Alliance 2024 Wins

In 2024, the National Alliance for Care at Home achieved numerous milestones, securing policy victories, advancing positive regulatory changes, and delivering critical resources and education to our members. Some highlights include:

Policy/Advocacy: Delayed implementation of the Hospice Special Focus Program (SFP) and the publication of the SFP bottom ten percent list, and secured telehealth flexibility extensions for both hospice and home health providers.
Regulatory Successes: Addressed burdensome audit concerns and influenced CMS rulemaking to better align with member needs.
Member Support: Provided direct member support on case-specific issues with CMS and Medicare Administrative Contractors (MACs) and launched toolkits and educational programs to enhance care quality, compliance, and strategic awareness of policy developments.
Grassroots Impact: Both legacy organizations hosted the largest gatherings on the Hill since the pandemic, with over 180 Congressional offices engaged. As the Alliance, we stand stronger than ever to amplify your voice and advocate for the funding and resources necessary to continue delivering high-quality care in the home.
Media Engagement: The Alliance has been active in the media, advocating for our members’ interests and ensuring your voice is prominently heard. The Alliance dominated media coverage of our sector this year, clearly positioning ourselves as the unifying voice and advocate for the care at home community.

Service Line Highlights

Home Health

Policy:
- Achieved a three-month extension of telehealth for the home health Face-to-Face Encounter from any geographic location including when the patient is in their home.
- Successfully mitigated significant Medicare rate reductions for calendar year 2025.
Regulatory:
- Resolved problematic home health audits by securing a correction to the incorrect interpretation and enforcement of conditions of participation as conditions of payment.
- Provided direct member support on case-specific issues, escalating numerous home health provider issues within various agencies.
- Influenced CMS through continued advocacy to allow therapists to conduct the initial and comprehensive assessments in all cases, which resulted in the agency implementing a Request for Information towards this change.
- Influenced CMS by providing recommendations on Conditions of Participation and interpretive guidelines, resulting in CMS revising the guidelines incorporating our recommendations.
Member Education and Resources:
- Delivered a comprehensive series of webinars addressing critical topics, including compliance and quality improvement, enabling our members to navigate through an increasingly complex legislative and regulatory landscape.
- Developed an Admission to Service Policy resource guide, providing actionable insights for our members.

Hospice

Policy:
- Achieved a three-month extension of telehealth for the hospice Face-to-Face Encounter, enabling our members to better meet the needs of their patients in their communities.
- Secured a delay in the Hospice Special Focus Program and the publication of the bottom ten percent list, enabling further analysis and continued conversations with the hospice community.
- Supported the Elizabeth Dole 21^st Century Veterans Burial and Veterans Healthcare and Benefits Improvement Act, correcting a current oversight that Veterans who elect Veterans Affairs (“VA”) hospice care outside of a VA facility may not be entitled to their full burial benefit.
- Influenced CMS in its decision to terminate the hospice component of the Value-Based Insurance Design (VBID) Demonstration on December 31, 2024.
Regulatory:
- Successfully influenced CMS to include Marriage and Family Therapists and Mental Health Counselors as optional instead of required members of the hospice interdisciplinary group.
- Secured delay of and corrections to certifying physician enrollment claims edit logic, reporting requirements and provider guidance.
- Achieved removal of problematic hospice benefit certification guidance issued by CMS within 24 hours of outreach, which would have improperly redefined when hospice certifications are required.
- Secured nationwide claims adjustments to ensure hospice’ claims were properly processed and provided direct member support to escalate certifying physician enrollment challenges with the MACs, resolving costly denials and service disruptions.
- Successfully engaged with the CMS Center for Program Integrity to address concerns about audit contractor practices and collaborated with other national associations representing hospice providers to address hospice program integrity concerns.
- Secured corrections to the Hospice Election Statement and Election Statement Addendum, to mitigate auditing errors.
- Secured a one-year extension of the telemedicine prescribing of controlled medications waiver, allowing terminally ill patients to receive timely medications.
- Provided direct member support on case-specific issues, escalating numerous hospice provider issues within various agencies.
Member Education and Resources
- Launched a Best Practices in Dementia Care and Ethical Dilemmas in Health Equity educational series.
- Delivered a comprehensive series of webinars addressing critical topics, such as the Hospice Special Focus Program, certifying physician enrollment, among other topics, enabling our members to prepare for evolving regulatory threats and opportunities.
- Published a Hospice Staffing Framework, developed with input from a combined Quality and Regulatory workgroup, representing the first revision since 2018.
- Published a Partnership in Care: Best Practices for Hospice Provider and Facility Collaboration toolkit, developed with input from a combined Quality/Regulatory workgroup, to support our hospice members caring for patients in facilities.
- Developed a Charting a Course to Quality: Hospice Quality Reporting Program Toolkit – comprehensive HQRP resource guide for our hospice members.
- Developed numerous Special Focus Program toolkits and resources, enabling our members to better prepare and adapt to the Program.
- Successfully collaborated with five national associations representing hospice and palliative care professionals to develop a Hospice Certifying Physician Edit Clarification – A Resource for Providers.

