Medicare Moratoria

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

by Kristin Rowan, Editor

Medicare Moratoria

CMS Halts All New Home Health & Hospice Agencies

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

More Investigations

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

Skirting Authority

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

What it Means for You

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

Statement from CMS

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

Dr. Mehmet Oz

Administrator, Centers for Medicare and Medicaid Services

More Information

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

Read the CMS Press Release

Full text of the Home Health Moratorium

Full text of the Hospice Moratorium

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

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

©2026 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Medicaid Reform

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

by Kristin Rowan, Editor

Medicaid Reform

New Efforts to Stop Fraud Before it Happens

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

Preserve Medicaid through Reform

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

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

Rep. David Schweikert

Chairman, Joint Economic Committee and House Ways and Means Oversight Subcommittee

Medicaid Waiver Programs

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

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

More Information

Read H. R. 7713

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

# # #

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

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

©2026 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Enhabit Sells Out to PE

by Kristin Rowan | Feb 26, 2026 | M&A

by Kristin Rowan, Editor

Enhabit Sells Out to PE

Kinderhook proposes billion dollar deal

Enhabit Home Health & Hospice announced this week they agreed to be acquired by Private Equity company Kinderhook industries. Enhabit has 247 home health and 115 hospice locations across 34 states. Stockholders will receive $13.80 per share from the publicly traded company after the acquisition is final and the company will longer be listed on the stock exchange. The stock buyout is reportedly just shy of 25% more than the stock value as of the close of business on February 20th.

Enhabit History

Enhabit made headlines in 2025 and again earlier in February surrounding its lawsuit against Chris Walker, Vistria Group, and Nautic Partners. In 2024, Encompass and Enhabit sued the parties for breach of duty when the principles involved created VitalCaring while still serving as senior officers for Enhabit. Enhabit, the former home health and hospice division of Encompass Health, collected $43 million in attorneys’ fees and mitigation damages on February 12, 2026.

Enhabit’s registered mission is A Better Way to Care®. The company purpose is to provide high-quality, compassionate care to every patient. Their core values and fundamental beliefs guide their behaviors and actions.

Deciding to Sell Out

“Following a thorough evaluation and extensive deliberations in consultation with our independent advisors, we are pleased to reach this agreement with Kinderhook. The Board evaluated the current state of the business, its outlook and opportunities, and is confident this transaction maximizes value for our stockholders and is in their best interest.”

Jeffrey W. Bolton

Chairman of the Board of Directors, Enhabit

CEO Barb Jacobsmeyer said the agreement is a “terrific outcome” for stockholders, clinicians, caregivers, patients, and families, citing resources and expertise that will come from Kinderhook. Meanwhile, Chris Michalik, Managing Director at Kinderhook said the company admires Enhabit’s leadership, patient-centered culture, and strong market position.

Pending Approval

Enhabit’s Board of Directors unanimously approved the acquisition. However, the deal still awaits approval from stockholders and regulatory bodies. Enhabit has scheduled a special meeting of stockholders for the vote. In conjunction with the SEC filing, some Enhabit executive officers filed a customary voting and support agreement, meaning they have granted proxy voting rights to Kinderhook. It is almost certain the acquisition will be approved by both companies. Only the regulatory approval is unknown.

# # #

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

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

©2026 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Purpose-Built AI for Care at Home

by Rowan Report | Jan 15, 2026 | Artificial Intelligence, Home Health, Hospice, Outcomes

by Isaac Greszes, Eleos

Purpose-Built AI for Care at Home

How Care at Home leaders can move beyond AI pilots

Care at Home is increasingly turning to AI to address documentation burden, clinician burnout, and regulatory pressure. While AI has the potential to address these issues and more, practical results remain uneven, leaving agencies with a lot of experimentation, but little clarity on actual value.

Evaluating AI solutions should focus on real-world outcomes, how the solution fits into your existing workflow, whether the software is scalable, and how it handles changing regulations. You should also look for AI solutions that are built for care at home (purpose-built). This series of articles will help you make informed, risk-aware decisions about AI adoption.

