Cover
Cover - shares | 3 Months Ended | |
Mar. 31, 2024 | Apr. 19, 2024 | |
Cover [Abstract] | ||
Document Type | 10-Q | |
Document Quarterly Report | true | |
Document Period End Date | Mar. 31, 2024 | |
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 $0.001 per share | |
Trading Symbol | AMED | |
Name of each exchange on which registered | NASDAQ | |
Entity Current Reporting Status | Yes | |
Entity Interactive Data Current | Yes | |
Entity Filer Category | Large Accelerated Filer | |
Entity Emerging Growth Company | false | |
Entity Small Business | false | |
Entity Shell Company | false | |
Entity Common Stock, Shares Outstanding | 32,676,879 | |
Amendment Flag | false | |
Document Fiscal Year Focus | 2024 | |
Document Fiscal Period Focus | Q1 | |
Entity Central Index Key | 0000896262 | |
Current Fiscal Year End Date | --12-31 |
CONSOLIDATED BALANCE SHEETS
CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands | Mar. 31, 2024 | Dec. 31, 2023 |
Current assets: | ||
Cash and cash equivalents | $ 108,234 | $ 126,450 |
Restricted cash | 12,470 | 12,413 |
Patient accounts receivable | 359,359 | 313,373 |
Prepaid expenses | 20,332 | 14,639 |
Other current assets | 26,053 | 30,060 |
Total current assets | 526,448 | 496,935 |
Property and equipment, net of accumulated depreciation of $96,056 and $92,422 | 42,684 | 41,845 |
Operating lease right of use assets | 88,425 | 88,939 |
Goodwill | 1,244,679 | 1,244,679 |
Intangible assets, net of accumulated amortization of $15,128 and $14,008 | 101,778 | 102,675 |
Other assets | 85,857 | 85,097 |
Total assets | 2,089,871 | 2,060,170 |
Current liabilities: | ||
Accounts payable | 36,249 | 28,237 |
Payroll and employee benefits | 131,631 | 136,835 |
Accrued expenses | 147,464 | 140,049 |
Termination fee paid by UnitedHealth Group | 106,000 | 106,000 |
Current portion of long-term obligations | 37,232 | 36,314 |
Current portion of operating lease liabilities | 26,284 | 26,286 |
Total current liabilities | 484,860 | 473,721 |
Long-term obligations, less current portion | 356,080 | 361,862 |
Operating lease liabilities, less current portion | 62,220 | 62,751 |
Deferred income tax liabilities | 43,229 | 40,635 |
Other long-term obligations | 828 | 1,418 |
Total liabilities | 947,217 | 940,387 |
Commitments and Contingencies—Note 7 | ||
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; 38,146,546 and 38,131,478 shares issued; 32,676,115 and 32,667,631 shares outstanding | 38 | 38 |
Additional paid-in capital | 795,063 | 787,177 |
Treasury stock, at cost, 5,470,431 and 5,463,847 shares of common stock | (469,243) | (468,626) |
Retained earnings | 762,325 | 747,925 |
Total Amedisys, Inc. stockholders’ equity | 1,088,183 | 1,066,514 |
Noncontrolling interests | 54,471 | 53,269 |
Total equity | 1,142,654 | 1,119,783 |
Total liabilities and equity | $ 2,089,871 | $ 2,060,170 |
CONSOLIDATED BALANCE SHEETS (Pa
CONSOLIDATED BALANCE SHEETS (Parenthetical) - USD ($) $ in Thousands | Mar. 31, 2024 | Dec. 31, 2023 |
Statement of Financial Position [Abstract] | ||
Property and equipment, accumulated depreciation | $ 96,056 | $ 92,422 |
Intangible assets, accumulated amortization | $ 15,128 | $ 14,008 |
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) | 38,146,546 | 38,131,478 |
Common stock, outstanding (shares) | 32,676,115 | 32,667,631 |
Treasury stock at cost (shares) | 5,470,431 | 5,463,847 |
CONSOLIDATED INCOME STATEMENT
CONSOLIDATED INCOME STATEMENT - USD ($) shares in Thousands, $ in Thousands | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Income Statement [Abstract] | ||
Revenues | $ 571,414 | $ 556,389 |
Cost of service, inclusive of depreciation | 321,537 | 315,010 |
General and administrative expenses: | ||
Salaries and benefits | 127,946 | 126,339 |
Non-cash compensation | 7,433 | 3,273 |
Merger-related expenses | 20,667 | 720 |
Depreciation and amortization | 4,271 | 4,443 |
Other | 57,941 | 64,225 |
Total operating expenses | 539,795 | 514,010 |
Operating income | 31,619 | 42,379 |
Other income (expense): | ||
Interest income | 1,727 | 406 |
Interest expense | (8,119) | (7,517) |
Equity in earnings from equity method investments | 910 | 123 |
Miscellaneous, net | 1,090 | (682) |
Total other expense, net | (4,392) | (7,670) |
Income before income taxes | 27,227 | 34,709 |
Income tax expense | (12,633) | (9,800) |
Net income | 14,594 | 24,909 |
Net (income) loss attributable to noncontrolling interests | (194) | 337 |
Net income attributable to Amedisys, Inc. | $ 14,400 | $ 25,246 |
Basic earnings per common share: | ||
Net income attributable to Amedisys, Inc. common stockholders | $ 0.44 | $ 0.78 |
Weighted average shares outstanding, basic (shares) | 32,670 | 32,558 |
Diluted earnings per common share: | ||
Net income attributable to Amedisys, Inc. common stockholders | $ 0.44 | $ 0.77 |
Weighted average shares outstanding, diluted (shares) | 32,979 | 32,643 |
CONSOLIDATED STATEMENTS OF STOC
CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY Statement - USD ($) $ in Thousands | Total | Common Stock | Additional Paid-in Capital | Treasury Stock | Retained Earnings | Noncontrolling Interests |
Balance, Stockholders Equity at Dec. 31, 2022 | $ 1,106,573 | $ 38 | $ 755,063 | $ (461,200) | $ 757,672 | $ 55,000 |
Balance (in shares) at Dec. 31, 2022 | 37,891,186 | |||||
Issuance of stock - employee stock purchase plan | 816 | 816 | ||||
Issuance of stock - employee stock purchase plan (shares) | 11,498 | |||||
Issuance/(cancellation) of non-vested stock | 0 | 0 | ||||
Issuance/(cancellation) of non-vested stock (shares) | 35,670 | |||||
Non-cash compensation | 3,273 | 3,273 | ||||
Surrendered Shares | (1,308) | (1,308) | ||||
Purchase of noncontrolling interest | (630) | (483) | (147) | |||
Noncontrolling interest distributions | (285) | (285) | ||||
Net income (loss) | 24,909 | 25,246 | (337) | |||
Balance, Stockholders Equity at Mar. 31, 2023 | 1,133,348 | $ 38 | 758,669 | (462,508) | 782,918 | 54,231 |
Balance (in shares) at Mar. 31, 2023 | 37,938,354 | |||||
Balance, Stockholders Equity at Dec. 31, 2023 | 1,119,783 | $ 38 | 787,177 | (468,626) | 747,925 | 53,269 |
Balance (in shares) at Dec. 31, 2023 | 38,131,478 | |||||
Issuance/(cancellation) of non-vested stock | 0 | 0 | ||||
