Current Actions

Protect Access to Home- and Community-Based Services

Wed, 10 Sep 2025 04:00:00 GMT

Medicaid home- and community-based services (HCBS) help older adults, people with disabilities, and families remain safe, healthy, and independent at home instead of being forced into institutional care. These services include home health, personal care, rehabilitation, transportation, nutrition, and more.

But access to HCBS is in crisis:

Nationally, more than 700,000 people remain on waiting lists, with average waits of over three years.
In Florida alone, 77,123 individuals are waiting to receive care through the Statewide Medicaid Managed Care (SMMC) Long-Term Care program.
Workforce shortages and chronic underfunding mean providers are turning away referrals because they can’t recruit and retain staff at current Medicaid reimbursement rates.

Florida’s SMMC program uses a priority scoring system to ensure the most fragile patients — those with the highest medical needs — get served first. But with tens of thousands still waiting, even high-priority Floridians are left without the care they desperately need.

Congress must protect and expand access to HCBS by increasing funding, rejecting harmful cuts or restrictions, and supporting the workforce that delivers these services.

Take action by contacting your members of Congress and urge them to strengthen HCBS so that Americans — including tens of thousands of Floridians — can receive care in the setting they prefer: their home.

Tell Congress to Expand Access to Home Health Services Through Occupational Therapy

Wed, 10 Sep 2025 04:00:00 GMT

The Medicare Home Health Accessibility Act (H.R. 2013) would amend the Social Security Act to allow Medicare beneficiaries to qualify for home health services solely based on a need for occupational therapy. Currently, patients must first qualify through the need for skilled nursing, physical therapy, or speech-language pathology services. This bipartisan legislation removes outdated barriers to care and modernizes Medicare policy to reflect the essential role occupational therapy plays in patient recovery, rehabilitation, and independent living.

Why it Matters

Enhances access to home-based care for Medicare beneficiaries.
Reduces unnecessary institutional care.
Recognizes occupational therapy as a standalone qualifying service.
Strengthens the home health workforce and supports aging in place.

Please urge your U.S. Representative to co-sponsor and support H.R. 2013. It’s time to remove outdated restrictions that limit access to critical in-home services.

Protect Home Health Access: Support the Home Health Stabilization Act

Mon, 08 Sep 2025 04:00:00 GMT

The Centers for Medicare & Medicaid Services (CMS) has finalized the Calendar Year (CY) 2026 Home Health Prospective Payment System (PPS) Final Rule, which includes a net payment reduction of approximately $19 per 30-day period — totaling a $220 million (-1.3%) cut to Medicare home health agencies nationwide. While far smaller than the originally proposed 9% reduction, this cut still compounds years of downward pressure on rates and threatens access to clinically necessary care delivered in the home.

The bipartisan Home Health Stabilization Act of 2025 (H.R. 5142), would prevent further erosion by holding 2026 and 2027 payment rates at 2025 levels and requiring CMS to apply a positive update. This stabilization period gives Congress, CMS, and stakeholders time to address flaws in the payment methodology, strengthen program integrity, and protect Medicare beneficiaries’ ability to receive care at home.

Without congressional action, continued rate instability will strain home health providers, limit capacity, and increase reliance on higher-cost institutional settings such as hospitals and nursing homes. Congress must step in now to safeguard access to home-based care for millions of seniors and individuals with disabilities.

TAKE ACTION: Tell your U.S. Representative to co-sponsor the Home Health Stabilization Act (H.R. 5142) and protect access to Medicare home health services.

Tell CMS: Protect Access to Medicare Home Health Care in 2027

Wed, 29 Jul 2026 04:00:00 GMT

The Centers for Medicare & Medicaid Services (CMS) has released its Calendar Year (CY) 2027 Home Health Prospective Payment System Proposed Rule, which would update Medicare payment rates and establish several significant policy and program-integrity changes affecting home health agencies.

CMS estimates that the proposal would increase aggregate Medicare home health payments by 2.4%, or approximately $420 million, compared with 2026. Although CMS is not proposing another permanent Patient-Driven Groupings Model (PDGM) behavioral adjustment, it would continue the 3% temporary reduction intended to recover estimated historical overpayments.

The rule would also recalibrate PDGM case-mix weights and Low Utilization Payment Adjustment (LUPA) thresholds, expand Medicare enrollment and revocation authorities, modify Home Health Quality Reporting Program (HHQRP) requirements, and seek feedback on community-based palliative care and the development of a home health-specific wage index.

Why Your Voice Matters

CMS needs to hear directly from the providers responsible for delivering care in patients’ homes. Agency-specific examples can demonstrate how payment policies, workforce costs, regulatory requirements, and administrative burdens affect access to care in communities across Florida.