AI is Coming Fast

Home health and hospice leaders are navigating a difficult balance: persistent workforce shortages, rising provider burnout, expanding documentation requirements, and increasing regulatory scrutiny — all within thin operating margins.

At the same time, AI has moved quickly from experimental to strategic. Many organizations are now evaluating AI not just for productivity, but for operational and administrative efficiency, clinician experience, compliance readiness, and financial performance.

And the stakes are high

Early results across the market have been inconsistent. Some organizations report meaningful reductions in administrative burden and a clear return on investment. However, others struggle to find value after adoption. The difference often lies not in whether AI was adopted, but how it was designed, supported, and governed.

The pilot problem

As AI adoption accelerates, many organizations find themselves caught in extended pilot cycles — testing multiple tools without committing to the operational changes required for scale. While pilots can validate technical feasibility, they rarely provide the consistency or measurement discipline needed to demonstrate sustained ROI in regulated care at home environments.

Quality over Quantity

Why the right evidence matters

In today’s AI market, product demonstrations are easy to produce. Documented outcomes are not.

Executive leaders should expect vendors to demonstrate real-world impact, supported by customer data, third-party validation, or peer-reviewed research. Credible AI partners should be able to explain how their results translate to care at home — and where limitations exist. The challenge is not the lack of information from pilots, but the lack of evidence those pilots results can be reproduced, measured, and sustained, in a care at home setting.

Objective Evidence that Matters

When evaluating AI platforms, leaders should look for evidence related to:

Documentation efficiency, such as reduced time per visit or faster note completion
Operational ROI, including quicker billing readiness or reduced rework
Compliance support, such as documentation completeness or audit preparedness
Provider experience, including reduced perceived administrative burden
Care outcomes, including patient engagement and satisfaction

AI solutions can impact efficiency and burnout. But, these outcomes are highly dependent on whether the solution was built for care at home, the quality of implementation, how easily it will integrate into your workflow, and governance. If a vendor cannot explain how results were achieved and whether they are reliable and repeatable outside the pilot, the vendor and the solution should be evaluated carefully.

General Purpose AI

And inconsistent results

Many AI tools marketed to healthcare organizations rely on general-purpose language models designed for tasks like summarization, chat, or content generation — not for producing structured clinical notes aligned to regulatory and reimbursement requirements.

Home health and hospice documentation often includes:

Clinical observations made in non-clinical environments
Structured requirements tied to reimbursement and regulation
Risk-sensitive language related to safety, decline, or end-of-life care
Significant variation across disciplines, visit types, and patient contexts

Where generic AI breaks down

In these settings, AI tools based on general-purpose language models introduce risks related to accuracy, hallucinations, bias, privacy, and workflow fit — because they were not designed to operate within structured clinical, regulatory, and reimbursement frameworks.

In practice, organizations report that the additional oversight required to validate or correct AI-generated output can reduce — or even negate — anticipated efficiency gains, limiting adoption and ROI. As a result, organizations often remain stuck in pilot mode — investing time and effort in validation without achieving the scale or consistency required for meaningful return.

The right question

When evaluating an AI solution, the right question is not whether the AI tool can record a conversation and translate it into notes or whether the tool can reduce documentation, but whether it can consistently support high-quality clinical documentation at scale without increading burden or creating compliance risks.

Purpose-Built AI

What it means and why it drives operational impact

In care at home environments, purpose-built AI should be evaluated less as a point solution and more as foundational infrastructure — one designed to support regulated clinical workflows consistently over time.

Many AI platforms label themselves as “purpose-built,” but leaders must look past marketing language to truly scrutinize the way the technology is designed and deployed. In regulated clinical environments, purpose-built AI typically incorporates:

Domain-specific clinical intelligence, informed by real documentation patterns
Provider involvement in defining structure, logic, and validation criteria
Structured outputs aligned to required note components, in addition to free-text summaries
Grounding mechanisms that reduce fabricated or misattributed content
Privacy-conscious data handling, with explicit limits on data retention and reuse

Research consistently shows that providers prefer AI systems that function as collaborative tools — preserving human oversight while reducing administrative load — rather than fully automated systems that completely bypass clinical judgment. These characteristics directly affect whether AI improves documentation time, supports compliance workflows, and earns provider trust — all prerequisites for driving ROI.
These design choices are what allow AI systems to move beyond experimentation and begin delivering durable efficiency, compliance support, and clinician adoption at scale.

