Alliance Responds to Hospice Final Rule

by Kristin Rowan | Aug 7, 2025 | Advocacy, CMS, Hospice, Medicare, Medicare Advantage, Regulatory

by Kristin Rowan, Editor

The Alliance Responds to CMS Hospice Final Rule

CMS Issues FY 2026 Hospice Final Rule

On August 1, 2026, CMS issues the FY 2026 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Programs Requirements Final Rule. Here are the high-level changes in this year’s final rule:

Rate Setting Changes
- A 3.3% inpatient hospital market basket percentage increase
- A 0.7% productivity adjustment (read decrease)
- Statutory cap increases from $34,465.34 to $35,361.44
Hospice Care Admission
- The physician member of the interdisciplinary group (IDG) may recommend admission to hospice care
Face-to-Face Attestation
- Signature and date requirements restored
- Eliminated requirement for attestation to be a separate and distinct document
- Attestation requirement can be a section or addendum to recert form, or part of a signed and dated clinical note
Hospice Quality Reporting Program

The HOPE tool will replace the HIS tool on October 1, 2025, despite comments to delay implementation
CMS published a HOPE Technical Information webpage ,an HQRP training library, and a Requirements and Best Practices webpage
CMS recognized the error in their HOPE burden calculations. The burden is 21.1% higher than initially reported. The difference will be “taken into consideration” in the next PRA package submission.
The separate reporting tool (QIES) and reports tool (CASPER) will sunset and iQIES will replace both tools.

FY 2026 Hospice Quality Reporting Program

National Alliance for Care at Home Statement

After CMS issued the final rule, the Alliance responds with a statement addressing the wage adjustment, HOPE tool implementation, and sttestation changes. Read the full press release here.

Wage Adjustment

The Alliance recognizes that the 2.6% wage update is higher than the proposed 2.4% adjustment issued earlier this year. However, The Alliance maintains its position that the update does not go far enough to offset the very high and very real operational costs that hospices across the country face.

Regulatory Relief

Both the physician member of the IDG recommending hospice admission and the inclusion of a clinical note to serve as attestation of a face-to-face were welcome changes to hospice regulations. The Alliance thanked CMS for these changes.

HOPE Tool Implementation

The Alliance was among the many commenters to CMS about the October 1, 2025 implementation date for the HOPE tool. Alliance CEO Dr. Steve Landers had this to say:

Despite responsiveness in other areas, the Alliance is deeply disappointed that CMS did not heed recommendations and delay the October 1, 2025 implementation of the Hospice Outcomes and Patient Evaluation (HOPE) tool nor waive the timeliness completion requirement for HOPE record submission. We expect providers to face a burdensome transition and urge CMS to remain responsive to real-world challenges, offering flexibility as providers navigate the change.

Dr. Steve Landers

CEO, National Alliance for Care at Home

The Alliance is committed to working with CMS to reduce spending and strengthen the Medicare hospice benefit. They also continue to support the CMS initiative to reduce fraud, waste, and abuse.

Final Thoughts

The Hospice Final Rule is not what we hoped for. The wage update was increase, but not by enough to make a real impact on the operational burden hospices face. CMS has provided technical training and education for the HOPE tool, but severely underestimated the financial burden connected to the transition. CMS continues to use outdated, incorrect, or faulty information in its calculations of wage rate updates and ignores the repeated comments from advocacy groups and hospice providers.

# # #

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

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

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

Tell CMS not to Kill Home Health

by Kristin Rowan | Aug 7, 2025 | Advocacy, CMS, Regulatory

by Kristin Rowan, Editor

The Alliance to Care at Home:

CMS needs your comments

CMS needs your comments on the home health proposed rule for FY 2026. Advocacy is a cornerstone of the mission of The National Alliance for Care at Home. From The Hill to the home, The Alliance fights for the future of the industry. But, they can’t do it alone.

Proposed Rule

The CMS proposed rule for FY 2026 has a net 6.4% decrease in payments to home health providers. Industry experts warn that this change will cause home health agencies to shutter their doors and it will leave many rural areas in a home health desert.

The Alliance Call to Action

At last week’s 2025 Financial Summit in Chicago, policy and industry experts provided ways to adjust how to write comments to CMS. According to Mary Carr, Vice President for Regulatory Affairs at National Alliance for Care at Home, it’s not enough for a few agencies and organizations to advocate for home health. Everyone has to submit comments about this. Carr says if done effectively, sending comments on proposed rules is one of the most powerful ways to stop these policy changes. The way you write your comment letters is important if you want them to have an impact.

