Perfect Storm

by Rowan Report | Feb 20, 2025 | Admin, Clinical, CMS, Regulatory

by Hannah Vale, CMO HealthRev Partners

Care at Home Industry Faces Perfect Storm

Industry Challenges in 2025

The care at home industry is grappling with an unprecedented crisis as staffing shortages, technological hurdles, and complex reimbursement models converge to create significant operational challenges. Industry experts warn that without immediate intervention, patient care could be severely impacted.

Staffing Crisis Reaches Critical Levels

The staffing shortage in home health care has intensified dramatically since the COVID-19 pandemic. Carole Carlson, Registered Nurse (RN), Administrator at Avant Home Care, is a veteran with 36 years of experience in the field. She reports unprecedented difficulty in recruiting registered nurses.

“We’re seeing a mass exodus of healthcare workers who have found remote work alternatives. This exodus has also led to a significant caregiver shortage, causing a decline in non-skilled care services.”

Carole Carlson

Administrator, Avant Home Care

RN Shortage

“The other issue is the RN shortage. This is our first time ever experiencing an RN shortage. We are not even getting applicants, whereas in the past we have always had nurses apply and were able to hire within a relatively short period of time,” Carlson added.

Michael Greenlee, Founder and CEO of HealthRev Partners, notes that the shortage is systemic, with insufficient new workers entering the field to meet growing demand. The situation is particularly dire in rural areas, where agencies face additional challenges in attracting and retaining staff.

Connectivity Issues on Top of Documentation Burden

The documentation requirements for home health care are proving to be a major source of burnout among nurses. Pointedly, in rural areas, the problem is exacerbated by poor connectivity:

Many patients still rely solely on landlines
Large areas lack cell coverage
Limited or no WiFi access is common

These issues often force nurses to complete documentation after hours, significantly impacting their work-life balance. Greenlee suggests that emerging satellite connectivity solutions could potentially address these issues in the future.

EMR Limitations

Electronic Medical Record (EMR) systems, while essential, present their own set of challenges. Agencies find that basic systems require multiple costly add-ons for full functionality.

Carlson identifies several gaps in current EMR systems:

Lack of built-in HIPAA-compliant dictation capabilities
Limited care plan template libraries requiring extensive manual input
Need for multiple add-ons to achieve full functionality

These limitations are forcing agencies to invest in additional software solutions, further straining already tight budgets.

Medicare Advantage Complicates Operations

The growing prevalence of Medicare Advantage plans is adding another layer of complexity to home health care operations. In one agency’s case, Medicare Advantage patients now represent 30% of their 160-patient census, equal to traditional Medicare patients. Each Medicare Advantage plan comes with different requirements, creating a significant administrative burden for agencies.

“Keeping up with the varying billing requirements across plans is a constant challenge for our small staff,” Carlson notes. “The need to maintain efficient workflows with clearinghouse and software updates for different payers is putting additional strain on already stretched resources”

Final Thoughts

As the care at home industry navigates these multifaceted challenges, experts stress the urgent need for comprehensive solutions to ensure the continued delivery of quality care to an aging population increasingly preferring to receive treatment at home.

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Hannah Vale, M.Ed. is a dynamic leader bringing a wealth of experience and marketing innovation to her role at HealthRev Partners. Hannah is dedicated to helping post acute agencies streamline processes, optimize reimbursement, and embrace tech-driven solutions. She is recognized as an advocate for empowering agencies with the tools and knowledge they need to drive successful growth. A lifelong learner and former educator turned entrepreneur with a proven track record in launching and scaling businesses, passionate about creating impactful strategies that unite purpose and business. Hannah is also the co-host of the Home Health Revealed podcast, where she discusses industry insights and shares stories from experts in all things pertaining to home health, hospice, and palliative care. Hannah holds a Bachelors Degree in Education from Cleveland State University and a Masters in Educational Leadership from Evangel University.

