Update on Public Participation in Rule Making

by Kristin Rowan | Mar 13, 2025 | Advocacy, CMS, Medicare Advantage, Regulatory

by Kristin Rowan, Editor

Update

Last week, we reached out to some of our contacts for responses to this change.

Former President of NAHC and current Senior Counsel at Arnall Golden Gregory Bill Dombi said:

It is difficult to discern the impact of the rescission of the waiver. One concern is whether the administration considers Medicaid a grant or benefit program thereby exempting it from APA public notice and comment rulemaking.

With respect to Medicare, if it is considered a benefit, there is still a Medicare statutory requirement of public notice and opportunity for comment through formal rulemaking that should effectively nullify the practical impact of the rescission of the waiver. All that said, we will need to see more before being to judge the impact.

Frequent guest author and Fellow, American Health Law Association, Elizabeth E. Hogue, Esq. had this to say:

Recission of the Richardson Waiver is not good news for providers.

Many federal agencies voluntarily committed to give notice and comment for actions that otherwise would be exempt. The US Department of Health and Human Services was one of the federal agencies that adopted this policy in October, 1970, in a memorandum commonly referred to as the “Richardson Waiver.” This policy was published in the Federal Register in 1971. HHS did not, however, promulgate the Waiver through notice and comment rulemaking.

The open process of give and take between agencies and providers under the Richardson Waiver resulted in resolution of important issues relatively informally. Now it appears that only policies mandated by statute will go through the rulemaking process. In other words, opportunities to resolve issues without formal resolution will be compromised.

The recission of the Waiver may also make administration of both the Medicaid and Medicare programs more complicated and less effective, especially in view of US Supreme Court decisions that say everything that hasn’t gone through the notice and comment process is not binding on providers.

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Below is the original article, published March 6, 2025

Public Participation Rescinded

The Administrative Procedure Act (APA) requires that an agency public a notice of proposed rulemaking in the Federal Register; allow sufficient time for public participation via written data, views, or arguments; and then publish a final rule. Matters relating to agency management, personnel, or public property; loans, grants, benefits, or contracts; and for “good cause” are exempt from the reporting requirements. The Richardson Waiver, adopted in 1971, waived the exemption and instructed agencies to use the good cause exemption sparingly. Effective immediately, the Richardson Waiver is rescinded.

“The policy waiving the statutory exemption…imposes on the Department obligations beyond the maximum procedural requirements specified by the APA, adds costs [that] are contrary to the efficient operation of the Department, and impedes the Department’s flexibility to adapt quickly to legal and policy mandates.”

Robert F. Kennedy, Jr.

Secretary, Department of Health and Human Services

What it Means

Public participation is now optional. Agencies and offices of the Department of HHS can, if desired, use the public notice and comment procedures for these matters, but are no longer required to do so. The Department will continue to follow these procedures in all circumstances in which they are required to do so.

Law firm Hogan Lovells, experts in healthcare law, wrote about the potential implications for the health care industry in a recent blog post. According to the firm, it is unclear how HHS will interpret the “benefits” portion of the exemption. HHS, and specifically CMS, currently uses the notice and comment procedure for various benefits programs, including Medicare and Medicaid. Secretary Kennedy’s statement clearly calls out the limitation in impacting any other law requiring notice and comment periods.

Public Participation in Medicare Rules

Hogan Lovells indicates that few if any policies written under the Medcare Act will be impacted by this change. The Medicare Act operates under additional rulemaking requirements under section 1871(a) of the SSA. Additionally, Azar v. Allina Health Services, 587 U.S. 566 (2019) confirms that Medicare rulemaking is independent from the APA. Some policies are currently exempt from the notice and comment obligations under the Medicare Act and will remain exempt.

Public Participation in Medicaid and CHIP rules

Medicare and CHIP fall under Title XIX of the SSA, which does not contain its own notice and comment requirements separate from the APA. HHS has used the APA notice and comment rules for many of the changes made to the Medicaid program. HHS could interpret the “benefits” clause as exempting Medicaid changes from the rule. Hogan Lovells states it is currently unclear whether HHS will take this route. They also purport the courts have not ruled on whether APA excludes Medicaid from the notice and comment requirements, and may not agree with that exclusion. Until the term “benefits” is better defined, Medicaid, CHIP, the insurance exchange marketplace, and TANF, among others, may be impacted.