Carr provided this guidance and tips on how to right an effective comment to CMS:

Remember that CMS is not looking for an agree/disagree statement

Provide good reasons for not keeping the proposed rule as is

Address very specific reasons why any part of the proposed rule is bad

Include the direct impact the proposal will have on your business, your staff, and your patients

Provide an alternative recommendation

Mention studies on how much less home health costs compared with SNFs and ALFs

Don’t let fear, anger, and anxiety detract from your message

Maintain professionalism and respect

Mention and thank CMS for any good aspects of the proposed rule

Include impact statements on reduction in services, delays to getting care, and areas that would be without any available home health care should the proposed rule stand

Mention the Other Side

No matter what side of the aisle you are usually on, we all must agree that care at home is an industry issue, not a Democrat or Republican issue. Hillary Loeffler, Vice President of policy and regulatory affairs at the Alliance, reluctantly mentions that the clawbacks, reductions, and methodology used to determine rates were put in place by the previous administration.

“It’s a new administration. I hate to say it, but I’m going to say, ‘This methodology was created by the Biden administration, and the Trump administration needs to do something about this.’ So, hopefully they take a fresh look at it.”

Hillary Loeffler

Vice President of Policy and Regulatory Affairs, National Alliance for Care at Home

Loeffler also suggests going directly to Congress with comments and letters in addition to CMS. The recent trend of lowering reimbursement rates causing fewer visits, less coverage, and longer wait times is untenable and complete reform of the home health benefit at the federal level is needed to ensure its survival, added Loeffler.

Illogical Arguments

Whether you are publishing comments on the home health proposed rule or writing a letter to your senators and representatives, steer clear of logical fallacies. These errors in reasoning are easy to fall prey to when you have an emotional investment in the issue at hand.

Ad Hominem

The very common Ad Hominem fallicy happens when the argument moves from the problem to the person. Blaming your representative or accusing CMS of hating home health rather than focusing on the impact of the pay cut will weaken our standing.

Slippery Slope

This fallicy involves stretching the consequences of an action beyond reality. Cutting home health payment rates will decrease care and increase start-of-care delays. It will not cause homelessness, mass hysteria, or a small pox outbreak.

Fallacy of Composition

If you’re familiar with standard contracts, you’ve read the clause that goes something like, “if any part of this contract is illegal, the rest is still intact.” The composition fallacy assumes that the whole of something matches its parts. The CMS proposed rule for FY 2026 has improvements, such as allowing physicians to do face-to-face appointments even if they are not the certifying physician. Don’t throw out the entire proposed rule. Rather focus on those parts that are clearly devastating to the industry.

Fallacy of Origin

Criticizing the rule based on its authors (CMS) as adversaries to care at home also negates the impact of our advocacy. CMS has been charged with maintaining government payments for health care in hospitals, physician groups, hospices, SNFs, and more. They have also been directed to cut costs, decrease spending, and maintain budget neutrality. The proposed rule is a death sentence for home health not because it came from CMS, but because of the flawed math. Address the calculations, the methodology, the assumption that care at home is more expensive than hospital or SNF care, and the number of people who will lose access to quality care.

CMS needs your comments now

Now that you know what issues to address and how to frame your argument, reach out. Contact CMS and your Congresspeople and submit your comments today. Comments are due by August 29th.

# # #

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

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

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

First Joint Event for NAHC & NHPCO

by Rowan Report | Aug 7, 2025 | Events, Home Health, Hospice, Partner News

FOR IMMEDIATE RELEASE
July 30, 2025
PHOTO LINK

National Alliance for Care at Home Hosts Inaugural Financial Summit

Over 700 industry leaders gather in Chicago for three-day event focused on financial leadership and innovation in home-based care

(Alexandria, VA and Washington, DC) — The National Alliance for Care at Home (the Alliance) successfully hosted its inaugural event, the 2025 Alliance Financial Summit, July 27-29 in Chicago, IL. The Summit brought together financial leaders from across the care at home community, with expert-led sessions, peer collaboration, and insights into market shifts and emerging technologies.

Arrival in Chicago

Welcome

The Summit officially launched Sunday evening with an opening keynote by Wendy Sue Swanson, MD, MBE, Founder and CEO of Skin Metal and Author of “Mama Doc Medicine.” Dr. Swanson delivered a forward-looking presentation on the intersection of medicine and technological innovation. The evening concluded with a Welcome Reception in the Exhibit Hall.

