Lawsuit: ‘Big Sharks’ Keeping ‘Small Fish’ Out of Home Health Market with Certificate of Need Laws

Two Nepalese immigrants who were barred from opening a home health agency due to Kentucky’s certificate of need law are now taking on the state in a lawsuit. Business partners Dipendra Tiwari and Kishor Sapkota had plans to open a home health agency that served the Bhutanese refugee population in the Louisville area. The idea […]

Why PDGM Neutrality May Be Easier Said Than Done

Home health stakeholders have closely followed skilled nursing facility (SNF) operators during their transition to the Patient-Driven Payment Model (PDPM), another Medicare payment overhaul that launched Oct. 1. So far, those observations have largely focused on how SNF operators have shifted their therapy strategies in response to PDPM, which is similar in design to the […]

National Home Health Spending Hits Record $102.2 Billion — With Room for Growth

National home health spending soared to new heights in 2018, a fact that strongly reflects the ongoing shift toward home- and community-based care and away from hospitals, skilled nursing facilities (SNFs) and other institutional settings. Overall, U.S. home health spending officially hit $102.2 billion in 2018, according to a new analysis from the Centers for […]

Despite $5.32B Decrease, CMS Likely to Keep Foot on Improper Payments Gas Pedal

The Medicare fee-for-service improper payment rate has fallen once again, thanks largely to the cleaner paperwork and ongoing compliance efforts of U.S. home health providers. Despite clear and steady progress in bringing improper payment rates down, though, the Centers for Medicare & Medicaid Services (CMS) is unlikely to relax its oversight anytime soon, industry leaders […]

Addus CEO Lauds Illinois Rate Increases

Over the years, Addus HomeCare Corporation (Nasdaq: ADUS) has faced its fair share of Illinois budget woes. But the company has finally received some positive news, announcing Monday that the Centers for Medicare & Medicaid Services (CMS) has approved two Illinois budgeted rate increases for the next couple years. Combined, the Frisco, Texas-based Addus expects […]

Signs Point to Non-Physician Home Health Certification Initially Happening Under Medicare Advantage

A bill that would eliminate Medicare’s physician-certification policy has drawn industry-wide support. But the Centers for Medicare & Medicaid Services (CMS) may first opt to test non-physician certification through Medicare Advantage (MA) in lieu of traditional Medicare. The Home Health Care Planning Improvement Act of 2019 — H.R. 2150 — was introduced in April. If […]

Breaking Down the Latest Home Health Compare Update

Home Health Compare has undergone its latest round of updates. Once again, nearly all measures saw improvement. The Centers for Medicare & Medicaid Services (CMS) officially updated Home Health Compare on Oct. 30. CMS typically updates the online tool built to educate consumers on quality of care on a quarterly basis. When it comes to […]

CMS Proposes New Rule Targeting Fiscal Integrity of Medicaid

In September, the owner and operator of an Atlanta-based in-home care provider pleaded guilty to defrauding Medicaid in a $1.2 million scheme. Shortly before that, a Boston-based in-home provider agreed to pay $1.95 million in a settlement to resolve allegations that it submitted Medicaid claims without physician authorization in August. These cases are both part […]

Aetna Medicare CMO: Home-Based Care Now Critical Part of Health Care Ecosystem

When Aetna, a CVS Health company (NYSE: CVS), announced 2020 Medicare Advantage (MA) offerings, the company set out to go beyond simply offering its members a list of benefits. Instead, the company wanted to take a more holistic approach to health, stressing that individuals’ social and personal needs play key roles in keeping them healthy.  […]