Department of Veterans Affairs

A notable exception to these changes is the rulemaking in the Department of Veterans Affairs as it relates to the Veterans Health Care act of 1992. This program implemented Federal contractor requirements that established pricing and contracting standards for drug manufacturers. The VA policies and rules have historically been enacted using guidance letters, avoiding the rulemaking process altogether.

Final Thoughts

There is too much that is yet unknown regarding this change to understand its full impact. There will be immediate changes, court rulings, further changes, and likely a lot of advocacy from national organizations fighting for transparency for Medicare, Medicaid, and other “benefit” programs. This will be an ongoing story and The Rowan Report will bring updates as they happen.

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Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news .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

Prior Authorization Requirement Removed by UnitedHealthcare

by Kristin Rowan | Mar 7, 2025 | Clinical, CMS, Medicare Advantage, Regulatory

by Kristin Rowan, Editor

Easier Access to Home Health

Prior authorization requirements can be cumbersome, delaying or even preventing care in some cases. Patients who need prior authorization to get he care they need also generally have form after form to fill out or to have completed by their PCP or hospital physician, who doesn’t have time for adequate visits, much less more paperwork.

As part of their ongoing efforts to reduce prior authorization volume by 10%, UnitedHealthcare has just announced a change in their home health services requirements.

Limits on Where Changes Apply

Beginning April 1, 2025, UHC will no longer require prior authorization or concurrent reviews for home health services managed by Home & Community (formerly naviHealth). This is the next step in an ongoing effort to modernize the authorization process and simplify health care for its members and providers.

These changes will apply to Medicare Advantage and Dual Special Needs Plan (D-SNP) beneficiaries in 36 states and the District of Columbia.

Alabama
Alaska
Arkansas
California
Colorado
Connecticut
Florida*
Georgia
Idaho
Illinois
Indiana
Iowa
Kansas

Kentucky
Louisiana
Maine
Maryland
Massachusetts
Nebraska
Nevada
New Mexico
North Carolina
North Dakota
Ohio
Oklahoma
Oregon

Pennsylvania
Rhode Island
South Carolina
Tennessee*
Texas
Utah
Virginia
Washington
Wisconsin
Wyoming
Washington, D.C.

*In Florida and Tennessee, the changes will not apply to D-SNP plans that are not managed by Home & Community.

Prior Authorization Additional Information

You should continue to request prior authorization and concurrent review through March 31, 2025. UHC reminds all providers that following CMS guidelines for providing home health care services is still required. And in states where a Medicare denial is required to get Medicaid prior authorizations, providers should submit their requests through the UHC provider portal.

The available information on this pending change is limited. We will provide updates should they become available. Please contact UHC directly through the provider portal if you have specific questions.

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BREAKING NEWS: Kennedy Rescinds Public Participation in Rule Making

by Kristin Rowan | Mar 7, 2025 | Advocacy, Breaking News, CMS, Medicare Advantage, Regulatory

by Kristin Rowan, Editor

Public Participation Rescinded

The Administrative Procedure Act (APA) requires that an agency publish a notice of proposed rulemaking in the Federal Register; allow sufficient time for public participation via written data, views, or arguments; and then publish a final rule. Matters relating to agency management, personnel, or public property; loans, grants, benefits, or contracts; and for “good cause” are exempt from the reporting requirements. The Richardson Waiver, adopted in 1971, waived the exemption and instructed agencies to use the good cause exemption sparingly. Effective immediately, the Richardson Waiver is rescinded.

Robert F. Kennedy, Jr.

Secretary, Department of Health and Human Services

What it Means

Public Participation in Medicare Rules

Public Participation in Medicaid and CHIP rules

Department of Veterans Affairs

Final Thoughts

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Special Focus Program Ends

by Kristin Rowan | Feb 20, 2025 | Advocacy, CMS, Hospice, Regulatory

by Kristin Rowan, Editor

Special Focus Program Not Well Received

When the Hospice Special Focus Program (SFP) first appeared, the industry was told the program would help CMS identify and improve the performance of hospice providers that were struggling to meet quality standards. CMS developed the program to strenthen oversight, promote quality improvements, and ensure compliance for underperforming hospice agencies.

Soon after its inception and implementation in 2022, numerous concerns emerged. The National Alliance for Care at Home (then NAHC and NHPCO) voiced concerns over the program’s reliance on incomplete data as well as the potential for the program to unfairly targed providers in underserved communities.