Issuance/(cancellation) of non-vested stock (shares) | 15,068 | |||||
Non-cash compensation | 7,886 | 7,886 | ||||
Surrendered Shares | (617) | (617) | ||||
Noncontrolling interest contributions | 1,764 | 1,764 | ||||
Noncontrolling interest distributions | (756) | (756) | ||||
Net income (loss) | 14,594 | 14,400 | 194 | |||
Balance, Stockholders Equity at Mar. 31, 2024 | $ 1,142,654 | $ 38 | $ 795,063 | $ (469,243) | $ 762,325 | $ 54,471 |
Balance (in shares) at Mar. 31, 2024 | 38,146,546 |
CONSOLIDATED STATEMENTS OF CASH
CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Cash Flows from Operating Activities: | ||
Net income | $ 14,594 | $ 24,909 |
Adjustments to reconcile net income to net cash (used in) provided by operating activities: | ||
Depreciation and amortization (inclusive of depreciation included in cost of service) | 6,138 | 5,694 |
Non-cash compensation | 7,886 | 3,273 |
Amortization and impairment of operating lease right of use assets | 8,566 | 8,622 |
Loss (gain) on disposal of property and equipment | 4 | (70) |
Loss on personal care divestiture | 0 | 2,186 |
Deferred income taxes | 2,594 | 2,772 |
Equity in earnings from equity method investments | (910) | (123) |
Amortization of deferred debt issuance costs | 248 | 248 |
Return on equity method investments | 170 | 1,787 |
Changes in operating assets and liabilities, net of impact of acquisitions: | ||
Patient accounts receivable | (46,806) | (7,476) |
Other current assets | (1,696) | (4,128) |
Operating lease right of use assets | (1,042) | (918) |
Other assets | 155 | (111) |
Accounts payable | 8,652 | (3,457) |
Accrued expenses | 3,029 | 741 |
Other long-term obligations | (591) | (28) |
Operating lease liabilities | (7,532) | (7,960) |
Net cash (used in) provided by operating activities | (6,541) | 25,961 |
Cash Flows from Investing Activities: | ||
Proceeds from the sale of deferred compensation plan assets | 21 | 19 |
Purchases of property and equipment | (2,670) | (1,350) |
Investments in technology assets | (223) | (210) |
Investment in equity method investee | (196) | 0 |
Proceeds from personal care divestiture | 0 | 47,787 |
Acquisitions of businesses, net of cash acquired | 0 | (350) |
Net cash (used in) provided by investing activities | (3,068) | 45,896 |
Cash Flows from Financing Activities: | ||
Proceeds from issuance of stock under employee stock purchase plan | 0 | 816 |
Shares withheld to pay taxes on non-cash compensation | (617) | (1,308) |
Noncontrolling interest contributions | 1,764 | 0 |
Noncontrolling interest distributions | (756) | (285) |
Proceeds from borrowings under revolving line of credit | 0 | 8,000 |
Repayments of borrowings under revolving line of credit | 0 | (8,000) |
Principal payments of long-term obligations | (8,941) | (55,313) |
Purchase of noncontrolling interest | 0 | (800) |
Net cash used in financing activities | (8,550) | (56,890) |
Net (decrease) increase in cash, cash equivalents and restricted cash | (18,159) | 14,967 |
Cash, cash equivalents and restricted cash at beginning of period | 138,863 | 54,133 |
Cash, cash equivalents and restricted cash at end of period | 120,704 | 69,100 |
Supplemental Disclosures of Cash Flow Information: | ||
Cash paid for interest | 8,188 | 6,654 |
Cash paid for income taxes, net of refunds received | 828 | 352 |
Cash paid for operating lease liabilities | 8,574 | 8,878 |
Cash paid for finance lease liabilities | 2,236 | 2,457 |
Supplemental Disclosures of Non-Cash Activity: | ||
Right of use assets obtained in exchange for operating lease liabilities | 7,173 | 7,083 |
Right of use assets obtained in exchange for finance lease liabilities | 4,326 | 20,790 |
Reductions to right of use assets resulting from reductions to operating lease liabilities | 168 | 141 |
Reductions to right of use assets resulting from reductions to finance lease liabilities | $ 496 | $ 369 |
NATURE OF OPERATIONS, CONSOLIDA
NATURE OF OPERATIONS, CONSOLIDATION AND PRESENTATION OF FINANCIAL STATEMENTS | 3 Months Ended |
Mar. 31, 2024 | |
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 high acuity care services with approximately 71% and 72% of our consolidated net service revenue derived from Medicare for the three-month periods ended March 31, 2024 and 2023, respectively. As of March 31, 2024, we owned and operated 346 Medicare-certified home health care centers, 165 Medicare-certified hospice care centers and 9 admitting high acuity care joint ventures in 37 states within the United States and the District of Columbia. We divested our personal care business on March 31, 2023. Amedisys and UnitedHealth Group Incorporated Merger On June 26, 2023, Amedisys, UnitedHealth Group Incorporated, a Delaware corporation ("UnitedHealth Group"), and Aurora Holdings Merger Sub Inc., a Delaware corporation and a wholly owned subsidiary of UnitedHealth Group ("Merger Sub"), entered into an Agreement and Plan of Merger, pursuant to which Merger Sub will merge with and into Amedisys with Amedisys continuing as the surviving corporation and becoming a wholly owned subsidiary of UnitedHealth Group. See Note 4 - Mergers, Acquisitions and Dispositions for additional information. 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, 2023, as filed with the Securities and Exchange Commission (“SEC”) on February 22, 2024 (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. 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. Reclassification Certain reclassifications have been made to the prior period's financial statements in order to conform to the current year presentation. In the prior year, the Company combined merger-related expenses with other general and administrative expenses within the condensed consolidated income statement. Merger-related expenses are reflected as a separate line item in the current year. This reclassification had no effect on our previously reported net income. 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 condensed consolidated financial statements from their respective dates of acquisition. In addition to our wholly owned subsidiaries, we also have certain equity investments that we either consolidate, account for under the equity method of accounting or account for under the cost method of accounting. See Note 3 - Investments for additional information. |
