The Alliance Responds to the Integrity and Protection Act

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

FOR IMMEDIATE RELEASE

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

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

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

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

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

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

Jennifer Sheets

CEO, National Alliance for Care at Home

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

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

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

# # #

About the National Alliance for Care at Home

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

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

LeadingAge Reacts to the Integrity and Protection Act

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

Leading Age React to Integrity and Protection Act

FOR IMMEDIATE RELEASE

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

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

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

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

Katie Smith Sloan

President and CEO, LeadingAge

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

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

LeadingAge Reacts to Integrity and Protection Act

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

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

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

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

About Leading Age

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

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

VA Policy Causes Death of Veteran

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

by Kristin Rowan, Editor

VA Policy Causes Death of Veteran

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

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

End of Care

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

End of Life

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

End of a Deadly Policy

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

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

Final Thoughts

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

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

# # #

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

Three Choices at the End of Life

by Rowan Report | Aug 7, 2026 | Clinical, Hospice

by guest author Barbara Karnes, RN

Cure, Life-Sustaining, or Comfort Care

When someone is facing a life-threatening illness, they and their loved ones are often asked to make medical decisions they never expected to face. Unfortunately, most of us don’t fully understand the choices before us. Knowing the difference between cure, life-sustaining treatment, and comfort care can help you make decisions that honor the kind of life – and death – you want.

Cure, life-sustaining treatment, and comfort care. These are the three paths available when we are faced with a life-threatening illness.

Cure

Cure means providing a return to a “normal” functioning life. I put normal in quotes because the word can be misleading. What is normal for one person may not be normal for another. Cure implies being able to participate in and enjoy the activities of everyday living. It means the malady is gone or controlled.

Life-Sustaining Treatment

Life-sustaining treatment means keeping the physical body alive by whatever means are deemed necessary. Many people refer to these treatments simply as “life support.” They can include artificial nutrition and hydration, ventilators, dialysis, respirators, and other advanced medical procedures. The goal becomes preserving life, even when the quality of life is greatly diminished.

Quality Improvement Project Hospice Domains

Comfort Care

Comfort care focuses on the quality of the life you are living rather than simply the length of that life. It includes physical care along with emotional, mental, and spiritual support. Comfort care addresses what is most important to your well-being now that your body is no longer able to meet all of your needs. It also guides and nurtures your family and those closest to you as everyone prepares for the end of life while continuing to live fully each day.

"Fix" or Provide Care?

We often get so caught up in getting “fixed” at any price that we lose sight of what our goal really is. Treatment does not necessarily mean cure. Yet most of us assume that if we do everything possible, we will get better. Sadly, too often we sacrifice the quality of the life we have today while pursuing a cure that may no longer be possible.

When deciding between cure, life-sustaining treatment, or comfort care, information and knowledge are vital components to making decisions. We need honest conversations about the likely outcome of treatment, the chances of success, life expectancy, and quality of life. Once you’ve had those conversations and decided what kind of living is most important to you, share those wishes with your physician, your family, and those closest to you—and put your decisions in writing.

There is no right or wrong choice. There is only the choice that best reflects your values and how you want to live the time you have.

# # #

Barbara Karnes, RN, is an award-winning end-of-life educator, award-winning nurse, NHPCO Hospice Innovator Award winner 2018, and 2015 International Humanitarian Woman of the Year

While at the bedside of hundreds of people during the dying process, Hospice Pioneer Barbara Karnes noticed that each death was following a near-identical script. Each person was going through the stages of death in almost the same manner, and most families came to her with similar questions. These realizations led Barbara to sit down and write Gone From My Sight, the “Little Blue Book” that changed the hospice industry.

Gone From My Sight is the original, and remains the most widely used, patient/family educational booklet on the signs of approaching death. It has been in print continuously since 1985 and has sold over 35 million copies worldwide. With its publication and distribution, Barbara created one of the most important tools in the end-of-life movement today.

©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

The Broadway Secret

by Rowan Report | Aug 7, 2026 | Admin, Home Care, Home Health, Hospice

by Aaron Marcum

The Home Care Back Stage

The Broadway secret every home care owner needs to know

A few years ago, I took my daughter to see “Wicked” in London’s West End.

From the moment the lights dimmed, we were transported. The performances were flawless, the choreography mesmerizing, and the vocals spine-tingling. For two and a half hours, we sat captivated by what appeared to be theatrical magic.

