Home-Based Healthcare Advisory
Langham Healthcare Advisory has a clear mission: to move healthcare home, and to move home-based care forward. I believe the home is the future of healthcare delivery. Realizing that future demands thoughtful policy, meaningful innovation, and principled leadership. LHA is here to help make it happen.
Perspectives
Perspectives on home health policy, reimbursement, operations, and the future of care-in-place written and curated for practitioners, patients, and families.
Featured · Public Comment
Taken as a whole, this is a constructive rule. It also proposes to keep recouping billions of dollars from home health agencies on the strength of a PDGM analysis CMS itself now concedes is confounded. This letter supports what deserves support and says plainly where the methodology does not hold up — written from twenty-plus years of delivering care in living rooms and discussing it in board rooms.
What the letter asks CMS to do
Resources
Trusted resources for patients, families, and caregivers navigating home-based care.
For Patients
Reliable information to help patients make informed decisions about home health and hospice services.
Medicare
Medicare Care Compare
Find and compare home health agencies and hospice providers in your area using Medicare's official tool.
Medicare
Medicare & Home Health Care
Official Medicare guide explaining what home health services are covered, who qualifies, and how to access them.
Hospice
How Medicare Hospice Works
Clear explanation of Medicare hospice benefits, eligibility, and what to expect from the hospice experience.
Care Navigation
Eldercare Locator
A free service of the U.S. Administration for Community Living connecting older adults and caregivers to trusted local services including home care, meal delivery, transportation, and legal aid.
Older Adults
National Council on Aging
A trusted national voice for older adults, offering resources on benefits, health programs, economic security, and community services for seniors and caregivers.
Medicare
Medicare.gov
The official U.S. Medicare website. Find coverage information, compare plans, locate providers, and manage your Medicare benefits in one place.
Medicare Tool
Home Health Services Checklist
An official Medicare checklist to help patients and families evaluate and compare home health agencies, covering quality, services offered, and what questions to ask.
Veterans
VA Health Care Benefits
Information on VA health care eligibility, home-based care options, and benefits available to veterans and their families through the U.S. Department of Veterans Affairs.
For Families
Guidance and support for family members and caregivers navigating home-based care alongside a loved one.
Caregiver Support
AARP Caregiving Resource Center
Practical tools, guides, and expert advice for families coordinating care for aging or seriously ill loved ones.
Home-based Care
National Alliance for Care at Home: Patients & Caregivers
Guidance from the National Alliance for Care at Home on end-of-life planning and caregiver support.
CMS Regulatory Updates
The latest CMS rulemaking for home health and hospice. Direct links to the Federal Register..
Home Health · Proposed Rule
CY 2027 Home Health PPS Proposed Rule (CMS-1844-P)
Proposes a 2.4% net aggregate increase, no additional permanent behavioral adjustment, a continued 3.0% temporary adjustment, palliative care under the home health benefit, a home health–specific wage index RFI, and Medicare-wide provider enrollment changes. Published July 6, 2026; comments closed August 31, 2026.
Hospice · Final Rule
FY 2027 Hospice Wage Index Final Rule
Finalizes a 2.3% hospice payment update, sets the aggregate cap at $36,174.75, introduces the nine-measure Service and Spending Variation Index, and requires the election statement addendum for all beneficiaries. Published August 3, 2026; effective October 1, 2026.
Physician Fee Schedule · Proposed Rule
CY 2027 Medicare Physician Fee Schedule Proposed Rule
Proposes limiting RPM and RTM payment to clinical staff employed by the billing practice, requiring an initiating visit, revaluing device payment, and seeks comment on consolidating remote monitoring codes into four G-codes.
Home Health · Final Rule
CY 2026 Home Health PPS Final Rule
Finalizes a 2.4% payment update for CY 2026, quality reporting program changes, and updates to the HHVBP Expanded Model. Published December 2, 2025.
Hospice · Final Rule
FY 2026 Hospice Wage Index Final Rule
Finalizes a 2.6% hospice payment update and sets the aggregate cap at $35,361.44 for FY 2026. Published August 5, 2025.
Home Health · Policy Manual
Medicare Benefit Policy Manual: Chapter 7, Home Health Services
The authoritative CMS policy manual chapter governing Medicare home health coverage, eligibility, conditions of participation, and billing guidance.
Hospice · Policy Manual
Medicare Benefit Policy Manual: Chapter 9, Hospice Services
The authoritative CMS policy manual chapter covering Medicare hospice coverage, eligibility, election, benefit periods, and conditions of participation.
Program Integrity & Oversight
Where the oversight bodies are looking, and what agencies should expect. Primary sources from CMS, GAO, and the HHS Office of Inspector General.