# # #

This article is part 1 in a 4-part series. Come back next week for “Scalability, Security, and Governance.”

About Eleos

At Eleos, we believe the path to better healthcare is paved with provider-focused technology. Our purpose-built AI platform streamlines documentation, simplifies compliance and surfaces deep care insights to drive better client outcomes. Created using real-world care sessions and fine-tuned by our in-house clinical experts, our AI tools are scientifically proven to reduce documentation time by more than 70% and boost client engagement by 2x. With Eleos, providers are free to focus less on administrative tasks and more on what got them into this field in the first place: caring for their clients.

©2026 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

What can Providers Give to Patients, Part 7

by Elizabeth E. Hogue, Esq. | Dec 12, 2025 | Admin, Clinical, Legal

by Elizabeth E. Hogue, Esq.

What Providers can Give to Patients

Providers, including marketers, are tempted to give patients and potential patients free items and services. While providers usually have good intentions, they must comply with applicable requirements.

Read Parts 1-6

OIG Advisory Opinion

This article provides an example from OIG Advisory Opinion No. 09-11 that shows how the OIG applies exceptions described in this series of articles.

A Case Example

The request for this Advisory Opinion was submitted by a hospital that provides free blood pressure checks to anyone who requests the service during certain hours. The hospital said that it does not advertise free blood pressure checks, which are provided by a member of the nursing staff who follows specific guidelines and procedural checklists.

The hospital also said that free blood pressure checks are not conditioned on use of any other goods or services from the hospital or any other particular provider. No discounts are offered for follow-up services. Recipients of blood pressure checks are advised to see their own practitioners when results are abnormal. The hospital does not bill any payor, including the Medicare and Medicaid Programs, for this service.

OIG Analysis

In its analysis, the OIG first referenced the exception for preventive services described in Part 5 of this series.

The OIG then pointed out that the fair market value of this service, especially if recipients use the service more than once, may exceed the limits of $15 per service or $75 per year described in Part 2 of this series. Therefore, said the OIG, the services may constitute a kickback.

According to the OIG, blood pressure checks are preventive services. The key question, however, is whether the free care promotes the provision of other, non-preventive care reimbursed by the Medicare and/or Medicaid Programs.

Is It Promotional?

In this case, the OIG said that it is unlikely that free blood pressure checks will result in the provision of other services. The factual basis for this conclusion in the Advisory Opinion was that the hospital did not:

Make appointments with its practitioners for individuals with abnormal results
Offer individuals discounts for additional covered services
Otherwise promote its particular programs

Crafted with Care

“In sum,” said the OIG, “the Arrangement is appropriately crafted so as to avoid improper ties to the provision of other services…For these same reasons, we conclude that we would not impose administrative sanctions arising in connection with either the anti-kickback statute or the CMP on the Hospital in connection with the Arrangement.”

Final Thoughts

The 7 parts of this series describe and summarize the laws and exceptions to providing incentives, gifts, and help to patients in accordance with the Anti-Kickback Statute and the Civil Monetary Penalties Law. As long as you are following these regulations, providers should certainly use all of the exceptions available to them to provide better quality of care for patients.

# # #

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.

Feedback Adjusts Final Rule

by Rowan Report | Dec 4, 2025 | CMS, Medicare, Regulatory

FOR IMMEDIATE RELEASE
November 28, 2025

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

National Alliance for Care at Home: CMS Modifies Final Payment Rule Based on Stakeholder Feedback, but 1.3% Cut Still Undermines Access

Despite positive changes in final rule, home health leaders remain deeply concerned payment cuts will continue to impact patient access to care at home

ALEXANDRIA, VA and WASHINGTON, D.C. The National Alliance for Care at Home (the Alliance) today acknowledged that the Centers for Medicare & Medicaid Services (CMS) made significant adjustments in the Home Health Perspective Payment System (HH PPS) Final Rule for CY 2026 in response to community concerns regarding patient access and data integrity.