It looks like magic

But here’s what struck me as I watched: what we were experiencing wasn’t magic at all. It was the result of an incredibly sophisticated operation happening behind that curtain—an operation most audience members never think about.

Dan Sullivan, founder of Strategic Coach, calls this the “Front Stage” and “Back Stage” of your business. And it’s a framework that every home care owner needs to understand.

What Makes Broadway, Broadway?

When you pay for a West End ticket, you’re not just paying for talented actors. You’re paying for a lighting crew coordinating hundreds of cues per show, costume designers managing dozens of quick changes, sound engineers balancing multiple wireless microphones in real-time, stage managers calling hundreds of technical cues with split-second precision, and a production team that rehearsed for months before opening night.

The Front Stage—what the audience sees—only shines because of an exceptional Back Stage.

Your home care business has the same dynamic

Front and Center

In our industry, the Front Stage is your care professional arriving at Mrs. Johnson’s home at 9 AM. It’s the smile, the gentle assistance with morning medication, the conversation during breakfast, and the compassionate help with bathing and dressing.

That’s what your clients see. That’s what their families remember. That’s how your business gets judged.

But we all know that caregiver showing up prepared, on time, and trained isn’t an accident.

Behind the Scenes

Your Back Stage makes it possible:

Care Coordination ensures the right caregiver with the right skills is scheduled for the right client. When this system fails, clients feel it immediately.
Billing Systems that work seamlessly mean caregivers get paid accurately and on time—because nothing destroys Back Stage morale faster than payroll errors.
Compliance Infrastructure keeps you operating legally and safely, protecting both your clients and your business.
Recruitment and Hiring processes that attract quality candidates. With projections showing a national shortage of 151,000 caregivers by 2030 and 355,000 by 2040, your Back Stage recruiting determines whether you have anyone to put on the Front Stage. As a side note, I personally believe the shortages are greater than this.
Training Programs that don’t just check boxes but actually prepare caregivers for real situations. The 2025 Activated Insights Benchmarking Report found that agencies offering 8+ hours of orientation training had median revenue of $2.4 million compared to $2.03 million for those with 3 or fewer hours.
Retention Strategies because the average caregiver costs $2,600 to replace Activated Insights. Your Back Stage culture determines whether caregivers stay or leave.

The Numbers Tell a Sobering Story

Here’s the reality: the home care industry’s turnover rate reached 79.2% in 2023 Home Health Care News—the highest it’s been in five years. Think about that. In an agency with 100 caregivers, you’re replacing nearly 80 of them every single year.

But it gets worse. Nearly four out of five caregivers leave their job within the first 100 days of employment. That means the caregivers you just spent weeks recruiting, screening, and training? Most of them won’t even make it through their first three months.

When your Back Stage is weak, these statistics become your reality.

The "Community Theater" Problem

We’ve all attended shows where you could tell the Back Stage was struggling.
Maybe you’ve seen a local production where an actor missed their entrance, the lighting was off, a scene change took too long, or the sound cut out.

You couldn’t see the Back Stage problems, but you absolutely felt them.
The same thing happens in home care.

A weak back stage

When your Back Stage is weak:

Caregivers show up late (or not at all) because scheduling is chaotic
Families receive incorrect bills because systems are disconnected
Care quality suffers because training is inconsistent
Your reputation erodes one Front Stage failure at a time

Your clients might not know your payroll system crashed or that your care coordinator called in sick for the 4th time this month, but they experience the consequences.

The Broadway Standard Question

So here’s the question every home care owner must ask:

Is your business operating at Broadway standards, or community theater? Be honest.

When you look at your Back Stage operations:

Can your care coordinators instantly access complete client information?
Do your caregivers have clear protocols for every situation they might encounter?
Is your billing accurate enough that families rarely question an invoice?
Do you have documented processes, or is everything “in someone’s head”?
Could your business run smoothly if your top coordinator was suddenly unavailable?

The best home care agencies—the ones with waiting lists and stellar reputations—aren’t just lucky. They’ve built Broadway-quality Back Stage operations.

They’ve invested in systems, training, and processes. They’ve documented their playbook. They’ve made the Back Stage so strong that the Front Stage can shine consistently, every single day.

Because here’s what I learned watching “Wicked”: excellence isn’t about one amazing moment. It’s about a thousand excellent decisions that happen when no one is watching.

