Cover
Cover - shares | 6 Months Ended | |
Jun. 30, 2020 | Jul. 24, 2020 | |
Cover [Abstract] | ||
Document Type | 10-Q | |
Document Quarterly Report | true | |
Document Period End Date | Jun. 30, 2020 | |
Document Transition Report | false | |
Entity File Number | 0-24260 | |
Entity Registrant Name | AMEDISYS INC | |
Entity Incorporation, State or Country Code | DE | |
Entity Tax Identification Number | 11-3131700 | |
Entity Address, Street Name | 3854 American Way | |
Entity Address, Suite | Suite A | |
Entity Address, City | Baton Rouge | |
Entity Address, State | LA | |
Entity Address, Postal Zip Code | 70816 | |
City Area Code | 225 | |
Local Phone Number | 292-2031 | |
Title of each class | Common Stock, par value $0.001 per share | |
Trading Symbol | AMED | |
Name of each exchange on which registered | NASDAQ | |
Entity Current Reporting Status | Yes | |
Entity Interactive Data Current | Yes | |
Entity Filer Category | Large Accelerated Filer | |
Entity Emerging Growth Company | false | |
Entity Small Business | false | |
Entity Shell Company | false | |
Entity Common Stock, Shares Outstanding | 32,466,660 | |
Amendment Flag | false | |
Document Fiscal Year Focus | 2020 | |
Document Fiscal Period Focus | Q2 | |
Entity Central Index Key | 0000896262 | |
Current Fiscal Year End Date | --12-31 |
CONSOLIDATED BALANCE SHEETS
CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands | Jun. 30, 2020 | Dec. 31, 2019 |
Current assets: | ||
Cash and cash equivalents | $ 177,278 | $ 30,294 |
Restricted cash | 3,049 | 66,196 |
Patient accounts receivable | 249,030 | 237,596 |
Prepaid expenses | 10,788 | 8,243 |
Other current assets | 9,395 | 8,225 |
Total current assets | 449,540 | 350,554 |
Property and equipment, net of accumulated depreciation of $100,963 and $96,137 | 25,007 | 28,113 |
Operating lease right of use assets | 92,904 | 84,791 |
Goodwill | 937,088 | 658,500 |
Intangible assets, net of accumulated amortization of $12,649 and $7,044 | 81,813 | 64,748 |
Deferred income taxes | 25,463 | 21,427 |
Other assets | 33,673 | 54,612 |
Total assets | 1,645,488 | 1,262,745 |
Current liabilities: | ||
Accounts payable | 33,383 | 31,259 |
Payroll and employee benefits | 128,275 | 120,877 |
Accrued expenses | 169,722 | 137,111 |
Provider relief fund advance | 70,000 | 0 |
Current portion of long-term obligations | 10,718 | 9,927 |
Current portion of operating lease liabilities | 29,950 | 27,769 |
Total current liabilities | 442,048 | 326,943 |
Long-term obligations, less current portion | 392,713 | 232,256 |
Operating lease liabilities, less current portion | 61,611 | 56,128 |
Other long-term obligations | 26,857 | 5,905 |
Total liabilities | 923,229 | 621,232 |
Commitments and Contingencies—Note 5 | ||
Equity: | ||
Preferred stock, $0.001 par value, 5,000,000 shares authorized; none issued or outstanding | 0 | 0 |
Common stock, $0.001 par value, 60,000,000 shares authorized; 36,831,298 and 36,638,021 shares issued; and 32,442,719 and 32,284,051 shares outstanding | 37 | 37 |
Additional paid-in capital | 665,580 | 645,256 |
Treasury stock, at cost 4,388,579 and 4,353,970 shares of common stock | (257,625) | (251,241) |
Accumulated other comprehensive income | 0 | 15 |
Retained earnings | 312,859 | 246,383 |
Total Amedisys, Inc. stockholders’ equity | 720,851 | 640,450 |
Noncontrolling interests | 1,408 | 1,063 |
Total equity | 722,259 | 641,513 |
Total liabilities and equity | $ 1,645,488 | $ 1,262,745 |
CONSOLIDATED BALANCE SHEETS (Pa
CONSOLIDATED BALANCE SHEETS (Parenthetical) - USD ($) $ in Thousands | Jun. 30, 2020 | Dec. 31, 2019 |
Statement of Financial Position [Abstract] | ||
Property and equipment, accumulated depreciation | $ 100,963 | $ 96,137 |
Intangible assets, accumulated amortization | $ 12,649 | $ 7,044 |
Preferred stock, par value (usd per share) | $ 0.001 | $ 0.001 |
Preferred stock, authorized (shares) | 5,000,000 | 5,000,000 |
Preferred stock, issued (shares) | 0 | 0 |
Preferred stock, outstanding (shares) | 0 | 0 |
Common stock, par value (usd per share) | $ 0.001 | $ 0.001 |
Common stock, authorized (shares) | 60,000,000 | 60,000,000 |
Common stock, issued (shares) | 36,831,298 | 36,638,021 |
Common stock, outstanding (shares) | 32,442,719 | 32,284,051 |
Treasury stock at cost (shares) | 4,388,579 | 4,353,970 |
CONSOLIDATED STATEMENTS OF OPER
CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($) shares in Thousands, $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2020 | Jun. 30, 2019 | Jun. 30, 2020 | Jun. 30, 2019 | |
Income Statement [Abstract] | ||||
Net service revenue | $ 485,059 | $ 492,984 | $ 976,744 | $ 960,324 |
Other operating income | 22,780 | 0 | 22,780 | 0 |
Cost of service, excluding depreciation and amortization | 295,228 | 290,752 | 580,965 | 566,026 |
General and administrative expenses: | ||||
Salaries and benefits | 105,617 | 98,356 | 207,183 | 193,186 |
Non-cash compensation | 6,725 | 5,538 | 12,634 | 12,153 |
Other | 44,003 | 48,408 | 93,268 | 91,810 |
Depreciation and amortization | 6,334 | 5,179 | 11,672 | 8,074 |
Operating expenses | 457,907 | 448,233 | 905,722 | 871,249 |
Operating income | 49,932 | 44,751 | 93,802 | 89,075 |
Other income (expense): | ||||
Interest income | 214 | 20 | 227 | 44 |
Interest expense | (2,752) | (4,332) | (5,983) | (7,681) |
Equity in earnings from equity method investments | 487 | 3,716 | 964 | 4,932 |
Miscellaneous, net | (2,703) | 193 | (2,440) | 429 |
Total other expense, net | (4,754) | (403) | (7,232) | (2,276) |
Income before income taxes | 45,178 | 44,348 | 86,570 | 86,799 |
Income tax expense | (10,031) | (10,308) | (19,377) | (21,186) |
Net income | 35,147 | 34,040 | 67,193 | 65,613 |
Net income attributable to noncontrolling interests | (473) | (298) | (717) | (567) |
Net income attributable to Amedisys, Inc. | $ 34,674 | $ 33,742 | $ 66,476 | $ 65,046 |
Basic earnings per common share: | ||||
Net income attributable to Amedisys, Inc. common stockholders, basic (usd per share) | $ 1.07 | $ 1.05 | $ 2.05 | $ 2.03 |
Weighted average shares outstanding, basic (shares) | 32,412 | 32,075 | 32,371 | 32,038 |
Diluted earnings per common share: | ||||
Net income attributable to Amedisys, Inc. common stockholders, diluted (usd per share) | $ 1.04 | $ 1.02 | $ 2 | $ 1.98 |
Weighted average shares outstanding, diluted (shares) | 33,285 | 32,933 | 33,259 | 32,913 |
CONSOLIDATED STATEMENTS OF STOC
CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY Statement - USD ($) $ in Thousands | Total | Common Stock | Additional Paid-in Capital | Treasury Stock | Accumulated Other Comprehensive Income | Retained Earnings | Noncontrolling Interests |
Balance, Stockholders Equity at Dec. 31, 2018 | $ 482,633 | $ 36 | $ 603,666 | $ (241,685) | $ 15 | $ 119,550 | $ 1,051 |
Balance (in shares) at Dec. 31, 2018 | 36,252,280 | ||||||
Issuance of stock - employee stock purchase plan | 1,534 | 1,534 | |||||
Issuance of stock - employee stock purchase plan (shares) | 15,037 | ||||||
Issuance of stock - 401(k) plan | 4,613 | 4,613 | |||||
Issuance of stock - 401(k) plan (shares) | 38,402 | ||||||
Issuance/(cancellation) of non-vested stock | 0 | $ 0 | 0 | ||||
Issuance/(cancellation) of non-vested stock (shares) | 97,181 | ||||||
Exercise of stock options | 1,343 | 1,343 | |||||
Exercise of stock options (in shares) | 42,691 | ||||||
Non-cash compensation | 12,153 | 12,153 | |||||
Surrendered Shares | (4,490) | (4,490) | |||||
Noncontrolling interest distribution | (457) | (457) | |||||
Net income | 65,613 | 65,046 | 567 | ||||
Balance, Stockholders Equity at Jun. 30, 2019 | 562,942 | $ 36 | 623,309 | (246,175) | 15 | 184,596 | 1,161 |
Balance (in shares) at Jun. 30, 2019 | 36,445,591 | ||||||
Balance, Stockholders Equity at Mar. 31, 2019 | 521,200 | $ 36 | 613,714 | (244,373) | 15 | 150,854 | 954 |
Balance (in shares) at Mar. 31, 2019 | 36,337,743 | ||||||
Issuance of stock - employee stock purchase plan | 752 | 752 | |||||
Issuance of stock - employee stock purchase plan (shares) | 7,181 | ||||||
Issuance of stock - 401(k) plan | 2,318 | 2,318 | |||||
Issuance of stock - 401(k) plan (shares) | 18,811 | ||||||
Issuance/(cancellation) of non-vested stock | 0 | $ 0 | 0 | ||||
Issuance/(cancellation) of non-vested stock (shares) | 46,019 | ||||||
Exercise of stock options | 987 | 987 | |||||
Exercise of stock options (in shares) | 35,837 | ||||||
Non-cash compensation | 5,538 | 5,538 | |||||
Surrendered Shares | (1,802) | (1,802) | |||||
Noncontrolling interest distribution | (91) | (91) | |||||
Net income | 34,040 | 33,742 | 298 | ||||
Balance, Stockholders Equity at Jun. 30, 2019 | 562,942 | $ 36 | 623,309 | (246,175) | 15 | 184,596 | 1,161 |
Balance (in shares) at Jun. 30, 2019 | 36,445,591 | ||||||
Balance, Stockholders Equity at Dec. 31, 2019 | 641,513 | $ 37 | 645,256 | (251,241) | 15 | 246,383 | 1,063 |
Balance (in shares) at Dec. 31, 2019 | 36,638,021 | ||||||
Issuance of stock - employee stock purchase plan | 1,686 | 1,686 | |||||
Issuance of stock - employee stock purchase plan (shares) | 11,358 | ||||||
Issuance of stock - 401(k) plan | 3,057 | 3,057 | |||||
Issuance of stock - 401(k) plan (shares) | 18,312 | ||||||
Issuance/(cancellation) of non-vested stock | 0 | $ 0 | 0 | ||||
Issuance/(cancellation) of non-vested stock (shares) | 84,884 | ||||||
Exercise of stock options | 2,947 | 2,947 | |||||
Exercise of stock options (in shares) | 78,723 | ||||||
Non-cash compensation | 12,634 | 12,634 | |||||
Surrendered Shares | (6,384) | (6,384) | |||||
Noncontrolling interest distribution | (372) | (372) | |||||
Write-off of other comprehensive income | (15) | (15) | |||||
Net income | 67,193 | 66,476 | 717 | ||||
Balance, Stockholders Equity at Jun. 30, 2020 | 722,259 | $ 37 | 665,580 | (257,625) | 0 | 312,859 | 1,408 |
Balance (in shares) at Jun. 30, 2020 | 36,831,298 | ||||||
Balance, Stockholders Equity at Mar. 31, 2020 | 680,144 | $ 37 | 656,266 | (255,291) | 0 | 278,185 | 947 |
Balance (in shares) at Mar. 31, 2020 | 36,746,554 | ||||||
Issuance of stock - employee stock purchase plan | 826 | 826 | |||||
Issuance of stock - employee stock purchase plan (shares) | 5,295 | ||||||
Issuance/(cancellation) of non-vested stock | 0 | $ 0 | 0 | ||||
Issuance/(cancellation) of non-vested stock (shares) | 29,461 | ||||||
Exercise of stock options | 1,763 | 1,763 | |||||
Exercise of stock options (in shares) | 49,988 | ||||||
Non-cash compensation | 6,725 | 6,725 | |||||
Surrendered Shares | (2,334) | (2,334) | |||||
Noncontrolling interest distribution | (12) | (12) | |||||
Net income | 35,147 | 34,674 | 473 | ||||
Balance, Stockholders Equity at Jun. 30, 2020 | $ 722,259 | $ 37 | $ 665,580 | $ (257,625) | $ 0 | $ 312,859 | $ 1,408 |
Balance (in shares) at Jun. 30, 2020 | 36,831,298 |
CONSOLIDATED STATEMENTS OF CASH
CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | 12 Months Ended | ||
Jun. 30, 2020 | Jun. 30, 2019 | Jun. 30, 2020 | Jun. 30, 2019 | Dec. 31, 2019 | |
Cash Flows from Operating Activities: | |||||
Net income | $ 35,147 | $ 34,040 | $ 67,193 | $ 65,613 | |
Adjustments to reconcile net income to net cash provided by operating activities: | |||||
Depreciation and amortization | 11,672 | 8,074 | |||
Non-cash compensation | 6,725 | 5,538 | 12,634 | 12,153 | |
Non-cash 401(k) employer match | 0 | 4,686 | |||
Amortization and impairment of operating lease right of use assets | 18,558 | 17,495 | |||
Gain on disposal of property and equipment | (94) | (2) | |||
Loss on sale of equity method investment | 2,980 | 0 | |||
Write-off of other comprehensive income | (15) | 0 | |||
Deferred income taxes | (4,036) | 5,875 | |||
Equity in earnings from equity method investments | (487) | (3,716) | (964) | (4,932) | |
Amortization of deferred debt issuance costs/debt discount | 437 | 433 | |||
Return on equity investment | 2,744 | 842 | |||
Changes in operating assets and liabilities, net of impact of acquisitions: | |||||
Patient accounts receivable | 8,997 | (24,165) | |||
Other current assets | (3,469) | (8,343) | |||
Other assets | (675) | (56) | |||
Accounts payable | (6,452) | (9,475) | |||
Accrued expenses | 27,990 | 29,262 | |||
Other long-term obligations | 20,746 | (181) | |||
Operating lease liabilities | (16,365) | (16,200) | |||
Operating lease right of use assets | (1,924) | (1,754) | |||
Net cash provided by operating activities | 139,957 | 79,325 | |||
Cash Flows from Investing Activities: | |||||
Proceeds from sale of deferred compensation plan assets | 21 | 213 | |||
Proceeds from the sale of property and equipment | 80 | 146 | |||
Purchases of property and equipment | (1,701) | (2,693) | |||
Investments in equity method investees | (875) | (210) | |||
Proceeds from sale of equity method investment | 17,876 | 0 | |||
Acquisitions of businesses, net of cash acquired | (299,723) | (345,414) | |||
Net cash used in investing activities | (284,322) | (347,958) | |||
Cash Flows from Financing Activities: | |||||
Proceeds from issuance of stock upon exercise of stock options | 2,947 | 1,343 | |||
Proceeds from issuance of stock to employee stock purchase plan | 1,686 | 1,534 | |||
Shares withheld to pay taxes on non-cash compensation | (6,384) | (4,490) | |||
Noncontrolling interest distribution | (372) | (457) | |||
Proceeds from borrowings under term loan | 0 | 175,000 | |||
Proceeds from borrowings under revolving line of credit | 424,500 | 184,500 | |||
Repayments of borrowings under revolving line of credit | (259,500) | (92,000) | |||
Principal payments of long-term obligations | (4,675) | (2,277) | |||
Debt issuance costs | 0 | (847) | |||
Provider relief fund advance | 70,000 | 0 | |||
Net cash provided by financing activities | 228,202 | 262,306 | |||
Net increase (decrease) in cash, cash equivalents and restricted cash | 83,837 | (6,327) | |||
Cash, cash equivalents and restricted cash at beginning of period | 96,490 | 20,229 | $ 20,229 | ||
Cash, cash equivalents and restricted cash at end of period | $ 180,327 | $ 13,902 | 180,327 | 13,902 | $ 96,490 |
Supplemental Disclosures of Cash Flow Information: | |||||
Cash paid for interest | 3,292 | 4,187 | |||
Cash paid for income taxes, net of refunds received | 8,153 | 7,849 | |||
Cash paid for operating lease liabilities | 18,289 | 17,954 | |||
Cash paid for finance lease liabilities | 986 | 792 | |||
Supplemental Disclosures of Non-Cash Activity: | |||||
Right of use assets obtained in exchange for operating lease liabilities | 18,891 | 102,231 | |||
Right of use assets obtained in exchange for finance lease liabilities | 487 | 1,806 | |||
Reductions to right of use assets resulting from reductions to operating lease liabilities | $ 407 | $ 911 |
NATURE OF OPERATIONS, CONSOLIDA
NATURE OF OPERATIONS, CONSOLIDATION AND PRESENTATION OF FINANCIAL STATEMENTS | 6 Months Ended |
Jun. 30, 2020 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
NATURE OF OPERATIONS, CONSOLIDATION AND PRESENTATION OF FINANCIAL STATEMENTS | NATURE OF OPERATIONS, CONSOLIDATION AND PRESENTATION OF FINANCIAL STATEMENTS Amedisys, Inc., a Delaware corporation, (together with its consolidated subsidiaries, referred to herein as “Amedisys,” “we,” “us,” or “our”) is a multi-state provider of home health, hospice and personal care services with approximately 74% of our revenue derived from Medicare for the three and six-month periods ended June 30, 2020 and 2019. As of June 30, 2020, we owned and operated 322 Medicare-certified home health care centers, 190 Medicare-certified hospice care centers and 14 personal-care care centers in 39 states within the United States and the District of Columbia. Basis of Presentation In our opinion, the accompanying unaudited condensed consolidated financial statements contain all adjustments (consisting solely of normal recurring adjustments) necessary to present fairly our financial position, our results of operations and our cash flows in accordance with U.S. generally accepted accounting principles (“U.S. GAAP”) for interim financial reporting. Our results of operations for the interim periods presented are not necessarily indicative of the results of our operations for the entire year and have not been audited by our independent auditors. This report should be read in conjunction with our consolidated financial statements and related notes included in our Annual Report on Form 10-K for the year ended December 31, 2019, as filed with the Securities and Exchange Commission (“SEC”) on February 19, 2020 (the “Form 10-K”), which includes information and disclosures not included herein. Certain information and footnote disclosures normally included in annual financial statements prepared in accordance with U.S. GAAP have been condensed or omitted from the interim financial information presented, as allowed by SEC rules and regulations. Recently Adopted Accounting Pronouncements In June 2016, the Financial Accounting Standards Board ("FASB") issued Accounting Standards Update ("ASU") 2016-13, Financial Instruments - Credit Losses (Topic 326) , which provides guidance for measuring credit losses on financial instruments. Our adoption of this standard on January 1, 2020 did not have a material effect on our condensed consolidated financial statements. Recently Issued Accounting Pronouncements In December 2019, the FASB issued ASU 2019-12, Income Taxes (Topic 740) - Simplifying the Accounting for Income Taxes, which simplifies the accounting for income taxes by removing certain exceptions to the general principles in Topic 740 and improves consistent application by clarifying and amending existing guidance. The ASU is effective for annual and interim periods beginning after December 15, 2020. Early adoption is permitted. While the Company does not expect a material impact upon adoption of ASU 2019-12, we are still evaluating the effect the standard will have on our consolidated financial statements and related disclosures and ongoing financial reporting. Use of Estimates Our accounting and reporting policies conform with U.S. GAAP. In preparing the unaudited condensed consolidated financial statements, we are required to make estimates and assumptions that impact the amounts reported in the condensed consolidated financial statements and accompanying notes. Actual results could differ from those estimates. Principles of Consolidation These unaudited condensed consolidated financial statements include the accounts of Amedisys, Inc. and our wholly owned subsidiaries. All significant intercompany accounts and transactions have been eliminated in our accompanying unaudited condensed consolidated financial statements, and business combinations accounted for as purchases have been included in our unaudited condensed consolidated financial statements from their respective dates of acquisition. In addition to our wholly owned subsidiaries, we also have certain equity investments that are accounted for as set forth below. Investments We consolidate investments when the entity is a variable interest entity and we are the primary beneficiary or if we have controlling interests in the entity, which is generally ownership in excess of 50%. Third party equity interests in our consolidated joint ventures are reflected as noncontrolling interests in our condensed consolidated financial statements. |
SUMMARY OF SIGNIFICANT ACCOUNTI
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES | 6 Months Ended |
Jun. 30, 2020 | |
Accounting Policies [Abstract] | |
