Almost Family Takes on Regulations With State-Level Approach

As the home health care industry continues to pursue all options to reduce the burdens of new and incoming laws and regulations, one major provider is taking its agenda into its own hands.

Louisville, Kentucky-based Almost Family (Nasdaq: AFAM) has found success by advocating on its own, without the help of outside lobbying resources. The company, which is one of the largest home health care providers in the nation, has taken a state-by-state approach to achieve some of their goals, including getting bills introduced to simplify managed care payment and care delivery systems.

By comparison, other industry organizations and associations, like the National Association for Home Care & Hospice, have worked on pushing through reforms at the federal level and are taking aim at legislative opportunities with a relatively new Congress that may be more favorable to fewer requirements and major health care changes. The Visiting Nurse Associations of America (VNAA) is eyeing new opportunities to relieve burdens by pushing through cuts to regulations—a strategy more in line with the new Trump administration.


Almost Family’s lobbying team is bare bones—just “two men and a truck,” according to Denis Fleming, Jr., vice president of government relations with Almost Family. Fleming also works with Coulter Minix, director of government relations at Almost Family, on advocacy efforts.

“Our experience is unique and also uniquely successful,” Fleming told HHCN of the company’s approach.

While the company also focuses on helping push through changes at the federal level, a state-by-state approach is working, according to Fleming.


Almost Family is working closely with lawmakers in Tennessee and Wisconsin to get managed care bills on the table to ease burdens.

While the industry has continually seen cuts in home health reimbursements rates as part of rebasing, Almost Family has been advocating for higher reimbursements rates for personal care programs in a few states.

In Wisconsin, Almost Family helped get a 4% increase for the state’s personal care program into Gov. Scott Walker’s budget. The budget includes a 2% increase of $5,034,000 for fiscal year 2017-2018 and another 2% increase of $9,936,300 for fiscal year 2018-2019. The increase is the first rate change in nine years.

If it passes, the increase will likely help reduce turnover among care staff in Wisconsin, where Almost Family saw rates as high as 50% to 60%, according to Fleming. Almost Family has a growing presence in Wisconsin, after the company acquired ResCare assets in the state in 2016.

Turnover is nearly just as bad in Ohio, where gradual cuts to home care and licensed nursing rates has reduced pay for these workers by about $1 less per hour than a decade ago. Ohio Gov. John Kasich’s budget recently included a 5% proposal for higher wages for personal care direct support staff. Fleming said their data played a role in securing the rate increase.

Unique Connections

While Almost Family also works with industry organizations and associations, the company is unique in its strategy to go it alone, for the most part. Taking issues right into lawmakers’ offices, Fleming sees the value in working directly with public officials and “energizing” caregivers to show their work—the challenges and the successes—first-hand.

“We lead not with outside lobbyists but with our CEO Bill Yarmuth and President Steve Guenther, who each have 25-plus years with the company,” Fleming said. “They are policy oriented and data driven. We are convinced it’s more authentic to have the actual operators and caregivers propose policy, particularly at the federal level.”

This approach may be successful for other reasons, including cozy connections in Washington, D.C. Fleming himself has a background working in politics, having worked as general counsel to the Governor of Kentucky and as chief of staff to a Congressional member for eight years.

At the federal level, Almost Family was the only home health care company that testified before the Congressional Ways and Means Health Subcommittee on value-based purchasing.

Looking ahead, Fleming and co. are continually focused on getting higher rates approved, putting guardrails on home care audits and piloting home care presumptive eligibility.

Written by Amy Baxter

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