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

Threats to Your Business

by Tim Rowan | Feb 14, 2025 | Editorial, Regulatory

by Tim Rowan, Editor Emeritus

Threats to Your Business

Two seemingly unrelated news items jumped out at me that could be threats to your business while I was away tending to funeral preparations for my brother’s wife. Before I analyze those reports, please indulge me as I start with a personal note. I cannot speak highly enough of the end-of-life care my sister-in-law received from the team at Dynamic Hospice of the Los Angeles area, coordinated by longtime friend of The Rowan Report, Michelle Hofhine. They deserve more than this simple public thanks can accomplish.

Health Insurance's Uncertain Future

In a February 7 article for Axios, Caitlin Owens speculates that the Trump administration’s economizing efforts may eventually move to health insurance, particularly the excessive profits from their Medicare Advantage business lines. Explaining why both Moody’s and S&P Global Ratings downgraded their outlook from “stable” to “negative,” Owens cited rising medical costs, the inability to fully offset those costs by hiking premiums, pharmacy benefit manager tightening the screws, and recent strain in operating performance as regulators crack down on insurance abuses in both Medicare Advantage and Medicaid.

Image of letters spelling health and wealth

The author of the piece also mentioned the trend of large providers refusing to renew MA contracts due to underpayment and unjustified care denials. Some employers, she said, are bypassing insurers and contracting directly with providers. The inability to provide service to MA beneficiaries, who make up 50% of the Medicaid patients, could be a threat to your business and the care at home industry.

The downside of this analysis for Home Health and Hospice providers, as well as Medicare Home Care agencies, is that MA and Managed Care may start to shift more costs to their customers to make up their “losses.” The upside is that this is another opportunity for the industry as a whole to renew its advocacy efforts to try again to convince government payers that in-home care saves them more than it costs them.

It is too soon to predict what policy changes HHS Secretary Kennedy and CMS Administrator Oz will enact, but it is safe to assume they will adopt the White House’s goal to slash government spending. During a time when private payers see their margins squeezed and public payers are looking to cut costs, renewing our sector’s decades-long message that we are the quintessential economizing solution may mean that message will finally be heard.

Private Equity Bad for Patients, Senate Finds

The second surprising report came from the U.S. Senate Budget Committee. In a scathing bipartisan report of an in-depth investigation spearheaded by Chuck Grassley (R-Iowa) and Sheldon Whitehouse (D-RI), the committee declared that “private equity investment in health care has negative consequences for patients and providers.”

Titled “Profits Over Patients,” the 162-page report focuses on two of the largest private equity firms that have recently invested in two large hospital systems. We mention it because there has been an atmosphere of celebration in recent years at post-acute care conferences about the renewed interest in Home Health and Home Care among investors.

Here are some of the reasons the Senate recommends caution:

Emphasis on profit over quality of care: “Documents obtained by the Committee detailed how private equity’s ownership of hospitals earned investors millions, while patients suffered and hospitals experienced health and safety violations, understaffing, reduced quality of patient care and closures.”
“Chronic understaffing” leads to much longer wait times for patients
Closures for “economic reasons” force patients to drive long distances for care
Higher frequency of health and safety violations puts patients at risk
Minutes of some board meetings show discussions focus only on profit maximization tactics — cost cutting, increasing patient volume, and managing labor expenses — with little to no discussion of patient outcomes or quality of care at their hospitals
In one extreme case, according to Senator Whitehouse, one firm “paid out $645 million in dividends and preferred stock redemption to its investors and shareholders, while it took out hundreds of millions in loans that it eventually defaulted on.

Senator Whitehouse added in the report, “Private equity investors have pocketed millions while driving hospitals into the ground and then selling them off, leaving towns communities to pick up the pieces.”

Let's Finish With Optimism

Three weeks is not enough time to evaluate the impact of any one four-year term in office. We have clues about the new administration’s approach to healthcare in general and in-home care in particular, but only clues. Perhaps the future is malleable. Perhaps now is the time to turn up the volume. We know patients prefer care in the home. Maybe, with our advocacy, this government will prefer it too.