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES | SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES Revenue Recognition We account for revenue from contracts with customers in accordance with ASU 2014-09, Revenue from Contracts with Customers (Topic 606) and ASU 2015-14, Revenue from Contracts with Customers (Topic 606): Deferral of the Effective Date (collectively, "ASC 606"), and as such, we recognize revenue in the period in which we satisfy our performance obligations under our contracts by transferring our promised services to our customers in amounts that reflect the consideration to which we expect to be entitled in exchange for providing patient care, which are the transaction prices allocated to the distinct services. The Company's cost of obtaining contracts is not material. Revenues are recognized as performance obligations are satisfied, which varies based on the nature of the services provided. Our performance obligation is the delivery of patient care services in accordance with the nature and frequency of services outlined in physicians' orders, which are determined by a physician based on a patient's specific goals. The Company's performance obligations relate to contracts with a duration of less than one year; therefore, the Company has elected to apply the optional exemption provided by ASC 606 and is not required to disclose the aggregate amount of the transaction price allocated to performance obligations that are unsatisfied or partially unsatisfied as of the end of the reporting period. The unsatisfied or partially unsatisfied performance obligations are generally completed when the patients are discharged, which generally occurs within days or weeks of the end of the reporting period. We determine the transaction price based on gross charges for services provided, reduced by estimates for contractual and non-contractual revenue adjustments. Contractual revenue adjustments are recorded for the difference between our standard rates and the contracted rates to be realized from patients, third party payors and others for services provided. Non-contractual revenue adjustments include discounts provided to self-pay, uninsured patients or other payors, adjustments resulting from payment reviews and adjustments arising from our inability to obtain appropriate billing documentation, authorizations or face-to-face documentation. Subsequent changes to the estimate of the transaction price are recorded as adjustments to net service revenue in the period of change. Non-contractual revenue adjustments are recorded for self-pay, uninsured patients and other payors by major payor class based on our historical collection experience, aged accounts receivable by payor and current economic conditions. The non-contractual revenue adjustments represent the difference between amounts billed and amounts we expect to collect based on our collection history with similar payors. The Company assesses its ability to collect for the healthcare services provided at the time of patient admission based on the Company's verification of the patient's insurance coverage under Medicare, Medicaid, and other commercial or managed care insurance programs. Medicare represents approximately 74% of the Company's consolidated net service revenue for the three and six-month periods ended June 30, 2020 and 2019. Amounts due from third-party payors, primarily commercial health insurers and government programs (Medicare and Medicaid), include variable consideration for retroactive revenue adjustments due to settlements of audits and payment reviews. We determine our estimates for non-contractual revenue adjustments related to payment reviews based on our historical experience and success rates in the claim appeals and adjudication process. We determine our estimates for non-contractual revenue adjustments related to our inability to obtain appropriate billing documentation, authorizations, or face-to-face documentation based on our historical experience, which primarily includes a historical collection rate of over 99% on Medicare claims. Revenue is recorded at amounts we estimate to be realizable for services provided. Revenue by payor class as a percentage of total net service revenue is as follows: For the Three-Month Periods Ended June 30, For the Six-Month Periods 2020 2019 2020 2019 Home Health: Medicare 40 % 44 % 41 % 45 % Non-Medicare - Episodic-based 6 % 9 % 6 % 9 % Non-Medicare - Non-episodic based 14 % 12 % 14 % 12 % Hospice (1): Medicare 34 % 30 % 33 % 29 % Non-Medicare 2 % 1 % 2 % 1 % Personal Care 4 % 4 % 4 % 4 % 100 % 100 % 100 % 100 % (1) Acquired Compassionate Care Hospice on February 1, 2019, RoseRock Healthcare on April 1, 2019, Asana Hospice on January 1, 2020 and AseraCare on June 1, 2020. Home Health Revenue Recognition Medicare Revenue Effective January 1, 2020, the Centers for Medicare and Medicaid Services ("CMS") implemented a revised case-mix adjustment methodology, the Patient-Driven Groupings Model ("PDGM"), to better align payment with patient care needs and ensure that clinically complex and ill beneficiaries have adequate access to home health care. PDGM uses 30-day periods of care rather than 60-day episodes of care as the unit of payment, eliminates the use of the number of therapy visits provided in determining payment and relies more heavily on clinical characteristics and other patient information. Net service revenue is recorded based on the established Federal Medicare home health payment rate for a 30-day period of care ("billing period"). PDGM uses timing, admission source, functional impairment levels and principal and other diagnoses to case-mix adjust payments. The case-mix adjusted payment for a 30-day period of care is subject to additional adjustments based on certain variables, including, but not limited to (a) an outlier payment if our patient's care was unusually costly (capped at 10% of total reimbursement per provider number); (b) a low utilization payment adjustment (“LUPA”) if the number of visits provided was less than the established threshold, which ranges from two to six visits and varies for every case-mix group under PDGM; (c) a partial payment if a patient transferred to another provider or from another provider before completing the 30-day period of care; and (d) the applicable geographic wage index. Payment for non-routine supplies are now included in the 30-day payment rate. Medicare can also make various adjustments to payments received if we are unable to produce appropriate billing documentation or acceptable authorizations. We estimate the impact of such adjustments based on our historical experience, which primarily includes a historical collection rate of over 99% on Medicare claims, and record this estimate during the period in which services are rendered as a reduction to revenue and a corresponding reduction to patient accounts receivable. Amounts due from Medicare include variable consideration for retroactive revenue adjustments due to settlements of audits and payment reviews. We determine our estimates for non-contractual revenue adjustments related to payment reviews based on our historical experience and success rates in the claim appeals and adjudication process. The Medicare home health benefit requires that beneficiaries be homebound (meaning that the beneficiary is unable to leave their home without a considerable and taxing effort), require intermittent skilled nursing, physical therapy or speech therapy services, and receive treatment under a plan of care established and periodically reviewed by a physician. In order to provide greater flexibility during the novel coronavirus pandemic ("COVID-19"), CMS has relaxed the definition of homebound status. During the pandemic, a beneficiary is considered homebound if they have been instructed by a physician not to leave their home because of a confirmed or suspected COVID-19 diagnosis or if the patient has a condition that makes them more susceptible to contracting COVID-19. Therefore, if a beneficiary is homebound due to COVID-19 and requires skilled services, the services will be covered under the Medicare home health benefit. All Medicare contracts are required to have a signed plan of care which represents a single performance obligation, comprised of the delivery of a series of distinct services that are substantially similar and have a similar pattern of transfer to the customer. Accordingly, the Company accounts for the series of services ("episode") as a single performance obligation satisfied over time, as the customer simultaneously receives and consumes the benefits of the goods and services provided. An episode starts the first day a billable visit is performed and ends 60 days later or upon discharge, if earlier, with multiple continuous episodes allowed. As noted above, under PDGM, we are now reimbursed for 30-day periods of care rather than 60-day episodes of care. ASC 606 notes that if an entity has a right to consideration from a customer in an amount that corresponds directly with the value of the entity’s performance completed to date, the entity may recognize revenue in the amount to which the entity has a right to invoice. We have elected to apply the "right to invoice” practical expedient and therefore, our revenue recognition is based on the reimbursement we are entitled to for each 30-day payment period. We utilize our historical average length of stay for each 30-day period of care as the measure of progress towards the satisfaction of our performance obligation. A portion of reimbursement from each Medicare episode is billed near the start of each 30-day period of care, and cash is typically received before all services are rendered. Any cash received from Medicare for a request for anticipated payment (“RAP”) for a 30-day period of care that exceeds the associated revenue earned is recorded to accrued expenses within our condensed consolidated balance sheet. Non-Medicare Revenue Episodic-based Revenue. We recognize revenue in a similar manner as we recognize Medicare revenue for amounts that are paid by other insurance carriers, including Medicare Advantage programs; however, these amounts can vary based upon the negotiated terms which generally range from 90% to 100% of Medicare rates. Non-episodic based Revenue. Gross revenue is recorded on an accrual basis based upon the date of service at amounts equal to our established or estimated per-visit rates. Contractual revenue adjustments are recorded for the difference between our standard rates and the contracted rates to be realized from patients, third parties and others for services provided and are deducted from gross revenue to determine net service revenue. We also make non-contractual revenue adjustments to non-episodic revenue based on historical experience, to reflect the estimated transaction price. We receive a minimal amount of our net service revenue from patients who are either self-insured or are obligated for an insurance co-payment. Hospice Revenue Recognition Hospice Medicare Revenue Gross revenue is recorded on an accrual basis based upon the date of service at amounts equal to the estimated payment rates. The estimated payment rates are predetermined daily or hourly rates for each of the four levels of care we deliver. The four levels of care are routine care, general inpatient care, continuous home care and respite care. Routine care accounted for 98% of our total net Medicare hospice service revenue for the three and six-month periods ended June 30, 2020 and 99% and 98% of our total net Medicare hospice service revenue for the three and six-month periods ended June 30, 2019. There are two separate payment rates for routine care: payments for the first 60 days of care and care beyond 60 days. In addition to the two routine rates, we may also receive a service intensity add-on (“SIA”). The SIA is based on visits made in the last seven days of life by a registered nurse (“RN”) or medical social worker (“MSW”) for patients in a routine level of care. The performance obligation is the delivery of hospice services to the patient, as determined by a physician, each day the patient is on hospice care. We make adjustments to Medicare revenue for non-contractual revenue adjustments, which include our inability to obtain appropriate billing documentation or acceptable authorizations and other reasons unrelated to credit risk. We estimate the impact of these non-contractual revenue adjustments based on our historical experience, which primarily includes a historical collection rate of over 99% on Medicare claims, and record it during the period services are rendered. Additionally, our hospice service revenue is subject to certain limitations on payments from Medicare which are considered variable consideration. We are subject to an inpatient cap limit and an overall Medicare payment cap for each provider number. We monitor these caps on a provider-by-provider basis and estimate amounts due back to Medicare if we estimate a cap has been exceeded. We record these adjustments as a reduction to revenue and an increase in accrued expenses within our condensed consolidated balance sheet. Providers are required to self-report and pay their estimated cap liability by February 28 th of the following year. As of June 30, 2020, we have recorded $8.1 million for estimated amounts due back to Medicare in accrued expenses for the Federal cap years ended October 31, 2013 through September 30, 2020; $2.0 million of this balance was acquired with the AseraCare acquisition. As of December 31, 2019, we had recorded $5.7 million for estimated amounts due back to Medicare in accrued expenses for the Federal cap years ended October 31, 2013 through September 30, 2020. Hospice Non-Medicare Revenue Gross revenue is recorded on an accrual basis based upon the date of service at amounts equal to our established rates or estimated per day rates, as applicable. Contractual revenue adjustments are recorded for the difference between our standard rates and the contractual rates to be realized from patients, third party payors and others for services provided and are deducted from gross revenue to determine our net service revenue. We also make non-contractual adjustments to non-Medicare revenue based on historical experience, to reflect the estimated transaction price. Personal Care Revenue Recognition Personal Care Revenue We generate net service revenues by providing our services directly to patients based on authorized hours, visits or units determined by the relevant agency, at a rate that is either contractual or fixed by legislation. Net service revenue is recognized at the time services are rendered based on gross charges for the services provided, reduced by estimates for contractual and non-contractual revenue adjustments. We receive payment for providing such services from payors, including state and local governmental agencies, managed care organizations, commercial insurers and private consumers. Payors include the following elder service agencies: Aging Services Access Points (ASAPs), Senior Care Options (SCOs), Program of All-Inclusive Care for the Elderly (PACE) and the Veterans Administration (VA). Government Grants In the absence of specific guidance to account for government grants under U.S. GAAP, we have decided to account for government grants in accordance with International Accounting Standard ("IAS") 20, Accounting for Government Grants and Disclosure of Government Assistance , and as such, we recognize grant income on a systematic basis in line with the recognition of expenses or the loss of revenues for which the grants are intended to compensate. We recognize grants once both of the following conditions are met: (1) we are able to comply with the relevant conditions of the grant and (2) the grant will be received. During the three-month period ended June 30, 2020, our home health and hospice segments received approximately $100 million from the CARES Act Provider Relief Fund, which is inclusive of $2 million related to our equity method investments (see Note 9 - Novel Coronavirus Pandemic ("COVID-19") for additional information). We also acquired approximately $5 million of CARES Act funds in connection with the acquisition of AseraCare Hospice. The terms and conditions note that the funds received can be used for health care related expenses or lost revenues that are attributable to coronavirus. As of June 30, 2020, for our wholly-owned subsidiaries, we have decided to only utilize grant funds to the extent that we have qualifying COVID-19 expenses. Accordingly, for our wholly-owned subsidiaries, we will not be using the funds to cover lost revenues resulting from COVID-19 during the six-month period ended June 30, 2020. The income associated with the COVID-19 expenses incurred by our home health and hospice segments to date, which total $22 million, is reflected within other operating income in our condensed consolidated statements of operations. While we anticipate incurring additional COVID-19 expenses in the future, we currently do not believe that we will fully utilize the funds received; therefore, we have recorded a liability related to the funds that we do not expect to utilize totaling $70 million which is reflected in the Provider Relief Fund Advance account in current liabilities within our condensed consolidated balance sheet. Funds that we intend to use in the future to cover COVID-19 expenses, which we have estimated to be approximately $11 million, have been recorded to a deferred liability account within accrued expenses in our condensed consolidated balance sheet. These estimates may change as our ability to utilize and retain the funds will depend on the magnitude, timing and nature of the impact of the pandemic. We do not intend to return any funds until the end of the public health emergency or as otherwise instructed by the U.S. Department of Health and Human Services ("HHS"). Our personal care segment received funds from the Mass Home Care ASAP COVID-19 Provider Sustainability Program totaling less than $1 million. We will be using these funds to cover COVID-19 expenses as well. The income is reflected within other operating income in our condensed consolidated statements of operations. Cash, Cash Equivalents and Restricted Cash Cash and cash equivalents include certificates of deposit and all highly liquid debt instruments with maturities of three months or less when purchased. Our cash balance as of June 30, 2020 includes $103 million associated with the CARES Act Provider Relief Fund. We separated these funds into their own account and will only transfer the funds to our operating account once we have incurred expenses that comply with the Provider Relief Fund terms and conditions. Restricted cash includes cash that is not available for ordinary business use. As of June 30, 2020, we had $3.0 million of restricted cash that was placed into escrow accounts related to the potential indemnity and working capital adjustment provisions within the Asana Hospice and AseraCare Hospice purchase agreements ($1.5 million and $1.0 million, respectively) and to secure the purchase of personal protective equipment from new suppliers in response to COVID-19 ($0.5 million). Patient Accounts Receivable We report accounts receivable from services rendered at their estimated transaction price, which includes contractual and non-contractual revenue adjustments based on the amounts expected to be due from payors. Our patient accounts receivable are uncollateralized and consist of amounts due from Medicare, Medicaid, other third-party payors and patients. As of June 30, 2020, there is only one single payor, other than Medicare, that accounts for more than 10% of our total outstanding patient receivables (approximately 10.1%). Thus, we believe there are no other significant concentrations of