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


Forum of States Power Point Presentations

HHAC attended the annual Forum of States and NAHC conference and expo in St. Louis last week. Please see the attachments for two of the Forum of States presentations that we thought would be of particular interest to NAHC members.


7 Personas of a Caregiver Webinar and Study

Wednesday, November 30th (1:00 p.m.) 

Webinar Title: 2022 National Personal Care Workforce Data Study

Webinar Description: Join us for the unveiling of a new data study, conducted by NAHC and MissionCare Collective. In partnership with one of the world’s largest data companies, we’ve evaluated 65K+ personal care workers across more than 90 data sources. The analysis includes identification of seven personas of today’s worker and key motivations and drivers to recruit, engage, and retain caregiver talent. All attendees will receive a copy of the full report.

Speaker Bio: 

Maggie Keen is a nationally recognized expert on healthcare recruitment, retention, and motivation. She's spent the last 8 years consulting with top healthcare organizations and serves as Vice President of MissionCare Collective. Maggie regularly speaks at leading industry events across the nation, inspiring audiences to rethink their recruitment strategy. Her unique insights stem from her team's front-row seat into the complexities and challenges of the front-line labor market. Maggie’s mission is to change the culture of care, to bring meaning and purpose to care careers, and to imagine a world where both care workers are more inspired and patients get the care they need.

Registration Link:

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