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

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

Treatment in Place from Emergency Medical Services

by Elizabeth E. Hogue, Esq. | Feb 14, 2025 | Clinical, Medicare Advantage, Regulatory

by Elizabeth E. Hogue, Esq.

Treatment in Place

Providers of services to patients in their homes are anecdotally familiar with situations in which patients need help at home, but do not qualify for home health services and have not arranged for or are unable to afford home care/private duty services. These patients need assistance, but do not need transport.

The Problem

The problem for Emergency Medical Services (EMS) is nonpayment for services if patients are not transported for services.

Can EMS Charge Without Transport

The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services has weighed in on whether local EMS can meet this need and bill patients’ insurance for treatment in place (TIP) services. The OIG has “blessed” the provision and billing of these services in Advisory Opinion No. 24-09 issued on November 21, 2024.

Treatment in Place Requirements to Bill Insurance

Specifically, the OIG says that EMS may provide services to patients in their homes or TIP services and bill Patients’ insurers if the following requirements are met:

Charges to patients’ insurers would be limited for emergency responses only.
Charges for TIP services must be based on the level of care furnished to patients and cannot exceed amounts currently claimed for payment for the same levels of care furnished in connection with ambulance transports.
Charges are made regardless of whether patients are enrolled in commercial insurance plans or federal health programs.
EMS accepts payment for TIP services from patients’ health insurances as payment in full.
Patients will not be billed for any cost-sharing amounts under patients’ health insurance, including federal health care programs for covered TIP services, regardless of whether they are residents or nonresidents of the county where TIP services are provided.
EMS cannot later claim cost-sharing amounts waived as bed debts for payments under federal health care programs or otherwise shift the burden of cost-sharing waivers onto federal health care programs, other payors, or individuals by, for example, balance billing.

Cost-Sharing

In light of the above, the OIG first acknowledged that the prohibition on waivers of cost-sharing under the federal anti-kickback statute (AKS) is applicable and that the requirements of a safe harbor that addresses waivers of cost-sharing amounts for municipally owned ambulances are not met by the proposed arrangement. The OIG also said that the proposed arrangement would result in remuneration in the form of cost-sharing waivers for TIP services and TIP services provided at no charge to patients. Consequently, remuneration provided implicates both the AKS and the Beneficiary Inducements CMP.

Risk

Nonetheless, the OIG concluded that the arrangement involves a low risk of fraud and abuse. In addition to the above requirements, the OIG concluded that neither Medicare Part B nor the State Medicaid Program currently covers TIP services; only a handful of Medicare Advantage Plans and some Medicaid Programs currently cover TIP services. This means that, in most circumstances, the arrangement will result in no costs to federal health care programs and, in fact, may reduce costs by avoiding ambulance transport or subsequent hospital care. Patients may also receive care more quickly and efficiently, and at more appropriate levels of care when they receive TIP services.

Treatment in Place Cost-sharing Waivers

Finally, according to the OIG, waivers of cost-sharing for TIP services or the provision of free TIP services are unlikely to affect patients’ decisions to use future emergency ambulance services reimbursed by federal health care programs.

Providers are increasingly aware that patients need a variety of services in their homes. The OIG has opened another door!

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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.

©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

Creditable Coverage for Medicare Part D

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

by Kristin Rowan, Editor

CMS 2026 Updates to Prescription Plan

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

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

Current Creditable Coverage Determination

The current simplified determinations method is as follows:

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

Creditable Coverage

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

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

Impact

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

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

For Additional Information

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

# # #

Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news .She also has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

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

Is Medicaid Down for the Count?

by Kristin Rowan | Feb 6, 2025 | Breaking News, Regulatory

by Kristin Rowan, Editor

Medicaid Payment System Goes Dark

On Monday, January 27, President Trump, through the Office of Management and Budget, announced a temporary freeze on federal spending while his newly designated head of the Department of Government Efficiency ensures all spending follows the executive orders the President has signed. The memo was vague and caused widespread confusion across government departments. Almost immediately after the memo was circulated, Medicaid programs could not access the Payment Management Services web portal, the entity responsible for paying Medicaid claims.