Keynote

The day’s keynote session featured Alliance CEO Dr. Steve Landers alongside a panel of experts including Ken Albert, President and CEO of Andwell Health; Trisha Crissman, President and CEO of CommonSpirit Health at Home; and Hillary Loeffler, Vice President of Policy & Regulatory Affairs for the Alliance. Panel discussions addressed the potential impact of payment cuts in the Centers for Medicare & Medicaid Services Calendar Year 2026 Home Health proposed rule, hospice policy developments, workforce challenges and solutions, and actionable strategies for providers to protect the future of home-based care. Attendees then moved into a full day of concurrent sessions before an evening reception on the Chicago River.

Steven Landers, CEO, The Alliance, Financial Summit

The Alliance Financial Summit Riverwalk Reception

The Alliance Financial Summit Attendee Map

Networking and Education

Tuesday featured dedicated peer-to-peer networking sessions, allowing for informal conversation and knowledge sharing, before the opportunity for more concurrent sessions. The Summit concluded with a closing keynote expert panel featuring leaders from the Alliance’s Home Health and Hospice Financial Managers Association (HHFMA).

“This first Alliance event exceeded our expectations, bringing together care at home leaders from across the nation to connect, learn, and recommit to our shared vision of an America where everyone has access to the highest quality, person-centered healthcare wherever they call home,” said Alliance CEO Dr. Steve Landers. “The content was both practical, grounded in the day-to-day challenges and successes of providers, while incorporating innovation and aspiration to drive future growth and success.”

The Alliance has announced two additional events for 2025: Alliance Advocacy Week, September 8-11 in Washington, DC, and the National Alliance for Care at Home Annual Meeting and Exposition, November 1-4 in New Orleans, LA.

# # #

About the National Alliance for Care at Home

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

Press Contact
communications@allianceforcareathome.org
Elyssa Katz | 571-281-0220

HHAeXchange Expands in Manhattan

by Rowan Report | Jul 24, 2025 | Partner News

FOR IMMEDIATE RELEASE

Contact: Hollie Barnridge
Alloy, on behalf of HHAeXchange
855-300-8209
hhaexchange@alloycrew.com

HHAeXchange Unveils New Corporate Headquarters in New York City

New location reaffirms the company’s commitment to its employees and customers with expanded office space to support enhanced collaboration, creativity, and innovation

NEW YORK, June 3, 2025 – HHAeXchange, a leader in homecare management solutions for providers, caregivers, managed care organizations (MCOs), and state Medicaid programs, today announced the opening of its new corporate headquarters in New York City.

Located in the heart of Midtown Manhattan, the reimagined workspace is a reflection of the company’s recent growth and its commitment to delivering advanced solutions for the home and community based services (HCBS) industry. The new space also marks an important step in uniting teams from HHAeXchange’s recent acquisitions of Sandata, Cashé Software, and Generations Homecare System. Efforts to foster stronger collaboration across functions will accelerate the delivery of a more connected, efficient experience for customers nationwide.

“We are always striving to better meet the needs of our customers, and bringing our employees together at our new headquarters will support greater collaboration that drives product innovation. New York has been our home base since 2008, and we’re proud to grow the HHAeXchange footprint locally while creating a welcoming work environment for our network of employees, customers, and partners from across the nation.”

Paul Joiner

CEO, HHAeXchange

For more than 15 years, HHAeXchange has been at the forefront of homecare technology, innovating software solutions that empower personal care providers, self-direction program administrators, MCOs, and state Medicaid agencies to achieve operational efficiency, increased compliance, and improved member outcomes. The new central office space reflects HHAeXchange’s focus on supporting its teams and customers, helping to advance care delivery for all members.

In addition to the office’s collaborative workspace, HHAeXchange’s new headquarters features state-of-the-art employee training rooms and flexible meeting spaces designed to foster engagement with customers, prospective clients, and partners.

In His Own Words

We sat down with Paul Joiner, CEO of HHAeXchange, to talk about the new office space, how its impacting the company culture, and what’s next for the company. See our accompanying article here.

About HHAeXchange

Founded in 2008, HHAeXchange is the leading technology platform for homecare and self-direction program management. Developed specifically for Medicaid home and community-based services (HCBS), HHAeXchange connects state agencies, managed care organizations, providers, and caregivers through its intuitive web-based platform, enabling unparalleled communication, transparency, efficiency, and compliance. In 2024, HHAeXchange expanded through the strategic acquisitions of Sandata, Cashé Software, and Generations Homecare System, strengthening its commitment to advancing the industry. For more information, visit hhaexchange.com or follow the company on X, LinkedIn, and Facebook.