Between February 2020 and January 2025, numerous state and national organizations have introduced Hospice Acts to Congress, given feedback to CMS on improvements to SFP, and filed lawsuits against the CMS.

Ramping Up the Opposition

In mid-2024, following the Council of States meeting, monthly opposition to the SFP became standard:

The McDermott Report highlighted significant flaws in the algorithm used for the program. Again, there was an objection over the use of incomplete and inconsistent data.
Bi-partisan Congress members sent a letter to CMS requesting revisions to SFP, criticizing outdated survey data and suggested that the quality metrics were inappropriately weighted.
Alliance CEO Steve Landers publicly criticized the implementation of SFP in his op-ed.
Representatives introduced Bill H.R. 10097 to delay SFP implementation, stating it would give CMS time to address the problems with the program and ensure fair application of standards for low-performing hospices without impacting quality programs.
The Texas Association for Home Care & Hospice; Indiana Association for Home & Hospice Care; Association for Home & Hospice Care of North Carolina; South Carolina Home Care & Hospice Association; and Houston Hospice filed a lawsuit challenging the SFP as unlawful and arbitrary.

CMS Backs Down

This week, CMS announced that it has paused the implementation of SFP for the calendar year 2025. The CMS statement say the pause will allow CMS to “further evaluate the program.” There is no mention of the opposition or the ongoing lawsuits.

The hospice special focus program page on the CMS website reads:

Effective February 14, 2025, implementation of the Hospice Special Focus Program for CY 2025 has ceased so that CMS may further evaluate the program. Please contact QSOG_Hospice@cms.hhs.gov for policy questions.

All additional information about the program has been removed from the website page.

Special Focus Program gets First Positive Feedback

For the first time since 2020, industry leaders are applauding a CMS move regarding SFP. The move is halting the program altogether, but at least its positive feedback.

“This decision is a positive move acknowledging that the current approach is not working as intended. The hospice community has long advocated for strong oversight and patient protections, but the SFP, as implemented, was deeply flawed, unlawful, and harmful to the very patients it was meant to protect.”

National Alliance for Care at Home

You can read the full statement from The Alliance in their press release.

Final Thoughts

It seems it is not often that CMS hears what the industry tells them. Reimbursement rates continue to drop, documentation is increasingly complex, and the industry has suffered from their misconceptions about what we need. This time, at least, there was enough pressure and advocacy from Congress and from you, the people who are impacted daily by their decisions, to cause them to rethink this program. Keep up the good work and continue to advocate for yourself and for care at home. Perhaps this is not the last time CMS will listen.

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Creditable Coverage for Medicare Part D

by Kristin Rowan | Feb 14, 2025 | Admin, Regulatory

by Kristin Rowan, Editor

CMS 2026 Updates to Prescription Plan

The Centers for Medicare & Medicaid Services (CMS), as part of the Inflation Reduction Act of 2022 (IRA), released a draft of the calendar year 2026 redesign program instructions. The new provisions for Medicare Part D include:

An annual out-of-pocket maximum of $2,100, up from $2,000 in 2025
A selected drug subsidy program
The requirement that Part D plans offer enrollees the option to spread out their out-of-pocket costs over the year
Maximum charge of $35 for insulin regardless of deductible, co-pay, or out-of-pocket spending reached
No out-of-pocket costs for recommended vaccines
New requirements for Creditable Coverage

Current Creditable Coverage Determination

The current simplified determinations method is as follows:

The plan provides coverage for brand and generic prescriptions;
The plan provides reasonable access to retail providers;
The plan is designed to pay on average at least 60% of participants’ prescription drug expenses; and
The plan satisfies at least one of the following:
- The coverage has no annual benefit maximum or maximum annual benefit payable by the plan of at least $25,000;
- The coverage has an actuarial expectation that the amount payable by the plan will be at least $2,000 annually per Medicare-eligible individual; or
- For employer plan sponsors that have integrated prescription drug and health coverage, the integrated plan has no more than a $250 deductible per year, has no annual benefit maximum or a maximum annual benefit of at least $25,000, and has no less than a $1,000,000 lifetime combined benefit maximum.