SUMMARY OF SIGNIFICANT ACCOUNTI
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES | 3 Months Ended |
Mar. 31, 2024 | |
Accounting Policies [Abstract] | |
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES | SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES Revenue Recognition We account for service revenue from contracts with customers in accordance with Accounting Standards Codification ("ASC") 606, Revenue from Contracts with Customers , and as such, we recognize service 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. Our 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. Our performance obligations relate to contracts with a duration of less than one year; therefore, we have elected to apply the optional exemption provided by ASC 606 and are 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 audits and 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 industry 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. We assess our ability to collect for the healthcare services provided at the time of patient admission based on our verification of the patient's insurance coverage under Medicare, Medicaid, and other commercial or managed care insurance programs. 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 audits and 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 collection experience. Net service revenue by payor class as a percentage of total net service revenue for each of our operating segments as described in Note 8 - Segment Information is as follows: For the Three-Month Periods Ended March 31, 2024 2023 Home Health: Medicare 38 % 39 % Non-Medicare - Episodic-based 8 % 7 % Non-Medicare - Non-episodic based 18 % 15 % Hospice: Medicare 33 % 33 % Non-Medicare 2 % 2 % Personal Care (1) — % 3 % High Acuity Care 1 % 1 % 100 % 100 % (1) We divested our personal care business on March 31, 2023. Home Health Revenue Recognition Medicare Revenue 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, we account 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. Each 60-day episode includes two 30-day periods of care. Net service revenue is recorded based on the established Federal Medicare home health payment rate for a 30-day period 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 period of care. 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. The Patient-Driven Groupings Model ("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; (c) a partial payment if a patient is transferred to another provider or from another provider before completing the 30-day period of care; and (d) the applicable geographic wage index. Payments for routine and non-routine supplies are 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 collection 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 to revenue with 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 audits and 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 his/her 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. The notice of admission ("NOA") process implemented by the Centers for Medicare and Medicaid Services ("CMS") requires a one-time submission for each patient that establishes the home health period of care and covers all contiguous 30-day periods of care until the patient is discharged from home health services. If the NOA is not submitted timely, a payment reduction is applied equal to 1/30 of the 30-day payment rate for each day from the start of care date until the date the NOA is submitted. Non-Medicare Revenue Payments from non-Medicare payors are either a percentage of Medicare rates, per-visit rates or case rates depending upon the terms and conditions established with such payors. Approximately 30% of our managed care contract volume affords us the opportunity to receive additional payments if we achieve certain quality or process metrics as defined in each contract (e.g. star ratings and acute-care hospitalization rates). We record revenue associated with these metrics at the time the amounts are probable and estimable. 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, the majority of which range from 90% to 100% of Medicare rates. Non-episodic based Revenue. For our per visit contracts, 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. For our case rate contracts, gross revenue is recorded over our historical average length of stay using the established case rate for each admission. 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 our 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. Under our case rate contracts, we may receive reimbursement before all services are rendered. Any cash received that exceeds the associated revenue earned is recorded to deferred revenue in accrued expenses within our condensed consolidated balance sheets. 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 97% of our total Medicare hospice service revenue for the three-month periods ended March 31, 2024 and 2023. 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 or medical social worker 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 collection experience, which primarily includes a historical collection rate of over 99% on Medicare claims, and record it during the period services are rendered. 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 audits and payment reviews based on our historical experience and success rates in the claim appeals and adjudication process. 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 sheets. Providers are required to self-report and pay their estimated cap liability by February 28 th of the following year. As of March 31, 2024 and December 31, 2023, we had recorded $2.3 million for estimated amounts due back to Medicare in accrued expenses for the Federal cap years ended October 31, 2017 through September 30, 2024. 