However, the Alliance remains concerned that any payment cut for home health providers will continue to compromise access for the millions of Medicare beneficiaries who rely on these services to age and recover from illness or injury safely at home.

Since 2019, Medicare home health providers have experienced severe cuts that have already led to a cascade of home health agency closures and reduced patient access to care, especially in rural and underserved communities. The cuts finalized by CMS today – 1.023% permanent and 3% temporary – will likely continue to exacerbate these trends.

“While the Alliance acknowledges that CMS took into account some of the home health community’s recommended changes in its final rule, resulting in a lower payment cut for next year, a 1.3% overall reduction in payments compared to 2025 will likely result in continued reductions in patient access, the closure of more home health agencies, and more patients waiting in costly hospital settings instead of recovering safely at home.”

– Dr. Steve Landers, CEO for the Alliance

The Alliance commends CMS for revisiting aspects of its flawed payment approach, including the conclusion of permanent payment adjustments with CY 2026 (using data from CY 2020 through 2022) based on issues that CMS acknowledged with isolating PDGM behavior changes from non-PDGM behavior changes in CYs 2023 and beyond. In total, CMS’s changes from proposed to final rule amount to approximately $915 million more in payments to home health agencies for 2026. However, any cut will be detrimental in the face of years of compounding decreases, and more action is needed to help preserve integrity, stability, and predictability in Medicare’s home health benefit. While CMS reduced the amount of overpayments that inform the temporary payment adjustments down to 4.7 billion for CYs 2020 through 2024, home health agencies will continue to face several more years of temporary adjustments without additional action.

“Home health care is among the most trusted, cost-effective, and patient-centered services in the Medicare program. The Alliance thanks its members, the broader home health community, and allied organizations and leaders for their advocacy to help achieve this substantial improvement for home health providers and patients nationwide. Congress must take further action to enact lasting reforms to the system that protect patient access to these services and ensure the sustainability of the Medicare home health benefit.”

Steve Landers

CEO, National Alliance for Care at Home

Expanding access to home health care is essential to improving health outcomes, enhancing patient independence, and reducing healthcare costs. Research shows that when patients are unable to access clinically appropriate home health services, hospital readmissions are 35% higher, mortality rates are 43% greater, emergency department utilization grows by 16%, and total spending is 5.4% more than if patients were able to access the services they need. Protecting this vital benefit is also popular as 70% of U.S. voters are opposed to Medicare home health cuts.

# # #

About the National Alliance for Care at Home

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

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

BREAKING NEWS: Home Health Final Rule

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

by Kristin Rowan, Editor

BREAKING NEWS

Home Health Final Rule

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

Payment & Policy Updates

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

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

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

Read the CMS Fact Sheet

Face-to-Face

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

Home Health VBPM

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

Care of Patients
Communications between Providers and Patients
Specific Care Issues

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

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

Medicare Provider Enrollment Revocation

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

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

Additional Changes

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

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

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

Read the Final Rule and additional Documents

Final Thoughts

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

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

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

# # #

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

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

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

What Can Providers Give to Patients, Part 5

by Elizabeth E. Hogue, Esq. | Nov 25, 2025 | Admin, Clinical, Legal

by Elizabeth E. Hogue, Esq.

What Can Providers Give...

Recap

Providers, including marketers, are tempted to give patients and potential patients free items and services. While providers usually have good intentions, they must comply with applicable requirements.

Part 1

As Part 1 of this series indicates, there are two applicable federal statutes: the Anti-Kickback Statute (AKS) and the Civil Monetary Penalties Law (CMPL). Part 1 also makes it clear that there are a number of exceptions. If providers meet the requirements of applicable exceptions, they can give patients and potential patients free items and services that would otherwise violate applicable requirements.