CMS · Enrollment
Provider Enrollment Moratoria
CMS's official page for the nationwide home health and hospice enrollment moratoria, effective May 13, 2026 for six months. Covers initial applications, non-exempt changes in majority ownership, and new branch locations. CMS may extend in six-month increments.
GAO · June 2026
Medicare Hospice: Action Needed to Pay More Efficiently for Routine Home Care
GAO found Medicare paid $16.7 billion for hospice routine home care in 2022–2024 versus $9.1 billion under home health per-visit rates, and recommends Congress direct HHS to restructure the payment.
HHS OIG · June 2026
Medicare Could Have Saved $255.1 Million on Certain New Hospice Enrollees
Forty-five of 100 sampled initial certification periods did not meet eligibility or documentation requirements. OIG recommends targeted pre- or post-payment review; CMS concurred.
MedPAC
The Medicare Payment Advisory Commission's most recent analysis and payment policy recommendations touching home health, hospice, and Medicare Advantage.
June 2026 · Medicare Advantage
Chapter 4: MA Enrollment and Post-Acute Care Provider Finances
MedPAC's estimate of how rising Medicare Advantage penetration is associated with the financial performance of hospitals, home health agencies, SNFs, and IRFs.
June 2026 · Hospice
Chapter 5: Access to Hospice and Complex Palliative Services
Examines payment accuracy and access barriers for high-cost palliative services among beneficiaries with end-stage renal disease or cancer.
March 2026 · Home Health
Chapter 8: Home Health Care Services
MedPAC's analysis of Medicare home health utilization, spending, quality, and payment adequacy, with recommendations for Congress.
March 2026 · Hospice
Chapter 10: Hospice Services
MedPAC's analysis of Medicare hospice utilization, spending, and quality, including a recommendation to eliminate the FY 2027 payment rate update.
Clinical Research
Peer-reviewed studies, clinical findings, and evidence-based resources advancing the science of care delivered at home.
JAMA Network Open · Jul 2026
Advanced Medical Care at Home Among Patients With Acute Heart Failure
Huang CW, Huynh DN, Han B, et al. Across 307 matched pairs, home-based advanced care showed no difference in readmissions, mortality, days alive and out of hospital, or guideline-directed therapy at 30 and 60 days.
JAMA Network Open · Oct 2025
Postacute Care Use and Outcomes Among Medicare Advantage vs Traditional Medicare Beneficiaries
Roy I, Hutchins F, Rose L, et al. Policymakers must balance cost reduction with access and quality, ensuring that patient-reported outcomes and caregiver burdens are addressed in future reforms.
Thought Leadership
Perspectives from clinicians, researchers, and policy leaders shaping the future of care delivered at home.
Industry Report
2025 PAC Industry Trend Report
Trella Health's annual analysis of post-acute care trends, market dynamics, and data-driven insights shaping home health and hospice.
Industry Chartbook
2025 RIHC Home Health Chartbook
Annual data chartbook from the Research Institute for Home Care, tracking utilization, outcomes, and trends across the home health industry.
Foundation Research
Age-Friendly Care, John A. Hartford
The John A. Hartford Foundation's framework and strategy for advancing age-friendly health systems that prioritize what matters most to older adults.
About
Langham Healthcare Advisory, LLC is a solo advisory practice and my personal passion project focused on one thing: care in the home. I enjoy supporting entrepreneurs, consumers, investors, healthcare organizations, and technology companies who are navigating the opportunities and complexities of care delivered in the home.
My work sits at the intersection of strategy, technology, and innovation. But what drives it is simpler than that. It's about how we make people feel: clinicians who are stretched thin, patients navigating a confusing system, and families doing their best to support someone they love.
It has never been more important for organizations to really know their "why" and to consistently remember to "learn, unlearn, and relearn".
About Bud
I trained as a physical therapist and began my career in acute care before making my way to home health as a field clinician. My foundation in this industry is clinical, not administrative. I've seen care from the bedside, and that perspective has shaped everything I've done since.
Over the course of my career I served as Executive Vice President for a publicly traded home health and hospice organization, leading teams focused on clinical excellence, strategy, and innovation. I've had the privilege of working alongside some of the best people in this industry, and I don't take that lightly.
I've served on boards, contributed to multiple CMS Technical Expert Panels, and remain actively engaged in shaping the future of home-based care through my work as a Health Evolution Fellow and member of the Coalition for Health AI (CHAI). I also serve as a senior advisor to several companies working to change this industry for the better, including CareBestie and Enzo Health.
Outside of work, I'm an avid cyclist, beekeeper, farmer, and rancher. Those pursuits keep me grounded, and honestly, they're not so different from what I do professionally. Both require patience, an appreciation for systems, and a willingness to do hard things in unpredictable conditions.
Contact
I'd welcome the opportunity to learn about your organization and explore how I can support your home-based care mission. The best way to reach me is on LinkedIn — send a connection request or message and I'll follow up directly.