Congress,” Zebley added. “We will continue to work in earnest with the administration and lawmakers to solidify telehealth as a lasting pillar of American healthcare.”

# # #

About the ATA

As the only organization completely focused on advancing telehealth, the American Telemedicine Association is committed to ensuring that everyone has access to safe, affordable, and appropriate care when and where they need it, enabling the system to do more good for more people. The ATA represents a broad and inclusive member network of leading healthcare delivery systems, academic institutions, technology solution providers and payers, as well as partner organizations and alliances, working to advance industry adoption of telehealth, promote responsible policy, advocate for government and market normalization, and provide education and resources to help integrate virtual care into emerging value-based delivery models.

About ATA Action

ATA Action recognizes that telehealth and virtual care have the potential to transform the healthcare delivery system by improving patient outcomes, enhancing the safety and effectiveness of care, addressing health disparities, and reducing costs. ATA Action is a registered 501c6 entity and an affiliated trade organization of the American Telemedicine Association (ATA).

© 2025 This press release was submitted to The Rowan Report by ATA Action via prnewswire.com and is reprinted here with permission. For additional information, please see the contact information above.