Less than a month before election day, the Democratic and Republican candidates for president are dueling over home-based care plans.

Vice President Kamala Harris announced on “The View” this week a proposal that would allow home care to be administered through traditional Medicare.

On the same day, former President Donald Trump and his campaign released a rebuttal, pointing toward home care-related policy implemented from 2017-2020, plus additional plans for a potential second term.

Harris’ proposal is a more lofty one. It would also – if implemented – create a massive tailwind for home care providers across the country. But, as LeadingAge President and CEO Katie Smith Sloan pointed out after the proposal, “we cannot overstate that without staff, there is no care.”

Trump, meanwhile, pointed to expanded supplemental benefits in Medicare Advantage (MA) as a way for seniors to access more home care-related services. His campaign team also focused on economic points that it believes will make aging in place easier for Americans under his leadership.

In this exclusive, members-only HHCN+ Update, I make the mistake of venturing into the presidential candidates’ plans for home-based care. Specifically, I examine how viable the plans are, and what they could mean for providers, if implemented.

Home-based care takes center stage

Home-based care providers were likely pulling their hair out over the predictable confusion that arose from Harris’ proposal Tuesday.

Home health care is already a robust benefit provided under the Medicare program, and generally includes services delivered to seniors after an acute health event.

Home care is not currently available under traditional Medicare, however, and generally includes non-medical services to help with activities of daily living.

The only place where home care is paid for under Medicare is through MA supplemental benefits, and MA pays for just a sliver of all home care provided currently.

So, yes, Harris’ proposal would be groundbreaking, if implemented. It would completely change the scope of the Medicare program.

As for the companies it would directly impact, pick a notable name in home care.

Currently, home care providers have a large addressable market: seniors with the ability to pay out of pocket for home care services; Medicaid beneficiaries in need of home- and community-based services (HCBS); veterans in need of home care, paid for through Veterans Affairs (VA); and a small portion of MA beneficiaries and long-term care insurance clients.

If home care were paid for by Medicare in the future, that would take the concept of “unlimited demand” to a new level. There are over 30,000 home care agencies in the country, almost all of which would have a new market opportunity if Medicare became another means to pay for home care.

The one potential downfall for providers would be former private-pay home care clients being able to use Medicare to pay for services. Private-pay home care doesn’t come without challenges, but it remains one of the most profitable forms of home-based care business.

Home health providers – which already provide care to Medicare beneficiaries, almost exclusively – would also see a business boon. Many of them already provide home care, and the ability to care for clients through one revenue source in both service lines would be massively beneficial.

After all, home-based care is responsible for one of the only successful Center for Medicare and Medicaid Innovation (CMMI) demonstrations of late. The Home Health Value-Based Purchasing (HHVBP) Model – now implemented nationwide – has already saved Medicare billions, and is likely to save many more billions moving forward.

“We think access to personal care services could at least double from six million customers today. By our estimate, the extra spending would expand the [total addressable market] by ~30% to $110 billion per year,” Macquarie Capital wrote in an analyst note this week. “Since Medicare covers home-based medical services, we expect a wider adoption of the integrated care model following added personal care services coverage. This could also expedite the transition to value-based care. Providers could benefit from aligned incentives, streamlined operations and cost synergies.”

Then comes the question of viability, however.

Harris is not the first person to propose such an idea. Home care stakeholders have suggested it for years, but so have other policymakers.

“When the Affordable Care Act was passed, a component similar to this was included and that ultimately was stripped out,” Tyler Giesting, a director of health care and life sciences at West Monroe, told me this week. “I think we’ve seen it fail in the past for reasons that come down to: can it be economically viable? The challenge would be getting something like this passed, in the way that it has been described so far.”

The Harris campaign has suggested that it would pay for the proposal, in part, by cutting Medicare payments for drugs. It estimated that the proposal would cost around $40 billion per year.

But other estimates suggest that it would cost closer to $400 billion.

Harris sees the proposal as a way to aid the “sandwich generation” – adults that have aging parents to take care of, as well as children. Those responsibilities make it tough to maintain employment.

For Harris, the key would be to convince the right stakeholders of the overall value of home care. It wouldn’t be enough to just prove that more Americans could continue contributing to the economy if they had additional help at home for their older relatives.

Harris’ team would need to instead pitch this as a long-term cost savings project. If more seniors had access to home care, less seniors would be driving up U.S. health care costs in hospitals, emergency rooms and more costly brick-and-mortar facilities.