Creditable Coverage

Medicare beneficiaries must enroll in Medicare Part D, unless they have other prescription coverage. If a beneficiary goes more than 63 days without prescription coverage, they may incur a late enrollment penalty. Creditable coverage has to have a value equal to or greater than the defined coverage for Part D. This requirement is not new. Group health plans have been calculating creditable coverage since the inception of the Part D program. What is new is that CMS has determined that the simplified method of determining creditable coverage is no longer accurate. The revised method must include all of the following:

Provide reasonable coverage for brand name and generic prescription drugs and biological products
Provide reasonable access to retail pharmacies
Is designed to pay on average at least 72% of participants’ prescription drug expenses

Impact

Persons over the age of 65 who qualify for Medicare, but who are still employed may have an employer sponsored or paid health insurance plan. Many of these plans have combined health and drug coverage. These plans will now have to provide creditable coverage, presumably for all beneficiaries, not just those who are eligible for Medicare.

The coverage has no annual benefit maximum or maximum annual benefit payable by the plan of at least $25,000;
The coverage has an actuarial expectation that the amount payable by the plan will be at least $2,000 annually per Medicare-eligible individual; or
For employer plan sponsors that have integrated prescription drug and health coverage, the integrated plan has no more than a $250 deductible per year, has no annual benefit maximum or a maximum annual benefit of at least $25,000, and has no less than a $1,000,000 lifetime combined benefit maximum.

For Additional Information

If you are currently offering an employee sponsored health plan, or need more information on Part D coverage, refer to the CMS Fact Sheet and the Program Instructions.

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Medicare Advantage Lowers Home Health Care Use

by Kristin Rowan | Feb 6, 2025 | Hospice, Medicare Advantage

by Kristin Rowan, Editor

End-of-Life Care in Medicare Advantage vs Traditional Medicare

Using research from CMS, researchers from Mt. Sinai in New York and Brown University in Rhode Island studied the data of adults aged 66 and older who passed away and had Medicare coverage in their final year of life. Included in the study were people potentially eligible for home health care and not in a nursing facility, hospital, or hospice care setting. Data from close to 1.8 million people was analyzed. The researchers identified whether the participants received home health care and how many days of end-of-life care they received.

Home Health Higher in Traditional Medicare

Of the nearly 1.8 million participants, the average age was 82. 51.5% were female and 36.5% were enrolled in Medicare Advantage. In the final year of life, home health care use was recorded at 37.5% for MA enrollees and 41.7% for traditional Medicare.

When the researchers looked at different demographic groups within the data sets, home health care usage was higher in traditional Medicare in most groups. However, among American Indian and Alaska Native groups, Medicare Advantage had a slightly higher rate of home health use at 37.9% compared with 37.1% in Traditional Medicare.

Conversely, in the Asian or Pacific Islander demographic, home health use rate was 32.6% in MA and 41.8% in TM. Similarly, the rate of use among the Hispanic group was 33% in MA and 44% in TM. Following a similar trend, in the non-Hispanic Black group home health usage in MA was 38.8% compared with 42.9% in TM. Likewise, among the non-Hispanic White group, home health use in MA was 37.9% versus 41.5% for TM. For those of unknown race, usage was 36.1% in MA compared with 40.1% in TM.

Days of Care Lower in Medicare Advantage

Home health users across all racial and ethnic demographic groups enrolled as Medicare Advantage beneficiaries had fewer days of care in home health than those enrolled in Traditional Medicare. The stand-out group in this part of the research was those of Hispanic descent, who averaged 81.9 days in home health care in Medicare Advantage compared with 111.9 days in Traditional Medicare.

Implications

The researchers indicated some limitations in the study, namely that data was pulled from pre-covid patients because of the changes in home health during covid. The study should be repeated with post-covid data. One of the researchers received personal fees while serving as a senior advisor to CMS. Another received personal fees as a section editor for UpToDate. A third researcher reported receiving personal fees from Abt and UpToDate.

Despite these limitations, the implications of the study show that end-of-life care is not the same between Medicare and Medicare Advantage patients. Medicare Advantage is largely operating on a Value-Based Purchasing Model. The fewer services the beneficiary receives, the more money the primary doctor, hospital, and payer keep. It is not surprising, therefore, that MA patients get fewer services for less time. Patients who switch from Traditional Medicare to Medicare Advantage, especially if they are your patients, should be informed that they are still eligible for home health care and hospice care, but they may have to ask for it.