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 our historical experience to reflect the estimated transaction price. Personal Care Revenue Recognition Personal Care Revenue For the periods prior to the divestiture of our personal care line of business on March 31, 2023, we generated net service revenue by providing our services directly to patients based on authorized hours, visits or units determined by the relevant agency, at a rate that was either contractual or fixed by legislation. Net service revenue was recognized at the time services were rendered based on gross charges for the services provided, reduced by estimates for contractual and non-contractual revenue adjustments. We received payment for providing such services from payors, including state and local governmental agencies, managed care organizations, commercial insurers and private consumers. Payors included 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"). High Acuity Care Revenue Recognition High Acuity Care Revenue Our revenues are primarily derived from contracts with (1) health insurance plans for the coordination and provision of home recovery care services to clinically-eligible patients who are enrolled members in those insurance plans and (2) health system partners for the coordination and provision of home recovery care services to clinically-eligible patients who are discharged early from a health system facility to complete their inpatient stay at home. Under our health insurance plan contracts, we provide home recovery care services, which include hospital-equivalent ("H H") and skilled nursing facility ("SNF") equivalent services ("SNF H"), for high acuity care patients on a full risk basis whereby we assume the financial risk for the coordination and payment of all hospital or SNF replacement medical services necessary to treat the medical condition for which the patient was diagnosed in a home-based setting for a 30-day (H H) or 60-day (SNF H) episode of care in exchange for a fixed contracted bundled rate. For H H programs, the fixed rate is based on the assigned diagnosis related group ("DRG") and the 30-day post-discharge related spend. For SNF H programs, the fixed rate is based on the 60-day post-discharge related spend. Our performance obligation is the coordination and provision of patient care in accordance with physicians’ orders over either a 30-day or 60-day episode of care. The majority of our care coordination services and direct patient care is provided in the first five seven Under our contracts with health system partners, we provide home recovery care services for high acuity patients on a limited risk basis whereby we assume the risk for certain healthcare services during the remainder of an inpatient acute stay serviced at the patient’s home (completing H H - "CH H") in exchange for a contracted per diem rate. The performance obligation is the coordination and provision of required medical services, as determined by the treating physician, for each day the patient receives inpatient-equivalent care at home. As such, net service revenue is recognized as services are administered and as our performance obligations are satisfied on a per diem basis, reduced by estimates for revenue adjustments. We recognize adjustments to revenue during the period in which changes to estimates of assigned patient diagnoses or episode terminations become known, in accordance with the applicable managed care contracts. For certain health insurance plans, revenue is reduced by amounts owed by enrollees to healthcare providers under deductible, coinsurance or copay provisions of health insurance plan policies, since those amounts are repaid to the health insurance plans by us as part of a retrospective reconciliation process. Cash, Cash Equivalents and Restricted Cash Cash and cash equivalents include money market funds, certificates of deposit and all highly liquid debt instruments with maturities of three months or less when purchased. The Company maintains cash with commercial banks, which are insured by the Federal Deposit Insurance Corporation (“FDIC”). At various times, the Company has deposits in these financial institutions in excess of the amount insured by the FDIC. The Company has not experienced any losses related to these balances and believes its credit risk to be minimal. The carrying amounts of our cash and cash equivalents approximate their fair values, which are primarily based on Level 1 inputs. Restricted cash includes cash that is not available for ordinary business use. As of March 31, 2024 and December 31, 2023, we had $12.5 million and $12.4 million, respectively, classified as restricted cash related to funds placed into escrow accounts in connection with the indemnity, closing payment and other provisions within the purchase agreements of our Evolution Health LLC acquisition and our personal care line of business divestiture. The following table summarizes the balances related to our cash, cash equivalents and restricted cash (amounts in millions): As of March 31, 2024 As of December 31, 2023 Cash and cash equivalents $ 108.2 $ 126.5 Restricted cash 12.5 12.4 Cash, cash equivalents and restricted cash $ 120.7 $ 138.9 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. Our non-Medicare third-party payor base is comprised of a diverse group of payors that are geographically dispersed across the country. As of March 31, 2024, there is one single payor, other than Medicare, that accounts for more than 10% of our total outstanding patient receivables (approximately 13%). 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 collectability risk associated with our Medicare accounts, which represented 55% and 69% of our patient accounts receivable at March 31, 2024 and December 31, 2023, 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. The Company uses Change Healthcare, a subsidiary of UnitedHealth Group, to submit patient claims to Medicare and all other payors for reimbursement. On February 22, 2024, UnitedHealth Group announced that on February 21, 2024, Change Healthcare’s information technology systems were impacted by a cybersecurity incident. The Change Healthcare cybersecurity incident did not impact our day-to-day operations; however, we were delayed in submitting patient claims to certain non-Medicare payors. There was minimal impact to our Medicare claim submissions as we were able to quickly redirect our Medicare claims to an alternative clearinghouse. As of the date of this filing, we are substantially caught up with our non-Medicare claim submissions; however, the delays in submitting non-Medicare claims resulted in a reduction of our operating cash flow and an estimated increase to our accounts receivable of approximately $60 million during the three month-period ended March 31, 2024. 