The question is: what's happening in your Back Stage?

Want to build your Broadway-worthy Back Stage?

Stay in the know with strategies, insights, and practical resources designed specifically for home care owners. Subscribe to receive updates, newsletters like this, and tools that will help you elevate both your Front Stage performance and Back Stage excellence. Because your caregivers—and your clients—deserve a five-star experience every single time.

# # #

Aaron Marcum is an entrepreneur and thought leader who has dedicated his career to transforming the home care industry and nurturing business leaders.

As the founder of Home Care Pulse (now Activated Insights), he pioneered the Best of Home Care® program, revolutionizing quality standards in senior care across North America. His expertise as a Certified Blue Ocean Strategy practitioner and former Certified EOS Implementer has helped shape some of home care’s most respected brands.

Update: CMS Response to Arizona Hospice

by Tim Rowan | Aug 7, 2026 | Admin, Advocacy, CMS, Hospice, Waste Fraud and Abuse

by Tim Rowan, Editor Emeritus

Update: CMS Sides with NGS in Arizona Hospice Case

Letter Says "Typos Count"

We are sad to have to report that CMS has rejected the evidence that a hospice’s report of change of ownership was due to a typo. The consultant retained to help with their appeal received this letter.

The CMS Letter

Thank you for your email. Based on our review, we do not see any issues with the revocation decision. The provider did file a reconsideration, and on May 6, 2026, we issued a decision upholding the 42 C.F.R. § 424.535(a)(8)(ii) revocation. Their main argument is that there was no change in ownership and, as a result, they should not have been subject to PPEO. However, the applications submitted by the provider clearly reflected 100% changes in ownership. In addition, the provider had an 80% PPEO claim denial rate, and none of these denials were overturned on claim appeal. Please note that the provider filed an appeal with the ALJ on June 18th. Given that the case is pending, we should not take any other action until the appeal has concluded.

Best Regards,

Anaga Nmagu, JD.
Director, Division of Provider Enrollment Appeals
Provider Enrollment & Oversight Group
Center for Program Integrity
Centers for Medicare & Medicaid Services
Office: (410) 786-4690
Email: anaga.nmagu1@cms.hhs.gov

Home Health and Hospice Respond

The more stories we can collect about CMS contractors overstepping their authority, improperly denying claims, up to and including putting honest providers out of business, the more convincing we will be when we confront the perpetrators. We urge you to tell us your stories. We will never publish your name.

If you, a client, or someone you know has stories about CMS contractors, please reach out to editor@therowanreport.com or tim@rowanresources.com.

# # #

Tim Rowan is a 33-year home care technology consultant who co-founded and served as Editor and principal writer of this publication for 25 years. He continues to occasionally contribute news and analysis articles under The Rowan Report’s new ownership. He also continues to work part-time as a Home Care recruiting and retention consultant. More information: RowanResources.com
Tim@RowanResources.com

2027 Home Health Proposed Rule

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

by Kristin Rowan, Editor

2027 Home Health Proposed Rule

The Alliance Responds

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

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

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

Jennifer Sheets

CEO, the Alliance

Permanent and Temporary Rate Adjustments

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

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

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

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

Alignment of HH QRP and HHVBP

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

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

Aligning HH QRP and expanded HHVBP Model measure reporting periods.

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

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

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

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

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

Read the TEP Summary Report.

LUPA Updates

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

Requests for Comment

Send your comments to CMS by August 31, 2026

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

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

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

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

# # #

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

Hiring and Retaining Professional Caregivers

by Rowan Report | Jul 31, 2026 | Admin, Recruitment & Retention

by Roger McManus, MBA

Hiring and Retaining Professional Caregivers

What Really Keeps People in This Work

People who work in home‑based care, whether licensed home health clinicians or trained home care aides, do something unusual in the healthcare world. They walk into a stranger’s home and step into the middle of that person’s daily life. Their role is to try to help them stay, or get, healthy, stable, safe, and dignified. All this happens in someone else’s environment. That fact impacts the hiring and retention challenge for agencies.

While somewhat overlapping, home health and home care are different fields. Home health visits are shorter, clinically focused, and built around medical goals. Home care shifts are longer, non‑medical by law, and often revolve around companionship, safety, and daily living support. But the shared denominator, the home environment, creates a common reality. Agencies must find and keep people who can handle the emotional, practical, and interpersonal demands of working inside a client’s private world.