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Medicare Advantage Increase for Payers, not Providers

by Kristin Rowan | Jan 23, 2025 | Artificial Intelligence, Breaking News, CMS, Medicare Advantage, Regulatory

by Kristin Rowan, Editor

CMS Announces Medicare Advantage Pay Hike

On January 13, 2025, CMS announced its plans to increase payments to Medicare Advantage plans by 4.33%. Policy changes for Medicare Advantage and Part D include changes in how the agency calculates payments to health plans. A spokesperson from CMS said that the policy change provides access to affordable, high-quality care. The changes, however, don’t increase payments to the people actually providing the care, only to the payers.

Opposition

While major health plans across the U.S. were thrilled with the announcement and saw substantial stock price hikes immediately after, not everyone is on board. The American Medical Association (AMA) outlined how physicians who treat Medicare patients are getting pay cuts from CMS for the fifth year in a row. Meanwhile, HHS OIG released a report finding that MA insurers profited $7.5 billion from risk-adjusted payments in 2023.

“It’s unbelievable they’re giving insurance companies that had record profits an increase while at the same time cutting payment to physician practices that are struggling to survive. This contrast highlights the urgent need for Congress to prioritize linking payment to physician practices to the cost of providing care.”

Bruce Scott, M.D.

President, American Medical Association

Out-of-Pocket Cost Increase

In addition to the higher payments, the advance proposal includes an increase in the Part D deductible from $590 to $615. With this proposal, the out-of-pocket maximum will increase from $2,000 to $2,100 as well. Cost sharing after the deductible is reached but before the out-of-pocket max is reached will also increase. There is no increase for beneficiaries whose income is less than 100% of the Federal Poverty Level.

Coverage Increase

The CMS advance proposal calls for coverage and policy changes. Medicare and Medicaid programs will now cover anti-obesity medications. The plan imposes stricter rules on MA policies to prevent denial of reasonable and necessary services that would be covered under Medicare Part A and B. Finally, imposed guardrails on the use of AI. The guardrails will ensure AI systems are unbiased in patient care decisions. Additionally, the guardrails will ensure they do not perpetuate existing inequity in access to and receipt of medical services. The American Hospital Association appplauded this last change.

“The AHA commends CMS for taking important steps to increase oversight of 2026 Medicare Advantage plans to help ensure enrollees have equal access to medically necessary health care services. The AHA has previously raised concerns about the negative effects of certain Medicare Advantage practices and policies…that are more restrictive than Traditional Medicare and can compromise enrollee access to Medicare-covered services.”

Ashley Thompson

Senior Vice President, American Hospital Association

Changes are not Definite

Even though CMS has announced these changes to start in January, 2026, they are not set in stone. As of January 20, 2025, we are operating under anew administration and the changes under Trump have already started. CMS intends to continue it’s three-year plan to update the MA risk adjustment model and the implementation of the Inflation Reduction Act. However, it seems likely that the Inflation Reduction Act will be replaced with a different plan for inflation.

Jeff Davis, director of health policy at McDermott+ believes it is likely that Trump’s team will throw out the updates to MA and Part D as well as Biden’s proposed staffing mandate for SNFs. In the first 24 hours of his Presidency, Trump revoked both Biden’s “Strengthening Medicaid and the Affordable Care Act” and “Continuing to Strengthen Americans’ Access to Affordable, Quality Health Coverage” executive orders. He also rescinded the Drug Pricing Model executive order that covered obesity drugs, lowered the price of some drugs, and accelerated FDA approval for drugs that address unmet medical needs.

As Yet Unknown

As was to be expected, many of Trump’s initial 78 executive orders are already facing lawsuits from various entities. There are as of yet no definitive answers to changes in Medicare, Medicare Advantage, or other policies that impact healthcare and care at home. The Rowan Report will continue to follow these stories as they unfold.

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Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news. 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

Right at Home and PocketRN Partner for Dementia

by Rowan Report | Jan 16, 2025 | Partner News

FOR IMMEDIATE RELEASE

Contact: William Leiner
COO
will.leiner@pocketrn.com

Right at Home and PocketRN Enter Strategic Partnership to Provide New Medicare Care Model for Seniors with Dementia

Right at Home and PocketRN today announced a strategic partnership to provide support to Medicare dementia beneficiaries.

WASHINGTON, DC, UNITED STATES, January 15, 2025. Right at Home, a nationwide provider of in-home care, and PocketRN, a leading provider of virtual nursing care, today announced a strategic partnership to provide support to certain Medicare beneficiaries with dementia.