receivables that would subject us to any significant credit risk in the collection of our patient accounts receivable. We write off accounts on a monthly basis once we have exhausted our collection efforts and deem an account to be uncollectible. We believe the collectibility risk associated with our Medicare accounts, which represent 60% and 58% of our patient accounts receivable at June 30, 2020 and December 31, 2019, respectively, is limited due to our historical collection rate of over 99% from Medicare and the fact that Medicare is a U.S. government payor. We do not believe there are any significant concentrations of revenues from any payor that would subject us to any significant credit risk in the collection of our accounts receivable. Medicare Home Health For our home health patients, our pre-billing process includes verifying that we are eligible for payment from Medicare for the services that we provide to our patients. Our Medicare billing begins with a process to ensure that our billings are accurate through the utilization of an electronic Medicare claim review. We submit a RAP for 20% of our estimated payment for each 30-day period of care. The full amount of the payment for each 30-day period of care is billed after the period of care has been completed (“final billed”). The RAP received for that billing period is then deducted from our final payment. If a final bill is not submitted within the greater of 90 days from the start of the 30-day period of care, or 60 days from the date the RAP was paid, any RAPs received for that billing period will be recouped by Medicare from any other claims in process for that particular provider number. The RAP claim must then be resubmitted. CMS has mandated the full elimination of RAPs in 2021. Medicare Hospice For our hospice patients, our pre-billing process includes verifying that we are eligible for payment from Medicare for the services that we provide to our patients. Our Medicare billing begins with a process to ensure that our billings are accurate through the utilization of an electronic Medicare claim review. We bill Medicare on a monthly basis for the services provided to the patient. Non-Medicare Home Health, Hospice and Personal Care For our non-Medicare patients, our pre-billing process primarily begins with verifying a patient’s eligibility for services with the applicable payor. Once the patient has been confirmed for eligibility, we will provide services to the patient and bill the applicable payor. Our review and evaluation of non-Medicare accounts receivable includes a detailed review of outstanding balances and special consideration to concentrations of receivables from particular payors or groups of payors with similar characteristics that would subject us to any significant credit risk. Fair Value of Financial Instruments The following details our financial instruments where the carrying value and the fair value differ (amounts in millions): Fair Value at Reporting Date Using Financial Instrument Carrying Value as of June 30, 2020 Quoted Prices in Active Significant Other Significant Long-term obligations $ 403.6 $ — $ 404.1 $ — The fair value hierarchy is based on three levels of inputs, of which the first two are considered observable and the last unobservable, that may be used to measure fair value. The three levels of inputs are as follows: • Level 1 – Quoted prices in active markets for identical assets and liabilities. • Level 2 – Inputs other than Level 1 that are observable, either directly or indirectly, such as quoted prices for similar assets or liabilities; quoted prices in markets that are not active; or other inputs that are observable or can be corroborated by observable market data for substantially the full term of the assets or liabilities. • Level 3 – Unobservable inputs that are supported by little or no market activity and are significant to the fair value of the assets or liabilities. Our deferred compensation plan assets are recorded at fair value and are considered a level 2 measurement. For our other financial instruments, including our cash and cash equivalents, patient accounts receivable, accounts payable, payroll and employee benefits and accrued expenses, we estimate the carrying amounts approximate fair value. Weighted-Average Shares Outstanding Net income per share attributable to Amedisys, Inc. common stockholders, calculated on the treasury stock method, is based on the weighted average number of shares outstanding during the period. The following table sets forth, for the periods indicated, shares used in our computation of the weighted-average shares outstanding, which are used to calculate our basic and diluted net income attributable to Amedisys, Inc. common stockholders (amounts in thousands): For the Three- For the Six- 2020 2019 2020 2019 Weighted average number of shares outstanding - basic 32,412 32,075 32,371 32,038 Effect of dilutive securities: Stock options 570 537 582 548 Non-vested stock and stock units 303 321 306 327 Weighted average number of shares outstanding - diluted 33,285 32,933 33,259 32,913 Anti-dilutive securities 14 159 21 143 Business Combinations We account for acquisitions using the acquisition method of accounting in accordance with Accounting Standards Codification (“ASC”) 805, Business Combinations |
ACQUISITIONS
ACQUISITIONS | 6 Months Ended |
Jun. 30, 2020 | |
Business Combinations [Abstract] | |
ACQUISITIONS | ACQUISITIONS We complete acquisitions from time to time in order to pursue our strategy of increasing our market presence by expanding our service base and enhancing our position in certain geographic areas as a leading provider of home health, hospice and personal care services. The purchase price paid for acquisitions is negotiated through arm’s length transactions, with consideration based on our analysis of, among other things, comparable acquisitions and expected cash flows. Acquisitions are accounted for as purchases and are included in our condensed consolidated financial statements from their respective acquisition dates. Goodwill generated from acquisitions is recognized for the excess of the purchase price over tangible and identifiable intangible assets because of the expected contributions of the acquisitions to our overall corporate strategy. We typically engage outside appraisal firms to assist in the fair value determination of identifiable intangible assets for significant acquisitions. The preliminary purchase price allocation is adjusted, as necessary, up to one year after the acquisition closing date if management obtains more information regarding asset valuations and liabilities assumed. Home Health Division On March 1, 2020, we acquired the regulatory assets of a home health provider in Washington for a purchase price of $3.0 million. The purchase price was paid with cash on hand on the date of the transaction. Based on the Company's preliminary valuation, we recorded goodwill of $2.8 million and other intangibles (certificate of need) of $0.2 million in connection with the acquisition. On April 18, 2020, we acquired the regulatory assets of a home health provider in Kentucky for a purchase price of $0.7 million. The purchase price was paid with cash on hand on the date of the transaction. Based on the Company's preliminary valuation, we recorded goodwill of $0.5 million and other intangibles (certificate of need) of $0.2 million in connection with the acquisition. Hospice Division On January 1, 2020, we acquired Asana Hospice ("Asana"), a hospice provider with locations in Pennsylvania, Ohio, Texas, Missouri and Kansas for a purchase price of $66.3 million, net of cash acquired of $0.7 million. Under the purchase agreement, the purchase price is subject to a net working capital adjustment, whereby the purchase price will be adjusted to the extent the actual net working capital of Asana as of the closing differs from the required net working capital under the purchase agreement. The net working capital adjustment, which was finalized during the three-month period ended June 30, 2020, reduced the purchase price by $0.7 million, from $66.3 million to $65.6 million. The Company is in the process of finalizing its valuation of the assets acquired and liabilities assumed. During the three-month period ended June 30, 2020, we recorded measurement period adjustments based on changes to management's estimates and assumptions related to the assets acquired and liabilities assumed. Based on the Company's preliminary valuation, the total estimated consideration of $65.6 million has been allocated to assets acquired and liabilities assumed as of the acquisition date as follows (amounts in millions): Amount Patient accounts receivable $ 5.7 Property and equipment 0.2 Operating lease right of use assets 0.9 Intangible assets 5.6 Total assets acquired 12.4 Accounts payable (3.1) Payroll and employee benefits (1.5) Accrued expenses (0.3) Operating lease liabilities (0.9) Total liabilities assumed (5.8) Net identifiable assets acquired 6.6 Goodwill 59.0 Total estimated consideration $ 65.6 Intangible assets acquired include licenses ($2.0 million), acquired names ($1.3 million) and non-compete agreements ($2.3 million). The acquired names and non-compete agreements will be amortized over a weighted-average period of 2.0 years. Asana contributed approximately $7.1 million in net service revenue and an operating loss of $0.9 million (inclusive of acquisition and integration costs totaling $0.3 million and intangibles amortization totaling $1.0 million) during the three-month period ended June 30, 2020 and $14.4 million in net service revenue and an operating loss of $2.2 million (inclusive of acquisition and integration costs totaling $1.4 million and intangibles amortization totaling $1.4 million) during the six-month period ended June 30, 2020. On June 1, 2020, we acquired Homecare Preferred Choice, Inc., doing business as AseraCare Hospice ("AseraCare"), a national hospice care provider with 44 locations, for a purchase price of $230.4 million, net of cash acquired and inclusive of a $32 million tax asset. Under the purchase agreement, the purchase price is subject to a net working capital adjustment, whereby the purchase price will be adjusted to the extent the actual net working capital of AseraCare as of the closing differs from the required net working capital under the purchase agreement. The net working capital adjustment will be finalized during the third quarter of 2020. The Company is in the process of reviewing the fair value of the assets acquired and liabilities assumed. We have estimated the fair value of acquired names and licenses based on the values assigned in prior acquisitions. These amounts, along with the value of non-compete agreements, will be adjusted upon receipt of the final valuation report. Based on the Company's preliminary valuation, the total estimated consideration of $230.4 million has been allocated to assets acquired and liabilities assumed as of the acquisition date as follows (amounts in millions): Amount Patient accounts receivable $ 14.7 Prepaid expenses 0.9 Property and equipment 0.6 Operating lease right of use assets 5.4 Intangible assets 16.7 Other assets 0.2 Total assets acquired 38.5 Accounts payable (5.5) Payroll and employee benefits (6.4) Accrued expenses (6.9) Operating lease liabilities (5.4) Other long-term obligations (0.2) Total liabilities assumed (24.4) Net identifiable assets acquired 14.1 Goodwill 216.3 Total estimated consideration $ 230.4 Intangible assets acquired include licenses ($10.2 million), acquired names ($5.8 million) and favorable lease contracts ($0.7 million). The acquired names will be amortized over a weighted-average period of 2.0 years. We recorded unfavorable lease contracts of $0.2 million in other long-term obligations within our condensed consolidated balance sheet as of June 30, 2020. AseraCare contributed approximately $9.2 million in net service revenue and an operating loss of $3.0 million (inclusive of acquisition and integration costs totaling $3.3 million and intangibles amortization totaling $0.2 million) during the three and six-month periods ended June 30, 2020. The following table contains unaudited pro forma condensed consolidated statement of operations information for the three and six-month periods ended June 30, 2020 and 2019 assuming that the AseraCare acquisition closed on January 1, 2019 (amounts in millions, except per share data). The pro forma financial information includes various assumptions, including those related to the preliminary purchase price allocation of assets acquired and liabilities assumed. The pro forma financial information may vary in future quarters based on the final valuations and analysis of the fair value of the assets acquired and liabilities assumed. For the Three- For the Six- 2020 2019 2020 2019 Net service revenue $ 504.3 $ 523.6 $ 1,025.3 $ 1,020.5 Operating income 51.9 44.9 94.8 88.8 Net income attributable to Amedisys Inc. 35.5 32.0 65.1 61.1 Basic earnings per share 1.09 1.00 2.01 1.91 Diluted earnings per share 1.07 0.97 1.96 1.86 The pro forma information presented above includes adjustments for (i) amortization of identifiable intangible assets, (ii) interest on additional debt required to fund the acquisition, (iii) non-recurring transaction costs and (iv) income taxes based on the Company's statutory tax rate. This pro forma information is presented for illustrative purposes only and may not be |
LONG-TERM OBLIGATIONS
LONG-TERM OBLIGATIONS | 6 Months Ended |
Jun. 30, 2020 | |
Debt Disclosure [Abstract] | |
LONG-TERM OBLIGATIONS | LONG-TERM OBLIGATIONS Long-term debt consists of the following for the periods indicated (amounts in millions): June 30, 2020 December 31, 2019 $175.0 million Term Loan; interest rate at Base Rate plus Applicable Rate or Eurodollar Rate plus Applicable Rate (1.7% at June 30, 2020); due February 4, 2024 $ 168.4 $ 171.7 $550.0 million Revolving Credit Facility; interest only payments; interest rate at Base Rate plus Applicable Rate or Eurodollar Rate plus Applicable Rate (1.7% at June 30, 2020); due February 4, 2024 235.0 70.0 Promissory notes 0.2 0.6 Finance leases 2.9 3.4 Principal amount of long-term obligations 406.5 245.7 Deferred debt issuance costs (3.1) (3.5) 403.4 242.2 Current portion of long-term obligations (10.7) (9.9) Total $ 392.7 $ 232.3 First Amendment to Amended and Restated Credit Agreement On February 4, 2019, we entered into the First Amendment to our Credit Agreement (as amended by the First Amendment, the "Amended Credit Agreement"). The Amended Credit Agreement provides for a senior secured credit facility in an initial aggregate principal amount of up to $725.0 million, which includes a $550.0 million Revolving Credit Facility under the Credit Agreement and a term loan facility with a principal amount of up to $175.0 million (the "Term Loan Facility" and collectively with the Revolving Credit Facility, the "Credit Facility"), which was added by the First Amendment. We borrowed the entire principal amount of the Term Loan Facility on February 4, 2019 in order to fund a portion of the purchase price of the Compassionate Care Hospice ("CCH") acquisition, with the remainder of the purchase price and associated transactional fees and expenses funded by proceeds from the Revolving Credit Facility. The loans issued under the Credit Facility bear interest on a per annum basis, at our election, at either: (i) the Base Rate plus the Applicable Rate or (ii) the Eurodollar Rate plus the Applicable Rate. The “Base Rate” means a fluctuating rate per annum equal to the highest of (a) the federal funds rate plus 0.50% per annum, (b) the prime rate of interest established by the Administrative Agent, and (c) the Eurodollar Rate plus 1% per annum. The “Eurodollar Rate” means the quoted rate per annum equal to the London Interbank Offered Rate (“LIBOR”) or a comparable successor rate approved by the Administrative Agent for an interest period of one, two, three or six months (as selected by us). The “Applicable Rate” is based on the consolidated leverage ratio and is presented in the table below. As of June 30, 2020, the Applicable Rate is 0.50% per annum for Base Rate loans and 1.50% per annum for Eurodollar Rate loans. We are also subject to a commitment fee and letter of credit fee under the terms of the Amended Credit Agreement, as presented in the table below. Pricing Tier Consolidated Leverage Ratio Commitment Fee Letter of Credit Fee Eurodollar Rate Loans Base Rate Loans I ≥ 3.00 to 1.0 0.35% 1.75% 2.00% 1.00% II < 3.00 to 1.0 but ≥ 2.00 to 1.0 0.30% 1.50% 1.75% 0.75% III < 2.00 to 1.0 but ≥ 0.75 to 1.0 0.25% 1.25% 1.50% 0.50% IV < 0.75 to 1.0 0.20% 1.00% 1.25% 0.25% The final maturity date of the Credit Facility is February 4, 2024. The Revolving Credit Facility will terminate and be due and payable as of the final maturity date. The Term Loan Facility, however, is subject to quarterly amortization of principal in the amount of (i) 0.625% for the period commencing on February 4, 2019 and ending on March 31, 2020, (ii) 1.250% for the period commencing on April 1, 2020 and ending on March 31, 2023, and (iii) 1.875% for the period commencing on April 1, 2023 and ending on February 4, 2024. The remaining balance of the Term Loan Facility must be paid upon the final maturity date. In addition to the scheduled amortization of the Term Loan Facility, and subject to customary exceptions and reinvestment rights, we are required to prepay the Term Loan Facility, first, and the Revolving Credit Facility, second, with 100% of all net cash proceeds received by any loan party or any subsidiary thereof in connection with (a) any asset sale or disposition where such loan party receives net cash proceeds in excess of $5 million or (b) any debt issuance that is not permitted under the Amended Credit Agreement. The Amended Credit Agreement requires maintenance of two financial covenants: (i) a consolidated leverage ratio of funded indebtedness to Earnings Before Interest, Taxes, Depreciation and Amortization ("EBITDA"), as defined in the Amended Credit Agreement, and (ii) a consolidated interest coverage ratio of EBITDA to cash interest charges, as defined in the Amended Credit Agreement. Each of these covenants is calculated over rolling four-quarter periods and also is subject to certain exceptions and baskets. The Amended Credit Agreement also contains customary covenants, including, but not limited to, restrictions on: incurrence of liens, incurrence of additional debt, sales of assets and other fundamental corporate changes, investments, and declarations of dividends. These covenants contain customary exclusions and baskets as detailed in the Amended Credit Agreement. In connection with our entry into the Amended Credit Agreement, we recorded $0.8 million in deferred debt issuance costs as long-term obligations, less current portion within our condensed consolidated balance sheet during the year ended December 31, 2019. The Revolving Credit Facility is guaranteed by substantially all of our wholly-owned direct and indirect subsidiaries. The Amended Credit Agreement requires at all times that we (i) provide guarantees from wholly-owned subsidiaries that in the aggregate represent not less than 95% of our consolidated net revenues and adjusted EBITDA from all wholly-owned subsidiaries and (ii) provide guarantees from subsidiaries that in the aggregate represent not less than 70% of consolidated adjusted EBITDA, subject to certain exceptions. Our weighted average interest rate for borrowings under our $550.0 million Revolving Credit Facility was 2.1% and 2.5% for the three and six-month periods ended June 30, 2020, respectively, and 4.0% for the three and six-month periods ended June 30, 2019. Our weighted average interest rate for borrowings under our $175.0 million Term Loan Facility was 2.0% and 2.6% for the three and six-month periods ended June 30, 2020, respectively, and 4.0% for the three-month period ended June 30, 2019 and for the period February 4, 2019 to June 30, 2019. As of June 30, 2020, our consolidated leverage ratio was 1.3, our consolidated interest coverage ratio was 14.8 and we are in compliance with our covenants under the Amended Credit Agreement. In the event we are not in compliance with our debt covenants in the future, we would pursue various alternatives in an attempt to successfully resolve the non-compliance, which might include, among other things, seeking debt covenant waivers or amendments. As of June 30, 2020, our availability under our $550.0 million Revolving Credit Facility was $286.2 million as we have $235.0 million outstanding in borrowings and $28.8 million outstanding in letters of credit. Joinder Agreements In connection with the CCH acquisition, we entered into a Joinder Agreement, dated as of February 4, 2019 (the “CCH Joinder”), pursuant to which CCH and its subsidiaries were made parties to, and became subject to the terms and conditions of, the Amended Credit Agreement, the Amended and Restated Security Agreement, dated as of June 29, 2018 (the “Amended and Restated Security Agreement”), and the Amended and Restated Pledge Agreement, dated as of June 29, 2018 (the “Amended and Restated Pledge Agreement”). In connection with the AseraCare acquisition, we entered into a Joinder Agreement, dated as of June 12, 2020, pursuant to which the AseraCare entities were made parties to, and became subject to the terms and conditions of, the Amended Credit Agreement, the Amended and Restated Security Agreement and the Amended and Restated Pledge Agreement (the “AseraCare Joinder,” and together with the CCH Joinder, the “Joinders”). Pursuant to the Joinders, the Amended and Restated Security Agreement and the Amended and Restated Pledge Agreement, CCH and its subsidiaries and the AseraCare entities granted in favor of the Administrative Agent a first lien security interest in substantially all of their personal property assets and pledged to the Administrative Agent each of their respective subsidiaries' issued and outstanding equity interests. CCH and its subsidiaries and the AseraCare entities also guaranteed our obligations, whether now existing or arising after the respective effective dates of the Joinders, under the Amended Credit Agreement pursuant to the terms of the Joinders and the Amended Credit Agreement. |
