As the home health industry still awaits the final Medicare home health payment rule, the National Alliance for Care at Home (the Alliance) is ready to go “full bore” with a legislative backup plan. 

The organization is not just focused on the topline payment number, according to Scott Levy, chief government affairs officer at the Alliance. The organization will scrutinize the Centers for Medicare & Medicaid’s (CMS) methodologies and implementation plans once the final rule is issued. At the same time, the organization is ready to push the Home Health Stabilization Act of 2025 if the final rule includes a massive cut to the home health Medicare rate.

Levy said the current legislative climate, combined with several key industry factors, gives the bill a stronger chance than prior attempts to protect the Medicare home health benefit.

The contents of the final Medicare home health payment rule will, in part, determine the Alliance’s approach to 2026. Also on the organization’s docket for the new year is pushing for key deregulations – most top of mind: the 80/20 rule.

Home Health Care News sat down with Levy to discuss the realistic outcomes of the Medicare home health payment rule, the likely fate of the Home Health Stabilization Act and why 2025 was a “transformative” year for the industry.

Below is that conversation, edited for length and clarity.

HHCN: What are the various realistic outcomes we might see when the Medicare home health payment rule is finally announced?

Levy: Since June 30, we have had a war room-like mentality, pushing very hard to produce the most comprehensive comment letter. But ultimately, when you submit policy ideas to CMS, it’s in their hands. We do know there’s been significant outreach to them, so I feel pretty confident we’re not going to see a 9% cut. I don’t think we’re going to see the final rule look like the proposed rule. … I don’t want to give any sort of false impressions that we know, but I do think that our advocacy work has mattered.

I think we will see some meaningful movement, but is that going to be significant enough for this industry? Because this is the biggest proposed rule we’ve ever seen. Our public messaging has been that we understand and we appreciate that CMS, in years past, has mitigated. But just mitigating it by half is not sufficient for this industry at this time, because if a billion dollars becomes half a billion dollars, it’s still a really massive impact on this space.

What are the contingency plans if the final rule resembles the proposed rule?

It’s not just what the rule looks like, the number, but how did they get there? Is there a shift in the way that they’re looking at the measurements and the methodologies, how they’re going to implement? Do they take some of the meaningful recommendations that the industry is given, including some of the stuff that the Alliance put in our letter? So we are going to take some time to really absorb how they got there, but we are prepared, if necessary, to continue with pushing the Home Health Stabilization Act that was introduced in the House by Congressman Hern and Congresswoman Sewell. And we will call on our supporters and advocates to do so.

If the rule comes out where we have to go the legislative route full bore, then we’ll be ready.

There have been other bills designed to protect the Medicare home health benefit that have not passed. Can the industry really pin hope on the Home Health Stabilization Act?

There are a lot of differences between the prior years’ legislation and the goals of those versus what the purpose of the Home Health Stabilization Act has been, number one.

Number two, we are in a different legislative environment right now. The shutdown has not been helpful for moving this bill through any sort of meaningful regular order progress. We have continued to have good discussions with Capitol Hill and congressional offices and staff about why this is important, if the rule comes out in a bad manner. But the prior legislation was really a significant change to the policy. We don’t have time for a significant change in policy right now. What we are asking for in the Stabilization Act is a pause.

We need time to look deeper under the hood at how this has happened. If CMS doesn’t have the ability to really dig into [public comments], which they should, but if they choose not to, we need time. Whereas prior year, you were looking at a massive reform by freezing it. It’s not to say that that’s not the next step that shouldn’t come, but not right now, [so close to] the end of the year. It’s going to be a sprint. Making that comparison to years past, while instructive, I think there are some major differences between both the legislation and the environment.

Also, the industry is in a significantly different position. The first year that the first legislation was introduced in the summer of 2022 was on the heels of the first round of cuts being proposed in the calendar year 2023 proposed rule. We’re now three years into that, and 9% permanent cuts have already been taken. So it’s not like this is the first or the second. We’re going into year four, so that’s a significant difference as well.

Besides the final rule, what regulations or policies in flux right now are top of mind for you?

We want to be able to take advantage of this administration’s goal to see some deregulation, because we know that there are a lot of burdens of regulation that providers have been experiencing. So focusing in on those deregulation executive orders, re-urging some of the stuff that we brought up in the RFIs over the course of the year, when the administration came out … especially for an industry that is squeezed right now, as home health and hospice are from a staffing level. We want to make sure that we are highlighting and recognizing those policies that really are burdensome on the clinician at the bedside, that’s taking away from their ability to deliver care, just to check some bureaucratic box that hasn’t necessarily aided in the delivery of that care. Highlighting those is really something that we’re going to focus on over the last portion of the year and into next year, to really hone in not only our policy goals, but also somewhere where we align very directly with this administration’s goals: reducing those burdens.

What regulations would you like to see rolled back? Does that include the 80/20 rule? 

80/20 is at the top of the list. Some of the impacts on the paperwork that our clinicians are having to complete, and the timeliness of it, when it’s not actually going to patient care, that’s another one. We have a whole list of them that we submitted to CMS for both home health, hospice and HCBS, but 80/20 is definitely front and center.

As we approach the end of 2025, what is your key takeaway from this year?

It’s been a transformative year for the industry, just from a structural standpoint, with the Alliance coming together and being the leading voice for care in the home policy.

But it has been a very busy year for this first year, starting with reconciliation and the impacts to HCBS. On the hospice front, making sure that the integrity of the hospice benefit is maintained and stays within the fee-for-service structure and out of Medicare Advantage. We started working on the home health issue in January. We got the message out in advance that if this was going to happen. Those are three really large things that have taken up this year.

Many of them will actually carry over into 2026. The reconciliation bill passed, but now it’s got to be implemented. So how that impacts at the state level will draw up a lot of what our 2026 work will be for Medicaid. And then continuing to push back on any efforts on hospice is going to be foremost for that service line.

And then with home health, a lot’s going to be told about what our 2026 looks like by how 2025 ends. If you don’t have a vibrant home health system, I don’t know how hospital-at-home really works. I don’t know how you can reduce institutional care if you don’t have the workforce in the home to take care of people. These are things that the administration we know cares a lot about, and we want to be on that path next year to where we’re working on those solutions and not continue to fight on past policies.