In the News

Fixing the ‘Toxic’ Home Health-Medicare Advantage Relationship

Home Health Care News | By Andrew Donlan

The home health industry’s battle with Medicare Advantage (MA) plans for fair rates has gone from a few stakeholders saying “the quiet part out loud” earlier this year to nearly every major provider in the country talking about the issue with regularity.

My colleagues and I have covered the topic extensively. But we’ve moved beyond the question of how providers feel about MA rates for home health and moved onto the next: How can the problem be solved?

Taking a step back, here are a few of the certainties we know:

  • All signs point to MA being the dominant insurer type among Medicare beneficiaries by the end of the decade.
  • MA pays far lower rates for home health services compared to fee for service (FFS). Encompass Health Corporation (NYSE: EHC) said this week that MA rates are at a 40% “discount” compared to FFS. Intrepid USA Healthcare Services confirmed that number was about in line with its experience – and even suggested the rates were sometimes lower than that.
  • Two companies with significant market share in MA – Humana Inc. (NYSE: HUM) and UnitedHealth Group (NYSE: UNH) – have already – or are in the process of – acquiring two of the largest home health providers in the country in Kindred at Home and LHC Group Inc. (Nasdaq: LHCG), respectively.
  • Some have described MA as the federal government’s “darling.” But the Office of Inspector General (OIG) recently published a report condemning MA organizations for limiting beneficiaries’ access to necessary care and denying payments to providers for services that are covered under Medicare and MA billing rules.

“It’s been a challenge because, not only is the rate lower, but the processing of the claims is 6 to 8 times harder for your back office revenue cycle,” Intrepid USA CEO John Kunysz told me. “They just put in so many hurdles.”

Based in Texas, Intrepid USA providers home health and hospice services, with over 60 locations spanning across 17 states.

In this week’s exclusive, members-only HHCN+ Update, I explore the tumultuous relationship between the home health industry and MA, and also try to highlight some potential solutions for the road ahead.


Notice of Proposed Rule: Employee or Independent Contractor Classification Under the Fair Labor Standards Act, RIN 1235-AA43

On October 13, 2022, the U.S. Department of Labor published a Notice of Proposed Rulemaking (NPRM) to revise the Department’s guidance on how to determine who is an employee or independent contractor under the Fair Labor Standards Act (FLSA). The NPRM proposes to rescind a prior rule, Independent Contractor Status Under the Fair Labor Standards Act (2021 IC Rule),  that was published on January 7, 2021 and replace it with an analysis for determining employee or independent contractor status that is more consistent with the FLSA as interpreted by longstanding judicial precedent. The Department believes that its proposed rule would reduce the risk that employees are misclassified as independent contractors, while providing added certainty for businesses that engage (or wish to engage) with individuals who are in business for themselves.

The initial deadline for interested parties to submit comments on the NPRM was November 28, 2022. On October 26, 2022, the Department published a notice in the Federal Register, extending the deadline to submit comments by 15 days. The Department encourages interested parties to submit comments on this proposal by December 13, 2022 (the new deadline). The full text of the NPRM, as well as information on the deadline for submitting comments and the procedures for submitting comments, can be found at The NPRM’s comment period closes at 11:59 p.m. ET on December 13, 2022.

Anyone who submits a comment (including duplicate comments) should understand and expect that the comment, including any personal information provided, will become a matter of public record and will be posted without change to The Wage and Hour Division posts comments gathered and submitted by a third-party organization as a group under a single document ID number on, including any personal information provided.


Revised Guidance for Staff Vaccination Requirements

The Centers for Medicare & Medicaid Services (CMS) released QSO-23-02-ALLRevised Guidance for Staff Vaccination Requirements. CMS is revising its guidance and survey procedures for all provider types related to assessing and maintaining compliance with the staff vaccination regulatory requirements.

To learn more and view the memo, visit the Policy & Memos to States and Regions website


CareAcademy Training System Discount for AHH Members & Partners 

CareAcademy provides high-quality, state-approved training for home health agencies, home care agencies, franchise systems, and payors that increases learner knowledge for better health outcomes. With easy-to-use, web-based courses and a robust administrator platform, CareAcademy offers education and compliance solutions for home care and home health organizations of all sizes, small agencies to multi-state enterprises. Tailored training packages are available with a 10% discount for APTA Home Health members; please schedule a time to learn more:


RSV, Other Viruses Making it Hard to Find a Bed in Children’s Hospitals 

Washington Post | By Fenit Nirappil and Ariana Eunjung Cha

Children’s hospitals are under strain in the United States as they care for unusually high numbers of kids infected with RSV and other respiratory viruses.

It’s the latest example of how the pandemic has upended the usual seasonal patterns of respiratory illnesses, denying a respite for health-care professionals ahead of a potential hectic winter as the coronavirus, influenza and other viruses collide.

Respiratory syncytial virus, a common cause of cold-like illness in young children known as RSV, started surging in late summer, months before its typical season from November to early spring. This month, the United States has been recording about 5,000 cases per week, according to federal data, which is on par with last year but far higher than October 2020, when more coronavirus restrictions were in effect and very few people were getting RSV.

“It’s very hard to find a bed in a children’s hospital — specifically an intensive care unit bed for a kid with bad pneumonia or bad RSV because they are so full,” said Jesse Hackell, a doctor who chairs the committee on practice and ambulatory medicine for the American Academy of Pediatrics.

Nearly three-quarters of pediatric hospital beds are occupied, according to federal health data. Rhode Island, the District of Columbia and Delaware report more than 94 percent of pediatric beds occupied. Maine, Arizona, Texas, Kentucky, Oklahoma and Missouri reported between 85 and 90 percent of beds occupied. The data is limited to facilities that report the information.

Several children’s hospitals in the D.C. area have been at capacity for weeks; 18 children were waiting for a room in the ICU on Tuesday at Children’s National in the District.

D.C. Realtor Kate Foster-Bankey was more attuned to RSV after she started hearing from clients whose children were afflicted with the virus in recent weeks, including one whose child was admitted to Children’s National.

Then her 3-year-old daughter Isabelle fell ill, becoming lethargic, complaining of a fast heartbeat and not eating. They waited two hours in the packed waiting room of a pediatric urgent-care center where Foster-Bankey, a mother of four, was used to seeing only a handful of patients.

During a follow-up visit Tuesday, Isabelle was transported by ambulance to the emergency room of a children’s hospital, where she tested positive for RSV and had to wait until the following morning for a bed.

“It sounds like in covid, we gutted our pediatric care,” said Foster-Bankey, 41. “Kids shouldn’t have to wait in a waiting room with a bunch of other sick kids for hours.”

At Connecticut Children’s Hospital, the emergency room is so full that patients are being triaged in hallways. Teens with bone fractures and appendicitis are being diverted or transferred to adult-care centers to create additional space for respiratory patients. Hospital officials are considering the possibility of enlisting the National Guard to set up tents and care for the influx of patients.

Over the past nine days, 110 children with RSV have come in to the emergency room, and at times as many as 25 children with RSV were waiting for an inpatient bed, said Juan Salazar, physician in chief at Connecticut Children’s. He said that for the first time in his career he has had to mandate doctors in other specialties such as endocrinology and rheumatology work with RSV patients — a situation reminiscent of the “all hands on deck” approach many adult hospitals took in March 2020, when the coronavirus began to sweep through the United States.

“During my tenure here I haven’t seen anything like this,” said Salazar, who has worked in infectious diseases for 30 years.

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