That is already a battle home care providers face. They are regularly trying to convince payers that more home care equals less overall cost. But a concrete plan, and concrete evidence of those potential savings, would have to be laid out.

“It’s one thing to have this idealistic proposal perspective, and it’s another to actually put it into action with a detailed plan,” Giesting said. “Then, there’s also getting it passed and put into law.”

A detailed plan is key. Even if we accept the idea that more access to home care could ease burden on Americans, while also keeping overall health care costs down, the implementation of the proposal through Medicare would need to be tirelessly thought out.

For instance, New York’s Consumer Directed Personal Assistance Program (CDPAP) – which allows family members to be paid to care for loved ones in need of home care – has been a fiscal disaster for the state.

Self-directed care has potential. It allows unpaid caregivers to be compensated, and for home care recipients to direct their own care. But it’s also hard to oversee.

For what it’s worth, if the proposal did move forward, I think the best way to go about it would be to prioritize care from existing, quality home care agencies. Agencies that train and vet their caregivers, ones that have been providing care professionally for a long time.

Trump proposals

The Trump campaign’s home care proposals are more understated. And, like Harris’ plans, more details would be needed to project true impact – for potential home care beneficiaries and providers.

“President Trump will prioritize home care benefits by shifting resources back to at-home senior care, overturning disincentives that lead to care worker shortages and supporting unpaid family caregivers through tax credits and reduced red tape,” the Trump campaign wrote in a release, in preparation for Harris’ announcement this week.

The campaign also evoked MA supplemental benefits. MA supplemental benefits – through the primarily health related pathway and the Special Supplemental Benefits for the Chronically Ill (SSBCI) pathway – were created during Trump’s presidential term.

The benefit that allows for home care services is dubbed In-Home Support Services (IHSS). MA plans have pulled back on offering IHSS in 2024, however.

“The Trump administration provided new Medicare Advantage supplemental benefits that included modifications to help keep seniors safe in their homes, respite care for caregivers, transportation coverage, additional in-home support services and assistance and non-opioid pain management alternatives,” the release continued.

The campaign also pointed out other indirect factors that have led to home care inaccessibility of late, such as inflation, which it believes it can continue to bring down.

Spotlight and policy

Home-based care being in the nationwide spotlight is a good thing for providers and older Americans.

But it’s also worth taking stock of where that spotlight has gotten us before. The Biden-Administration has been laser-focused on home care, but mostly HCBS through Medicaid.

Meanwhile, home health providers have been left behind. Advocates are in the throes of a three-year long fight against continued rate cuts from the Centers for Medicare & Medicaid Services (CMS), as other home-based care proposals are taking shape from both campaigns.

Home health providers are seeing their traditional Medicare payments cut, while also receiving payments from MA plans that often don’t cover the cost of care. All the while, MA penetration continues.

In April of 2023, I wrote about why federal support for home-based care is missing the mark.

While proposals from both campaigns this week contain some good elements, that fact remains true.

As home-based care takes center stage once again, Medicare-certified home health providers are forced to stand behind the curtains, at a time when their margins are evaporating.

“I would also want to remind the Biden, Harris administration that the existing Medicare home health program is under assault currently, and has been since 2020, with billions of dollars in cuts that have diminished access to care, so I think that investment and a stabilization of the existing Medicare home health benefit is something that is also needed,” Partnership for Quality Home Healthcare CEO Joanne Cunningham told HHCN this week. “With this news, I would just offer that recommendation and reminder.”

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The need for a new ICD-10 code for sepsis survivors was spurred by findings from a VNS Health study showing that sepsis was noted in admission assessments only 7% of the time. This caused researchers to question whether home health providers were aware that a patient had been diagnosed with sepsis. The study also identified the risk factors associated with early readmission of sepsis survivors.

“Having an ICD-10 code for sepsis aftercare lets providers know when a patient discharged to them is a sepsis survivor,” Dr. Kathryn H. Bowles, director of the VNS Health Center for Home Care Policy & Research, told Home Health Care News. “When people are hospitalized for sepsis, they are not discharged until the illness is resolved. When sepsis is resolved, it falls to the patient’s history and may not be included in the current problem list communicated during the transition to post-acute care.”