The Memo

The language used in the memo on federal spending was broad and overreaching. As such, many federal organizations were unclear as to whether the memo applied to them. The message in the memo was that the administration intended to curb any spending that does not improve the day-to-day lives of the people. Throughout the day Monday, the White House sent clarifications about what programs would not be impacted. Among them were food assistance programs like SNAP, WIC, and Meals on Wheels, and Medicaid. The medicaid payment portal went down, despite this clarification.

Exclusions

Multiple state and federal agencies reached out to the White House for clarification following the release of the memo. Explicitly excluded from the freeze are direct benefit plans like Social Security and Medicare. In addition to the programs named in the memo, clarification on additional programs that would not be impacted included Medicaid. Despite the temporary website outage, claims were still being processed and payments were still being made.

Immediate Lawsuits

Almost simultaneously with the distribution of the memo, several non-profit organizations filed suit against the federal government. They called Trump’s action an “unlawful and unconstitutional” act, even temporarily. The pause on federal spending was set to go into effect at 5 p.m. ET on Tuesday. Minutes before, U.S. District Judge Loren L. AliKhan put a pause on the pause.

Temporary Freeze on the Temporary Freeze

To allow both sides time to construct an argument, the judge stayed the funding freeze until Monday, February 3. That morning, the judge will hear arguments and consider the issue. After the stay, attorneys general from 22 states and D.C. filed their own lawsuit to permanently block the freeze and prevent any future attempts to cut off already approved federal funding.

Then Comes the Thaw

If the judge allows the freeze to move forward, Trump has given every agency until February 10 to account for and explain all spending programs within their departments. Once the accounting has been reviewed, likely the OMB and the Department of Government Efficiency will determine which federal spending programs can resume operation.

There is no indication yet as to whether Trump will extend the February 10 deadline, given the delay in the courts. By the time the judge rules on Monday, however, we hope the White House will have issued additional details and guidance to avoid additional disruption to essential services like Medicare and Medicaid.

Final? Ruling

Early Monday, Judge AliKhan said she was not convinced by the argument that nonprofit groups have no case against the funding freeze since the OMB rescinded the memo. The administration argued that a brief pause on funding to align federal spending is within the law. The administration also suggests that the courts have no standing to block it. AliKhan has indicated that she will likely grant a longer temporary order to stay the funding freeze.

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Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news .She also has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

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

Urgent Plea to Safeguard Your Caregivers

by Kristin Rowan | Feb 6, 2025 | Admin, Caring for the Caregiver, Clinical

by Kristin Rowan, Editor

Care at Home Worker Safety is not Optional!

I will rarely present an editorial piece that is based only on my opinions. I hold a few about care at home in general, but at least attempt to use statistics, facts, and history to support my positions. This is one area where the facts and numbers are all there, but using them is not as effective as sharing these stories. No matter where your agency is in its growth, no matter how large or small, no matter your plans for 2025, if you have not started a safety committee, created safety protocols and operating procedures, and invested in GPS-enabled emergency response systems for your staff, do so NOW, so this story doesn’t become your story.

One More Story is One Too Many

The tragic death of Joyce Grayson made headlines across the country both immediately after her death and for months after with lawsuits and new regulations in her state. This week, another avoidable incident left a home health aide in Massachusetts bedridden and temporarily unable to walk.

The aide, who asked to remain anonymous said she thought she was going to die. “I was screaming Help! Help!,” while a man in his 70s, for whom she has provided care for more than two years, attacked her with a knife. The man repeatedly stabbed, slashed, and sliced her while she kept kicking at him and thrashing her body. Despite all her attempts to escape, the man would not let her get up.

“I was tired,” she recalled, after fending off her attacker, “I’m gonna die here, I think that, but in that moment I remembered my sons, my family and giving me power. I confronted him.”

As she fled the apartment, the man followed her with a piece of wood. She ran down the hallway, where a security guard intervened. The man lost his balance during the struggle and fell. The home health aide spend two days in the hospital, receiving blood transfusions and dozens of stitches. She has decided no to return to her job, which she has held for a decade.