HCAF has made it easy to participate. Use our Legislative Action Center to personalize and submit comments directly to CMS by August 31, 2026.

Your comments do not need to address every provision. Focus on the issues that matter most to your agency and explain how the proposals would affect your patients, caregivers, workforce, and operations.

Key Points to Address

Payment Adequacy and the 3% Temporary Reduction

Thank CMS for not proposing another permanent PDGM behavioral adjustment.
Urge CMS to reconsider or withdraw the proposed 3% temporary reduction.
Explain how continued reductions affect staffing, wages, service areas, referral acceptance, and patients’ access to care.
Describe increases in labor, transportation, technology, insurance, compliance, and supply costs.
Include agency-specific information showing why the proposed aggregate increase may not reflect the financial effect on individual providers.

PDGM Recalibration and Patient Access

Describe how changes to case-mix weights, functional levels, comorbidity adjustments, and LUPA thresholds could affect your agency.
Identify patient populations or clinical groups that may be disproportionately affected.
Encourage CMS to monitor whether recalibration creates access barriers for clinically complex or underserved patients.

Medicare Enrollment and Retroactive Revocations

Express concern about making all Medicare enrollment revocations retroactive to the date CMS determines noncompliance began.
Explain how retroactive revocations could expose providers to substantial repayment liability for services delivered in good faith.
Ask CMS to preserve appropriate notice, due-process, corrective-action, and appeal protections.
Recommend limiting retroactive revocations to cases involving fraud, intentional misconduct, or clear evidence that a provider was not eligible to participate.

Ownership Changes and Expanded Accountability

Request clear guidance regarding which ownership transactions require reenrollment, surveys, or accreditation.
Encourage CMS to establish reasonable notice and correction periods for technical or inadvertent noncompliance.
Ask CMS to avoid policies that could unnecessarily disrupt legitimate ownership transitions or patients’ continuity of care.
Recommend safeguards ensuring that providers are not penalized for adverse actions involving individuals or organizations without a meaningful connection to current operations.

Community-Based Palliative Care

Support CMS’s recognition that the Medicare home health benefit can play an important role in delivering palliative care to eligible patients.
Ask CMS to clarify how palliative care differs from hospice and how it may be provided alongside disease-directed treatment.
Recommend practical examples for inclusion in the Medicare Benefit Policy Manual.
Identify barriers involving eligibility, referrals, documentation, payment, care coordination, or audit interpretation.
Share examples demonstrating effects on hospitalizations, emergency department use, patient experience, caregiver support, or care transitions.

Home Health-Specific Wage Index

Explain whether hospital wage data accurately reflect the labor markets and workforce costs experienced by your agency.
Support development of a home health-specific wage index if it would more accurately reflect the cost of recruiting and retaining home-based clinicians.
Encourage CMS to use reliable, transparent data and provide adequate transition protections before implementing a new methodology.
Describe geographic or workforce challenges affecting your service area.

Quality Reporting and Advance Care Planning

Explain how accelerated Outcome and Assessment Information Set (OASIS) submission and correction deadlines would affect agency workflows and compliance.
Support digital improvements that make reconsiderations more efficient and transparent.
Provide feedback on the potential Advance Care Planning quality measure, including documentation burden, patient choice, measure design, and alignment with existing workflows.
Ask CMS to avoid duplicative reporting requirements and allow sufficient implementation time.

Tips for an Effective Comment

Identify your agency and the Florida communities you serve.
Describe your patient population and workforce.
Focus on two or three provisions that directly affect your organization.
Include specific operational, financial, workforce, or patient-access examples.
Explain not only what CMS should change, but why the change matters.
Do not include patient names or protected health information.

Take Action Today

Please personalize the suggested message with your agency’s experience and submit it through HCAF’s Legislative Action Center no later than August 31, 2026.

Your firsthand perspective can help CMS understand the real-world consequences of its proposals and support policies that preserve access to high-quality care in the home.

Urge Congress to Cosponsor the Continuous Skilled Nursing Quality Improvement Act of 2025

Wed, 29 Jul 2026 04:00:00 GMT

HCAF is urging members of Congress to cosponsor the Continuous Skilled Nursing Quality Improvement Act of 2025 (S. 1920/H.R. 6592), bipartisan legislation that modernizes Medicaid policy for continuous skilled (private duty) nursing services. The bill improves oversight, establishes national quality standards, and clarifies regulatory requirements to ensure medically complex individuals — many of them children — can safely receive high-quality care in their homes.

This legislation is critical to strengthening access to care, stabilizing the nursing workforce, and reducing unnecessary administrative barriers that delay or disrupt services. Your voice matters. Please contact your federal elected officials today and urge them to cosponsor this important bipartisan bill.