Part 2

Part 2 describes an exception for items and services of nominal value with a retail value of no more than $15 per item or $75 in the aggregate per patient on an annual basis that may be given by providers to beneficiaries. Providers may not, however, give cash or cash equivalents.

Part 3

Part 3 describes the circumstances under which providers may give free items and services to patients with demonstrated financial need.

Part 4

Part 4 summarizes recent guidance from the Office of Inspector General (OIG) about giving incentives to promote vaccination against COVID-19.

Care & Services

According to the OIG, providers may also give patients free preventive care items or services. The definition of remuneration under the CMPL regulations excludes incentives given to patients/potential patients to promote the delivery of preventive care services so long as the delivery of such services is not directly or indirectly related to the provision of other services reimbursed in whole or in part by the Medicare Program or other state and federal healthcare programs. Preventive services include:

Prenatal services or postnatal well-baby visits, or specific clinical services described in the current U.S. Preventive Services Task Force’s Guide to Clinical Preventive Services
Services that are reimbursable in whole or in part by the Medicare Program, or other federal and state care programs

Incentives

However, incentives related to preventive services may not include:

Cash or instruments convertible to cash
Incentives of value that are disproportionally large in relationship to the value of the preventive care services in terms of either the value of the services or the future health care costs reasonably expected to be avoided as a result of preventive care

Preventive

Any tie between provision of exempt covered preventive care services and covered services that are not preventive may, therefore, violate the CMPL and the AKS.

The OIG has stated that some free or discounted services may fit within the preventive care exception described above. These services may include free blood sugar screenings and cholesterol tests.

Anti-Kickback Exceptions

The AKS does not include an exception similar to the provisions of the CMPL described above. In commentary to Supplemental Compliance Guidance for Hospitals, however, the OIG said:

From an anti-kickback perspective, the chief concern is whether an arrangement to induce patients to obtain preventive care services is intended to induce other business payable by a Federal health program. Relevant factors in making this evaluation would include, but not be limited to: the nature and scope of the preventive care services; whether the preventive care services are tied direct or indirectly to the provision of other items or services and, if so, the nature and scope of the other services; the basis on which patients are selected to receive the free or discounted services; and whether the patient is able to afford the services.

Final Thoughts

Based upon the above, the OIG is unlikely to challenge the provision of free preventive services given to patients and potential patients, under either the CMPL or the AKS, so long as the above requirements are met.

# # #

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.

What Can Providers Give to Patients, Pt 3

by Elizabeth E. Hogue, Esq. | Oct 30, 2025 | Legal

by Elizabeth E. Hogue, Esq.

What Can Providers Give to Patients

Part 1 & 2 Recap

Providers, including marketers, are tempted to give patients and potential patients free items and services. While providers usually have good intentions, they must comply with applicable requirements.

As Part 1 of this series indicates, there are two applicable federal statutes: the Anti-Kickback Statute (AKS) and the Civil Monetary Penalties Law (CMPL). Part 1 also makes it clear that there are a number of exceptions. If providers meet the requirements of applicable safe harbors or exceptions, they can give patients and potential patients free items and services that would otherwise violate applicable requirements.

Part 2 describes an exception for items and services of nominal value with a retail value of no more than $15 per item or $75 in the aggregate per patient on an annual basis that may be given by providers to beneficiaries. Providers may not, however, give cash or cash equivalents.

Exceptions to the Rule

The OIG also says that providers may give free items and services to patients with demonstrated financial need. The exception based on financial need does not include cash or cash equivalents. Cash equivalents include checks, gift certificates, and gift cards.

The CMPL says that the following requirements must be met to qualify for this exception:

- - The items or services are not offered as part of any advertisement or solicitation.
  - The offer to give items or services is not tied to the provision of other items or services reimbursed in whole or in part by the Medicare or Medicaid Programs.
  - There is a reasonable connection between the items or services and the medical care of the patient.
  - Providers give items or services after a determination has been made in good faith that patients are in financial need.

The AKS does not include a similar safe harbor or exception, but the OIG has stated that the AKS does not prohibit discounts to uninsured patients who are unable to pay for items and services.