COMMITMENTS AND CONTINGENCIES
COMMITMENTS AND CONTINGENCIES | 6 Months Ended |
Jun. 30, 2020 | |
Commitments and Contingencies Disclosure [Abstract] | |
COMMITMENTS AND CONTINGENCIES | COMMITMENTS AND CONTINGENCIES Legal Proceedings - Ongoing We are involved in the following legal actions: Subpoena Duces Tecum and Civil Investigative Demands Issued by the U.S. Department of Justice On May 21, 2015, we received a Subpoena Duces Tecum (“Subpoena”) issued by the U.S. Department of Justice. The Subpoena requests the delivery of information regarding 53 identified hospice patients to the United States Attorney’s Office for the District of Massachusetts. It also requests the delivery of documents relating to our hospice clinical and business operations and related compliance activities. The Subpoena generally covers the period from January 1, 2011 through May 21, 2015. We are fully cooperating with the U.S. Department of Justice with respect to this investigation. On November 3, 2015, we received a civil investigative demand (“CID”) issued by the U.S. Department of Justice pursuant to the federal False Claims Act relating to claims submitted to Medicare and/or Medicaid for hospice services provided through designated facilities in the Morgantown, West Virginia area. The CID requests the delivery of information to the United States Attorney’s Office for the Northern District of West Virginia regarding 66 identified hospice patients, as well as documents relating to our hospice clinical and business operations in the Morgantown area. The CID generally covers the period from January 1, 2009 through August 31, 2015. We are fully cooperating with the U.S. Department of Justice with respect to this investigation. On June 27, 2016, we received a CID issued by the U.S. Department of Justice pursuant to the federal False Claims Act relating to claims submitted to Medicare and/or Medicaid for hospice services provided through designated facilities in the Parkersburg, West Virginia area. The CID requests the delivery of information to the United States Attorney’s Office for the Southern District of West Virginia regarding 68 identified hospice patients, as well as documents relating to our hospice clinical and business operations in the Parkersburg area. The CID generally covers the period from January 1, 2011 through June 20, 2016. We are fully cooperating with the U.S. Department of Justice with respect to this investigation. Based on our analysis of sample claims data in connection with preliminary settlement discussions with the U.S. Department of Justice regarding the above matters, we have recorded a total of $6.5 million to accrued expenses in our condensed consolidated balance sheet related to this matter. Due to the ongoing nature of the investigations and current stage of the settlement discussions, we are unable to estimate a range of potential loss at this time, and we cannot predict the timing or outcome of these investigations. In addition to the matters referenced in this note, we are involved in legal actions in the normal course of business, some of which seek monetary damages, including claims for punitive damages. Based on information available to us as of the date of this filing, we do not believe that these normal course actions, when finally concluded and determined, will have a material impact on our consolidated financial condition, results of operations or cash flows. Legal fees related to all legal matters are expensed as incurred. Other Investigative Matters - Ongoing Compassionate Care Hospice Corporate Integrity Agreement On January 30, 2015, CCH entered into a corporate integrity agreement ("CIA") with the Office of Inspector General-HHS (“OIG”). The CIA required that CCH provide annual on-site compliance training; develop and implement policies to ensure compliance with federal health care program requirements; screen new and current employees to ensure that they are eligible to participate in federal health care programs; establish a compliance committee that contains both a Compliance Officer and a Chief Quality Officer; retain a Governing Authority expert who will periodically complete a compliance program review; and retain an independent review organization ("IRO") to complete claims reviews for hospice services rendered in New York. The OIG waived the claims review for the final year of the CCH CIA based on the closure of the New York operations. Additionally, the CIA required that CCH report substantial overpayments that CCH discovered it had received from federal health care programs, as well as probable violations of federal criminal, civil or administrative health care laws. Upon breach of the CIA, CCH could have become liable for payment of certain stipulated penalties, or could have been excluded from participation in federal health care programs. The CIA had a term of five years that ended on January 30, 2020. We filed our final annual report on March 25, 2020. Other Investigative Matters - Completed Corporate Integrity Agreement On April 23, 2014, with no admissions of liability on our part, we entered into a settlement agreement with the U.S. Department of Justice relating to certain of our clinical and business operations. Concurrently with our entry into this agreement, we entered into a CIA with the OIG. The CIA formalized various aspects of our already existing ethics and compliance programs and contained other requirements designed to help ensure our ongoing compliance with federal health care program requirements. Among other things, the CIA required us to maintain our existing compliance program, executive compliance committee and compliance committee of the Board of Directors; provide certain compliance training; continue screening new and current employees to ensure they are eligible to participate in federal health care programs; engage an IRO to perform certain auditing and reviews and prepare certain reports regarding our compliance with federal health care programs, our billing submissions to federal health care programs and our compliance and risk mitigation programs; and provide certain reports and management certifications to the OIG. Additionally, the CIA specifically required that we report substantial overpayments that we discovered we had received from federal health care programs, as well as probable violations of federal health care laws. The corporate integrity agreement had a term of five years that ended on April 21, 2019. We filed our final annual report on July 19, 2019. On May 5, 2020, the Company received notice from the OIG that the Company's five-year CIA with the OIG has been completed. Third Party Audits - Ongoing From time to time, in the ordinary course of business, we are subject to audits under various governmental programs including Recovery Audit Contractors (“RACs”), Zone Program Integrity Contractors (“ZPICs”), Uniform Program Integrity Contractors ("UPICs"), Program Safeguard Contractors (“PSCs”) and Medicaid Integrity Contributors (“MICs”) in which third party firms engaged by CMS conduct extensive reviews of claims data to identify potential improper payments. We cannot predict the ultimate outcome of any regulatory reviews or other governmental audits and investigations. In July 2010, our subsidiary that provides hospice services in Florence, South Carolina received from a ZPIC a request for records regarding a sample of 30 beneficiaries who received services from the subsidiary during the period of January 1, 2008 through March 31, 2010 (the “Review Period”) to determine whether the underlying services met pertinent Medicare payment requirements. We acquired the hospice operations subject to this review on August 1, 2009; the Review Period covers time periods both before and after our ownership of these hospice operations. Based on the ZPIC’s findings for 16 beneficiaries, which were extrapolated to all claims for hospice services provided by the Florence subsidiary billed during the Review Period, on June 6, 2011, the Medicare Administrative Contractor (“MAC”) for the subsidiary issued a notice of overpayment seeking recovery from our subsidiary of an alleged overpayment. We dispute these findings, and our Florence subsidiary has filed appeals through the Original Medicare Standard Appeals Process, in which we are seeking to have those findings overturned. An administrative law judge ("ALJ") hearing was held in early January 2015. On January 18, 2016, we received a letter dated January 6, 2016 referencing the ALJ hearing decision for the overpayment issued on June 6, 2011. The decision was partially favorable with a new overpayment amount of $3.7 million with a balance owed of $5.6 million, including interest, based on 9 disputed claims (originally 16). We filed an appeal to the Medicare Appeals Council on the remaining 9 disputed claims and also argued that the statistical method used to select the sample was not valid. No assurances can be given as to the timing or outcome of the Medicare Appeals Council decision. As of June 30, 2020, Medicare has withheld payments of $5.7 million (including additional interest) as part of their standard procedures once this level of the appeal process has been reached. In the event we are not able to recoup this alleged overpayment, we are entitled to be indemnified by the prior owners of the hospice operations for amounts relating to the period prior to August 1, 2009. On January 10, 2019, an arbitration panel from the American Health Lawyers Association determined that the prior owners' liability for their indemnification obligation was $2.8 million. This amount is recorded as an indemnity receivable within other assets in our condensed consolidated balance sheet as of June 30, 2020. In July 2016, the Company received a request for medical records from SafeGuard Services, L.L.C (“SafeGuard”), a ZPIC, related to services provided by some of the care centers that the Company acquired from Infinity Home Care, L.L.C. The review period covers time periods both before and after our ownership of the care centers, which were acquired on December 31, 2015. In August 2017, the Company received Requests for Repayment from Palmetto GBA, LLC ("Palmetto") regarding Infinity Home Care of Lakeland, LLC ("Lakeland Care Centers") and Infinity Home Care of Pinellas, LLC ("Clearwater Care Center"). The Palmetto letters are based on a statistical extrapolation performed by SafeGuard which alleged an overpayment of $34.0 million for the Lakeland Care Centers on a universe of 72 Medicare claims totaling $0.2 million in actual claims payments using a 100% error rate and an overpayment of $4.8 million for the Clearwater Care Center on a universe of 70 Medicare claims totaling $0.2 million in actual claims payments using a 100% error rate. The Lakeland Request for Repayment covers claims between January 2, 2014 and September 13, 2016. The Clearwater Request for Repayment covers claims between January 2, 2015 and December 9, 2016. As a result of partially successful Level I and Level II Administrative Appeals, the alleged overpayment for the Lakeland Care Centers has been reduced to $26.0 million and the alleged overpayment for the Clearwater Care Center has been reduced to $3.3 million. The Company has now filed Level III Administrative Appeals, and will continue to vigorously pursue its appeal rights, which include contesting the methodology used by the ZPIC contractor to perform statistical extrapolation. The Company is contractually entitled to indemnification by the prior owners for all claims prior to December 31, 2015, for up to $12.6 million. At this stage of the review, based on the information currently available to the Company, the Company cannot predict the timing or outcome of this review. The Company estimates a low-end potential range of loss related to this review of $6.5 million (assuming the Company is successful in seeking indemnity from the prior owners and unsuccessful in demonstrating that the extrapolation method used by SafeGuard was erroneous). The Company has reduced its high-end potential range of loss from $38.8 million (the maximum amount Palmetto claims has been overpaid for both the Lakeland Care Centers and the Clearwater Care Center, of which amount $12.6 million is subject to indemnification by the prior owners) to $29.3 million based on the partial success achieved by the Company in prosecuting its Level I and II Administrative Appeals. As of June 30, 2020, we have an accrued liability of approximately $17.4 million related to this matter. We expect to be indemnified by the prior owners for approximately $10.9 million of the total $12.6 million available indemnification related to this matter and have recorded this amount within other assets in our condensed consolidated balance sheet as of June 30, 2020. The net of these two amounts, $6.5 million, was recorded as a reduction in revenue in our condensed consolidated statements of operations during 2017. As of June 30, 2020, $1.5 million of receivables have been impacted by this payment suspension. Insurance We are obligated for certain costs associated with our insurance programs, including employee health, workers’ compensation and professional liability. While we maintain various insurance programs to cover these risks, we are self-insured for a substantial portion of our potential claims. We recognize our obligations associated with these costs, up to specified deductible limits in the period in which a claim is incurred, including with respect to both reported claims and claims incurred but not reported. These costs have generally been estimated based on historical data of our claims experience. Such estimates, and the resulting reserves, are reviewed and updated by us on a quarterly basis. Our health insurance has an exposure limit of $1.3 million for any individual covered life. Our workers’ compensation insurance has a retention limit of $1.0 million per incident and our professional liability insurance has a retention limit of $0.3 million per incident. |
SEGMENT INFORMATION
SEGMENT INFORMATION | 6 Months Ended |
Jun. 30, 2020 | |
Segment Reporting [Abstract] | |
SEGMENT INFORMATION | SEGMENT INFORMATIONOur operations involve servicing patients through our three reportable business segments: home health, hospice and personal care. Our home health segment delivers a wide range of services in the homes of individuals who may be recovering from surgery, have a chronic disability or terminal illness or need assistance with completing important personal tasks. Our hospice segment provides palliative care and comfort to terminally ill patients and their families. Our personal care segment provides patients with assistance with the essential activities of daily living. The “other” column in the following tables consists of costs relating to executive management and administrative support functions, primarily information services, accounting, finance, billing and collections, legal, compliance, risk management, procurement, marketing, clinical administration, training, human resources and administration. Management evaluates performance and allocates resources based on the operating income of the reportable segments, which includes an allocation of corporate expenses directly attributable to the specific segment and includes revenues and all other costs directly attributable to the specific segment. Segment assets are not reviewed by the company’s chief operating decision maker and therefore are not disclosed below (amounts in millions). For the Three-Month Period Ended June 30, 2020 Home Hospice Personal Other Total Net service revenue $ 290.2 $ 177.1 $ 17.7 $ — $ 485.0 Other operating income 15.1 7.2 0.5 — 22.8 Cost of service, excluding depreciation and amortization 184.0 97.2 14.1 — 295.3 General and administrative expenses 72.2 40.9 2.9 40.3 156.3 Depreciation and amortization 0.9 0.5 0.1 4.8 6.3 Operating expenses 257.1 138.6 17.1 45.1 457.9 Operating income (loss) $ 48.2 $ 45.7 $ 1.1 $ (45.1) $ 49.9 For the Three-Month Period Ended June 30, 2019 Home Hospice Personal Other Total Net service revenue $ 318.6 $ 153.2 $ 21.2 $ — $ 493.0 Cost of service, excluding depreciation and amortization 187.8 87.3 15.6 — 290.7 General and administrative expenses 74.0 34.9 3.2 40.2 152.3 Depreciation and amortization 1.1 0.4 — 3.7 5.2 Operating expenses 262.9 122.6 18.8 43.9 448.2 Operating income (loss) $ 55.7 $ 30.6 $ 2.4 $ (43.9) $ 44.8 For the Six-Month Period Ended June 30, 2020 Home Hospice Personal Other Total Net service revenue $ 593.8 $ 346.5 $ 36.4 $ — $ 976.7 Other operating income 15.1 7.2 0.5 — 22.8 Cost of service, excluding depreciation and amortization 363.8 189.0 28.2 — 581.0 General and administrative expenses 147.9 79.6 6.3 79.2 313.0 Depreciation and amortization 1.9 1.1 0.1 8.6 11.7 Operating expenses 513.6 269.7 34.6 87.8 905.7 Operating income (loss) $ 95.3 $ 84.0 $ 2.3 $ (87.8) $ 93.8 For the Six-Month Period Ended June 30, 2019 Home Hospice Personal Other Total Net service revenue $ 628.7 $ 290.2 $ 41.4 $ — $ 960.3 Cost of service, excluding depreciation and amortization 373.5 161.4 31.1 — 566.0 General and administrative expenses 145.4 63.9 6.3 81.5 297.1 Depreciation and amortization 2.1 0.8 0.1 5.1 8.1 Operating expenses 521.0 226.1 37.5 86.6 871.2 Operating income (loss) $ 107.7 $ 64.1 $ 3.9 $ (86.6) $ 89.1 |