VNS Health provides home, hospice, and personal and private care services in New York. The Center for Home Care Policy & Research conducts research to support home- and community-based services and inform decision-making providers, policymakers and consumers.

“Because sepsis has a high readmission rate mainly due to recurrence, any patient who has had sepsis is at risk, and many suffer a long recovery dealing with the after-effects of sepsis,” Bowles continued. “Research showed timely attention the first week after sepsis discharge effectively decreases 30-day readmissions. If the next level of care doesn’t know the patient is a sepsis survivor, providers cannot activate effective protocols for prevention. The new code will alert the next level of care.”

An ongoing study by the same research team revealed the lack of a diagnostic code to identify sepsis survivors after discharge. Home health personnel explained that because sepsis is an acute care condition treated and resolved in the hospital, they cannot place it on the home care record. The study provided evidence that because of this communication gap, home care providers and clinicians may not be prompted to give the attention and close monitoring that sepsis recovery warrants.

“As our team discovered, there was a serious communication gap between hospitals and post-acute care providers when it came to caring for sepsis survivors,” Bowles said. “Without knowing an incoming patient had recently survived sepsis, home care providers were missing an important piece of the puzzle in determining a plan of care. Because there was no aftercare code, sepsis survivors were being coded as having pneumonia or urinary tract infection, or ‘other aftercare.’ However, as we know, knowledge is power, and with this code, home care teams and patients are empowered. They can provide the necessary care to avoid a recurrence of sepsis and preventable hospitalizations or death.”

Following the publication of these findings, the research team led an advocacy effort to persuade the CDC to adopt a diagnostic code defining sepsis aftercare as a separate condition. The new code was accepted and announced in July and took effect Oct. 1.

“Knowing the patient is a sepsis survivor alerts the team to activate evidence-based protocols for timely start of care and outpatient follow-up, close surveillance, antibiotic stewardship and patient teaching,” Bowels explained. “Sepsis strikes fast, so patients and caregivers must be educated to monitor their temperature, take their medications as prescribed and call their home care providers immediately if they feel worse.”

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The report found that patients receiving care through the program differed demographically from those at traditional inpatient facilities. Generally, hospital-at-home (HaH) patients were more likely to be white, live in urban areas, and less likely to receive Medicaid or low-income subsidies. These differences may be due to the criteria established by participating hospitals to identify suitable patients for this type of care.

Patients receiving care at home generally experienced fewer catheter-associated urinary tract infections. Mortality rates were also lower. Those with less complex respiratory and infectious conditions had lower 30-day readmission rates than those in traditional inpatient settings. However, readmission rates for patients with more complex respiratory infections were higher for those receiving care at home.

The study found that patients receiving care at home through the initiative resulted in lower Medicare spending during the 30-day post-discharge period. Furthermore, even though at-home patients received the same services as those in traditional hospital settings, they used fewer of the same services. This suggests that hospitals experience lower costs over time when providing care to patients in their homes.

The study also revealed that at-home patients required care slightly longer than those in traditional settings, but the difference was negligible (less than a day).

Feedback collected from patients, caregivers and family members about at-home care was overwhelmingly positive. Patients reported feeling more relaxed, less anxious and less depressed at home, which seemed to facilitate their recovery. Caregivers and family members believed better health outcomes were one of the main benefits of receiving care in a familiar and comfortable environment.

“People who have been in a brick-and-mortar hospital and also cared for in their home report that they sleep better in their beds and that it is less noisy and confusing,” Nancy Foster, vice president for quality and patient safety at the American Hospital Association (AHA), recently told Home Health Care News. “For older folks who sometimes get confused when they’re away from home, this is a way for them not to experience those challenging effects of being hospitalized but still receive hospital-level care.”

Lessons learned

While the feedback received was primarily positive, it also revealed some limitations and opportunities.

One concern was the potential need for additional care, especially for patients with limited mobility. While approved hospitals are expected to provide all nursing care, including help with daily activities, CMS received feedback that, at times, family members took time off to be with their loved ones or hired extra nursing aides.

Another common concern was the program’s effective implementation. Specifically, there was potential for confusion among clinicians and hospital staff regarding the services provided and among patients about what services are covered by Medicare.

Overall, feedback from patients and caregivers aligned with existing evidence on HaH programs; they generally viewed the care provided as safe, effective and a positive experience.