Good faith determinations that patients are in financial need are key. Determinations should be based on policies and procedures that providers consistently apply to make these decisions. Policies and procedures should include requirements to document financial need. Such policies and procedures are often referred to as policies on “charity care.”

Determining Need

Providers have discretion to take a variety of factors into account to determine financial need. Such factors may include:

- - - Patients’ income, assets and expenses
    - Amounts due for services and items provided

Accuracy Matters

Needless to say, providers should avoid inflated income guidelines that result in free items or services given to beneficiaries who are not really in financial need.

Providers may ask patients to provide documentation of their financial status. Decisions about financial need may also be based on other reasonable methods, such as documented interviews with patients and questionnaires.

Policies and procedures that govern free items and services given to patients should also require periodic review of patients’ financial status, since it may change over time. Providers should recheck patients’ needs at reasonable intervals to help ensure that their financial status has not changed significantly.

Final Thoughts

The key to using this exception is undoubtedly consistent application of a policy and procedure to make determinations about financial need. Now is the time to review or develop and implement policies that cover free items and services given to patients.

This is part 3 of a 5-part series. Come back next week for part 4.

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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.

Interoperability: The Unreachable Dream

by Kristin Rowan | Oct 17, 2025 | Interoperability

by Kristin Rowan, Editor

Interoperability

The Unreachable Dream

Healthcare and care at home have been reaching for interoperability for decades. When I started working in the care at home industry, there was a learning curve for terminologies, abbreviations (oy! with the abbreviations already!), and the pain points experienced by agencies and vendors. Interoperability was at the top of that list. 2009, the first full year I worked in care at home, was the year Congress mandated EHRs and data exchange. The mandate did not accomplish much. Incompatible data structures limit post-acute care data to the most recent health event, not the patient’s full medical record.

Data Exchange

Following the EHR mandate, Congress continued to add regulations and rules to advance data exchange. Starting with HIPAA in 1996, interoperability advanced as follows:

Health Insurance Portability and Accountability Act ensures patient data stays private both within a healthcare system and during data exchange

Congress mandated the use of EHRs throughout healthcare

HITECH Act launched Health Information Exchanges (HIEs) that support secure exchange of information between health systems

Health Level 7 (HL7) designed a framework that establishes protocols for data exchange

Fast Healthcare Interoperability Resources (FHIR), an updated of HL7, enables processes in 84% of hospitals and 61% of clinician offices

21st Century Care Act allows patients to access their own medical information and requires developers to publish APIs and ensure all data in the patient health record is accessible through that API

Trusted Exchange Framework and Common Agreement (TEFCA) lists principles, terms, and conditions to standardize data

CMS Interoperability Framework pushes interoperability nationwide through improved data quality; advanced technology; data aggregation; and alignment of data, tools, and measures

Following the EHR mandate, Congress continued to add regulations and rules to advance data exchange. Starting with HIPAA in 1996, interoperability advanced as follows:

Health Insurance Portability and Accountability Act ensures patient data stays private both within a healthcare system and during data exchange
Congress mandated the use of EHRs throughout healthcare
HITECH Act launched Health Information Exchanges (HIEs) that support secure exchange of information between health systems
Health Level 7 (HL7) designed a framework that establishes protocols for data exchange
Fast Healthcare Interoperability Resources (FHIR), an updated of HL7, enables processes in 84% of hospitals and 61% of clinician offices
21st Century Care Act allows patients to access their own medical information and requires developers to publish APIs and ensure all data in the patient health record is accessible through that API
Trusted Exchange Framework and Common Agreement (TEFCA) lists principles, terms, and conditions to standardize data
CMS Interoperability Framework pushes interoperability nationwide through improved data quality; advanced technology; data aggregation; and alignment of data, tools, and measures

Thirty Years Later

Despite the laws, regulations, frameworks, and mandates, interoperability is not much better than it was in 1996. I had an experience this year that both enlightened and infuriated me. I switched health insurance plans for a variety of reasons. My new plan didn’t cover most of the doctors, hospitals, and health systems I had been using for many many years. So in February, I found a new PCP and had the standard start of care visit to establish my health history: current conditions, past conditions, past surgeries & procedures, current medications, etc. I requested referrals to new specialists and updates to prescriptions. My PCP performed a “complete physical” that was nothing more than a cursory overview. And then I waited.