Long-term retention depends significantly on the caregiver’s ability to adapt with a chameleon-like mindset.

The Home Environment Changes Everything

A hospital or clinic has structure; a home does not. Workers deal with cluttered living rooms, anxious adult children, and unpredictable pets. They see clients who may be having a good day, a bad day, or something in between. They have to be able to read the situation, adjust their tone, and figure out how to help without dominating.

This is not a skill you can measure with a résumé alone. Agencies that hire well look beyond credentials. They look for temperament — calmness, respect, patience, and the ability to stay professional even when the environment may be anything but.

Retention starts with hiring people who can work in this setting.

Why Turnover Hits Home Based Care Harder

Turnover in this field isn’t just inconvenient. It’s disruptive in ways that office‑based healthcare rarely experiences.

When a home health clinician leaves, cases get reshuffled, documentation gets delayed, and continuity of care suffers. When a home care aide leaves, long‑standing client relationships can collapse overnight. The Patient is most aware. Families notice. Referral partners notice.

Workers leave for predictable reasons:

Home health clinicians may feel isolated or overwhelmed by documentation and case complexity.

Home care aides may feel undervalued or stuck in roles with no visible progression.

Both groups may struggle with inconsistent schedules, long drive times, or emotionally draining cases.

Retention improves when agencies acknowledge these realities instead of treating turnover as “just part of the industry.”

Creating a Support System That Actually Works

The best retention strategies aren’t flashy. They’re consistent, practical, and rooted in what workers experience every day.

Home health clinicians need clinical leadership that is reachable. Not a voicemail box. Not a once‑a‑week check‑in. They need someone who answers the phone when a wound looks worse, when a medication list doesn’t match the chart, or when a family is spiraling. Caregivers knowing they have that backup reduces burnout more than any bonus ever will.

Home care aides need respect and inclusion. They may not have medical licenses, but they are the ones who see the client’s real daily life. Agencies that treat aides as essential contributors, not interchangeable labor, see stronger loyalty and longer tenure.

Across both groups, communication is the glue. Workers stay when they feel connected to a team that listens and responds.

Logical Rewards

Incentives That Make Sense in the Field

Many agencies try bonuses, gift cards, or occasional “thank you” events. Those gestures are fine, but they rarely change long‑term behavior. Logical rewards do.

These incentives tie directly to the realities of home‑based work:

Readiness bonuses for workers who reliably take short‑notice visits.

Incentives for on‑time arrival, complete documentation, or strong client feedback.

Skill‑tier pay ladders that reward additional certifications or specialized training.

Continuity bonuses for maintaining long‑term client relationships without disruption.

These rewards reinforce the behaviors that stabilize the agency. They’re not random. They’re strategic.

Onboarding and Training:

The First Impression That Never Goes Away

Retention begins the moment a new worker walks through your door. A chaotic onboarding process sends a message that “this agency is disorganized.” A clear, supportive onboarding process sends the opposite message that “we know what we’re doing, and we want you to succeed.”

Home health clinicians need onboarding that covers real‑world clinical scenarios, documentation expectations, and the unpredictable nature of home visits. Home care aides need onboarding that prepares them for communication challenges, safety issues, and the emotional realities of working with seniors.

Ongoing training matters just as much. Workers stay when they see a path forward, something to grow into, not just a job to survive.

Retention Is Not HR, It is Strategy

Agencies that retain their workers don’t just solve staffing problems. They build a competitive advantage. Families trust agencies whose workers stay. Referral partners prefer agencies that don’t constantly reshuffle cases. Regulators appreciate agencies with consistent documentation and stable clinical outcomes.

Retention is not a side project. It is a core business function.

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Roger McManus is the author of several books on entrepreneurship, including “Entrepreneurial Insanity in the Home Care Business,” which he co-wrote with Tim Rowan. He advises Home Care owners and HR professionals on techniques for recruiting, retaining, and rewarding caregivers.

©2026 by The Rowan Report, Peoria, AZ. All rights reserved. This excerpt was provided to The Rowan Report and is printed with permission.

Healthcare Workers May be Deported

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

by Tim Rowan, Editor Emeritus

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

Thousands of Healthcare Workers Could be Deported

Florida Will Be Hit Hardest

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

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

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

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

Why So Many in Florida?