“Clinicians, doctors and nurses who have been involved in the HaH program are enthusiastic about it,” Foster said. “It allows them to have a deeper relationship with their patients, to see more of what their home life is like, and to be able to advise them on how to recover well and then how to stay well from whatever condition brought them into the hospital, even if that hospital was their home.”

The waivers and flexibilities associated with the AHCAH initiative expire Dec. 31, and its future remains unclear.

“By the end of the year, Congress will need to act to extend the Medicare waiver,” Foster said. “We’ve heard considerations of a bill that would extend it for five years, but we don’t know whether that will be passed.”

Foster added that if the bill is not passed, no fee-for-service Medicare or Medicaid patient could be cared for at home.

“Congress is concerned that we can demonstrate high-quality care being delivered, that we are not putting a tremendous burden on family members or other loved ones in the home, and they have expressed concern about whether this would be equitable,” Foster said. “However, we see a dominance of people with more limited means benefiting enormously from the hospital-at-home program.”

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The agency issued an informational bulletin last month reminding states of federal renewal requirements and available flexibilities to ensure continued coverage for individuals eligible for HCBS through Medicaid. This bulletin continues CMS’ efforts to minimize coverage gaps, particularly during and after the public health emergency unwinding process, and to ensure eligible individuals retain or are re-enrolled in Medicaid.

For home care providers, a renewed government effort to clean up HCBS protocols – like in the Medicaid Access Rule – helps keep patients on census and enables better care geared toward value.

Following the end of the COVID-19 public health emergency in 2023, states restarted regular eligibility renewals for those enrolled in Medicaid and Children’s Health Insurance Program (CHIP) coverage, a process often called “Medicaid unwinding.” This included renewals for individuals who needed assistance with daily living activities.

As states restarted renewals, many individuals faced challenges renewing their coverage because of administrative barriers. States experienced unprecedented renewals, resulting in backlogs in some areas, according to CMS. Many states also experienced system and compliance issues, which the agency directed them to address.

Throughout unwinding, CMS has strongly urged states to adopt federal strategies that make it easier for eligible individuals to renew Medicaid. On Aug. 19, CMS issued guidance outlining strategies states can adopt to help eligible individuals receiving HCBS retain their coverage.

These strategies are designed to simplify eligibility and enrollment processes, maximize the use of available and accurate information, and reduce the burden on individuals and state Medicaid agencies, allowing eligible individuals receiving HCBS to maintain their coverage, independence and engagement in community life.

In accordance with the guidelines, states are required to regularly review Medicaid eligibility, in line with federal regulations, to ensure continued access to HCBS for those who are still eligible. Some of the current flexibilities that help maintain coverage and access to HCBS include collaborating with local agencies to improve “no wrong door” systems for assisting individuals in maintaining Medicaid enrollment. States can also choose to exclude some or all countable income or resources when renewing coverage for individuals receiving HCBS for a specific period of time.

No wrong door means consumers can enter any service with the expectation that if it is not appropriate for them, they will receive assistance in accessing the most relevant services.

“During the COVID-19 pandemic, the Families First Coronavirus Response Act mandated that states maintain continuous enrollment in Medicaid for people,” Home Assist Health President and CEO Sara Wilson told Home Health Care News. “However, this continuous eligibility requirement ended with the public health emergency, leading to various challenges for states transitioning out of it. These challenges included staffing shortages, training needs, outdated operating systems and communication issues. As a result, procedural errors occurred, leading to wrongful termination of participants and creating gaps in care. These gaps can pose increased financial and health risks for the individuals affected.”

Phoenix-based Home Assist Health is a nonprofit home care provider.

“HCBS enables individuals to age and recover in the comfort of their homes,” Wilson said. “Continuity in these programs is crucial in upholding this right, guaranteeing access to care, and safeguarding the health and well-being of participants.”

During the renewal process, eligibility must first be confirmed using the state’s asset verification system without requiring additional information from the individual (ex parte). Ex parte renewals are one of the most vital tools for states to keep eligible people covered and prevent terminations due to red tape, as demonstrated by CMS data last year.

“Ensuring people have access to comprehensive, high-quality health coverage is a top priority for the Biden-Harris Administration,” a CMS spokesperson told HHCN. “That is why we have urged states to take up every tool CMS made available to help eligible people renew coverage and to protect them from becoming disenrolled due to red tape as states conducted Medicaid and CHIP renewals following the end of the Medicaid continuous enrollment condition in 2023, a process often called ‘Medicaid unwinding.’