Patients’ Right to Freedom of Choice

by Elizabeth E. Hogue, Esq. | Jul 24, 2025 | Admin, CMS, Home Health, Hospice, Medicaid, Medicare, Regulatory

by Elizabeth E. Hogue, Esq.

Patient's Right to Freedom of Choice of Providers

U.S. Supreme Court Weighs In

Patient’s rights to freedom of choice of providers who will render care to them is currently based on four key sources:

Court decisions that establish the right of all patients, regardless of payor source and the setting in which services are rendered, to control treatment, including who provides it
Federal statutes for both the Medicare and Medicaid Programs that establish the right of patients whose care is paid for by these programs to choose providers to render care – Specifically, Section 1802 (42 U.S. C. 1395a) states as follows: “(a) Basic freedom of choice.- Any individual entitled to insurance benefits under this title may obtain health services from any institution, agency, or person qualified to participate under this title if such institution, agency or person undertakes to provide him such services.”
The Balanced Budget Act of 1997 (BBA), which currently requires hospitals to provide a list of home health agencies and hospices to patients. According to the BBA, the list must meet the following criteria: (a) Providers that render services in the geographic area in which patients reside, are Medicare-certified, and request to be included must appear on the list given to patients. (b) If hospitals have a financial interest in any provider that appears on the list, this interest must be disclosed on the list.
Conditions of Participation (COP’s) of the Medicare Program that are the same as the provisions of the BBA described above

Supreme Court Decision

The U.S Supreme Court has now issued a decision about the federal statute for the Medicaid Program described above in Medina v. Planned Parenthood South Atlantic, et al. [No, 23-1276 (June 26, 2025)]. This case involves the any-qualified-provider provision in the statute above that requires states to ensure that any individual eligible for medical assistance may obtain it from any provider qualified to perform the service who undertakes to provide it. The question is whether individual Medicaid beneficiaries may sue state officials under the above statute for failing to comply with the any-qualified-provider provision.

Exclusions on "any-qualified-provider" provision

The State of South Carolina excluded Planned Parenthood from the Medicaid Program. An enrollee in the Medicaid Program sued the State based on the above statute because she said that she wanted to receive Medicaid services from Planned Parenthood.

Federal enforcement; not private

The Court said that spending power statutes, such as Medicaid Programs, are especially unlikely to create the right for individuals to sue the states. The typical remedy for state noncompliance is federal funding termination. Private enforcement, such as suits by individuals, requires states to voluntarily and knowingly consent to private suits based on clear and unambiguous alerts from Congress to the states that private enforcement is a funding condition.

The Court concluded that the above statute does not permit individuals to sue the States for violation of their right to freedom of choice of providers.

# # #

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.

Paul Joiner: On the Record

by Kristin Rowan | Jul 24, 2025 | Admin, Artificial Intelligence, Home Health, Hospice

by Kristin Rowan, Editor

Paul Joiner

On the Record

Paul Joiner, CEO of HHAeXchange, sat down with The Rowan Report Editor Kristin Rowan to discuss the company’s new headquarters in Manhattan, the company culture he’s creating, his dedication to support those helping our most vulnerable populations.

In His Own Words

The Rowan Report: Paul, thank you for taking the time to talk to us. HHAeXchange is going through some significant growth recently. And now you’ve moved your headquarters from Long Island to Manhattan, correct? How did that decision come about?

Paul Joiner: HHAeXchange has been in Manhattan for a long time. Sandata, who we acquired earlier this year, was in Long Island. But, the move was planned with or without Sandata. We needed a nice sized space to convene people. We valued a large, multi-purpose meeting space over individual office space. It’s a space where the teams can meet when they come to town, where we can host clients, and larger company meetings.

RR: How does the new space support your team?

Paul: The majority of our team is remote. I don’t think remote work is healthy for everyone. It varies from person to person. It’s not a long-term healthy option. Returning back to the office 9-5 five days a week isn’t practical and not all that healthy either. We have created policies, a workspace, and a culture where people are invited to visit. Some come 2-3 days per week. Some only once a month. We maintain flexibility for our teams to work when and where they need to work. Being a single parent, for example, is really hard, so we stay flexible to support single parents to be where they need to be.