“He’s not going to kill me. He’s not going to pull me down.”

Home Health Aide Attacked on the Job

Next Time, it Could be You

No care at home worker deserves to feel unsafe or to be attacked at work. No agency owner wants to be the headline of the next story about a home care worker who ended up in the hospital or the morgue. Don’t be the next agency that has to explain to a family how this happened to their mother, daughter, son, or uncle, or cousin. No child wants to find out that their parent isn’t coming home because they did not have the means to call for help.

Act Now, Before it's Too Late

You might be surprised, if you asked, how many of your caregivers have ever felt uneasy, unsafe, or uncomfortable during their shift. Whether is the client, a family member of the client, pets, firearms, the neighborhood, or something else, most lone workers will experience some degree of fear. While not entirely preventable, there are steps you can take to minimize the risk:

- Ask your employees for honest feedback
- Research the client, family members, and the neighborhood for safety issues
- Create a committee comprising management, administrators, and caregivers, to create a safety plan
- Invest in training for your staff to include deescalation techniques, situational awareness, self-defense, and any other classes your safety committee deams necessary
- INVEST IN GPS-ENABLED EMERGENCY RESPONSE SYSTEMS FOR EVERY EMPLOYEE, NOW!

Recommendations

As a company that engages in software adoption consulting, we don’t often make direct recommendations, prefering instead to tailor software selection to each agency and its unique needs. This is one area where I will make the exception and continue to make the exception until every lone worker in and out of the care at home industry is equipped with a safety device.

POM Safe

POM Safe is a personal safety solution that allows lone workers to get help when needed, but was designed to incorporate prevention and de-escalation. “The best 911 call is the one that never happens.”

The device includes features such as:

- Fake phone calls to allow the caregiver to step away from a situation
- Check on me to alert the agency if the caregiver has not checked in after an appointment
- Appointment Sync to give first responders precise locations in an emergency
- One-tap text sending a pre-written text with precise GPS location
- Incident Reports to prevent future incidents
- Two-way calling to a dispatcher when emergency help is needed
- Voice activation when your caregiver can’t get to the device
- Real-time crime data by neighborhood
- Sex offender registries
- 24/7 emergency dispatch
- Device or app-based

Katana Safety

The Katana safety device attaches directly to the caregiver’s phone. It has a quick-trigger activation to bypass the phone’s lock screen, and provides instant help 24/7.

This device includes features such as:

- Audible and inaudible alerts that launch GPS signals and connect worker to call center
- 24/7 highly trained PERS center
- Safety text and call after an alert with immediate dispatch if caregiver does not answer
- Walk with me feature to have a dispatcher stay in contact while the caregiver gets to safety
- Circle of safety to alert up to seven people in case of emergency
- Customizable safety commands that each clinician sets up with voice activation
- Beacon backup if bluetooth fails
- Text messaging with GPS location
- Employee check-in with voluntary location tracking and pin drop
- 2-year battery life
- Options to connect by app, fob, watch, or voice

Final Thoughts

Ensuring the safety of your employees before you send them out to care for your clients is not an optional benefit, a “nice to have,” or something you can do when you “get around to it.” Providing the training and safety devices needed to make sure each and every one of your caregivers makes it home every day should be your top priority. Whether you choose one of the devices above or go with a different option, start looking for one now. If you need help starting your safety committee or writing a survey to assess the safety risks in your agency, I will help you. With all of the technology available to us, there should no longer be any stories of caregivers who were attacked and did not have the means to call for help.

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Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news .She also has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

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

Medicare Advantage Lowers Home Health Care Use

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

by Kristin Rowan, Editor

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

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

Home Health Higher in Traditional Medicare

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

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

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

Days of Care Lower in Medicare Advantage

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

Implications

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

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

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Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news .She also has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

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

Bill Dombi to Continue the Care at Home Fight in D.C.

by Kristin Rowan | Feb 6, 2025 | Advocacy, Regulatory

by Kristin Rowan, Editor

Bill Dombi Key Supporter of Care at Home

The end of 2024 and the official merger of NAHC and NHPCO also brought to a close the extensive service to the care at home industry by former NAHC President Bill Dombi. Dombi served as vice president for law from 1987 to 2017. He was named interim presidnt in 2017 and president in 2018, where he served until 2024.