SHARE REPURCHASE SHARE REPURCHA
SHARE REPURCHASE SHARE REPURCHASE | 6 Months Ended |
Jun. 30, 2020 | |
Equity [Abstract] | |
SHARE REPURCHASE | SHARE REPURCHASE 2019 Stock Repurchase Program On February 25, 2019, we announced that our Board of Directors authorized a stock repurchase program, under which we could have repurchased up to $100 million of our outstanding common stock through March 1, 2020. Under the terms of the program, we were allowed to repurchase shares from time to time in open market transactions, block purchases or in private transactions in accordance with applicable federal securities laws and other legal requirements. We were allowed to enter into Rule 10b5-1 plans to effect some or all of the repurchases. The timing and the amount of the repurchases would be determined by management based on a number of factors, including but not limited to share price, trading volume and general market conditions, as well as on working capital requirements, general business conditions and other factors. We did not repurchase any shares pursuant to this stock repurchase program during 2020. The stock repurchase program expired on March 1, 2020. |
RELATED PARTY TRANSACTIONS RELA
RELATED PARTY TRANSACTIONS RELATED PARTY TRANSACTIONS | 6 Months Ended |
Jun. 30, 2020 | |
Related Party Transactions [Abstract] | |
RELATED PARTY TRANSACTIONS | RELATED PARTY TRANSACTIONSDuring 2018, we made a $7.0 million investment in Medalogix, a healthcare predictive data and analytics company; this investment is accounted for under the equity method. We incurred costs of approximately $0.7 million and $1.1 million during the three and six-month periods ended June 30, 2020, respectively, and approximately $0.1 million during the three and six-month periods ended June 30, 2019 in connection with the usage of Medalogix's analytics platforms. We believe that the terms of these transactions are consistent with those negotiated at arm's length. |
Extraordinary and Unusual Items
Extraordinary and Unusual Items | 6 Months Ended |
Jun. 30, 2020 | |
Unusual or Infrequent Items, or Both [Abstract] | |
COVID-19 | NOVEL CORONAVIRUS PANDEMIC ("COVID-19") In March 2020, the World Health Organization declared COVID-19 a pandemic. As a healthcare at home company, we have been and will continue to be impacted by the effects of COVID-19; however, we remain committed to carrying out our mission of caring for our patients. We will continue to closely monitor the impact of COVID-19 on all aspects of our business, including the impacts to our employees, patients and suppliers; however, at this time, we are unable to estimate the ultimate impact the pandemic will have on our consolidated financial condition, results of operations or cash flows. On March 27, 2020, the bipartisan Coronavirus Aid, Relief, and Economic Security Act ("CARES Act") was signed into legislation. The CARES Act provides for $100 billion to healthcare providers, including hospitals on the front lines of the COVID-19 pandemic. Of this total allocated amount, $30 billion was distributed immediately to providers based on their proportionate share of Medicare fee-for-service reimbursements in 2019. Healthcare providers were required to sign an attestation confirming receipt of the funds and agree to the terms and conditions of payment. Our home health and hospice segments received approximately $100 million from the first $30 billion of funds distributed to healthcare providers in April 2020, which is inclusive of $2 million related to our equity method investments. We also acquired approximately $5 million of CARES Act funds in connection with the acquisition of AseraCare. Consistent with the terms and conditions for receipt of the payment, we are allowed to use the funds to cover lost revenue and health care costs related to COVID-19, and we are required to properly and fully document the use of these funds in reports to the U.S. Department of Health and Human Services ("HHS"). As of June 30, 2020, for our wholly-owned subsidiaries, we have decided to only utilize grant funds to the extent we have qualifying COVID-19 expenses, which totaled $22 million for our home health and hospice segments for the six-month period ended June 30, 2020. Accordingly, for our wholly-owned subsidiaries, we will not be using the funds to cover lost revenues resulting from COVID-19 during the six-month period ended June 30, 2020. While we anticipate incurring additional COVD-19 expenses in the future, we currently do not believe that we will fully utilize the funds received; therefore, we have recorded a liability related to the funds that we do not expect to utilize totaling $70 million which is reflected in the Provider Relief Fund Advance account in current liabilities within our condensed consolidated balance sheet. Funds that we intend to use in the future to cover COVID-19 expenses, which we have estimated to be approximately $11 million, have been recorded to a deferred liability account within accrued expenses in our condensed consolidated balance sheet. These estimates may change as our ability to utilize and retain the funds will depend on the magnitude, timing and nature of the impact of the pandemic. We do not intend to return any funds until the end of the public health emergency or as otherwise instructed by HHS. |
SUMMARY OF SIGNIFICANT ACCOUN_2
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Policies) | 6 Months Ended |
Jun. 30, 2020 | |
Accounting Policies [Abstract] | |
Basis of Presentation | Basis of Presentation In our opinion, the accompanying unaudited condensed consolidated financial statements contain all adjustments (consisting solely of normal recurring adjustments) necessary to present fairly our financial position, our results of operations and our cash flows in accordance with U.S. generally accepted accounting principles (“U.S. GAAP”) for interim financial reporting. Our results of operations for the interim periods presented are not necessarily indicative of the results of our operations for the entire year and have not been audited by our independent auditors. |
Recent Accounting Pronouncements | Recently Adopted Accounting Pronouncements In June 2016, the Financial Accounting Standards Board ("FASB") issued Accounting Standards Update ("ASU") 2016-13, Financial Instruments - Credit Losses (Topic 326) , which provides guidance for measuring credit losses on financial instruments. Our adoption of this standard on January 1, 2020 did not have a material effect on our condensed consolidated financial statements. Recently Issued Accounting Pronouncements In December 2019, the FASB issued ASU 2019-12, Income Taxes (Topic 740) - Simplifying the Accounting for Income Taxes, which simplifies the accounting for income taxes by removing certain exceptions to the general principles in Topic 740 and improves consistent application by clarifying and amending existing guidance. The ASU is effective for annual and interim periods beginning after December 15, 2020. Early adoption is permitted. While the Company does not expect a material impact upon adoption of ASU 2019-12, we are still evaluating the effect the standard will have on our consolidated financial statements and related disclosures and ongoing financial reporting. |
Use of Estimates | Use of Estimates Our accounting and reporting policies conform with U.S. GAAP. In preparing the unaudited condensed consolidated financial statements, we are required to make estimates and assumptions that impact the amounts reported in the condensed consolidated financial statements and accompanying notes. Actual results could differ from those estimates. |
Principles of Consolidation | Principles of Consolidation These unaudited condensed consolidated financial statements include the accounts of Amedisys, Inc. and our wholly owned subsidiaries. All significant intercompany accounts and transactions have been eliminated in our accompanying unaudited condensed consolidated financial statements, and business combinations accounted for as purchases have been included in our unaudited condensed consolidated financial statements from their respective dates of acquisition. In addition to our wholly owned subsidiaries, we also have certain equity investments that are accounted for as set forth below. |
Investments | Investments We consolidate investments when the entity is a variable interest entity and we are the primary beneficiary or if we have controlling interests in the entity, which is generally ownership in excess of 50%. Third party equity interests in our consolidated joint ventures are reflected as noncontrolling interests in our condensed consolidated financial statements. |
Revenue Recognition | Revenue Recognition We account for revenue from contracts with customers in accordance with ASU 2014-09, Revenue from Contracts with Customers (Topic 606) and ASU 2015-14, Revenue from Contracts with Customers (Topic 606): Deferral of the Effective Date (collectively, "ASC 606"), and as such, we recognize revenue in the period in which we satisfy our performance obligations under our contracts by transferring our promised services to our customers in amounts that reflect the consideration to which we expect to be entitled in exchange for providing patient care, which are the transaction prices allocated to the distinct services. The Company's cost of obtaining contracts is not material. Revenues are recognized as performance obligations are satisfied, which varies based on the nature of the services provided. Our performance obligation is the delivery of patient care services in accordance with the nature and frequency of services outlined in physicians' orders, which are determined by a physician based on a patient's specific goals. The Company's performance obligations relate to contracts with a duration of less than one year; therefore, the Company has elected to apply the optional exemption provided by ASC 606 and is not required to disclose the aggregate amount of the transaction price allocated to performance obligations that are unsatisfied or partially unsatisfied as of the end of the reporting period. The unsatisfied or partially unsatisfied performance obligations are generally completed when the patients are discharged, which generally occurs within days or weeks of the end of the reporting period. We determine the transaction price based on gross charges for services provided, reduced by estimates for contractual and non-contractual revenue adjustments. Contractual revenue adjustments are recorded for the difference between our standard rates and the contracted rates to be realized from patients, third party payors and others for services provided. Non-contractual revenue adjustments include discounts provided to self-pay, uninsured patients or other payors, adjustments resulting from payment reviews and adjustments arising from our inability to obtain appropriate billing documentation, authorizations or face-to-face documentation. Subsequent changes to the estimate of the transaction price are recorded as adjustments to net service revenue in the period of change. Non-contractual revenue adjustments are recorded for self-pay, uninsured patients and other payors by major payor class based on our historical collection experience, aged accounts receivable by payor and current economic conditions. The non-contractual revenue adjustments represent the difference between amounts billed and amounts we expect to collect based on our collection history with similar payors. The Company assesses its ability to collect for the healthcare services provided at the time of patient admission based on the Company's verification of the patient's insurance coverage under Medicare, Medicaid, and other commercial or managed care insurance programs. Medicare represents approximately 74% of the Company's consolidated net service revenue for the three and six-month periods ended June 30, 2020 and 2019. Amounts due from third-party payors, primarily commercial health insurers and government programs (Medicare and Medicaid), include variable consideration for retroactive revenue adjustments due to settlements of audits and payment reviews. We determine our estimates for non-contractual revenue adjustments related to payment reviews based on our historical experience and success rates in the claim appeals and adjudication process. We determine our estimates for non-contractual revenue adjustments related to our inability to obtain appropriate billing documentation, authorizations, or face-to-face documentation based on our historical experience, which primarily includes a historical collection rate of over 99% on Medicare claims. Revenue is recorded at amounts we estimate to be realizable for services provided. Revenue by payor class as a percentage of total net service revenue is as follows: For the Three-Month Periods Ended June 30, For the Six-Month Periods 2020 2019 2020 2019 Home Health: Medicare 40 % 44 % 41 % 45 % Non-Medicare - Episodic-based 6 % 9 % 6 % 9 % Non-Medicare - Non-episodic based 14 % 12 % 14 % 12 % Hospice (1): Medicare 34 % 30 % 33 % 29 % Non-Medicare 2 % 1 % 2 % 1 % Personal Care 4 % 4 % 4 % 4 % 100 % 100 % 100 % 100 % (1) Acquired Compassionate Care Hospice on February 1, 2019, RoseRock Healthcare on April 1, 2019, Asana Hospice on January 1, 2020 and AseraCare on June 1, 2020. Home Health Revenue Recognition Medicare Revenue Effective January 1, 2020, the Centers for Medicare and Medicaid Services ("CMS") implemented a revised case-mix adjustment methodology, the Patient-Driven Groupings Model ("PDGM"), to better align payment with patient care needs and ensure that clinically complex and ill beneficiaries have adequate access to home health care. PDGM uses 30-day periods of care rather than 60-day episodes of care as the unit of payment, eliminates the use of the number of therapy visits provided in determining payment and relies more heavily on clinical characteristics and other patient information. Net service revenue is recorded based on the established Federal Medicare home health payment rate for a 30-day period of care ("billing period"). PDGM uses timing, admission source, functional impairment levels and principal and other diagnoses to case-mix adjust payments. The case-mix adjusted payment for a 30-day period of care is subject to additional adjustments based on certain variables, including, but not limited to (a) an outlier payment if our patient's care was unusually costly (capped at 10% of total reimbursement per provider number); (b) a low utilization payment adjustment (“LUPA”) if the number of visits provided was less than the established threshold, which ranges from two to six visits and varies for every case-mix group under PDGM; (c) a partial payment if a patient transferred to another provider or from another provider before completing the 30-day period of care; and (d) the applicable geographic wage index. Payment for non-routine supplies are now included in the 30-day payment rate. Medicare can also make various adjustments to payments received if we are unable to produce appropriate billing documentation or acceptable authorizations. We estimate the impact of such adjustments based on our historical experience, which primarily includes a historical collection rate of over 99% on Medicare claims, and record this estimate during the period in which services are rendered as a reduction to revenue and a corresponding reduction to patient accounts receivable. Amounts due from Medicare include variable consideration for retroactive revenue adjustments due to settlements of audits and payment reviews. We determine our estimates for non-contractual revenue adjustments related to payment reviews based on our historical experience and success rates in the claim appeals and adjudication process. The Medicare home health benefit requires that beneficiaries be homebound (meaning that the beneficiary is unable to leave their home without a considerable and taxing effort), require intermittent skilled nursing, physical therapy or speech therapy services, and receive treatment under a plan of care established and periodically reviewed by a physician. In order to provide greater flexibility during the novel coronavirus pandemic ("COVID-19"), CMS has relaxed the definition of homebound status. During the pandemic, a beneficiary is considered homebound if they have been instructed by a physician not to leave their home because of a confirmed or suspected COVID-19 diagnosis or if the patient has a condition that makes them more susceptible to contracting COVID-19. Therefore, if a beneficiary is homebound due to COVID-19 and requires skilled services, the services will be covered under the Medicare home health benefit. All Medicare contracts are required to have a signed plan of care which represents a single performance obligation, comprised of the delivery of a series of distinct services that are substantially similar and have a similar pattern of transfer to the customer. Accordingly, the Company accounts for the series of services ("episode") as a single performance obligation satisfied over time, as the customer simultaneously receives and consumes the benefits of the goods and services provided. An episode starts the first day a billable visit is performed and ends 60 days later or upon discharge, if earlier, with multiple continuous episodes allowed. As noted above, under PDGM, we are now reimbursed for 30-day periods of care rather than 60-day episodes of care. ASC 606 notes that if an entity has a right to consideration from a customer in an amount that corresponds directly with the value of the entity’s performance completed to date, the entity may recognize revenue in the amount to which the entity has a right to invoice. We have elected to apply the "right to invoice” practical expedient and therefore, our revenue recognition is based on the reimbursement we are entitled to for each 30-day payment period. We utilize our historical average length of stay for each 30-day period of care as the measure of progress towards the satisfaction of our performance obligation. A portion of reimbursement from each Medicare episode is billed near the start of each 30-day period of care, and cash is typically received before all services are rendered. Any cash received from Medicare for a request for anticipated payment (“RAP”) for a 30-day period of care that exceeds the associated revenue earned is recorded to accrued expenses within our condensed consolidated balance sheet. Non-Medicare Revenue Episodic-based Revenue. We recognize revenue in a similar manner as we recognize Medicare revenue for amounts that are paid by other insurance carriers, including Medicare Advantage programs; however, these amounts can vary based upon the negotiated terms which generally range from 90% to 100% of Medicare rates. Non-episodic based Revenue. Gross revenue is recorded on an accrual basis based upon the date of service at amounts equal to our established or estimated per-visit rates. Contractual revenue adjustments are recorded for the difference between our standard