The Waiting Game

And waited…and waited…. I thought all these organizations and standards were supposed to make this easier. Still, I waited.

I waited for an “invitation” to my PCPs portal to see my visit notes and test results
I waited for my PCP to send referrals to new specialists
I waited for my health insurance provider to inevitably tell me the specialist wasn’t covered under my plan
I waited for a new referral from my PCP
I waited for appointments, results, and recommendations
I waited for access to new patient portals
I waited for the portal to figure out how to give me access to three different providers in the same app
- (spoiler alert: I have to log in to the same app three different ways to access three different providers; my providers can see all the information in one place, but I can’t)
I waited for test results to appear in each portal; some I had to call and request, some I’m still waiting for

Data Exchange "Advancements"

According to my research, 84% of hospitals and 61% of clinicians are currently using FHIR, designed to improve interoperability between different health systems using standard data formats and APIs.

Last month I had an appointment. Correction: I thought I had an appointment for an imaging scan. I thought this because the scheduling nurse called me to confirm the appointment day, time, and location. When I arrived, the check-in nurse couldn’t find me in their system.

It wasn’t just that she didn’t see my appointment. No, it was that she couldn’t find me at all. (We later discovered it was still pending because the imaging department never confirmed the appointment after the scheduling nurse added it.)

She could see no current or future appointments. She could see no past appointments because they were booked a different way. She couldn’t find any record of me at all. You see, my record started in the next building over.

Error 404: Not Found

Every one of these facilities is in the same healthcare system. (Think ACME hospital, ACME imaging, ACME specialist doctor, and ACME lab) Every office is part of the same healthcare system and none of them can see each other’s information. ACME hospital can’t see the schedule for ACME imaging and can’t schedule imaging appointments outside the hospital. For that, I have to call ACME imaging.

But wait! The doctor wrote my referral for ACME hospital, not ACME imaging. I need a new referral.
But wait! Neither the healthcare system nor the specialist can write a new referral. My payer will only accept a referral from my PCP.
But wait! My PCP has no idea what the referral is for, how it was written, or where it’s supposed to go because my PCP can’t access my records from the healthcare system.

This is advanced data exchange using FHIR, HIE, TEFCA, and QHIN. My health system uses our local HIE and CommonWell Health Alliance, an interoperability network designated as a federal QHIN. Apparently, this ensures the health system can share data with participating providers, but not with themselves.

Home Health is Even Further Behind the Curve

After so many years, so many advancements, and so many regulations, interoperability is no more “solved” than it was in 2009. Even the health systems that are using all the tools aren’t even internally interoperable.

Home Health has an even harder time attaining interoperability.

It is more difficult for HHAs to access patient information, which usually has to be manually imported into the home health EHR
Patient consent is required, but HHAs often deal with patients who don’t have the capacity to consent
Despite the requirement of APIs, most health information is spread out across multiple systems and the HHA only get information from the referring facility
Nearly 80% of HHAs use an EHR
Only 28% of HHAs are electronically exchanging information with outside facilities
Only 18% can integrate shared data into automated workflows
HHAs did not receive the financial incentives that larger healthcare systems got to push interoperability
TEFCA participation is not mandatory, slowing down the process of approving a data connection and exchange

Many legacy EHRs have met significant challenges moving into interoperability. Competitors in the space had no financial incentive to create standard languages and formatting designed to share information. HHAs are left with two choices:

The costly, time-consuming task of reviewing, selecting, and onboarding an entirely new EHR –or–

Piece together workarounds with multiple 3rd party or internal solutions haphazardly strung together to resemble interoperability

Time is Up

The call for interoperability started in 1996. With little advancement and not much hope on the horizon, we (your patients) are looking for other ways to get what we need. Next week, I’ll talk about my predictions for how interoperability will progress for the next generation.

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

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

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