As the unwinding process demonstrated, states’ choices have real consequences for eligible people’ ability to maintain coverage during Medicaid and CHIP renewals. While states must follow federal Medicaid and CHIP requirements, they have broad flexibility within these requirements when administering their programs. States can take steps to help eligible people, including people who receive HCBS, stay covered. These steps include improving ex parte rates, taking up CMS’ strategies that make renewals easier to navigate (including strategies outlined in our recent guidance), and addressing other barriers to coverage.”

CMS issued guidance to help states adopt strategies to improve ex parte rates. With these efforts, Medicaid and CHIP ex parte rates doubled nationwide from about 25% in April 2023 to 50% of renewals due in May 2024.

The agency also recently finalized a rule that builds on critical lessons learned during Medicaid unwinding by streamlining and simplifying how people enroll in and renew Medicaid and CHIP from now on. These improvements will reportedly help millions of eligible people with HCBS enroll in and maintain Medicaid coverage moving forward.

For example, for those eligible for Medicaid based on disability, the rule prohibits states from requiring in-person interviews, requires states to provide a reasonable period for applicants to return information and documentation, and requires states to accept renewals in multiple ways, such as online, by phone, mail or in person.

Regarding compliance with renewal requirements, the guidance issued on Sept. 20 details steps that all states must take to ensure their compliance with federal renewal requirements for Medicaid and CHIP and avoid further action by CMS.

States must assess their compliance with federal requirements, submit the results to CMS, and submit a plan to resolve any issues. Building on insights from the unwinding period, this action will help ensure state compliance with key federal renewal requirements, safeguarding individuals’ ability to renew their health coverage and strengthening the integrity of the Medicaid program, according to CMS.

“HCBS is crucial for long-term care services, allowing participants to choose home-based care while promoting individual choice and control,” Wilson said. “Home care providers should work with their state Medicaid authorities to support this transition process for members.”

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The settlement is being paid to resolve allegations that Oak Street violated the False Claims Act, specifically by paying kickbacks to third-party insurance agents. The DOJ alleged that Oak Street paid kickbacks to those agents in exchange for the recruitment of seniors to its primary care clinics.

The violations occurred from September 2020 to December 2022, through Oak Street’s “Client Awareness Program,” which involved those insurance agents, who then urged seniors eligible for Medicare Advantage (MA) to consider Oak Street services. 

“Agents then referred interested seniors to an Oak Street Health employee via a three-way phone call, otherwise known as a ‘warm transfer,’ and/or an electronic submission,” the DOJ said. “In exchange, Oak Street Health paid agents typically $200 per beneficiary referred or recommended. These payments incentivized agents to base their referrals and recommendations on the financial motivations of Oak Street Health rather than the best interests of seniors.”

The settlement acknowledges that Oak Street knowingly provided kickbacks to these insurance agents during the above time period.

As part of the overall settlement, the whistleblower will receive $9.9 million.

“Health care providers that attempt to profit from kickbacks will be held accountable,” Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division, said in a statement. “We are committed to rooting out illegal practices committed by Medicare Advantage providers, insurance agents and brokers that undermine the interests of federal health care programs and the patients they serve.”

Oak Street Health is a senior-focused primary care provider. CVS Health purchased the company for more than $10 billion in 2023. Like its peer Walgreens Boots Alliance (Nasdaq: WBA), CVS has built out a significant health care services arm as part of a company evolution. In addition to Oak Street – which does provide some care in the home – CVS Health has the home-focused, value-based care platform Signify Health under its belt. It also owns Aetna.

CVS acquired Signify Health for $8 billion, around the same time it acquired Oak Street.

Oak Street’s violations came before it was officially a part of CVS.

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OHA’s Health Care Market Oversight (HCMO) program reviews health care business deals to ensure they do not harm the state’s citizens or communities. In July, both UnitedHealth Group and Amedisys submitted responses to the OHA’s request for information. The authority is still seeking public comments on this matter.

In addition to the issue in Oregon, the deal has faced scrutiny from federal antitrust regulators, including the U.S. Department of Justice (DOJ).

Amedisys and UnitedHealth agreed to sell certain locations to Dallas-based VitalCaring Group, likely to address those antitrust concerns. That deal is contingent on the UnitedHealth Group-Amedisys deal closing, however.