CMS Selects PocketRN

PocketRN was recently selected as a participant in the Guiding an Improved Dementia Experience (GUIDE) Model by the Centers for Medicare & Medicaid Services (CMS). As a GUIDE participant, PocketRN’s innovative “virtual nurse for life” approach will allow dementia patients and family caregivers to be specialty matched to nurses, who will become trusted companions that establish a long-term relationship with patients and families. PocketRN nurses also encourage openness to better understand individualized challenges; serve as continuous sources of education, coaching, monitoring, and emotional support; and are available as a 24/7 lifeline. Under the GUIDE Model, PocketRN will be available at no cost to eligible beneficiaries, with $0 copays.

PocketRN Right at Home Right at Home will provide in-home care and safety assessments for eligible beneficiaries to evaluate the safety of the home environment, to assess the ability of the beneficiary to manage and function at home, and to report to PocketRN other environmental, social, and behavioral factors that might impact the function and needs of the beneficiary and their caregiver. PocketRN and Right at Home will use these valuable reports to bring other resources included in the GUIDE benefit package to better support the beneficiary and allow them to stay in their home longer.

The GUIDE Model also provides respite services for certain people, enabling caregivers to take temporary breaks from their caregiving responsibilities. As part of its strategic partnership with PocketRN, Right at Home agencies will be providers of this key respite care service.

The anticipated outcomes of the GUIDE Model include increased caregiver empowerment and a reduction in Medicare and Medicaid expenditures–primarily achieved by preventing or delaying long-term nursing home stays. Additionally, the program aims to bring about a secondary reduction in hospital, emergency department, and post-acute care utilization. These outcomes closely align with the work that PocketRN is already doing and its mission to close the gap between home and healthcare.

“We couldn’t be more thrilled to bring our revolutionary nurse-led care model to the millions of dementia patients and families who need it most. With PocketRN, patients and families get unwavering support from a ‘virtual nurse for life’ as they navigate the complexities of managing dementia at NO cost to them. Nurses are hands-down the best clinicians to be the ‘glue’ to dementia patients and families throughout their journey–they’ve been doing so forever, and it’s high-time their work is valued by our system.”

Jenna Morgenstern-Gaines

CEO, PocketRN

“For over 25 years, Right at Home has empowered seniors to continue to live with independence and dignity while managing the effects of aging. This brand-new payment model will enable more seniors to experience the benefit of Right at Home services and support family members caring for seniors with dementia.”

Brady Schwab

Chief Growth Officer, Right at Home

GUIDE Model Participation

PocketRN will utilize its national network of expert nurses to dramatically expand access for dementia patients and families who otherwise may go without care. Its participation in the GUIDE Model will span eight years, with a one-year pre-implementation period for program development, community engagement, and infrastructure scaling before rolling out with a cohort of initial partners. Providers who are interested in partnering with PocketRN so their patients and families can get high-quality, personalized dementia care at no cost can contact nancy.gillette@pocketrn.com.

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About Right at Home

Founded in 1995, Right at Home offers in-home care to seniors and adults with disabilities who want to live independently. Most Right at Home offices are independently owned and operated and directly employ and supervise all caregiving staff. Each caregiver is thoroughly screened, trained, and bonded/insured before entering a client’s home. Right at Home’s global office is based in Omaha, Nebraska, with more than 700 franchise locations in the U.S. and five other countries. For more information about Right at Home, visit rightathome.net.

About PocketRN

PocketRN gives patients, families, and caregivers a “virtual nurse for life.” Its mission is to close the gap between home and healthcare by: enabling nurses to care proactively and continuously at the top of their license, enabling caregivers with peace of mind and the confidence to support others, and enabling patients to access whole-person, trusted, empathetic care when and where they want it. PocketRN is the glue that holds together fragmented experiences in care so that partners, clinicians, patients, and families get back more of what they need: quality time. For more information, visit www.pocketrn.com.

This press release was originally submitted to and appeared on EIN Presswire and is reprinted with permission.

GUIDE Model Expanding

by Kristin Rowan | Jan 16, 2025 | Clinical

by Kristin Rowan, Editor

GUIDE Launched with 390 Participants

On July 1, 204, CMS launched the GUIDE Model and announced that 390 organizations had signed on to participate. The Guiding an Improved Dementia Experience (GUIDE) Model is a voluntary model test amied at supporting people with dementia and their unpaid caregivers (family members).