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 bill Medicare following the end of each 30-day period of care or upon discharge, if earlier, for the services provided to the patient. 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 High Acuity 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. Business Combinations We account for acquisitions using the acquisition method of accounting in accordance with ASC 805, Business Combinations . Acquisitions are accounted for as purchases and are included in our condensed consolidated financial statements from their respective acquisition dates. Assets acquired, liabilities assumed and noncontrolling interests, if any, are measured at fair value on the acquisition date using the appropriate valuation method. Goodwill generated from acquisitions is recognized for the excess of the purchase price over tangible and identifiable intangible assets. In determining the fair value of identifiable intangible assets and any noncontrolling interests, we use various valuation techniques including the income approach, the cost approach and the market approach. These valuation methods require us to make estimates and assumptions surrounding projected revenues and costs, growth rates and discount rates. 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 March 31, 2024 Quoted Prices in Active Significant Other Significant $450 million Term Loan $ 366.3 $ — $ 361.6 $ — 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 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-Month Periods 2024 2023 Weighted average number of shares outstanding - basic 32,670 32,558 Effect of dilutive securities: Stock options 10 13 Non-vested stock and stock units 299 72 Weighted average number of shares outstanding - diluted 32,979 32,643 Anti-dilutive securities 388 323 |
INVESTMENTS
INVESTMENTS | 3 Months Ended |
Mar. 31, 2024 | |
Equity Method Investments and Joint Ventures [Abstract] | |
INVESTMENTS | INVESTMENTS We consolidate investments when the entity is a variable interest entity ("VIE") 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. We account for investments in entities in which we have the ability to exercise significant influence under the equity method if we hold 50% or less of the voting stock and the entity is not a VIE in which we are the primary beneficiary. The book value of investments that we account for under the equity method of accounting was $47.0 million and $46.1 million as of March 31, 2024 and December 31, 2023, respectively, and is reflected in other assets within our condensed consolidated balance sheets. We account for investments in entities in which we have less than 20% ownership interest under the cost method of accounting if we do not have the ability to exercise significant influence over the investee. The book value of investments that we account for under the cost method of accounting was $20.0 million as of March 31, 2024 and December 31, 2023 and is reflected in other assets within our condensed consolidated balance sheets. Our high acuity care segment includes interests in several joint ventures with health system partners and a professional corporation that employs clinicians. Each of these entities meets the criteria to be classified as a VIE. We have management agreements in place whereby we manage the entities and run the day-to-day operations. As such, we possess the power to direct the activities that most significantly impact the economic performance of the VIEs. The significant activities include, but are not limited to, negotiating provider and payor contracts, establishing patient care policies and protocols, making employment and compensation decisions, developing the operating and capital budgets, performing marketing activities and providing accounting support. We also have the obligation to absorb any expected losses and the right to receive benefits. Additionally, from time to time, we may be required to provide joint venture funding. As of March 31, 2024, we are consolidating all but one of our joint ventures with health system partners as well as the professional corporation as we have concluded that we are the primary beneficiary of these VIEs; the joint venture that is not consolidated is accounted for under the equity method of accounting. During the three-month period ended March 31, 2024, we entered into an agreement to wind-down and dissolve the operations of this unconsolidated joint venture. The terms of the agreements with each VIE prohibit us from using the assets of the VIE to satisfy the obligations of other entities. The carrying amount of the VIEs’ assets and liabilities included in our condensed consolidated balance sheets are as follows (amounts in millions): As of March 31, 2024 As of December 31, 2023 ASSETS Current assets: Cash and cash equivalents $ 9.1 $ 8.8 Patient accounts receivable 7.8 9.0 Other current assets — 0.1 Total current assets 16.9 17.9 Property and equipment — 0.1 Operating lease right of use assets — 0.1 Goodwill 8.5 8.5 Intangible assets 0.4 0.4 Other assets 0.4 0.3 Total assets $ 26.2 $ 27.3 LIABILITIES Current liabilities: Accounts payable $ 0.5 $ 0.5 Payroll and employee benefits 0.9 0.9 Accrued expenses 8.2 7.9 Total liabilities $ 9.6 $ 9.3 |
MERGERS AND ACQUISITIONS
MERGERS AND ACQUISITIONS | 3 Months Ended |
Mar. 31, 2024 | |
Business Combinations [Abstract] | |