“On an antitrust perspective, a number of states have adopted enhanced transaction notice requirements,” Les Levinson, partner and co-chair of the Transactional Health Law Group at Robinson+Cole, said during a recent Home Health Care News webinar. “There is a heightened interest in agencies being subject to a higher regulatory review. I think it’s something we have to pay attention to.”

UnitedHealth Group first agreed to purchase Amedisys – one of the largest home health providers in the country – in June 2023 for $3.3 billion.

According to comments published on the OHA website, the deal is not well-received by some groups in Oregon.

Mid Valley Health Care Advocates, based in Corvallis, Oregon, urged the OHA to deny the acquisition application, for instance.

“We are concerned that [UnitedHealth] as an insurer, and through Optum as a clinical provider and potentially as a home health and hospice provider, have the incentive and the ability to unfairly disadvantage competing providers and drive them from the market, reducing consumer choice,” the group said in a statement.

Another comment by the Oregon Nurses Association (ONA) read, “[UnitedHealth’s] track record of driving up profit margins at the expense of patients is not in alignment with Oregon values. Oregonians deserve high-quality, affordable health services; we are concerned that [UnitedHealth] will fail to provide that care if doing so interferes with their profitability. ONA urges OHA to reject the acquisition of Amedisys.”

With all that said, it is possible that a DOJ clearance of the deal could ultimately influence OHA’s decision, and move up the timeline to closure.

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Care.com is an online platform that connects people seeking to hire workers for various jobs – such as child and older adult care, care for individuals with special needs and pet sitting – with those looking for work. To contact job posters or seekers, users must purchase an auto-renewing paid subscription.

According to a federal complaint, the FTC alleges that Care.com’s marketing statements about the number of jobs available on its site and the income workers could expect were deceptive.

Care.com has agreed to a settlement that mandates it to refund $8.5 million to customers who were harmed by its practices. Additionally, the company is required to substantiate its earnings claims and accurately represent the number of jobs available through its platform.

“Care.com used inflated job numbers and baseless earnings claims to lure caregivers onto its platform and used deceptive design practices to trap consumers into subscriptions,” Samuel Levine, director of the FTC’s Bureau of Consumer Protection, said in a statement. “The order stops these unlawful practices, returns millions of dollars to consumers and helps ensure an honest marketplace for families looking for care and caregivers looking for work.”

Care.com’s platform enables individuals seeking caregivers to sign up and post job listings at no cost. Job seekers, on the other hand, need to buy a subscription to apply for these jobs. However, in order for a job poster to view a worker’s application, both parties need to have paid memberships.

The complaint alleges that the company’s advertising often includes an inflated number of job openings on its platform, misleadingly counting positions for which there are minimal hiring prospects.

In addition to the exaggerated job claims, the complaint alleges that Care.com misled users about potential earnings when finding a job through the platform. The company advertised hourly and weekly earnings to attract consumers into paying for subscriptions, despite lacking substantial data to support these earnings claims.

Care.com has been accused of not tracking earnings for jobs found on its platform and lacking credible information to support its earning claims in its advertising and marketing. The complaint states that Care.com’s claims about earnings for specific types of work are based on an average of those jobs listed on its site. It does not track or know the actual pay rates negotiated between job seekers and job posters after they make contact off the site.

According to the complaint, Care.com continued these deceptive earnings claims even after receiving a Notice of Penalty Offenses related to earnings claims from the FTC in 2021.

It is also alleged that Care.com has used illegal tactics to prevent users from canceling subscriptions.

When customers attempt to cancel, they are required to navigate through several unrelated links to locate information on how to do so. After finding the cancellation details, customers encounter multiple steps intentionally designed to make it difficult for them to successfully cancel, the complaint claims.

Settlement requirements

Under the proposed settlement terms, Care.com will be obligated to:

• Refund $8.5 million to consumers who have been harmed by its practices.
• Only make earnings claims that are true and based on evidence.
• Only make claims about the number of jobs posted on the site by users who can hire a potential applicant.
• Be transparent with consumers about communication methods prior to payment.
• Ensure users are given a straightforward method to cancel subscriptions on the site.

In response to the FTC’s statement, Care.com issued a similar response contesting the claims.