Overview

The GUIDE Model focuses on comprehensive, coordinated dementia care to improve the quality of life for people with dementia. It also hopes to reduce the strain on family caregivers and keep patients in their homes and communities longer. Medicare payments cover the package of care coordination, care management, caregiver education and support, and respite care.

Poor-Quality Dementia Care

The GUIDE Model aims to address the key drivers of poor-quality dementia care in five ways:

- Defining a standardized approach to dementia care delivery for model participants – this includes staffing considerations, services for people with dementia and their unpaid caregivers, and quality standards.
- Providing an alternative payment methodology to model participants – CMS provides a monthly per-beneficiary payment to support a team-based collaborative care approach.
- Addressing unpaid caregiver needs – the model aims to address the burden experienced by unpaid caregivers by requiring model participants to provide caregiver training and support services, including 24/7 access to a support line, as well as connections to community-based providers.
- Respite services – CMS pays model participants for respite services, which are temporary services provided to a beneficiary in their home, at an adult day center, or at a facility that can provide 24-hour care for the purpose of giving the unpaid caregiver temporary breaks from their caregiving responsibilities.
- Screening for Health-Related Social Needs – model participants are required to screen beneficiaries for psychosocial needs and health-related social needs (HRSNs) and help navigate them to local, community-based organizations to address these needs.

Health Equity

Aspects of GUIDE designed to improve health equity include:

- Requiring participating providers to implement HRSN screenings and referrals.
- Offering financial and technical support for development of new dementia care programs targeted to underserved areas with less access to specialty dementia care.
- Annual reporting by participants on progress towards health equity objectives, strategies, and targets.
- Using data from the model to identify disparities and target improvement activities.
- A health equity adjustment to the model’s monthly care management payment to provide additional resources to care for underserved beneficiaries.

Exclusive Inside Scoop

PocketRN gives patients, families, and caregivers a “nurse for life,” closing the gap between healthcare and care at home. This whole-person support allows patients and their caregivers to have access to medical care through their virtual nurse, who establishes a relationship with the patients and families.

On January 13, 2025, PocketRN announced a Strategic Partnership with Nevvon to pilot the GUIDE Model.

Nevvon is a global home and health care training tech company that certifies caregivers for continuing education. The app-based learning allows caregivers to go at their own pace, simplifying compliance, and empowering agencies to deliver exceptional care.

On January 15, 2025, PocketRN announced a Strategic Partnership with Right at Home to provide support to eligible Medicare beneficiaries with dementia.

Right at Home is a nationwide provider of in-home care and will provide care and safety assessments for eligible beneficiaries to evaluate the safety of the home environment, the ability of the patient to manage and function at home, and report back to PocketRN any other factors that might impact the patient and their family caregiver.

Later today, PocketRN will announce a National Strategic Partnership with with Assisting Hands® Home Care to test the care model.

Assisting Hands provides in-home care to seniors, individuals with disabilities, and people recovering from illness or injury. The agency has a significant portion of their client base with a dementia diagnosis. Their franchise system has locations across the United States.

“We couldn’t be more thrilled to bring our revolutionary nurse-led care model to the millions of dementia patients and families who need it most. With PocketRN, patients and families get unwavering support from a ‘virtual nurse for life’ as they navigate the complexities of managing dementia at NO cost to them. Nurses are hands-down the best clinicians to be the ‘glue’ for patients and their families throughout their dementia journey–they’ve been doing so forever, and it’s high-time their work is valued by our system.”

Jenna Morgenstern-Gaines

CEO, PocketRN

In Their Own Words

The Rowan Report spoke with Nancy Gillette, Chief Growth Officer at PocketRN for this exclusive scoop. Nancy explained that with this program, PocketRN will be able to provide a nurse to dementia patients, provide a clinical overlay to care at home, work with care at home partners for respite benefits, and become a referral source when a home care agency has an eligible patient.

Existing models and studies using PocketRN have shown up to a 30% reduction in urgent care visits, ER visits, and hospitalizations. The company is focusing on finding new strategic partners for a greater understanding of patient engagement from a home care agency standpoint.

Nancy gave us this inside information:

The three recent announcements are just the beginning. Expect more announcements in the next 30-60 days and then continuing throughout the year.

PocketRN will eventually be applying the GUIDE Model in agencies, patients already using PocketRN, and direct referrals across all 50 states.