MERGERS, ACQUISITIONS AND DISPOSITIONS | MERGERS, ACQUISITIONS AND DISPOSITIONS Mergers On June 26, 2023, Amedisys, UnitedHealth Group Incorporated, a Delaware corporation ("UnitedHealth Group"), and Aurora Holdings Merger Sub Inc., a Delaware corporation and a wholly owned subsidiary of UnitedHealth Group ("Merger Sub"), entered into an Agreement and Plan of Merger (the "Merger Agreement"), pursuant to which Merger Sub will merge with and into Amedisys with Amedisys continuing as the surviving corporation and becoming a wholly owned subsidiary of UnitedHealth Group (the “Merger”). Subject to the terms and conditions set forth in the Merger Agreement, at the effective time of the Merger (the "Effective Time"), by virtue of the Merger: (i) each share of Amedisys common stock (“Amedisys Common Stock”) held in treasury by Amedisys or owned by UnitedHealth Group or Merger Sub or any of their respective subsidiaries, in each case, immediately prior to the Effective Time will be cancelled (collectively, “cancelled shares”) without consideration; and (ii) each share of Amedisys Common Stock, other than any cancelled shares, issued and outstanding immediately prior to the Effective Time will be converted into the right to receive $101 per share in cash, without interest, less any applicable withholding taxes. The Merger is subject to a number of conditions to closing as specified in the Merger Agreement. These closing conditions include, among others, (i) approval by Amedisys stockholders at the Amedisys Stockholders Meeting (as defined in the Merger Agreement) of the proposal to adopt the Merger Agreement, which approval was obtained on September 8, 2023; (ii) the expiration or termination of the applicable waiting period (and any extension thereof) under the Hart-Scott-Rodino Antitrust Improvements Act of 1976, as amended; (iii) the receipt of the required state regulatory approvals; (iv) the absence of any law or order that has the effect of enjoining or otherwise prohibiting the completion of the Merger; and (v) the expiration or early termination of the waiting period (and any extension thereof) applicable to the consummation of the transactions contemplated by the Merger Agreement under all applicable antitrust laws without the imposition by any governmental entity of any term, condition, obligation, requirement, limitation, prohibition, remedy, sanction or other action that has resulted in or would reasonably be expected to result in a Burdensome Condition (as defined in the Merger Agreement). Termination of Option Care Health, Inc. ("OPCH") Merger Agreement As previously disclosed in Amedisys’ Current Report on Form 8-K filed with the SEC on May 3, 2023 and its Quarterly Report on Form 10-Q filed with the SEC on May 4, 2023, Amedisys entered into an Agreement and Plan of Merger on May 3, 2023 (the “OPCH Merger Agreement”) with OPCH, a Delaware corporation, and Uintah Merger Sub, Inc., a Delaware corporation and wholly-owned subsidiary of OPCH (“OPCH Merger Sub”). On June 26, 2023, Amedisys, OPCH and OPCH Merger Sub entered into the Termination Agreement (the “Termination Agreement”), pursuant to which the parties thereto agreed to terminate the OPCH Merger Agreement and grant mutual releases by the parties of all claims against the other parties based upon, arising from, in connection with or relating to the OPCH Merger Agreement. Pursuant to the terms of the Termination Agreement, each of the termination of the OPCH Merger Agreement and the mutual releases provided for in the Termination Agreement would become effective upon receipt by OPCH of a $106,000,000 termination fee payable by, or on behalf of, Amedisys within 24 hours of the execution of the Termination Agreement (i.e., before the market open on June 27, 2023). On June 26, 2023, following the execution of the Termination Agreement, UnitedHealth Group, on behalf of Amedisys, delivered funds to OPCH in an amount equal to $106,000,000, representing the termination fee payable to OPCH under the OPCH Merger Agreement and the Termination Agreement, satisfying the condition precedent to the effectiveness of the termination of the OPCH Merger Agreement and the releases contained in the Termination Agreement. If the Merger Agreement is terminated under certain specified circumstances, Amedisys may be required to reimburse UnitedHealth Group for the $106,000,000 termination fee that UnitedHealth Group, on Amedisys’ behalf, paid to OPCH in addition to the $125,000,000 termination fee payable by Amedisys to UnitedHealth Group upon termination of the Merger Agreement. The $106,000,000 termination fee was recorded to other income (expense) within our condensed consolidated income statement with a corresponding liability to termination fee paid by UnitedHealth Group within our condensed consolidated balance sheet during the three-month period ended June 30, 2023. 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 high acuity 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. Dispositions On February 10, 2023, we signed a definitive agreement to sell our personal care business (excluding the Florida operations, which were closed during the three-month period ended March 31, 2023). The divestiture closed on March 31, 2023. We received net proceeds of $47.8 million and recognized a $2.2 million loss during the three-month period ended March 31, 2023, which is reflected in miscellaneous, net within our condensed consolidated income statement. The net proceeds of $47.8 million is inclusive of $6.0 million that was placed into an escrow account in accordance with the closing payment and indemnity provisions within the purchase agreement. Of the total $6.0 million placed into escrow, $1.0 million was set aside for the closing payment adjustment. The closing payment calculated on the acquisition date included estimates for cash, working capital and various other items. Under the purchase agreement, the purchase price was subject to an adjustment for any differences between estimated amounts included in the closing payment and actual amounts at close. The closing payment adjustment was finalized during 2023 with $0.1 million being paid to Amedisys by the buyer. The $1.0 million in escrow related to the closing payment adjustment was released to Amedisys during 2023. The remaining $5.0 million placed into escrow, which was related to indemnity provisions within the purchase agreement, was released to Amedisys during the second quarter of 2024. The disposition of our personal care business did not qualify as a discontinued operation because it did not represent a change in strategy that has or will have a major effect on the Company's operations or financial results. We derecognized goodwill of $43.1 million in connection with the divestiture. |
LONG-TERM OBLIGATIONS
LONG-TERM OBLIGATIONS | 3 Months Ended |
Mar. 31, 2024 | |
Debt Disclosure [Abstract] | |