“We would not be in business for long if we manipulated optics, inflated statistics and attempted to trick our customers,” the statement said. “We have found that many care seekers prefer to see a level of interest in their job post before committing to a premium membership, and our basic service tier offers this ‘try before you buy’ opportunity. This does not mean that there is little to no chance that a caregiver will be hired for these jobs. When a seeker sees the array of caregivers available, the commitment to a premium membership enables seekers to contact and hire caregivers. Moreover, the annual fee that caregivers pay while active on our platform is a screening fee, which helps maintain the safety of our community.”

The statement also discusses the accusations of inflated earnings data and challenges with the cancellation process. The company concluded with the following statement.

“Given the care crisis in America, we believe our collective energy as a country should be on solutions, not nitpicking attacks. Care.com intends to keep our focus on what matters: American families and the hardworking caregivers who support them.”

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This comes after New York Gov. Kathy Hochul criticized the program, calling it “a racket,” telling Bloomberg News that it is “one of the most abused programs in the history of New York” as costs for the program have skyrocketed.

On July 2, the DOH announced that, “effective August 1, fiscal intermediary (FI) administrative payments will move to a non-risk distribution methodology for Medicaid Managed Care enrollees.”

The announcement emphasized upcoming changes, including the implementation of a three-tiered payment system for agencies that administer CDPAP based on the number of care hours completed monthly. Furthermore, reimbursements for direct care and administrative costs, typically paid at a single hourly rate, will now be split.

It is estimated that this could cut $200 million from state Medicaid payments to businesses that manage payroll and conduct administrative tasks for home health care aides and consumers. CDPAANYS said the cuts could result in lower wages and reduced access to care within the program.

Laura Cardwell, CDPAANYS’ director of operations and events, told Home Health Care News the proposed rates are “absolutely not sustainable, and that will become evident through the steps in the regulatory process.”

The DOH said it made the changes based on the Centers for Medicare & Medicaid Services’ (CMS) feedback and that “the new payment structure will be consistent with prior non-risk managed care payment arrangements, such as home and community-based service distributions.”

Still, those in the industry are concerned.

In a letter dated July 19, 2024, from the New York Health Plan Association, the Coalition of New York State Public Health Plans, the New York State Coalition of Managed Long-Term Care Plans, LeadingAge New York and the NYS Conference of Blue Cross Blue Shield Plans, who are not directly involved in the lawsuit, wrote, “It is worth noting that plans operate with an 89% medical loss ratio (MLR) – and rates are not supposed to be retroactively adjusted (in either direction). To the extent that plans have a surplus, funds will be recovered by the state through the MLR remittance process – making any additional premium reduction unreasonable and unnecessary at a time when plans must focus on implementing this significant policy change and minimizing member disruption.”

Home Care Association of New York State (HCA-NYS) CEO Al Cardillo told HHCN that they are highly concerned about the state’s actions in slashing the reimbursement of CDPAP.

“These cuts jeopardize the basic viability of care for this segment of the home care population and undermine the sustainability of the agencies essential for delivering the service,” he said. “Moreover, the cuts pile onto the already severe fragility of home care services access in New York state and will have the heaviest impact in the very geographic regions already suffering disproportionate home care loss due to underfunding. This policy flies in the face of the critical public need for home care and the role that home care fulfills as a core partner to hospitals and physicians in the continuum of care.”

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A U.S. judge decided not to block the Federal Trade Commission’s (FTC) ban on non-compete agreements this week, continuing an ongoing saga that home care providers are paying close attention to.

Broadly, the ban on non-competes is seen as generally positive for home care leaders, who can now freely move on to better career opportunities. It likely won’t affect caregivers much, as many already work for more than one agency.

Where it will likely have an effect, however, is in non-solicitation agreements. Those keep clients from using home care agency caregivers, and then ultimately hiring those caregivers directly and cutting out the agency. A non-solicitation is different from a non-compete, of course, but some states are already viewing them in the same light, which could be a major threat to home care operators.

The FTC in April banned non-competes in a 3-2 vote. It was a major change in direction, specifically because non-compete laws were historically handled on a state level. Some states – like California and Connecticut – already had very strict laws against non-compete agreements. Other states were less strict.

But this ban comes from the federal level.

“The rulings and the positions are going beyond just the traditional non-compete agreement into client service agreements that have direct-hire provisions or penalty provisions not allowing the client to hire the caregiver away,” Angelo Spinola, the home health, home care and hospice chair at the law firm Polsinelli, recently told Home Health Care News. “That’s a big concern with what the FTC is doing – that they’re going to take that position and apply the term non-compete very broadly. If you look at the language of the final rule, it absolutely suggests that’s going to be their enforcement position.”