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PocketRN and Nevvon

by Rowan Report | Jan 16, 2025 | Partner News

FOR IMMEDIATE RELEASE

Contacts: William Leiner
COO
will.leiner@pocketrn.com

James Cohen
CEO and Co-founder
james@nevvon.com

PocketRN & Nevvon Announce National Strategic Partnership to Transform Dementia Care through CMS’ Innovative GUIDE Model

Aims to Improve Care Coordination, Empower Caregivers, and Enhance Patient Outcomes

WASHINGTON, DC, UNITED STATES, January 13, 2025 /EINPresswire.com/ — Today, PocketRN, a leader in virtual nursing, and Nevvon, a global innovator in home and health care training technology, announced a National Strategic Partnership to pilot the Centers for Medicare & Medicaid Services (CMS) Guiding an Improved Dementia Experience (GUIDE) Model. This groundbreaking alternative payment model is designed to support individuals living with dementia and their caregivers.

Under this partnership, PocketRN and Nevvon will integrate their scalable virtual nursing and caregiver training solutions into Dementia Care Programs (DCPs) being tested nationwide. PocketRN is one of approximately 400 participants in the GUIDE Model, and this partnership with Nevvon will address systemic barriers such as limited access to high-quality training, caregiver burnout, and operational inefficiencies.

The CMS GUIDE Model, launched on July 1, 2024, introduces a new payment framework to ensure that individuals living with dementia receive holistic, person-centered care. It tackles caregiver burnout by offering respite care services to allow caregivers necessary breaks to maintain their health and well-being. The program also improves access to care by providing 24/7 availability of trained professionals through telehealth services, overcoming geographic barriers and ensuring equitable support. Additionally, it addresses training deficits with Nevvon’s multilingual, on-demand e-training modules, which empower caregivers with the skills and knowledge to navigate the complexities of dementia care. PocketRN’s “virtual nurse for life” model bridges fragmented services by connecting caregivers, patients, and clinicians, creating a seamless, coordinated care experience.

24/7 Nursing

PocketRN enables caregivers and patients to access 24/7 virtual nursing support and regular nurse check-ins, delivering preventative care and reducing reliance on unnecessary emergency services through real-time assistance. Nevvon enhances caregiver education through a user-friendly app that offers short, practical learning modules tailored to every stage of dementia care. With training available in 11 languages, Nevvon ensures inclusivity and meets state-specific regulatory requirements, allowing agencies to focus on caregiving rather than administrative tasks.

“The GUIDE model is a powerful step forward in bridging the gap between homecare and healthcare. Our partnership with Nevvon strengthens our ability to deliver equitable, innovative, and scalable solutions that meet the needs of caregivers and families across the country. Together, we are ensuring that no one—caregiver or patient—is left behind in this new era of dementia care.”

WIlliam Leiner

COO, PocketRN

“The CMS GUIDE model offers an unprecedented opportunity to reimagine dementia care by focusing on the needs of caregivers and patients alike,” said James Cohen, CEO of Nevvon. “By combining our innovative e-training platform with PocketRN’s virtual nursing solutions, we are equipping caregivers with the tools, confidence, and flexibility they need to provide compassionate, patient-centered care. Together, we’re not only transforming how dementia care is delivered but also ensuring that agencies, caregivers, and families have the support they need to thrive in this new care paradigm.”

This partnership supports the GUIDE Model’s broader goals, as highlighted in the Biden Administration’s Executive Order on Increasing Access to High-Quality Care and Supporting Caregivers and the National Plan to Address Alzheimer’s Disease. For more information on the CMS GUIDE Model, visit: https://www.cms.gov/priorities/innovation/innovation-models/guide.

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About Nevvon

Nevvon is a global innovative home and health care training technology company that certifies caregivers for the mandatory annual education they earn online. Our simple, intuitive app lets caregivers learn at their own pace, simplifying regulatory compliance while empowering agencies to deliver exceptional care. Learn more at https://www.nevvon.com/guide/.

About PocketRN

PocketRN gives patients, families, and caregivers a “virtual nurse for life,” closing the gap between homecare and healthcare. PocketRN empowers caregivers with peace of mind, patients with trusted care, and clinicians with tools to deliver proactive, whole-person support. Visit www.pocketrn.com to learn more or engage with PocketRN on LinkedIn, Facebook, and Instagram.

This press release was submitted to and originally appeared on EIN Presswire and is reprinted here with permission.

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