LONG-TERM OBLIGATIONS | 3.00 to 1.0 1.00% 2.00% 0.30% 1.75% II < 3.00 to 1.0 but > 2.00 to 1.0 0.75% 1.75% 0.25% 1.50% III < 2.00 to 1.0 but > 0.75 to 1.0 0.50% 1.50% 0.20% 1.25% IV < 0.75 to 1.0 0.25% 1.25% 0.15% 1.00% The final maturity date of the Amended Credit Facility is July 30, 2026. The Revolving Credit Facility will terminate and be due and payable as of the final maturity date. The Amended Term Loan Facility, however, is subject to quarterly amortization of principal in the amount of (i) 0.625% for the period commencing on July 30, 2021 and ending on September 30, 2023, and (ii) 1.250% for the period commencing on October 1, 2023 and ending on July 30, 2026. The remaining balance of the Amended Term Loan Facility must be paid upon the final maturity date. In addition to the scheduled amortization of the Amended Term Loan Facility, and subject to customary exceptions and reinvestment rights, we are required to prepay the Amended 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 Third Amended Credit Agreement. In accordance with the requirements above, net proceeds received from the divestiture of our personal care line of business were used to prepay a portion of our Amended Term Loan Facility during the three-month period ended March 31, 2023. The Third 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 Third Amended Credit Agreement, and (ii) a consolidated interest coverage ratio of EBITDA to cash interest charges, as defined in the Third Amended Credit Agreement. Each of these covenants is calculated over rolling four-quarter periods and also is subject to certain exceptions and baskets. The Third 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 Third Amended Credit Agreement. As of March 31, 2024, we are in compliance with our covenants under the Third Amended Credit Agreement. The Revolving Credit Facility is guaranteed by substantially all of our wholly-owned direct and indirect subsidiaries. The Third 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. As of March 31, 2024 and 2023, we had no outstanding borrowings under our $550.0 million Revolving Credit Facility. Our weighted average interest rate for borrowings under our Amended Term Loan Facility was 7.3% and 6.1% for the three-month periods ended March 31, 2024 and 2023, respectively. As of March 31, 2024, our availability under our $550.0 million Revolving Credit Facility was $514.2 million as we have no outstanding borrowings and $35.8 million outstanding in letters of credit. Joinder Agreements In connection with the Compassionate Care Hospice ("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 (now the Third 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 (now the Third Amended Credit Agreement), the Amended and Restated Security Agreement and the Amended and Restated Pledge Agreement (the “AseraCare Joinder"). In connection with the Contessa acquisition and the Second Amendment to the Credit Agreement, we entered into a Joinder Agreement, dated as of September 3, 2021, pursuant to which Contessa and its subsidiaries and Asana Hospice ("Asana"), which we acquired on January 1, 2020, and its subsidiaries were made parties to, and became subject to the terms and conditions of, the Second Amended Credit Agreement (now the Third Amended Credit Agreement), the Amended and Restated Security Agreement and the Amended and Restated Pledge Agreement (the “Contessa and Asana Joinder,” and together with the CCH Joinder and the AseraCare Joinder, the “Joinders”). Pursuant to the Joinders, the Amended and Restated Security Agreement and the Amended and Restated Pledge Agreement, CCH and its subsidiaries, the AseraCare entities, Contessa and its subsidiaries and Asana and its subsidiaries 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, the AseraCare entities, Contessa and its subsidiaries and Asana and its subsidiaries also guaranteed our obligations, whether now existing or arising after the respective effective dates of the Joinders, under the Third Amended Credit Agreement pursuant to the terms of the Joinders and the Third Amended Credit Agreement. Finance Leases Our outstanding finance leases totaling $29.3 million relate to leased equipment and fleet vehicles and bear interest rates ranging from 3.1% to 8.1%." id="sjs-B4">LONG-TERM OBLIGATIONS Long-term debt consists of the following for the periods indicated (amounts in millions): March 31, 2024 December 31, 2023 $450.0 million Term Loan; interest rate at Base Rate plus Applicable Rate or Term SOFR plus Applicable Rate ( 7.2 $ 366.3 $ 371.9 $550.0 million Revolving Credit Facility; interest only payments; interest rate at Base Rate plus Applicable Rate or Term SOFR plus Applicable Rate; due July 30, 2026 — — Finance leases 29.3 28.9 Principal amount of long-term obligations 395.6 400.8 Deferred debt issuance costs (2.3) (2.6) 393.3 398.2 Current portion of long-term obligations (37.2) (36.3) Long-term obligations, less current portion $ 356.1 $ 361.9 Third Amendment to the Credit Agreement Our Credit Agreement provides for a senior secured credit facility in an initial aggregate principal amount of up to $1.0 billion, which includes a $550.0 million Revolving Credit Facility and a term loan facility with a principal amount of up to $450.0 million (the "Amended Term Loan Facility" and collectively with the Revolving Credit Facility, the "Amended Credit Facility"). On March 10, 2023, we entered into the Third Amendment to our Credit Agreement (as amended by the Third Amendment, the "Third Amended Credit Agreement") which (i) formally replaced the use of the London Interbank Offered Rate ("LIBOR") with the Secured Overnight Financing Rate ("SOFR") for interest rate pricing and (ii) allowed for the disposition of our personal care business. The loans issued under the Amended 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 Term SOFR 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 Term SOFR plus 1% per annum. The “Term SOFR” means the quoted rate per annum equal to the SOFR for an interest period of one or three months (as selected by us) plus the SOFR adjustment of 0.10%. The “Applicable Rate” is based on the consolidated leverage ratio and is presented in the table below. As of March 31, 2024, the Applicable Rate is 0.75% per annum for Base Rate loans and 1.75% per annum for Term SOFR loans. We are also subject to a commitment fee and letter of credit fee under the terms of the Third