At the same time, we’ve seen the benefit of the connection and how much more healthy it is by physically coming together. For the younger workforce, they are enjoying getting together and coming into the office. We have to support our younger employees and their professional development. How do you professionally develop via Zoom or Teams? Physically coworking and promoting good and active environments compel people to come into the office. To build connections, you have to be together, not just on video.

RR: You have workers across the country, though. How does that work?

Paul: We have the main office here in Manhattan, a large and growing office in Minneapolis, and a smaller office in Miami. We try to keep people in areas that make it easy to meet. However, we do have some roles with certain criteria that allows for mostly remote work. Those teams come to one of the offices to meet when they can. We’ve hosted team meetings here and in Minneapolis recently.

RR: Has this new meeting space had an impact on the company culture?

Paul: Yeah, it has improved. We are having real, honest conversations about what needs to be improved. The team effort is the way we win and our teams understand that. We also understand that working hard doesn’t mean foregoing your life and the ability to recharge.

Work hard, be passionate, and motivate people with your mission and vision. The people we serve don’t have it easy, they are supporting the most vulnerable people.

RR: In a recent statement, you said that the new location will support collaboration and innovation. Do you have new features on the horizon? Are you investing in AI capabilities?

Paul: We have a lot in the works. We have a new mobile app in the beta phase that we’ll be rolling out that I’m really excited about. It’s actually an update, but it’s so massive that it’s basically new. We’re working on data analytics and data tracking for some of our largest clients. We’ve consolidated some screens into one spot to streamline and make the user more efficient. A lot of what we’re working on is foundational. We’re focusing on supporting companies as they scale.

RR: Are you looking into AI, either within the HHAeXchange platform, or in a partner?

Paul: Yeah, of course. AI is the future and it’s everywhere. We are looking at ways to return time to users, make it easier to train users, and make things easier on caregivers. We will try to generate more buzz around AI, but not until there’s real, tangible value. AI definitely needs to be part of our strategy, but being smart where we apply it to truly get the value-add for our clients. It has to improve the quality of life for the user. Does it improve the ability of caregivers to care for people?

RR: Do you have any additional acquisition or growth plans for the second half of 2025?

Paul: There’s a lot going on in the marketplace right now. A lot of our clients are growing really well also. So, we’re sort of in a heads-down mode. There’s a handful of things we’re looking at. Right now, I’m really excited about being a bigger participant across the full continuum of care for our populations. There are some opportunities to innovate and evolve to support integrated care over the next few years. I’ll just leave it at that…for now.

RR: Paul, thank you for joining me today. It’s always a pleasure.

# # #

About HHAeXchange

Founded in 2008, HHAeXchange is the leading technology platform for homecare and self-direction program management. Developed specifically for Medicaid home and community-based services (HCBS), HHAeXchange connects state agencies, managed care organizations, providers, and caregivers through its intuitive web-based platform, enabling unparalleled communication, transparency, efficiency, and compliance. In 2024, HHAeXchange expanded through the strategic acquisitions of Sandata, Cashé Software, and Generations Homecare System, strengthening its commitment to advancing the industry.

About Paul Joiner

Paul Joiner is an accomplished executive with extensive leadership experience in the healthcare sector. Currently serving as a Board Member at AssistRx, Joiner has held prominent positions, including Chief Executive Officer at both HHAeXchange and Kipu Health. Previous roles include Chief Operating Officer as well as Executive Vice President and General Manager at Availity, and Senior Vice President and General Manager of Health Plan. Joiner also served as Vice President of Client Engagement and Business Development at Midas+ Solutions, Xerox Healthcare Provider Solutions. Educational qualifications include a Master of Accountancy from Belmont University and a Bachelor of Accountancy from the University of Mississippi.

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

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

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

Non-Compliance Notifications & HOPE Training

by Kristin Rowan | Jul 24, 2025 | CMS, Hospice

by Kristin Rowan, Editor

Hospice Non-Compliance Notifications

On July 21, 2025, the CMS Hospice QRP Announcements page added an update titled “Hospice Quality Reporting Program: Non-Compliance Notifications.”

The Update Reads:

The Centers for Medicare & Medicaid Services (CMS) is providing notifications to hospices that were determined to be out of compliance with Hospice Quality Reporting Program (HQRP) requirements for calendar year (CY) 2024…. This will affect their fiscal year (FY) 2026 Annual Payment Update (APU). The Medicare Administrative Contractors (MACs) will distribute Non-compliance notifications and place them into hospices’ Certification and Survey Enhanced Reporting (CASPER) folders in QIES on July 21, 2025. Hospices that receive a letter of non-compliance may submit a request for reconsideration to CMS via email no later than 11:59 pm, August 26, 2025. If you receive a notice of non-compliance and would like to request a reconsideration, see the instructions in your notification and on the Reconsideration Requests webpage.