The aforementioned challenge to the non-compete ban was from a tree-trimming company. U.S. District Judge Kelley Hodge in Philadelphia wrote in a decision that the FTC has the power to ban practices that it deems anticompetitive.

Anticompetitive business practices – in M&A and otherwise – have been a major focus for the Biden administration.

In Medicare-certified home health care, the ban could also have significant effects.

Chip Kahn, the president and CEO of the Federation of American Hospitals, explained the health care impact shortly after the ban was voted on by the FTC. He did so through a hospital lens, but the sentiment also could apply to home health agencies.

“This final rule is a double whammy,” Kahn said. “The ban makes it more difficult to recruit and retain caregivers, while at the same time creating an anti-competitive, unlevel playing field between tax-paying and tax-exempt hospitals – a result the FTC rule precisely intended to prevent.”

Non-solicitations

Client service agreements – or non-solicitation agreements – are an essential part of home care.

Agencies pour money and resources into their caregivers to train them, upskill them and find them the right clients. Logically, it’s not right then for a client to be able to cut the agency out and hire them on their own.

But that’s already happening in certain areas. In California, for instance, agencies are having to tell clients they are no longer restricted by these agreements, according to Spinola. If agencies don’t do so, they could be fined thousands of dollars – per agreement.

“The point around direct hire clauses, that would, for me, probably be more so a concern that’s less controllable,” Care Advantage CEO Tim Hanold recently told Home Health Care News. “I know that those are things that we responsibly have in our agreements, especially for private pay. That is something that could create some issues for certain, considering how much time and energy we put into our professional caregiver workforce.”

Because of how big of a deal the non-compete ban is, it’s likely there will be a bevy of challenges to it across the country in the near-term future.

Ultimately, Spinola still believes that the ban will be done away with, or at least altered, given the history of states controlling this particular issue.

“This is state domain, not federal domain,” Spinola said. “If it were federal domain, it’s so significant that it should be something that goes through Congress, and through actual rulemaking and legislation, not through a branch where there’s really no way to stop them from doing what they want to do, other than this litigation.”

The post US Judge Elects Not To Block Non-Compete Ban, Spelling Trouble For Home Care Providers appeared first on Home Health Care News.

Hochul expressed her displeasure with the program during a conversation with Bloomberg News.

“I’m telling you right now, when you look on TikTok and you see ads of young people saying, ‘Guess what, you can make $37 an hour by sitting home with your Grandma. You know, here’s how you sign up,’ — it has become a racket,” Hochul said.

She went on to call the program “one of the most abused programs in the history of New York,” adding that “something has to give.”

CDPAP has increasingly become a point of discussion and contention during the state’s budget-setting season, as costs tied to the program have ballooned.

Broadly, CDPAP and other self-directed home care programs allow potential home care consumers to choose their own caregiver. A fiscal intermediary – such as a traditional home care agency, the state or another vendor – is generally involved in the process.

The idea behind these programs is to pay family caregivers who have been conducting unpaid labor, while also keeping seniors home and out of brick-and-mortar facilities that would cost the state more money. They are generally operated through state Medicaid programs.

Because of the nationwide caregiver shortage, some policymakers found this to be a sensible way to fill gaps in care. The hope was also that, eventually, these family caregivers would convert to full-time caregivers in certain instances.

Home care agencies, particularly in New York, often provide home care services while also acting as intermediaries for self-directed care.

But traditional home care agency leaders have been skeptical since the model began gaining more traction over the last few years. They see self-directed care as an area that can be exploited by fraudulent actors, as Hochul does. They also believe that the quality of care is likely to be lesser within these programs, as they spend time, money and resources to train their own caregivers.

Those leaders are also perturbed by OIG findings that come out highlighting fraud in “personal care.” That lumps all home care together, when much of that is coming from the area of self-directed care.

Besides the aforementioned reasons for self-directed care’s rise, the Biden administration has also pushed it.

Self-directed care remains an opportunity for the health care system to fill care gaps and reduce costs. But this mode of care’s rise could be – particularly in New York – a case of “too much, too soon.”

On her end, Hochul hopes to make changes to New York’s CDPAP program next year.

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