The National Alliance for Care at Home stated in public comments on August 31 that the Centers for Medicare & Medicaid Services' (CMS) proposed rule for 2027 Home Health Prospective Payment System rates does not do enough to undo prior harm or protect access to care. ^[1] Denis Fleming Jr. was installed as the Chief Government Affairs Officer for the National Alliance for Care at Home, an organization representing the nation's largest group of home care providers. ^[2] The Alliance estimated that the permanent adjustments will produce aggregate reductions of $18.9 billion from 2020 through 2030. ^[3] The Alliance noted that while CMS proposed a full annual payment update for the first time since 2022, this decision does not undo the harm already built into the payment rate. ^[4] The Alliance stated that four consecutive years of permanent adjustments have reduced the 30-day rate by 9.37% or over $1.5 billion annually. ^[5] Denis Fleming Jr. noted that the 2027 hospice payment rate increase of 2.3% does not keep up with inflation, despite data suggesting it was moderately changed. ^[6] Denis Fleming Jr. stated that the National Alliance favors Rep. Beth Van Dyne's (R-Texas) bill, which proposes a targeted approach to combat hospice fraud through accreditation provisions and background checks. ^[7] The National Alliance for Care at Home expressed concern about the nationwide moratorium on home health and hospice enrollment in Medicare, describing it as a blunt instrument that restricts access and business development. ^[8]