rates and the contracted rates to be realized from patients, third parties and others for services provided and are deducted from gross revenue to determine net service revenue. We also make non-contractual revenue adjustments to non-episodic revenue based on historical experience, to reflect the estimated transaction price. We receive a minimal amount of our net service revenue from patients who are either self-insured or are obligated for an insurance co-payment. Hospice Revenue Recognition Hospice Medicare Revenue Gross revenue is recorded on an accrual basis based upon the date of service at amounts equal to the estimated payment rates. The estimated payment rates are predetermined daily or hourly rates for each of the four levels of care we deliver. The four levels of care are routine care, general inpatient care, continuous home care and respite care. Routine care accounted for 98% of our total net Medicare hospice service revenue for the three and six-month periods ended June 30, 2020 and 99% and 98% of our total net Medicare hospice service revenue for the three and six-month periods ended June 30, 2019. There are two separate payment rates for routine care: payments for the first 60 days of care and care beyond 60 days. In addition to the two routine rates, we may also receive a service intensity add-on (“SIA”). The SIA is based on visits made in the last seven days of life by a registered nurse (“RN”) or medical social worker (“MSW”) for patients in a routine level of care. The performance obligation is the delivery of hospice services to the patient, as determined by a physician, each day the patient is on hospice care. We make adjustments to Medicare revenue for non-contractual revenue adjustments, which include our inability to obtain appropriate billing documentation or acceptable authorizations and other reasons unrelated to credit risk. We estimate the impact of these non-contractual revenue adjustments based on our historical experience, which primarily includes a historical collection rate of over 99% on Medicare claims, and record it during the period services are rendered. Additionally, our hospice service revenue is subject to certain limitations on payments from Medicare which are considered variable consideration. We are subject to an inpatient cap limit and an overall Medicare payment cap for each provider number. We monitor these caps on a provider-by-provider basis and estimate amounts due back to Medicare if we estimate a cap has been exceeded. We record these adjustments as a reduction to revenue and an increase in accrued expenses within our condensed consolidated balance sheet. Providers are required to self-report and pay their estimated cap liability by February 28 th of the following year. As of June 30, 2020, we have recorded $8.1 million for estimated amounts due back to Medicare in accrued expenses for the Federal cap years ended October 31, 2013 through September 30, 2020; $2.0 million of this balance was acquired with the AseraCare acquisition. As of December 31, 2019, we had recorded $5.7 million for estimated amounts due back to Medicare in accrued expenses for the Federal cap years ended October 31, 2013 through September 30, 2020. Hospice Non-Medicare Revenue Gross revenue is recorded on an accrual basis based upon the date of service at amounts equal to our established rates or estimated per day rates, as applicable. Contractual revenue adjustments are recorded for the difference between our standard rates and the contractual rates to be realized from patients, third party payors and others for services provided and are deducted from gross revenue to determine our net service revenue. We also make non-contractual adjustments to non-Medicare revenue based on historical experience, to reflect the estimated transaction price. Personal Care Revenue Recognition Personal Care Revenue |
Government Grants | Government Grants In the absence of specific guidance to account for government grants under U.S. GAAP, we have decided to account for government grants in accordance with International Accounting Standard ("IAS") 20, Accounting for Government Grants and Disclosure of Government Assistance , and as such, we recognize grant income on a systematic basis in line with the recognition of expenses or the loss of revenues for which the grants are intended to compensate. We recognize grants once both of the following conditions are met: (1) we are able to comply with the relevant conditions of the grant and (2) the grant will be received. During the three-month period ended June 30, 2020, our home health and hospice segments received approximately $100 million from the CARES Act Provider Relief Fund, which is inclusive of $2 million related to our equity method investments (see Note 9 - Novel Coronavirus Pandemic ("COVID-19") for additional information). We also acquired approximately $5 million of CARES Act funds in connection with the acquisition of AseraCare Hospice. The terms and conditions note that the funds received can be used for health care related expenses or lost revenues that are attributable to coronavirus. As of June 30, 2020, for our wholly-owned subsidiaries, we have decided to only utilize grant funds to the extent that we have qualifying COVID-19 expenses. Accordingly, for our wholly-owned subsidiaries, we will not be using the funds to cover lost revenues resulting from COVID-19 during the six-month period ended June 30, 2020. The income associated with the COVID-19 expenses incurred by our home health and hospice segments to date, which total $22 million, is reflected within other operating income in our condensed consolidated statements of operations. While we anticipate incurring additional COVID-19 expenses in the future, we currently do not believe that we will fully utilize the funds received; therefore, we have recorded a liability related to the funds that we do not expect to utilize totaling $70 million which is reflected in the Provider Relief Fund Advance account in current liabilities within our condensed consolidated balance sheet. Funds that we intend to use in the future to cover COVID-19 expenses, which we have estimated to be approximately $11 million, have been recorded to a deferred liability account within accrued expenses in our condensed consolidated balance sheet. These estimates may change as our ability to utilize and retain the funds will depend on the magnitude, timing and nature of the impact of the pandemic. We do not intend to return any funds until the end of the public health emergency or as otherwise instructed by the U.S. Department of Health and Human Services ("HHS"). Our personal care segment received funds from the Mass Home Care ASAP COVID-19 Provider Sustainability Program totaling less than $1 million. We will be using these funds to cover COVID-19 expenses as well. The income is reflected within other operating income in our condensed consolidated statements of operations. |
Cash, Cash Equivalents and Restricted Cash | Cash, Cash Equivalents and Restricted Cash Cash and cash equivalents include certificates of deposit and all highly liquid debt instruments with maturities of three months or less when purchased. Our cash balance as of June 30, 2020 includes $103 million associated with the CARES Act Provider Relief Fund. We separated these funds into their own account and will only transfer the funds to our operating account once we have incurred expenses that comply with the Provider Relief Fund terms and conditions. Restricted cash includes cash that is not available for ordinary business use. As of June 30, 2020, we had $3.0 million of restricted cash that was placed into escrow accounts related to the potential indemnity and working capital adjustment provisions within the Asana Hospice and AseraCare Hospice purchase agreements ($1.5 million and $1.0 million, respectively) and to secure the purchase of personal protective equipment from new suppliers in response to COVID-19 ($0.5 million). |
Patient Accounts Receivable | Patient Accounts Receivable We report accounts receivable from services rendered at their estimated transaction price, which includes contractual and non-contractual revenue adjustments based on the amounts expected to be due from payors. Our patient accounts receivable are uncollateralized and consist of amounts due from Medicare, Medicaid, other third-party payors and patients. As of June 30, 2020, there is only one single payor, other than Medicare, that accounts for more than 10% of our total outstanding patient receivables (approximately 10.1%). Thus, we believe there are no other significant concentrations of receivables that would subject us to any significant credit risk in the collection of our patient accounts receivable. We write off accounts on a monthly basis once we have exhausted our collection efforts and deem an account to be uncollectible. We believe the collectibility risk associated with our Medicare accounts, which represent 60% and 58% of our patient accounts receivable at June 30, 2020 and December 31, 2019, respectively, is limited due to our historical collection rate of over 99% from Medicare and the fact that Medicare is a U.S. government payor. We do not believe there are any significant concentrations of revenues from any payor that would subject us to any significant credit risk in the collection of our accounts receivable. Medicare Home Health For our home health patients, our pre-billing process includes verifying that we are eligible for payment from Medicare for the services that we provide to our patients. Our Medicare billing begins with a process to ensure that our billings are accurate through the utilization of an electronic Medicare claim review. We submit a RAP for 20% of our estimated payment for each 30-day period of care. The full amount of the payment for each 30-day period of care is billed after the period of care has been completed (“final billed”). The RAP received for that billing period is then deducted from our final payment. If a final bill is not submitted within the greater of 90 days from the start of the 30-day period of care, or 60 days from the date the RAP was paid, any RAPs received for that billing period will be recouped by Medicare from any other claims in process for that particular provider number. The RAP claim must then be resubmitted. CMS has mandated the full elimination of RAPs in 2021. Medicare Hospice For our hospice patients, our pre-billing process includes verifying that we are eligible for payment from Medicare for the services that we provide to our patients. Our Medicare billing begins with a process to ensure that our billings are accurate through the utilization of an electronic Medicare claim review. We bill Medicare on a monthly basis for the services provided to the patient. Non-Medicare Home Health, Hospice and Personal Care For our non-Medicare patients, our pre-billing process primarily begins with verifying a patient’s eligibility for services with the applicable payor. Once the patient has been confirmed for eligibility, we will provide services to the patient and bill the applicable payor. Our review and evaluation of non-Medicare accounts receivable includes a detailed review of outstanding balances and special consideration to concentrations of receivables from particular payors or groups of payors with similar characteristics that would subject us to any significant credit risk. |
Fair Value of Financial Instruments | Fair Value of Financial Instruments The following details our financial instruments where the carrying value and the fair value differ (amounts in millions): Fair Value at Reporting Date Using Financial Instrument Carrying Value as of June 30, 2020 Quoted Prices in Active Significant Other Significant Long-term obligations $ 403.6 $ — $ 404.1 $ — The fair value hierarchy is based on three levels of inputs, of which the first two are considered observable and the last unobservable, that may be used to measure fair value. The three levels of inputs are as follows: • Level 1 – Quoted prices in active markets for identical assets and liabilities. • Level 2 – Inputs other than Level 1 that are observable, either directly or indirectly, such as quoted prices for similar assets or liabilities; quoted prices in markets that are not active; or other inputs that are observable or can be corroborated by observable market data for substantially the full term of the assets or liabilities. • Level 3 – Unobservable inputs that are supported by little or no market activity and are significant to the fair value of the assets or liabilities. |
Weighted-Average Shares Outstanding | Weighted-Average Shares OutstandingNet income per share attributable to Amedisys, Inc. common stockholders, calculated on the treasury stock method, is based on the weighted average number of shares outstanding during the period. |
Business Combinations | Business Combinations We account for acquisitions using the acquisition method of accounting in accordance with Accounting Standards Codification (“ASC”) 805, Business Combinations |
SUMMARY OF SIGNIFICANT ACCOUN_3
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Tables) | 6 Months Ended |
Jun. 30, 2020 | |
Accounting Policies [Abstract] | |
Schedule of Revenue by Payor Class | Revenue by payor class as a percentage of total net service revenue is as follows: For the Three-Month Periods Ended June 30, For the Six-Month Periods 2020 2019 2020 2019 Home Health: Medicare 40 % 44 % 41 % 45 % Non-Medicare - Episodic-based 6 % 9 % 6 % 9 % Non-Medicare - Non-episodic based 14 % 12 % 14 % 12 % Hospice (1): Medicare 34 % 30 % 33 % 29 % Non-Medicare 2 % 1 % 2 % 1 % Personal Care 4 % 4 % 4 % 4 % 100 % 100 % 100 % 100 % (1) Acquired Compassionate Care Hospice on February 1, 2019, RoseRock Healthcare on April 1, 2019, Asana Hospice on January 1, 2020 and AseraCare on June 1, 2020. |
Schedule of Fair Value of Financial Instruments | The following details our financial instruments where the carrying value and the fair value differ (amounts in millions): Fair Value at Reporting Date Using Financial Instrument Carrying Value as of June 30, 2020 Quoted Prices in Active Significant Other Significant Long-term obligations $ 403.6 $ — $ 404.1 $ — |
Schedule of Weighted-Average Shares Outstanding | The following table sets forth, for the periods indicated, shares used in our computation of the weighted-average shares outstanding, which are used to calculate our basic and diluted net income attributable to Amedisys, Inc. common stockholders (amounts in thousands): For the Three- For the Six- 2020 2019 2020 2019 Weighted average number of shares outstanding - basic 32,412 32,075 32,371 32,038 Effect of dilutive securities: Stock options 570 537 582 548 Non-vested stock and stock units 303 321 306 327 Weighted average number of shares outstanding - diluted 33,285 32,933 33,259 32,913 Anti-dilutive securities 14 159 21 143 |
ACQUISITIONS (Tables)
ACQUISITIONS (Tables) | 6 Months Ended |
Jun. 30, 2020 | |
Business Combinations [Abstract] | |
Schedule of Business Acquisitions, Asana Hospice | The Company is in the process of finalizing its valuation of the assets acquired and liabilities assumed. During the three-month period ended June 30, 2020, we recorded measurement period adjustments based on changes to management's estimates and assumptions related to the assets acquired and liabilities assumed. Based on the Company's preliminary valuation, the total estimated consideration of $65.6 million has been allocated to assets acquired and liabilities assumed as of the acquisition date as follows (amounts in millions): Amount Patient accounts receivable $ 5.7 Property and equipment 0.2 Operating lease right of use assets 0.9 Intangible assets 5.6 Total assets acquired 12.4 Accounts payable (3.1) Payroll and employee benefits (1.5) Accrued expenses (0.3) Operating lease liabilities (0.9) Total liabilities assumed (5.8) Net identifiable assets acquired 6.6 Goodwill 59.0 Total estimated consideration $ 65.6 |
Schedule of Business Acquisitions, AseraCare Hospice | The Company is in the process of reviewing the fair value of the assets acquired and liabilities assumed. We have estimated the fair value of acquired names and licenses based on the values assigned in prior acquisitions. These amounts, along with the value of non-compete agreements, will be adjusted upon receipt of the final valuation report. Based on the Company's preliminary valuation, the total estimated consideration of $230.4 million has been allocated to assets acquired and liabilities assumed as of the acquisition date as follows (amounts in millions): Amount Patient accounts receivable $ 14.7 Prepaid expenses 0.9 Property and equipment 0.6 Operating lease right of use assets 5.4 Intangible assets 16.7 Other assets 0.2 Total assets acquired 38.5 Accounts payable (5.5) Payroll and employee benefits (6.4) Accrued expenses (6.9) Operating lease liabilities (5.4) Other long-term obligations (0.2) Total liabilities assumed (24.4) Net identifiable assets acquired 14.1 Goodwill 216.3 Total estimated consideration $ 230.4 |
Business Acquisition, Pro Forma Information | The following table contains unaudited pro forma condensed consolidated statement of operations information for the three and six-month periods ended June 30, 2020 and 2019 assuming that the AseraCare acquisition closed on January 1, 2019 (amounts in millions, except per share data). The pro forma financial information includes various assumptions, including those related to the preliminary purchase price allocation of assets acquired and liabilities assumed. The pro forma financial information may vary in future quarters based on the final valuations and analysis of the fair value of the assets acquired and liabilities assumed. For the Three- For the Six- 2020 2019 2020 2019 Net service revenue $ 504.3 $ 523.6 $ 1,025.3 $ 1,020.5 Operating income 51.9 44.9 94.8 88.8 Net income attributable to Amedisys Inc. 35.5 32.0 65.1 61.1 Basic earnings per share 1.09 1.00 2.01 1.91 Diluted earnings per share 1.07 0.97 1.96 1.86 |
LONG-TERM OBLIGATIONS LONG-TERM
LONG-TERM OBLIGATIONS LONG-TERM OBLIGATIONS (Tables) | 6 Months Ended |
Jun. 30, 2020 | |
Debt Disclosure [Abstract] | |
Schedule of Long-Term Debt | Long-term debt consists of the following for the periods indicated (amounts in millions): June 30, 2020 December 31, 2019 $175.0 million Term Loan; interest rate at Base Rate plus Applicable Rate or Eurodollar Rate plus Applicable Rate (1.7% at June 30, 2020); due February 4, 2024 $ 168.4 $ 171.7 $550.0 million Revolving Credit Facility; interest only payments; interest rate at Base Rate plus Applicable Rate or Eurodollar Rate plus Applicable Rate (1.7% at June 30, 2020); due February 4, 2024 235.0 70.0 Promissory notes 0.2 0.6 Finance leases 2.9 3.4 Principal amount of long-term obligations 406.5 245.7 Deferred debt issuance costs (3.1) (3.5) 403.4 242.2 Current portion of long-term obligations (10.7) (9.9) Total $ 392.7 $ 232.3 |
Schedule of Commitment Fee Under Credit Facilities | We are also subject to a commitment fee and letter of credit fee under the terms of the Amended Credit Agreement, as presented in the table below. Pricing Tier Consolidated Leverage Ratio Commitment Fee Letter of Credit Fee Eurodollar Rate Loans Base Rate Loans I ≥ 3.00 to 1.0 0.35% 1.75% 2.00% 1.00% II < 3.00 to 1.0 but ≥ 2.00 to 1.0 0.30% 1.50% 1.75% 0.75% III < 2.00 to 1.0 but ≥ 0.75 to 1.0 0.25% 1.25% 1.50% 0.50% IV < 0.75 to 1.0 0.20% 1.00% 1.25% 0.25% |
SEGMENT INFORMATION (Tables)
SEGMENT INFORMATION (Tables) | 6 Months Ended |