Details

Any reconsiderations containing protected health information (PHI) will not be processed. All PHI must be removed for a reconsideration to be reviewed.

Additionally, all submissions must be less than 20 MB overall (email message and attachments). Submissions that are greater than 20 MB in size cannot be processed.

HOPE Training

As the implementation date for the HOPE tool drew nearer, advocacy groups and hospice agencies expressed concern over it’s readiness. On June 6, 2025, The Rowan Report shared that three of the largest organizations urged CMS to delay the tool. The groups asked for proper information, education, and training.

CMS Response

As of now, CMS is not delaying the implementation of the HOPE tool. They have, however, published training tools for hospice providers. The first series of videos is Didactic Training. They cover an introduction to the tool, admin information, preferences and active diagnoses, health conditions, skin conditions, and medications.

On July 21, 2025, CMS announced the opening of registration for live HOPE training. “Hospice Outcomes and Patient Evaluation (HOPE) National Implementation Virtual Training Program Course 2: Coding Workshop.” CMS recommends completing The Didactic Training as a prerequisite to the Coding Workshop.

The Centers for Medicare & Medicaid Services (CMS) is offering a live coding workshop on August 5, 2025…. It will provide coding practice for items that are new for HOPE, as well as the existing and updated items carried over from the Hospice Item Set (HIS).

Register now at:The Hospice Outcomes and Patient Evaluation (HOPE) National Implementation Coding Workshop

Find the Didactic Recorded Training Series here.

Data Collection Starts Soon

The HOPE tool begins data collection on October 1, 2025. Key items hospice providers should understand:

More Frequent Assessments: HOPE introduces up to four assessment points per patient, capturing care from multiple angles during the first 30 days and at discharge.
Real-Time Data Capture: Unlike the retrospective nature of HIS, HOPE assessments are completed during live patient encounters, providing richer and more immediate insights.
Higher Stakes for Compliance: To avoid a reimbursement cut of up to 4%, agencies must ensure that at least 90% of HOPE assessments are submitted on time—a notable increase from the previous 2% penalty under HIS.
Public Reporting Timeline: While HIS data has been publicly available, HOPE data will not be released for public comparison until fiscal year 2028 or later, giving providers time to adapt.

*from the SimiTree blog: Understanding the Transition from HIS to HOPE

As the implementation of the HOPE tool gets closer, we will continue to share training information from CMS and other sources as it becomes available. If you need a referral to a hospice consultant to navigate the transition, please reach out to The Rowan Report.

# # #

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

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

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

“Planning for In-Home Care”

by Rowan Report | Jul 24, 2025 | Advocacy, Home Health, Hospice, Partner News

FOR IMMEDIATE RELEASE

Contact: Elyssa Katz
571-281-0220
communications@allianceforcareathome.org

The Alliance’s CaringInfo Program Launches New “Planning for In-Home Care” Section

Rebrands to Align with Expansion to Serve Full Home-Based Care Continuum

ALEXANDRIA, VA and WASHINGTON, DC – CaringInfo.org, a program of the National Alliance for Care at Home (the Alliance), is expanding its resources with a new website section – “Planning for In-Home Care” – as well as a brand refresh to align with its growing audience. CaringInfo provides free resources to educate and empower patients and caregivers to make informed decisions about home, serious illness, and end-of-life care and services.

CaringInfo

While CaringInfo began with a focus on serious illness and end-of-life care and support, the program’s content is expanding to provide information and resources on the full spectrum of home-based care services. As a first step in this expansion, CaringInfo has launched “Planning for In-Home Care,” a new section on the website focused on the various types of care available at home.

Planning for In-Home Care

The new section covers essential topics including when in-home care is needed, preparing for in-home caregivers, who provides in-home care services, how to find a caregiver, and how to pay for in-home care.

“CaringInfo is a valuable resource used widely among hospice, palliative, and advance care planning experts and professionals as well as patients and families who need help and guidance.”