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

Florida’s population is over 23.5 million

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

The national average is 18.9 percent

The state has 16 caregivers per thousand residents

The national average is 65 caregivers per thousand

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

Legal Battle Background

How Asylum Became Expulsion

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

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

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

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

Epilogue

The $tats

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

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

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

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Tim Rowan is a 33-year home care technology consultant who co-founded and served as Editor and principal writer of this publication for 25 years. He continues to occasionally contribute news and analysis articles under The Rowan Report’s new ownership. He also continues to work part-time as a Home Care recruiting and retention consultant. More information: RowanResources.com
Tim@RowanResources.com

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

Formal NGS Complaint Submitted to OIG

by Tim Rowan | Jul 31, 2026 | CMS, Hospice, Medicare, Waste Fraud and Abuse

by Tim Rowan, Editor Emeritus

Formal NGS Complaint Submitted to OIG

Hospice Wrongly Subjected to PPEO Fights Back

Two weeks ago, we reported on an Arizona hospice that found itself in the middle of a revalidation survey when its Medicare Administration Contractor incorrectly classified it as a new provider. NGS placed the hospice under Provisional Period of Enhanced Oversight (PPEO) and promptly terminated its owners following a separate, 10-claim audit. (See “NGS Shutters Valid Hospice” – July 17)

According to this hospice’s PECOS file, no change of ownership — or any other triggering event that would justify reclassification — ever occurred. The error led to a clinical review of a handful of claims, a determination of fraudulent billing, and a 10-year ban against the owners.

On Monday, July 27, the hospice submitted a formal complaint to the Office of the Inspector General at HHS regarding NGS practices. According to the Medicare consultant retained by the hospice, the formal referral became necessary after a letter to CMS Administrator Dr. Mehmet Oz, describing multiple missteps by NGS, went unanswered. A subsequent video meeting with low-level CMS staff resulted only in a defense of the contractor.

Executive Summary

The hospice allowed us to publish a general summary of the complaint, provided we do not share its name at this stage. The OIG referral documents specific instances that the complainant asserts are representative of a “systemic pattern of misconduct by Medicare contractors.”

The complaint says that such misconduct “enriches contractors at the expense of providers and the Medicare Trust Fund.” It further notes that offending contractors continue to operate with CMS trust while the Center’s leadership remains focused only on a limited number of fraudulent providers.

Demand for Restitution and Reform

Dr. Mehmet Oz shifted uncomfortably in his chair, a look that signaled something between frustration and distress clouding his famous face. The new CMS Administrator removed his reading glasses, laid the Medicare consultant’s letter on his desk, thanked his aide for handing it to him, and asked her to close the door behind her as she left. Who he may have called next is anyone’s guess, but he did have a staffer tell the letter-writer, “We called the MAC; they said they didn’t do it.”

The complaint calls for meaningful reform that restores fairness to providers whose practices have been terminated. It demands restitution for owners who have been placed on the Preclusion List for ten years, often based on improper classifications.

The OIG referral specifically requests that:

CMS take immediate investigative action

All affected providers receive restitution with interest, and

CMS subject the entire contractor model to a thorough audit, similar in rigor to prior OIG reviews that uncovered widespread errors in contractor processes, some going back decades.

The complaint emphasizes that, while effective detection and elimination of actual fraud is essential, it must not come at the expense of compliant providers.

Strength in Numbers: Protect Your Agency

As we did in our first report of this series, we are opening our doors, well, our contact information anyway, to all Home Health and Hospice providers in the Medicare program. CMS may be able to ignore evidence from one or two providers, but a larger volume of consistent reports is harder to ignore. Write to us at editor@therowanreport.com, or Tim@RowanResources.com. If putting your story in writing makes you nervous, call me at 719-499-8902. You have seen how I protect the identity of the two providers outlined in this story. I will do the same for you.

We also have ways to help you find assistance to write your own OIG complaint. Once we get 100 or more complaints submitted, we will have status to demand Congressional hearings. You can be part of the solution.

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Tim Rowan is a 33-year home care technology consultant who co-founded and served as Editor and principal writer of this publication for 25 years. He continues to occasionally contribute news and analysis articles under The Rowan Report’s new ownership. He also continues to work part-time as a Home Care recruiting and retention consultant. More information: RowanResources.com
Tim@RowanResources.com

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

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