Jun. 30, 2020 | |
Segment Reporting [Abstract] | |
Schedule of Operating Income of Reportable Segments | For the Three-Month Period Ended June 30, 2020 Home Hospice Personal Other Total Net service revenue $ 290.2 $ 177.1 $ 17.7 $ — $ 485.0 Other operating income 15.1 7.2 0.5 — 22.8 Cost of service, excluding depreciation and amortization 184.0 97.2 14.1 — 295.3 General and administrative expenses 72.2 40.9 2.9 40.3 156.3 Depreciation and amortization 0.9 0.5 0.1 4.8 6.3 Operating expenses 257.1 138.6 17.1 45.1 457.9 Operating income (loss) $ 48.2 $ 45.7 $ 1.1 $ (45.1) $ 49.9 For the Three-Month Period Ended June 30, 2019 Home Hospice Personal Other Total Net service revenue $ 318.6 $ 153.2 $ 21.2 $ — $ 493.0 Cost of service, excluding depreciation and amortization 187.8 87.3 15.6 — 290.7 General and administrative expenses 74.0 34.9 3.2 40.2 152.3 Depreciation and amortization 1.1 0.4 — 3.7 5.2 Operating expenses 262.9 122.6 18.8 43.9 448.2 Operating income (loss) $ 55.7 $ 30.6 $ 2.4 $ (43.9) $ 44.8 For the Six-Month Period Ended June 30, 2020 Home Hospice Personal Other Total Net service revenue $ 593.8 $ 346.5 $ 36.4 $ — $ 976.7 Other operating income 15.1 7.2 0.5 — 22.8 Cost of service, excluding depreciation and amortization 363.8 189.0 28.2 — 581.0 General and administrative expenses 147.9 79.6 6.3 79.2 313.0 Depreciation and amortization 1.9 1.1 0.1 8.6 11.7 Operating expenses 513.6 269.7 34.6 87.8 905.7 Operating income (loss) $ 95.3 $ 84.0 $ 2.3 $ (87.8) $ 93.8 For the Six-Month Period Ended June 30, 2019 Home Hospice Personal Other Total Net service revenue $ 628.7 $ 290.2 $ 41.4 $ — $ 960.3 Cost of service, excluding depreciation and amortization 373.5 161.4 31.1 — 566.0 General and administrative expenses 145.4 63.9 6.3 81.5 297.1 Depreciation and amortization 2.1 0.8 0.1 5.1 8.1 Operating expenses 521.0 226.1 37.5 86.6 871.2 Operating income (loss) $ 107.7 $ 64.1 $ 3.9 $ (86.6) $ 89.1 |
NATURE OF OPERATIONS, CONSOLI_2
NATURE OF OPERATIONS, CONSOLIDATION AND PRESENTATION OF FINANCIAL STATEMENTS - Narrative (Details) $ in Thousands | 3 Months Ended | 6 Months Ended | |||
Jun. 30, 2020USD ($)care_centerstate | Jun. 30, 2019 | Jun. 30, 2020USD ($)care_centerstate | Jun. 30, 2019USD ($) | Dec. 31, 2019USD ($) | |
Organization, Consolidation and Presentation of Financial Statements [Line Items] | |||||
Number of states with facilities | state | 39 | 39 | |||
Minimum ownership percentage for controlling interest (percent) | 50.00% | 50.00% | |||
Maximum ownership percentage for equity method investment (percent) | 50.00% | 50.00% | |||
Equity method investment, aggregate cost | $ 13,900 | $ 13,900 | $ 35,700 | ||
Proceeds from sale of equity method investment | 17,876 | $ 0 | |||
Loss on sale of equity method investment | $ (2,980) | $ 0 | |||
Home Health [Member] | |||||
Organization, Consolidation and Presentation of Financial Statements [Line Items] | |||||
Number of owned and operated care centers | care_center | 322 | 322 | |||
Hospice [Member] | |||||
Organization, Consolidation and Presentation of Financial Statements [Line Items] | |||||
Number of owned and operated care centers | care_center | 190 | 190 | |||
Personal Care | |||||
Organization, Consolidation and Presentation of Financial Statements [Line Items] | |||||
Number of owned and operated care centers | care_center | 14 | 14 | |||
Revenue from Contract with Customer | Medicare Revenue | |||||
Organization, Consolidation and Presentation of Financial Statements [Line Items] | |||||
Percent of net services revenue | 74.00% | 74.00% | 74.00% | 74.00% | |
Heritage Healthcare Innovation Fund, LP [Member] | |||||
Organization, Consolidation and Presentation of Financial Statements [Line Items] | |||||
Proceeds from sale of equity method investment | $ 17,900 | ||||
Loss on sale of equity method investment | $ (3,000) |
SUMMARY OF SIGNIFICANT ACCOUN_4
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Revenue Recognition Narrative (Details) $ in Millions | 3 Months Ended | 6 Months Ended | |||
Jun. 30, 2020USD ($) | Jun. 30, 2019 | Jun. 30, 2020USD ($)visit | Jun. 30, 2019 | Dec. 31, 2019USD ($) | |
Revenue Recognition, Multiple-deliverable Arrangements [Line Items] | |||||
Episode of care as episodic-based revenue (days) | 60 days | ||||
Net service revenue episode payment rate (days) | 30 days | ||||
Period of care as episodic-based revenue (days) | 30 days | ||||
Percentage of total reimbursement of outlier payment | 10.00% | ||||
Historical collection rate from Medicare | 99.00% | ||||
Hospice Medicare revenue rate accounted for routine care | 98.00% | 99.00% | 98.00% | 98.00% | |
Minimum [Member] | |||||
Revenue Recognition, Multiple-deliverable Arrangements [Line Items] | |||||
Low utilization payment adjustment, maximum number of visits | visit | 2 | ||||
Non-Medicare revenue term rates | 90.00% | ||||
Maximum [Member] | |||||
Revenue Recognition, Multiple-deliverable Arrangements [Line Items] | |||||
Low utilization payment adjustment, maximum number of visits | visit | 6 | ||||
Non-Medicare revenue term rates | 100.00% | ||||
Home Health [Member] | |||||
Revenue Recognition, Multiple-deliverable Arrangements [Line Items] | |||||
Historical collection rate from Medicare | 99.00% | ||||
Hospice [Member] | |||||
Revenue Recognition, Multiple-deliverable Arrangements [Line Items] | |||||
Historical collection rate from Medicare | 99.00% | ||||
Cap Year 2013 Through 2020 | |||||
Revenue Recognition, Multiple-deliverable Arrangements [Line Items] | |||||
Estimated amounts due back to Medicare | $ | $ 8.1 | $ 8.1 | $ 5.7 | ||
Medicare Revenue | Revenue from Contract with Customer | |||||
Revenue Recognition, Multiple-deliverable Arrangements [Line Items] | |||||
Percent of net services revenue | 74.00% | 74.00% | 74.00% | 74.00% | |
AseraCare Hospice [Member] | Cap Year 2013 Through 2020 | |||||
Revenue Recognition, Multiple-deliverable Arrangements [Line Items] | |||||
Estimated amounts due back to Medicare | $ | $ 2 | $ 2 |
SUMMARY OF SIGNIFICANT ACCOUN_5
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Revenue by Payor Class (Details) | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2020 | Jun. 30, 2019 | Jun. 30, 2020 | Jun. 30, 2019 | |
Revenue Recognition, Multiple-deliverable Arrangements [Line Items] | ||||
Revenue by payor class as a percentage of total net service revenue | 100.00% | 100.00% | 100.00% | 100.00% |
Home Health Medicare [Member] | ||||
Revenue Recognition, Multiple-deliverable Arrangements [Line Items] | ||||
Revenue by payor class as a percentage of total net service revenue | 40.00% | 44.00% | 41.00% | 45.00% |
Home Health Non-Medicare - Episodic Based [Member] | ||||
Revenue Recognition, Multiple-deliverable Arrangements [Line Items] | ||||
Revenue by payor class as a percentage of total net service revenue | 6.00% | 9.00% | 6.00% | 9.00% |
Home Health Non-Medicare - Non-Episodic Based [Member] | ||||
Revenue Recognition, Multiple-deliverable Arrangements [Line Items] | ||||
Revenue by payor class as a percentage of total net service revenue | 14.00% | 12.00% | 14.00% | 12.00% |
Hospice Medicare [Member] | ||||
Revenue Recognition, Multiple-deliverable Arrangements [Line Items] | ||||
Revenue by payor class as a percentage of total net service revenue | 34.00% | 30.00% | 33.00% | 29.00% |
Hospice Non-Medicare [Member] | ||||
Revenue Recognition, Multiple-deliverable Arrangements [Line Items] | ||||
Revenue by payor class as a percentage of total net service revenue | 2.00% | 1.00% | 2.00% | 1.00% |
Personal Care | ||||
Revenue Recognition, Multiple-deliverable Arrangements [Line Items] | ||||
Revenue by payor class as a percentage of total net service revenue | 4.00% | 4.00% | 4.00% | 4.00% |
SUMMARY OF SIGNIFICANT ACCOUN_6
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Government Grants (Details) - USD ($) $ in Thousands | 1 Months Ended | 3 Months Ended | 6 Months Ended | |||
Apr. 30, 2020 | Jun. 30, 2020 | Jun. 30, 2019 | Jun. 30, 2020 | Jun. 30, 2019 | Dec. 31, 2019 | |
Government Grants [Line Items] | ||||||
Funding Received From CARES Act | $ 100,000 | $ 100,000 | ||||
Other operating income | 22,780 | $ 0 | $ 22,780 | $ 0 | ||
Provider relief fund advance | 70,000 | 70,000 | $ 0 | |||
Estimated Future COVID-19 related expenses | 11,000 | |||||
Funding Received from Massachusetts COVID-19 Provider Sustainability Program | 1,000 | |||||
Equity Method Investments [Member] | ||||||
Government Grants [Line Items] | ||||||
Funding Received From CARES Act | 2,000 | 2,000 | ||||
Home Health and Hospice [Member] | ||||||
Government Grants [Line Items] | ||||||
COVID-19 Expenses Incurred | $ 22,000 | |||||
AseraCare Hospice [Member] | ||||||
Government Grants [Line Items] | ||||||
Funding Received From CARES Act | $ 5,000 | $ 5,000 |
SUMMARY OF SIGNIFICANT ACCOUN_7
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Cash and Cash Equivalents (Details) - USD ($) $ in Thousands | Jun. 30, 2020 | Dec. 31, 2019 |
Restricted Cash and Cash Equivalents Items [Line Items] | ||
Restricted cash | $ 3,049 | $ 66,196 |
Cash Balance Associated with Provider Relief Fund | 103,000 | |
Asana Hospice Aquisition [Member] | ||
Restricted Cash and Cash Equivalents Items [Line Items] | ||
Restricted cash | 1,500 | |
COVID-19 PPE [Member] | ||
Restricted Cash and Cash Equivalents Items [Line Items] | ||
Restricted cash | 500 | |
AseraCare Hospice [Member] | ||
Restricted Cash and Cash Equivalents Items [Line Items] | ||
Restricted cash | $ 1,000 |
SUMMARY OF SIGNIFICANT ACCOUN_8
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Patient Accounts Receivable Narrative (Details) - day | 6 Months Ended | |
Jun. 30, 2020 | Dec. 31, 2019 | |
Concentration Risk [Line Items] | ||
Accounts receivable derived from Medicare | 60.00% | 58.00% |
Percentage of patient receivables outstanding | 10.00% | |
Historical collection rate from Medicare | 99.00% | |
Rate of request for anticipated payment submitted for the initial episode of care | 20.00% | |
Maximum days to submit final bill from the start of episode | 90 | |
Maximum days to submit final bill from the date the request for anticipated payment was paid | 60 | |
Customer Concentration Risk | Accounts Receivable | Single Payor | ||
Concentration Risk [Line Items] | ||
Concentration risk (percent) | 10.10% |
SUMMARY OF SIGNIFICANT ACCOUN_9
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Fair Value of Financial Instruments (Details) | Jun. 30, 2020USD ($) |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | |
Debt Instrument Carrying Amount Excluding Finance Leases | $ 403,600,000 |
Fair Value, Inputs, Level 1 [Member] | |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | |
Long-term Debt, Fair Value | 0 |
Fair Value, Inputs, Level 2 [Member] | |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | |
Long-term Debt, Fair Value | 404,100,000 |
Fair Value, Inputs, Level 3 [Member] | |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | |
Long-term Debt, Fair Value | $ 0 |
SUMMARY OF SIGNIFICANT ACCOU_10
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Weighted-Average Shares Outstanding (Details) - shares shares in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2020 | Jun. 30, 2019 | Jun. 30, 2020 | Jun. 30, 2019 | |
Accounting Policies [Abstract] | ||||
Weighted average number of shares outstanding - basic (shares) | 32,412 | 32,075 | 32,371 | 32,038 |
Effect of dilutive securities: | ||||
Stock options (shares) | 570 | 537 | 582 | 548 |
Non-vested stock and stock units (shares) | 303 | 321 | 306 | 327 |
Weighted average number of shares outstanding - diluted (shares) | 33,285 | 32,933 | 33,259 | 32,913 |
Anti-dilutive securities (shares) | 14 | 159 | 21 | 143 |
ACQUISITIONS - Narrative (Detai
ACQUISITIONS - Narrative (Details) $ in Thousands | Jun. 01, 2020USD ($)care_center | Apr. 18, 2020USD ($) | Mar. 01, 2020USD ($) | Jan. 01, 2020USD ($) | Jun. 30, 2020USD ($) | Jun. 30, 2019USD ($) | Jun. 30, 2020USD ($) | Jun. 30, 2019USD ($) |
Business Acquisition [Line Items] | ||||||||
Net service revenue | $ 485,059 | $ 492,984 | $ 976,744 | $ 960,324 | ||||
Operating Income (Loss) | 49,932 | 44,751 | 93,802 | 89,075 | ||||
Depreciation and amortization | 6,334 | 5,179 | 11,672 | 8,074 | ||||
Hospice [Member] | ||||||||
Business Acquisition [Line Items] | ||||||||
Net service revenue | 177,100 | 153,200 | 346,500 | 290,200 | ||||
Operating Income (Loss) | 45,700 | 30,600 | 84,000 | 64,100 | ||||
Depreciation and amortization | 500 | 400 | 1,100 | 800 | ||||
Hospice [Member] | Asana Hospice [Member] | ||||||||
Business Acquisition [Line Items] | ||||||||
Payments to acquire business | $ 66,300 | |||||||
Cash Acquired from Acquisition | $ 700 | |||||||
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Assets, Receivables | 5,700 | 5,700 | ||||||
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Property, Plant, and Equipment | 200 | 200 | ||||||
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Operating lease right of use assets | 900 | 900 | ||||||
Acquisition, other intangibles recorded | 5,600 | 5,600 | ||||||
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Assets | 12,400 | 12,400 | ||||||
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Liabilities, Accounts Payable | (3,100) | (3,100) | ||||||
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Liabilities, Payroll and Employee Benefits | (1,500) | (1,500) | ||||||
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Liabilities, Accrued Expenses | (300) | (300) | ||||||
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Operating Lease Liabilities | (900) | (900) | ||||||
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Liabilities | (5,800) | (5,800) | ||||||
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Net | 6,600 | 6,600 | ||||||
Goodwill recorded during period | 59,000 | |||||||
Business Combination, Recognized Identifiable Assets Acquired, Goodwill, and Liabilities Assumed, Net | 65,600 | 65,600 | ||||||
Net service revenue | 7,100 | 14,400 | ||||||
Operating Income (Loss) | (300) | (1,600) | ||||||
Business Combination, Integration Related Costs | 300 | 1,400 | ||||||
Depreciation and amortization | 1,000 | 1,400 | ||||||
Business Acquisition Working Capital Adjustment | 700 | |||||||
Hospice [Member] | Asana Hospice [Member] | Medicare license [Member] | ||||||||
Business Acquisition [Line Items] | ||||||||
Acquisition, other intangibles recorded | 2,000 | 2,000 | ||||||
Hospice [Member] | AseraCare Hospice [Member] | ||||||||
Business Acquisition [Line Items] | ||||||||
Payments to acquire business | $ 230,400 | |||||||
Acquisition, number of care centers acquired | care_center | 44 | |||||||
Payments related to tax asset and working capital | $ 32,000 | |||||||
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Assets, Receivables | 14,700 | 14,700 | ||||||
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Assets, Prepaid Expense | 900 | 900 | ||||||
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Property, Plant, and Equipment | 600 | 600 | ||||||
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Operating lease right of use assets | 5,400 | 5,400 | ||||||
Acquisition, other intangibles recorded | 16,700 | 16,700 | ||||||
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Other Noncurrent Assets | 200 | 200 | ||||||
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Assets | 38,500 | 38,500 | ||||||
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Liabilities, Accounts Payable | (5,500) | (5,500) | ||||||
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Liabilities, Payroll and Employee Benefits | (6,400) | (6,400) | ||||||
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Liabilities, Accrued Expenses | (6,900) | (6,900) | ||||||
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Operating Lease Liabilities | (5,400) | (5,400) | ||||||
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Noncurrent Liabilities, Other | (200) | (200) | ||||||
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Liabilities | (24,400) | (24,400) | ||||||
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Net | 14,100 | 14,100 | ||||||
Goodwill recorded during period | 216,300 | |||||||
Business Combination, Recognized Identifiable Assets Acquired, Goodwill, and Liabilities Assumed, Net | 230,400 | 230,400 | ||||||
Net service revenue | 9,200 | 9,200 | ||||||
Operating Income (Loss) | (3,000) | (3,000) | ||||||
Business Combination, Integration Related Costs | 3,300 | 3,300 | ||||||
Depreciation and amortization | 200 | 200 | ||||||
Off-market Lease, Unfavorable | 200 | 200 | ||||||
Hospice [Member] | AseraCare Hospice [Member] | Medicare license [Member] | ||||||||
Business Acquisition [Line Items] | ||||||||
Acquisition, other intangibles recorded | 10,200 | 10,200 | ||||||
Home Health [Member] | ||||||||
Business Acquisition [Line Items] | ||||||||
Net service revenue | 290,200 | 318,600 | 593,800 | 628,700 | ||||
Operating Income (Loss) | 48,200 | 55,700 | 95,300 | 107,700 | ||||
Depreciation and amortization | 900 | $ 1,100 | 1,900 | $ 2,100 | ||||
WASHINGTON | Home Health [Member] | ||||||||
Business Acquisition [Line Items] | ||||||||
Payments to acquire business | $ 3,000 | |||||||
Goodwill recorded during period | 2,800 | |||||||
WASHINGTON | Home Health [Member] | Certificate of Need [Member] | ||||||||
Business Acquisition [Line Items] | ||||||||
Acquisition, other intangibles recorded | 200 | 200 | ||||||
KENTUCKY | Home Health [Member] | ||||||||
Business Acquisition [Line Items] | ||||||||
Payments to acquire business | $ 700 | |||||||
Goodwill recorded during period | 500 | |||||||
KENTUCKY | Home Health [Member] | Certificate of Need [Member] | ||||||||
Business Acquisition [Line Items] | ||||||||
Acquisition, other intangibles recorded | 200 | 200 | ||||||
Trade Names [Member] | Hospice [Member] | AseraCare Hospice [Member] | ||||||||
Business Acquisition [Line Items] | ||||||||
Acquisition, other intangibles recorded | 5,800 | $ 5,800 | ||||||
Noncompete Agreements [Member] | Hospice [Member] | Asana Hospice [Member] | ||||||||
Business Acquisition [Line Items] | ||||||||
Weighted-average amortization period | 2 years | |||||||
Acquisition, other intangibles recorded | 2,300 | $ 2,300 | ||||||
Acquired Names of Business [Member] | Hospice [Member] | Asana Hospice [Member] | ||||||||
Business Acquisition [Line Items] | ||||||||
Weighted-average amortization period | 2 years | |||||||
Acquisition, other intangibles recorded | 1,300 | $ 1,300 | ||||||
Acquired Names of Business [Member] | Hospice [Member] | AseraCare Hospice [Member] | ||||||||
Business Acquisition [Line Items] | ||||||||
Weighted-average amortization period | 2 years | |||||||
Favorable Lease Contract [Member] | Hospice [Member] | AseraCare Hospice [Member] | ||||||||
Business Acquisition [Line Items] | ||||||||
Acquisition, other intangibles recorded | $ 700 | $ 700 |
ACQUISITIONS - Pro Forma (Detai
ACQUISITIONS - Pro Forma (Details) - Hospice [Member] - AseraCare Hospice [Member] - USD ($) $ / shares in Units, $ in Millions | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2020 | Jun. 30, 2019 | Jun. 30, 2020 | Jun. 30, 2019 | |
Business Acquisition [Line Items] | ||||
Net service revenue | $ 504.3 | $ 523.6 | $ 1,025.3 | $ 1,020.5 |
Operating income | 51.9 | 44.9 | 94.8 | 88.8 |
Net income | $ 35.5 | $ 32 | $ 65.1 | $ 61.1 |
Basic earnings per share | $ 1.09 | $ 1 | $ 2.01 | $ 1.91 |
Diluted earnings per share | $ 1.07 | $ 0.97 | $ 1.96 | $ 1.86 |
LONG-TERM OBLIGATIONS - Schedul
LONG-TERM OBLIGATIONS - Schedule of Long-Term Debt (Details) - USD ($) $ in Millions | Jun. 30, 2020 | Dec. 31, 2019 |