Palliative Care

Policy:
- Successfully engaged with CMS Innovation Center teams focused on GUIDE and Making Care Primary models to emphasize the importance of palliative care’s role in new models and demonstrations.
Member Education and Resources:
- Hosted a four-part webinar series focused on building and growing palliative programs.
- Published a Palliative Care Billing Toolkit in May 2024 to inform our members of the various ways palliative care is delivered and can be compensated.

Home Care

Policy:
- Supported multiple legislative bills, including the Elizabeth Dole Home Care Act, Credit for Caring Act, SAVE Act, Recognizing the Support of Direct Care Professionals Act, Healthcare Workforce Resilience Act, Immigrants in Nursing & Allied Health Act, among others, to facilitate a strong and robust home care workforce.
- Opposed the Domestic Workers Bill of Rights Act, advocating for fair provider standards.
Regulatory:
- Successfully contributed to significant regulatory rule reversals, including the Department of Labor Independent Contractor final rule, Joint Employer rule, Federal Trade Commission ban on non-compete agreements, among others.
- Influenced federal guidance by submitting comments in support of the proposed Federal Adult Protective Services guidelines.
- Highlighted workforce challenges through submission of comments requesting inclusion of LPNs, home health aides, and caregivers in the Modernized Schedule A of the Labor Certification for Permanent Employment of Foreign Workers in the United States.
- Submitted comments requesting a specific carve out for home care in OSHA’s Heat Injury & Illness Prevention proposed rule.
Member Education and Resources:
- Provided a quarterly home health industry updates webinar series through a continued partnership with Polsinelli, which is set to continue in 2025.
- Hosted The State of the Direct Care Workforce webinar series jointly with the MissionCare Collective, providing valuable insights to our members.
- Released the State of the Direct Care Workforce Report jointly with MissionCare Collective, highlighting workforce trends.
- Filmed a “One Voice Many Stories” interview series and released in partnership with MissionCare Collective.
- Developed workplace violence tools and resources through a Safety Task Force.

Medicaid Home and Community-Based Services

Policy:
- Established quarterly meetings with CMS leadership to address Medicaid-related issues and promote collaborative problem solving.
- Contributed to the introduction of legislation (HR 8114) that would repeal the Medicaid 80-20 rule.
- Successfully influenced CMS through our advocacy which led to guidance regarding Medicaid renewals for older adults and people with disabilities.
- Engaged in Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) advocacy efforts which led to the removal of a cap on private duty nursing hours in North Dakota.
Regulatory:
- Successfully secured positive changes to the Medicaid 80-20 proposed rule, including a longer implementation timeline (2030), nurse supervision included in the 80% calculation, “excluded” services of travel, training, and PPE, and secured hardship and small provider exemptions.
Member Education and Resources:
- Hosted webinars on Access and Managed Care final rules, enabling members to be fully informed and actively prepare for changes.
- Provided an analysis of Medicaid Long Term Services and Supports Medical Loss Ratio resource, enabling members to better understand health plan payment policy.
- Developed a survey and fact sheet on referral rejection rates and fill-rates for Medicaid services.

Pediatric Care

Member Education and Resources:
- Hosted a two-part pediatric webinar series.
- Published 75^th issue of the Pediatric e-Journal.
- Created a resource to help our members work with private insurers to cover concurrent care for pediatric patients.
- Launched the most comprehensive pediatric hospice and palliative care needs assessment to date with almost 300 responses.

Grassroots Highlights

Hospice Action Week: From across the full spectrum of hospice and palliative care providers and stakeholders, including state association leaders, C-suite members, medical directors, nurses, volunteer coordinators, and more.
- Over 100 advocates attended, representing the largest Hospice Action Week gathering since the pandemic.
- Over 150 Congressional offices were visited, representing the largest Congressional office reach Hospice Action Week has had since the pandemic.
- Visits included 58 Senate offices, 98 Representative offices.
- Meetings were with members of all political parties, including offices of Speaker Mike Johnson and Leader Chuck Schumer.
- Advocates engaged with Congressional hospice champions, including a majority of House Ways and Means Committee members and members of the Senate Finance Committee.
- Advocates represented 34 states across the nation.
- More than 1/3 of attendees had never participated in any Congressional legislative visits on Capitol Hill previously.
- For the first time, included a large cohort of Veterans providers.
HAN Grassroots Stats:
- Highest influx of new advocates since 2021, with a 114% increase since last year and a 13% increase overall since 2021.Highest rate of participation per action alert since 2021, with a 26% increase compared to last year and an 11% increase overall since 2021.Highest average messages sent to Congress per alert since 2021, with a 12% increase since 2021 and a 37% increase compared to last year.
- Alert on Telehealth (supportive of the Hospice Recertification Flexibility Act) was highest participated in Action Alert since 2021, with the second highest # of messages sent to Congress on an alert since 2021.

Media Highlights

The Alliance in the News and Media

Our accomplishments this year are a testament to your voice and your passion for the delivery of high-quality care. We will continue to be your advocate, resource, and network, and now, we have more strength than ever before to help you achieve your goals now and in the future. As we move into the new year, we remain steadfast in our commitment to supporting your efforts, advocating for our field, and driving innovation in the home.

Thank you for your continued support and trust in the Alliance. We look forward to achieving even greater heights together in the year ahead.

We are stronger together.