Bill has been instrumental in the advancement of care at home policies at the federal level, a champion for advocacy for care at home at local, state, and national conferences and organizations, and spearheaded lawsuits and challenges to CMS rulings for year. His retirement, though well-earned, was a great loss to the industry.

Back in Action

On February 4, 2025, Arnall Golden Gregory law firm, of Atlanta and Washington D.C. an Am Law 200 law firm with a client-service model of “business sensibility” announced the additional of Bill Dombi to the firm as senior counsel. With more than 40 years of experience with litigation and policy in the care at home industry, Bill will continue his fight to advance care at home in D.C.

“It’s not a stretch to say that Bill is the face of the home healthcare space and the standard-bearer for advocating on its behalf, whether in state or federal court or through his deep-rooted experience and relationships within Congress and various federal agencies. In addition to tackling major policy issues, Bill has fiercely defended providers and patients in litigation across the country. His broad perspective and exceptional legal acumen will be invaluable to our already outstanding Healthcare practice, particularly in the areas of home health, hospice, and post-acute and long-term care litigation, benefitting both our teams and the clients we serve.”

Jason E. Bring

Healthcare Litigation co-chair, Arnall Golden Gregory LLP

From AGG

Bill has been actively involved with significant litigation matters affecting home health policy since 1976. Notably, he served as lead counsel in the lawsuit that resulted in the expansion of Medicare home health coverage in 1980, and he was pivotal in the creation of the Medicare hospice benefit in 1983, the institution of the Medicare Prospective Payment System (PPS) for home health in 2000, and national healthcare reform legislation in 2010. In 2017, Bill was selected as NAHC’s president and served through 2024, ultimately concluding his tenure as president emeritus and counsel of the National Alliance for Care at Home, the combined organization of NAHC and the National Hospice and Palliative Care Organization.

“To call Bill a major addition to AGG’s Healthcare practice would be an understatement,” said Sean P. Fogarty, AGG’s managing partner. “Bill has been a pillar in the home health industry for years, and I know I speak on behalf of the entire firm when I say we we’re thrilled to have him join our team.”

Bill is renowned for his commitment to advancing care at home through legal, legislative, and regulatory advocacy. His background spans all key advocacy forums, including Congress, regulatory bodies, and the courts, where he has engineered laws and regulations that directly impact home health and hospice providers. This breadth of experience empowers his private practice to offer clients with a practical framework for compliance standards and operational excellence.

“As I look to the next chapter of my career after almost 40 years at NAHC, it’s exciting to join such an impressive firm and group of professionals with a well-established and supportive culture. AGG is so unique in its earnest focus on collegiality and collaboration, and I look forward to continuing my hard work with my new colleagues on behalf of the dedicated home health providers we serve.”

Bill Dombi

Senior Counsel, AGG

A hall of famer among several home care and hospice organizations, Bill has also served as executive director for the Center of Health Care Law and Home Care and Hospice Financial Managers Association at NAHC. He continues to serve the industry as a member of the board of directors of the Research Institute for Home Care and the Hospice and Home Care Foundation of North Carolina. With Medicaid expenditures now exceeding $130 billion annually and Medicare home health services growing from $300 million to over $25 billion, Bill’s work has seen the evolution of home care from a cottage industry to a cornerstone of long-term care in the U.S.

Bill attended the University of Connecticut, where he earned his law degree, as well as a B.A. in political science.

About Arnall Golden Gregory LLP

Arnall Golden Gregory (AGG) is an Am Law 200 law firm with offices in Atlanta and Washington, D.C. Our client-service model is rooted in taking a “business sensibility” approach of fully understanding how our clients’ legal matters fit into their overall business objectives. Our transaction, litigation, regulatory, and privacy counselors serve clients in healthcare, real estate, retail, technology, fintech/payment systems, global commerce/global mobility, life sciences, logistics and transportation, government investigations, and government contracts. With our rich experience and know-how, we don’t ask “if,” we figure out “how.” Visit us at www.agg.com.