Debt Instrument [Line Items] | ||
Principal amount | $ 406.5 | $ 245.7 |
Deferred debt issuance costs | (3.1) | (3.5) |
Long-term obligations, including current portion | 403.4 | 242.2 |
Current portion of long-term obligations | (10.7) | (9.9) |
Long-term obligations, less current portion | 392.7 | 232.3 |
Term Loan [Member] | One Hundred Seventy Five Million Term Loan Facility [Member] | ||
Debt Instrument [Line Items] | ||
Principal amount | 168.4 | 171.7 |
Revolving Credit Facility [Member] | 550 Million Revolving Credit Facility [Member] | ||
Debt Instrument [Line Items] | ||
Principal amount | 235 | 70 |
Promissory Notes [Member] | ||
Debt Instrument [Line Items] | ||
Principal amount | 0.2 | 0.6 |
Finance leases [Member] | ||
Debt Instrument [Line Items] | ||
Principal amount | $ 2.9 | $ 3.4 |
LONG-TERM OBLIGATIONS - Sched_2
LONG-TERM OBLIGATIONS - Schedule of Long-Term Debt Additional Information (Details) | 6 Months Ended |
Jun. 30, 2020USD ($) | |
Term Loan [Member] | One Hundred Seventy Five Million Term Loan Facility [Member] | |
Debt Instrument [Line Items] | |
Debt instrument, face amount | $ 175,000,000 |
Maturity Date | Feb. 4, 2024 |
Term Loan [Member] | One Hundred Seventy Five Million Term Loan Facility [Member] | Eurodollar [Member] | |
Debt Instrument [Line Items] | |
Debt Instrument Interest Rate at Period End | 1.70% |
Revolving Credit Facility [Member] | 550 Million Revolving Credit Facility [Member] | |
Debt Instrument [Line Items] | |
Debt instrument, face amount | $ 550,000,000 |
Maturity Date | Feb. 4, 2024 |
Revolving Credit Facility [Member] | 550 Million Revolving Credit Facility [Member] | Eurodollar [Member] | |
Debt Instrument [Line Items] | |
Debt Instrument Interest Rate at Period End | 1.70% |
LONG-TERM OBLIGATIONS - Fees an
LONG-TERM OBLIGATIONS - Fees and Rates Under Credit Facilities (Details) | 6 Months Ended |
Jun. 30, 2020 | |
Consolidated Leverage Ratio: Greater Than Equal To 3.00 to 1.0 | |
Line of Credit Facility [Line Items] | |
Commitment fee percentage | 0.35% |
Letter Of Credit Fee | 1.75% |
Consolidated Leverage Ratio: Greater Than Equal To 3.00 to 1.0 | Eurodollar [Member] | |
Line of Credit Facility [Line Items] | |
Basis spread on variable rate | 2.00% |
Consolidated Leverage Ratio: Greater Than Equal To 3.00 to 1.0 | Base Rate [Member] | |
Line of Credit Facility [Line Items] | |
Basis spread on variable rate | 1.00% |
Consolidated Leverage Ratio: Less Than 3.00 to 1.0 but Greater Than Equal To 2.00 to 1.0 | |
Line of Credit Facility [Line Items] | |
Commitment fee percentage | 0.30% |
Letter Of Credit Fee | 1.50% |
Consolidated Leverage Ratio: Less Than 3.00 to 1.0 but Greater Than Equal To 2.00 to 1.0 | Eurodollar [Member] | |
Line of Credit Facility [Line Items] | |
Basis spread on variable rate | 1.75% |
Consolidated Leverage Ratio: Less Than 3.00 to 1.0 but Greater Than Equal To 2.00 to 1.0 | Base Rate [Member] | |
Line of Credit Facility [Line Items] | |
Basis spread on variable rate | 0.75% |
Consolidated Leverage Ratio: Less Than 2.00 to 1.0 but Greater Than Equal To 0.75 to 1.0 | |
Line of Credit Facility [Line Items] | |
Commitment fee percentage | 0.25% |
Letter Of Credit Fee | 1.25% |
Consolidated Leverage Ratio: Less Than 2.00 to 1.0 but Greater Than Equal To 0.75 to 1.0 | Eurodollar [Member] | |
Line of Credit Facility [Line Items] | |
Basis spread on variable rate | 1.50% |
Consolidated Leverage Ratio: Less Than 2.00 to 1.0 but Greater Than Equal To 0.75 to 1.0 | Base Rate [Member] | |
Line of Credit Facility [Line Items] | |
Basis spread on variable rate | 0.50% |
Consolidated Leverage Ratio: Less Than 0.75 to 1.0 | |
Line of Credit Facility [Line Items] | |
Commitment fee percentage | 0.20% |
Letter Of Credit Fee | 1.00% |
Consolidated Leverage Ratio: Less Than 0.75 to 1.0 | Eurodollar [Member] | |
Line of Credit Facility [Line Items] | |
Basis spread on variable rate | 1.25% |
Consolidated Leverage Ratio: Less Than 0.75 to 1.0 | Base Rate [Member] | |
Line of Credit Facility [Line Items] | |
Basis spread on variable rate | 0.25% |
Minimum [Member] | Consolidated Leverage Ratio: Greater Than Equal To 3.00 to 1.0 | |
Line of Credit Facility [Line Items] | |
Consolidated Leverage Ratio | 3 |
Minimum [Member] | Consolidated Leverage Ratio: Less Than 3.00 to 1.0 but Greater Than Equal To 2.00 to 1.0 | |
Line of Credit Facility [Line Items] | |
Consolidated Leverage Ratio | 2 |
Minimum [Member] | Consolidated Leverage Ratio: Less Than 2.00 to 1.0 but Greater Than Equal To 0.75 to 1.0 | |
Line of Credit Facility [Line Items] | |
Consolidated Leverage Ratio | 0.75 |
Maximum [Member] | Consolidated Leverage Ratio: Less Than 3.00 to 1.0 but Greater Than Equal To 2.00 to 1.0 | |
Line of Credit Facility [Line Items] | |
Consolidated Leverage Ratio | 3 |
Maximum [Member] | Consolidated Leverage Ratio: Less Than 2.00 to 1.0 but Greater Than Equal To 0.75 to 1.0 | |
Line of Credit Facility [Line Items] | |
Consolidated Leverage Ratio | 2 |
Maximum [Member] | Consolidated Leverage Ratio: Less Than 0.75 to 1.0 | |
Line of Credit Facility [Line Items] | |
Consolidated Leverage Ratio | 0.75 |
LONG-TERM OBLIGATIONS - Narrati
LONG-TERM OBLIGATIONS - Narrative (Details) - USD ($) | Feb. 04, 2019 | Jun. 30, 2020 | Jun. 30, 2019 | Jun. 30, 2019 | Jun. 30, 2020 | Jun. 30, 2019 | Feb. 04, 2024 | Dec. 31, 2019 | Mar. 31, 2020 | Mar. 31, 2023 |
Debt Instrument [Line Items] | ||||||||||
Debt issuance costs | $ 0 | $ 847,000 | ||||||||
Consolidated leverage ratio | 1.3 | 1.3 | ||||||||
Consolidated interest coverage ratio | 14.8 | 14.8 | ||||||||
Credit facility, maximum borrowing capacity | $ 725,000,000 | |||||||||
Principal amount | $ 406,500,000 | $ 406,500,000 | $ 245,700,000 | |||||||
Term Loan [Member] | One Hundred Seventy Five Million Term Loan Facility [Member] | ||||||||||
Debt Instrument [Line Items] | ||||||||||
Debt instrument, face amount | $ 175,000,000 | $ 175,000,000 | ||||||||
Weighted average interest rate (percent) | 2.00% | 4.00% | 4.00% | 2.60% | ||||||
Maturity Date | Feb. 4, 2024 | |||||||||
Principal amount | $ 168,400,000 | $ 168,400,000 | 171,700,000 | |||||||
Revolving Credit Facility [Member] | 550 Million Revolving Credit Facility [Member] | ||||||||||
Debt Instrument [Line Items] | ||||||||||
Debt instrument, face amount | $ 550,000,000 | $ 550,000,000 | ||||||||
Weighted average interest rate (percent) | 2.10% | 4.00% | 2.50% | 4.00% | ||||||
Maturity Date | Feb. 4, 2024 | |||||||||
Remaining availability under revolving credit facility | $ 286,200,000 | $ 286,200,000 | ||||||||
Principal amount | 235,000,000 | 235,000,000 | 70,000,000 | |||||||
Line of Credit [Member] | 550 Million Revolving Credit Facility [Member] | ||||||||||
Debt Instrument [Line Items] | ||||||||||
Outstanding letters of credit | $ 28,800,000 | $ 28,800,000 | ||||||||
Amended Credit Agreement [Member] | ||||||||||
Debt Instrument [Line Items] | ||||||||||
Debt issuance costs | $ 800,000 | |||||||||
Maturity Date | Feb. 4, 2024 | |||||||||
Additional interest rate above Federal Fund rate | 0.50% | |||||||||
Additional interest rate above Eurodollar rate | 1.00% | |||||||||
Percentage of consolidated revenue and adjusted EBITDA that guarantor wholly-owned subsidiaries represent | 95.00% | |||||||||
Percentage of adjusted EBITDA that guarantor subsidiaries represent | 70.00% | |||||||||
Amended Credit Agreement [Member] | 550 Million Revolving Credit Facility [Member] | ||||||||||
Debt Instrument [Line Items] | ||||||||||
Debt instrument, face amount | $ 550,000,000 | |||||||||
Amended Credit Agreement [Member] | One Hundred Seventy Five Million Term Loan Facility [Member] | ||||||||||
Debt Instrument [Line Items] | ||||||||||
Debt Instrument Periodic Payment Percentage | 0.625% | |||||||||
Debt instrument, face amount | $ 175,000,000 | |||||||||
Base Rate [Member] | Amended Credit Agreement [Member] | ||||||||||
Debt Instrument [Line Items] | ||||||||||
Description of variable rate basis | Fluctuating rate per annum equal to the highest of (a) the federal funds rate plus 0.50% per annum, (b) the prime rate of interest established by the Administrative Agent, and (c) the Eurodollar Rate for an interest period of one month plus 1% per annum. | |||||||||
Base Rate [Member] | Amended Credit Agreement [Member] | ||||||||||
Debt Instrument [Line Items] | ||||||||||
Basis spread on variable rate | 0.50% | |||||||||
Eurodollar [Member] | Amended Credit Agreement [Member] | ||||||||||
Debt Instrument [Line Items] | ||||||||||
Description of variable rate basis | Rate at which Eurodollar deposits in the London interbank market for an interest period of one, two, three or six months | |||||||||
Eurodollar [Member] | Term Loan [Member] | One Hundred Seventy Five Million Term Loan Facility [Member] | ||||||||||
Debt Instrument [Line Items] | ||||||||||
Debt Instrument Interest Rate at Period End | 1.70% | 1.70% | ||||||||
Eurodollar [Member] | Revolving Credit Facility [Member] | 550 Million Revolving Credit Facility [Member] | ||||||||||
Debt Instrument [Line Items] | ||||||||||
Debt Instrument Interest Rate at Period End | 1.70% | 1.70% | ||||||||
Eurodollar [Member] | Amended Credit Agreement [Member] | ||||||||||
Debt Instrument [Line Items] | ||||||||||
Basis spread on variable rate | 1.50% | |||||||||
Minimum [Member] | Amended Credit Agreement [Member] | ||||||||||
Debt Instrument [Line Items] | ||||||||||
Proceeds Received From Loan Party Of Subsidiary | $ 5,000,000 | |||||||||
Subsequent Event | Amended Credit Agreement [Member] | One Hundred Seventy Five Million Term Loan Facility [Member] | ||||||||||
Debt Instrument [Line Items] | ||||||||||
Debt Instrument Periodic Payment Percentage | 1.875% | 1.25% |
COMMITMENTS AND CONTINGENCIES -
COMMITMENTS AND CONTINGENCIES - Narrative (Details) $ in Thousands | Jun. 27, 2016patient | Jan. 18, 2016USD ($)claim | Nov. 03, 2015patient | May 21, 2015patient | Jan. 30, 2015 | Apr. 23, 2014 | Jun. 06, 2011beneficiary | Aug. 31, 2017USD ($)claim | Jun. 30, 2020USD ($) | Dec. 31, 2017USD ($) | Mar. 31, 2010beneficiary | Dec. 31, 2019USD ($) | Jan. 10, 2019USD ($) |
Loss Contingencies [Line Items] | |||||||||||||
Patient accounts receivable | $ 249,030 | $ 237,596 | |||||||||||
Health insurance retention limit | 1,300 | ||||||||||||
Workers compensation insurance retention limit | 1,000 | ||||||||||||
Professional liability insurance retention limit | 300 | ||||||||||||
South Carolina | Hospice [Member] | |||||||||||||
Loss Contingencies [Line Items] | |||||||||||||
Number of beneficiaries | beneficiary | 30 | ||||||||||||
Indemnity receivable | 2,800 | ||||||||||||
Indemnification amount | $ 2,800 | ||||||||||||
South Carolina | Hospice [Member] | Extrapolated | |||||||||||||
Loss Contingencies [Line Items] | |||||||||||||
Number of beneficiaries | beneficiary | 16 | ||||||||||||
South Carolina | Hospice [Member] | Unfavorable | |||||||||||||
Loss Contingencies [Line Items] | |||||||||||||
Recovery amount of overpayment made to subsidiary | $ 3,700 | ||||||||||||
Recovery amount of overpayment made to subsidiary including interest | $ 5,600 | ||||||||||||
Number of claims submitted by subsidiary | claim | 9 | ||||||||||||
Recovery amount of over payment made to subsidiary including interest withheld | 5,700 | ||||||||||||
US Department of Justice | Hospice [Member] | |||||||||||||
Loss Contingencies [Line Items] | |||||||||||||
Loss contingency accrual | 6,500 | ||||||||||||
US Department of Justice | Massachusetts | Hospice [Member] | |||||||||||||
Loss Contingencies [Line Items] | |||||||||||||
Number of patients | patient | 53 | ||||||||||||
US Department of Justice | Morgantown, West Virginia | Hospice [Member] | |||||||||||||
Loss Contingencies [Line Items] | |||||||||||||
Number of patients | patient | 66 | ||||||||||||
US Department of Justice | Parkersburg, West Virginia | Hospice [Member] | |||||||||||||
Loss Contingencies [Line Items] | |||||||||||||
Number of patients | patient | 68 | ||||||||||||
Amedisys CIA | |||||||||||||
Loss Contingencies [Line Items] | |||||||||||||
Corporate integrity agreement term (years) | 5 years | ||||||||||||
Compassionate Care Hospice CIA | |||||||||||||
Loss Contingencies [Line Items] | |||||||||||||
Corporate integrity agreement term (years) | 5 years | ||||||||||||
Safeguard Zone Program Integrity Contractor | Florida | |||||||||||||
Loss Contingencies [Line Items] | |||||||||||||
Loss contingency accrual | 17,400 | ||||||||||||
Indemnity receivable | 10,900 | ||||||||||||
Indemnification amount | $ 12,600 | ||||||||||||
Safeguard Zone Program Integrity Contractor | Florida | Infinity HomeCare | |||||||||||||
Loss Contingencies [Line Items] | |||||||||||||
Indemnification amount | 12,600 | ||||||||||||
Safeguard Zone Program Integrity Contractor | Florida | Home Health [Member] | |||||||||||||
Loss Contingencies [Line Items] | |||||||||||||
Florida ZPIC revenue reduction | $ 6,500 | ||||||||||||
Safeguard Zone Program Integrity Contractor | Florida | Home Health [Member] | Minimum [Member] | |||||||||||||
Loss Contingencies [Line Items] | |||||||||||||
Recovery amount of overpayment made to subsidiary | 6,500 | ||||||||||||
Safeguard Zone Program Integrity Contractor | Florida | Home Health [Member] | Maximum [Member] | |||||||||||||
Loss Contingencies [Line Items] | |||||||||||||
Recovery amount of overpayment made to subsidiary | 38,800 | 29,300 | |||||||||||
Safeguard Zone Program Integrity Contractor | Florida | Home Health [Member] | Infinity HomeCare | |||||||||||||
Loss Contingencies [Line Items] | |||||||||||||
Patient accounts receivable | 1,500 | ||||||||||||
Safeguard Zone Program Integrity Contractor | Lakeland, Florida | Home Health [Member] | |||||||||||||
Loss Contingencies [Line Items] | |||||||||||||
Recovery amount of overpayment made to subsidiary | $ 34,000 | 26,000 | |||||||||||
Number of claims submitted by subsidiary | claim | 72 | ||||||||||||
Actual claims payment | $ 200 | ||||||||||||
Error rate (percent) | 100.00% | ||||||||||||
Safeguard Zone Program Integrity Contractor | Clearwater, Florida | Home Health [Member] | |||||||||||||
Loss Contingencies [Line Items] | |||||||||||||
Recovery amount of overpayment made to subsidiary | $ 4,800 | $ 3,300 | |||||||||||
Number of claims submitted by subsidiary | claim | 70 | ||||||||||||
Actual claims payment | $ 200 | ||||||||||||
Error rate (percent) | 100.00% |
SEGMENT INFORMATION - Narrative
SEGMENT INFORMATION - Narrative (Details) | 6 Months Ended |
Jun. 30, 2020Segments | |
Segment Reporting [Abstract] | |
Number of reportable business segments | 3 |
SEGMENT INFORMATION - Operating
SEGMENT INFORMATION - Operating Income of Reportable Segments (Details) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2020 | Jun. 30, 2019 | Jun. 30, 2020 | Jun. 30, 2019 | |
Segment Reporting Information [Line Items] | ||||
Net service revenue | $ 485,059 | $ 492,984 | $ 976,744 | $ 960,324 |
Other operating income | 22,780 | 0 | 22,780 | 0 |
Cost of service, excluding depreciation and amortization | 295,228 | 290,752 | 580,965 | 566,026 |
General and administrative expenses | 156,300 | 152,300 | 313,000 | 297,100 |
Depreciation and amortization | 6,334 | 5,179 | 11,672 | 8,074 |
Operating expenses | 457,907 | 448,233 | 905,722 | 871,249 |
Operating income (loss) | 49,932 | 44,751 | 93,802 | 89,075 |
Home Health [Member] | ||||
Segment Reporting Information [Line Items] | ||||
Net service revenue | 290,200 | 318,600 | 593,800 | 628,700 |
Other operating income | 15,100 | 15,100 | ||
Cost of service, excluding depreciation and amortization | 184,000 | 187,800 | 363,800 | 373,500 |
General and administrative expenses | 72,200 | 74,000 | 147,900 | 145,400 |
Depreciation and amortization | 900 | 1,100 | 1,900 | 2,100 |
Operating expenses | 257,100 | 262,900 | 513,600 | 521,000 |
Operating income (loss) | 48,200 | 55,700 | 95,300 | 107,700 |
Hospice [Member] | ||||
Segment Reporting Information [Line Items] | ||||
Net service revenue | 177,100 | 153,200 | 346,500 | 290,200 |
Other operating income | 7,200 | 7,200 | ||
Cost of service, excluding depreciation and amortization | 97,200 | 87,300 | 189,000 | 161,400 |
General and administrative expenses | 40,900 | 34,900 | 79,600 | 63,900 |
Depreciation and amortization | 500 | 400 | 1,100 | 800 |
Operating expenses | 138,600 | 122,600 | 269,700 | 226,100 |
Operating income (loss) | 45,700 | 30,600 | 84,000 | 64,100 |
Personal Care | ||||
Segment Reporting Information [Line Items] | ||||
Net service revenue | 17,700 | 21,200 | 36,400 | 41,400 |
Other operating income | 500 | 500 | ||
Cost of service, excluding depreciation and amortization | 14,100 | 15,600 | 28,200 | 31,100 |
General and administrative expenses | 2,900 | 3,200 | 6,300 | 6,300 |
Depreciation and amortization | 100 | 0 | 100 | 100 |
Operating expenses | 17,100 | 18,800 | 34,600 | 37,500 |
Operating income (loss) | 1,100 | 2,400 | 2,300 | 3,900 |
Other | ||||
Segment Reporting Information [Line Items] | ||||
Net service revenue | 0 | 0 | 0 | 0 |
Other operating income | 0 | 0 | ||
Cost of service, excluding depreciation and amortization | 0 | 0 | 0 | 0 |
General and administrative expenses | 40,300 | 40,200 | 79,200 | 81,500 |
Depreciation and amortization | 4,800 | 3,700 | 8,600 | 5,100 |
Operating expenses | 45,100 | 43,900 | 87,800 | 86,600 |
Operating income (loss) | $ (45,100) | $ (43,900) | $ (87,800) | $ (86,600) |
SHARE REPURCHASE Narrative (Det
SHARE REPURCHASE Narrative (Details) $ in Millions | Feb. 25, 2019USD ($) |
Share Repurchase [Line Items] | |
Stock Repurchase Program, Authorized Amount | $ 100 |
Stock Repurchase Program Expiration Date | Mar. 1, 2020 |
RELATED PARTY TRANSACTIONS Narr
RELATED PARTY TRANSACTIONS Narrative (Details) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | 12 Months Ended | ||
Jun. 30, 2020 | Jun. 30, 2019 | Jun. 30, 2020 | Jun. 30, 2019 | Dec. 31, 2018 | |
Related Party Transaction [Line Items] | |||||
Payments to Acquire Investments | $ 875 | $ 210 | |||
Medalogix [Member] | |||||
Related Party Transaction [Line Items] | |||||
Payments to Acquire Investments | $ 7,000 | ||||
Related Party Transaction, Amounts of Transaction | $ 700 | $ 100 | $ 1,100 | $ 100 |
NOVEL CORONAVIRUS PANDEMIC "COV
NOVEL CORONAVIRUS PANDEMIC "COVID-19" (Details) - USD ($) $ in Thousands | 1 Months Ended | 3 Months Ended | 6 Months Ended | |||||
Apr. 30, 2020 | Jun. 30, 2020 | Jun. 30, 2019 | Jun. 30, 2020 | Jun. 30, 2019 | Apr. 24, 2020 | Mar. 27, 2020 | Dec. 31, 2019 | |
NOVEL CORONAVIRUS PANDEMIC "COVID-19" [Line Items] | ||||||||
Funding for Healthcare Providers, Including Hospitals | $ 100,000,000 | |||||||
Funding Immediately Distributed to Healthcare Providers Based on Their 2019 Medicare Fee-For-Service Reimbursements | $ 30,000,000 | |||||||
Funding Received From CARES Act | $ 100,000 | $ 100,000 | ||||||
Provider relief fund advance | 70,000 | $ 70,000 | $ 0 | |||||
Additional Funding Distributed to Healthcare Providers | $ 20,000,000 | |||||||
CARES Act Deferral of Employer Share Social Security Tax | 20,300 | 20,300 | ||||||
Estimated Future COVID-19 related expenses | 11,000 | |||||||
Other operating income | 22,780 | $ 0 | 22,780 | $ 0 | ||||
Home Health and Hospice [Member] | ||||||||
NOVEL CORONAVIRUS PANDEMIC "COVID-19" [Line Items] | ||||||||
COVID-19 Expenses Incurred | $ 22,000 | |||||||
AseraCare Hospice [Member] | ||||||||
NOVEL CORONAVIRUS PANDEMIC "COVID-19" [Line Items] | ||||||||
Funding Received From CARES Act | 5,000 | 5,000 | ||||||
Equity Method Investments [Member] | ||||||||
NOVEL CORONAVIRUS PANDEMIC "COVID-19" [Line Items] | ||||||||
Funding Received From CARES Act | $ 2,000 | $ 2,000 |