Dr. Steve Landers

CEO, The National Alliance for Care at Home

Landers, continued, “The launch of ‘Planning for In-Home Care’ marks an exciting step in the continued expansion of CaringInfo to provide resources and guidance on the full continuum of home-based care and to serve as a resource to all providers under the Alliance umbrella. Finding and navigating care at home can be difficult for patients and their loved ones, especially as it is often needed during life’s most vulnerable moments. These free, accessible resources help ensure everyone seeking home-based care can make informed decisions to get the support they need.”

Visual Update

The updated CaringInfo design is intended to remain familiar for return visitors who trust the site as their go-to source for making care decisions, while aligning with the Alliance’s core brand. This visual update indicates CaringInfo’s realignment to serve the full home-based care community, including home health, home care, Medicaid HCBS, palliative care, and hospice providers.

CaringInfo’s goal is that all people are making informed decisions about their care. In addition to easy-to-understand information about caregiving, advance care planning, and the types of care available to those who need it, CaringInfo also offers a complete library of annotated advance directive forms for all 50 states, plus Washington, DC and Puerto Rico. The full site is available in both English and Spanish.

Visit CaringInfo.org, which is free and available to all, to explore the full site as well as the new content.

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About the National Alliance for Care at Home

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

Impact of H.R. 1: The Homebound and Overlooked

by Tim Rowan | Jul 24, 2025 | Medicaid, Regulatory

Analysis by Tim Rowan, Editor Emeritus

The Impact of H.R. 1

Homebound and Overlooked

In early 2025, the Republican-led Congress introduced its proposed budget for FY2026 and beyond, a sweeping legislative effort aimed at curbing federal expenditures and restructuring entitlement programs. Medicaid, one of the largest healthcare safety nets in the United States, faces major revisions under this bill. Central to the proposed changes is the shift toward block grants or per-capita caps on federal funding. The legislation also rolls back incentives enacted into law by the Affordable Care act, including those that supported Medicaid expansion. The reconciliation bill, signed into law on July 4, also eliminates financial support for optional services such as home and community-based services (HCBS). A new set of work requirements in the new law will expand the paperwork burden for beneficiaries.

Risks for Home- and Community-Based Care

The figure below presents a visual from the Commonwealth Fund showing their projection of over $100 billion in cumulative federal Medicaid cuts by 2035. These reductions are expected to disproportionately affect non-mandated programs like HCBS, which are many times more economical than residential care. With diminished federal support, states will face pressure to reallocate limited resources, often at the expense of these optional, yet critical, programs. ¹

For nearly eight million elderly Americans, Medicaid-funded HCBS has helped reduce hospital admissions, extend independence, and relieve stress on long-term care facilities. However, the new budget cuts destabilize these programs. Barbara Merrill, CEO of ANCOR, expressed concern, stating, “When you cut federal Medicaid dollars, even for optional services, states have to make tough decisions about who gets care and when.”² Experts anticipate that approval delays, extended waitlists, and even termination of services could follow as states struggle to maintain existing infrastructure.

Comparing the 2005 Budget Bill to the Affordable Care Act

Compared to the Affordable Care Act (ACA), the Republican budget bill marks a significant policy reversal. The ACA expanded Medicaid eligibility and incentivized states to develop non-institutional care models. It emphasized preventive care and home-based treatment options, helping shift care away from costly institutional settings. By contrast, the new bill eliminates such incentives and introduces fiscal and operational barriers. According to data from Medicaid.gov and the Kaiser Family Foundation, Medicaid enrollment, which rose steadily during the ACA years, is projected to drop by 10% nationwide once the budget bill is implemented³. This decline reflects both tightening eligibility and retreat from HCBS programs.

Healthcare providers will need to brace for substantial ripple effects. With fewer patients accessing home care, hospitals and emergency departments may see an uptick in acute episodes related to unmanaged chronic conditions. Providers may also encounter staffing shortages and reduced reimbursements, undermining service quality and sustainability. Richard Edwards, policy director at Amivie Home Health, warned, “If states cut home care services, many patients have no other choice but to enter a skilled nursing facility. That’s not just a shift in care—it’s often a worse outcome at a higher cost.” ⁴ These operational challenges could exacerbate pressure on an already strained healthcare workforce.

Scope and Severity of Coming Changes

Today, over eight million seniors rely on Medicaid-funded HCBS, with an average annual cost per recipient of $29,000. Thirty-three states use HCBS waivers to administer these services, yet the average state waitlist already exceeds 3,000 applicants. Institutional care costs remain 57% higher than home care, making HCBS not only more humane but more fiscally prudent. Despite that, projected federal cuts of $100 billion by 2035 threaten to replace HCBS with nursing home care. Meanwhile, a national enrollment drop of 10% would leave millions at risk of losing coverage and care.