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Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news .She also has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

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

Telemedicine Rules from DEA

by Elizabeth E. Hogue, Esq. | Jan 23, 2025 | Clinical, Regulatory, Telehealth

by Elizabeth E. Hogue, Esq.

DEA Issues Three Telemedicine Rules

On January 16, 2025, the United States Drug Enforcement Administration (DEA) announced three new rules to make permanent some temporary flexibilities for telemedicine established during the COVID-19 public health emergency, including new provisions intended to protect patients. The DEA worked with the U.S. Department of Health and Human Services (HHS) to develop the new rules. The DEA made significant revisions to the draft rules proposed on March 1, 2023.

Exemptions

It is important to note that the new rules do not apply to telemedicine visits when patients have already been seen in person by medical providers. After patients have in-person visits with medical providers, any medications may be prescribed through telemedicine indefinitely. Also, if no medications are prescribed during telemedicine visits, the rules about telemedicine do not apply. In other words, patients can always have telemedicine visits with medical practitioners. The rules apply only if patients have never been seen in person by practitioners and controlled medications are prescribed during telemedicine visits.

Rule #1 - Remote Access to Opiod Meds

First, the DEA expanded remote access to buprenorphine, the medication used to treat opioid use disorder, via telemedicine encounters. This change allows patients to receive six-month supplies of buprenorphine through telephone consultations with providers. Additional prescriptions will, however, require an in-person visit to medical practitioners.

Rule #2: Schedule III-V Without In-Person Evaluation

The DEA also issued proposed rules that establish special registrations that allow patients to receive prescribed medications even though they have never had an in-person evaluation from a medical provider. This special registration is available to practitioners who treat patients for whom they will prescribe Schedule III-V controlled substances.

Prescribing Registrations for Schedule II

Advanced Telemedicine Prescribing Registrations are available for Schedule II medications when practitioners are board certified in one of the following specialties:

- Psychiatrists
- Hospice care physicians
- Physicians rendering treatment at long term care facilities
- Pediatricians for the prescribing medications identified as the most addictive and prone to diversion to the illegal drug market
These specialized providers can issue telemedicine prescriptions for Schedule II-V medications.

Call for Public Comment

The DEA seeks public comment on the following issues related to the proposed rules, including whether:

- Additional medical specialists should be authorized to issue Schedule II medications
- Special registrants should be physically located in the same state as patients for whom Schedule II medications are prescribed
- To limit Schedule II medications by telemedicine to practitioners whose practice issues less than 50% of prescriptions by telemedicine.

Online Registration

The DEA will also require online platforms to register with the DEA if they facilitate connections between patients and medical providers that result in prescription of medications. In addition, the DEA will also establish a national prescription drug monitoring program (PDMP) so that pharmacists and medical practitioners can see patients’ prescribed medication histories.

Rule #3: Exemption for Dept of Veterans Affairs

Finally, the DEA will exempt U.S. Department of Veterans Affairs (VA) practitioners from requirements for Special Registrations. After patients receive in-person medical examinations from VA practitioners, the provider-patient relationship is extended to all VA practitioners who engage in telemedicine with the patients.

Final Thoughts

Prescribing controlled substances is essential for some patients, including hospice patients. Practitioners must have the option to prescribe using telehealth.

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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.

©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

Medicare Advantage Increase for Payers, not Providers

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

by Kristin Rowan, Editor

CMS Announces Medicare Advantage Pay Hike

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

Opposition

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

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

Bruce Scott, M.D.

President, American Medical Association

Out-of-Pocket Cost Increase

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

Coverage Increase

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

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

Ashley Thompson

Senior Vice President, American Hospital Association

Changes are not Definite

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

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

As Yet Unknown

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

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Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news. She also has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©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