Richard Edwards, policy director at Amivie Home Health, explains, “If states cut home care services, many patients have no other choice but to enter a skilled nursing facility. That’s not just a shift in care—it’s often a worse healthcare and social outcome at a higher cost.” ⁴

8 million elderly rely on Medicaid HCBS
$29,000/year average cost per Medicaid home care recipient
33 states use HCBS waivers
Average state waitlist for HCBS exceeds 3,000 applicants
Institutional care costs 57% more than home care
Estimated federal Medicaid cuts by 2035: $100 billion
Projected national enrollment drop: 10%

Implications for Care at Home: Next Steps

To mitigate these risks, policy experts are advocating for pragmatic alternatives, knowing that implementation depends entirely on the direction in which political winds blow. Federal stabilization grants could offer targeted relief to states with high HCBS enrollment, preserving continuity of care. Streamlining waiver approvals would reduce bureaucratic delays and ease access for both providers and patients. Retaining key ACA incentives could help maintain momentum in home-based care innovation. States would also benefit from flexible financing rules, including reformed provider tax policies, to better manage Medicaid funds under new constraints.

Final Thoughts

Ultimately, the new budget, passed with no Democratic votes, may reshape eldercare delivery for years to come. With states facing hard choices, the healthcare community must prepare for transitions that could disrupt care and deepen inequities. Advocacy for vulnerable populations, investment in alternatives, and ongoing engagement in policy reform will be essential to ensure seniors receive the care they deserve in the setting they prefer.

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¹ Congressional Budget Office, Federal Healthcare Outlook 2025–2035
² Barbara Merrill, ANCOR Policy Brief, March 2025
³ Kaiser Family Foundation, Medicaid Enrollment Tracker, April 2025
⁴ Amivie Health, Testimony to House Budget Committee, June 2025

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

©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

Alora is CHAP Verified

by Rowan Report | Jul 24, 2025 | Partner News

FOR IMMEDIATE RELEASE

Contact: Alora Healthcare Systems
Media@AloraHealth.com
800-954-8250

Alora Healthcare Systems Earns CHAP Verified Status for Home Health, Hospice, and Home Care Software

ATLANTA, July 23, 2025 — Alora Healthcare Systems, a leading provider of cloud-based solutions for post-acute care, announced this week that its full suite of software solutions – Home Health, Hospice, and Home Care, has earned CHAP Verified status from CHAP, Inc. (Community Health Accreditation Partner).

This designation confirms that Alora’s solutions meet CHAP’s highest standards in operational excellence, compliance, and quality improvement. The verification process included a detailed review of Alora’s functionality and alignment with CHAP’s Standards of Excellence. CHAP verified that Alora’s software fully supports compliance and actively enhances care delivery.

“The Alora team consistently delivers impressive software across Home Health, Hospice, and Home Care, marked by its user-friendly interface, extensive customization options, and powerful tools for operations and compliance. Their dedication to listening to customer feedback is evident in continuous enhancements like the OASIS-E analyzer, real-time reporting, and integrated HR and billing platforms, all designed to meet individual care needs and regulatory requirements efficiently.”

Teresa Harbour

COO, CHAP, Inc.

CHAP Verified status highlights Alora’s ability to support agencies in achieving compliance while advancing post-acute care technology. The platform is designed for efficiency, enabling high-quality, patient-centered care amid a changing regulatory landscape.

Sathish John, CEO of Alora, remarked, “This achievement is a direct reflection of our mission to simplify workflows for clinicians, administrators, and caregivers, while focusing on compliance, quality, and feedback.”

Alora’s comprehensive platform includes tools for documentation, billing, scheduling, visit verification, compliance, HR, and more, providing a streamlined experience for both skilled and non-skilled care.

This recognition strengthens Alora’s commitment to empowering home-based care agencies with CHAP Verified solutions that drive excellence and regulatory confidence.

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About Alora

Alora is a leading provider of cloud-based home care software, home health software, and hospice software, for agencies across the U.S. Known for its intuitive interface and award-winning support, Alora delivers robust, integrated tools that empower agencies to streamline operations, ensure compliance, and focus on patient care.

About CHAP

CHAP is the nation’s first accrediting body for home and community-based healthcare organizations. As an independent, nonprofit accrediting body, CHAP advances the highest standards of community-based care.