Amended Credit Agreement, as presented in the table below. Pricing Tier Consolidated Leverage Ratio Base Rate Loans Term SOFR Loans and SOFR Daily Floating Rate Loans Commitment Fee Letter of Credit Fee I > 3.00 to 1.0 1.00% 2.00% 0.30% 1.75% II < 3.00 to 1.0 but > 2.00 to 1.0 0.75% 1.75% 0.25% 1.50% III < 2.00 to 1.0 but > 0.75 to 1.0 0.50% 1.50% 0.20% 1.25% IV < 0.75 to 1.0 0.25% 1.25% 0.15% 1.00% The final maturity date of the Amended Credit Facility is July 30, 2026. The Revolving Credit Facility will terminate and be due and payable as of the final maturity date. The Amended Term Loan Facility, however, is subject to quarterly amortization of principal in the amount of (i) 0.625% for the period commencing on July 30, 2021 and ending on September 30, 2023, and (ii) 1.250% for the period commencing on October 1, 2023 and ending on July 30, 2026. The remaining balance of the Amended Term Loan Facility must be paid upon the final maturity date. In addition to the scheduled amortization of the Amended Term Loan Facility, and subject to customary exceptions and reinvestment rights, we are required to prepay the Amended 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 Third Amended Credit Agreement. In accordance with the requirements above, net proceeds received from the divestiture of our personal care line of business were used to prepay a portion of our Amended Term Loan Facility during the three-month period ended March 31, 2023. The Third 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 Third Amended Credit Agreement, and (ii) a consolidated interest coverage ratio of EBITDA to cash interest charges, as defined in the Third Amended Credit Agreement. Each of these covenants is calculated over rolling four-quarter periods and also is subject to certain exceptions and baskets. The Third 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 Third Amended Credit Agreement. As of March 31, 2024, we are in compliance with our covenants under the Third Amended Credit Agreement. The Revolving Credit Facility is guaranteed by substantially all of our wholly-owned direct and indirect subsidiaries. The Third 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. As of March 31, 2024 and 2023, we had no outstanding borrowings under our $550.0 million Revolving Credit Facility. Our weighted average interest rate for borrowings under our Amended Term Loan Facility was 7.3% and 6.1% for the three-month periods ended March 31, 2024 and 2023, respectively. As of March 31, 2024, our availability under our $550.0 million Revolving Credit Facility was $514.2 million as we have no outstanding borrowings and $35.8 million outstanding in letters of credit. Joinder Agreements In connection with the Compassionate Care Hospice ("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 (now the Third 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 (now the Third Amended Credit Agreement), the Amended and Restated Security Agreement and the Amended and Restated Pledge Agreement (the “AseraCare Joinder"). In connection with the Contessa acquisition and the Second Amendment to the Credit Agreement, we entered into a Joinder Agreement, dated as of September 3, 2021, pursuant to which Contessa and its subsidiaries and Asana Hospice ("Asana"), which we acquired on January 1, 2020, and its subsidiaries were made parties to, and became subject to the terms and conditions of, the Second Amended Credit Agreement (now the Third Amended Credit Agreement), the Amended and Restated Security Agreement and the Amended and Restated Pledge Agreement (the “Contessa and Asana Joinder,” and together with the CCH Joinder and the AseraCare Joinder, the “Joinders”). Pursuant to the Joinders, the Amended and Restated Security Agreement and the Amended and Restated Pledge Agreement, CCH and its subsidiaries, the AseraCare entities, Contessa and its subsidiaries and Asana and its subsidiaries 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, the AseraCare entities, Contessa and its subsidiaries and Asana and its subsidiaries also guaranteed our obligations, whether now existing or arising after the respective effective dates of the Joinders, under the Third Amended Credit Agreement pursuant to the terms of the Joinders and the Third Amended Credit Agreement. Finance Leases Our outstanding finance leases totaling $29.3 million relate to leased equipment and fleet vehicles and bear interest rates ranging from 3.1% to 8.1%. |
Income Taxes
Income Taxes | 3 Months Ended |
Mar. 31, 2024 | |
INCOME TAXES [Abstract] | |
Income Tax Disclosure | INCOME TAXES We use the asset and liability approach for measuring deferred tax assets and liabilities based on temporary differences existing at each balance sheet date using currently enacted tax rates. Our deferred tax calculation requires us to make certain estimates about future operations. Deferred tax assets are reduced by a valuation allowance when we believe it is more likely than not that some portion or all of the deferred tax assets will not be realized. The effect of a change in tax rate is recognized as income or expense in the period that includes the enactment date. Management regularly assesses the ability to realize deferred tax assets based upon the weight of available evidence, including such factors as recent earnings history and expected future taxable income. In the event future taxable income is below management’s estimates or is generated in tax jurisdictions different than projected, we could be required to increase the valuation allowance for deferred tax assets. This would result in an increase in our effective tax rate. The recognition of income taxes at interim periods is completed using an estimated annual effective tax rate. The effective tax rate for the period is influenced by the relationship of the amount of “effective tax rate drivers” (i.e. non-deductible expenses, non-taxable income, tax credits, valuation allowance, uncertain tax positions, etc.) to income or loss before taxes. For the three-month period ended March 31, 2024, the company incurred merger related expenses totaling $20.7 million, which is a significant and unusual reduction to income before taxes and is inclusive of $17.0 million of “effective tax rate drivers.” Consequently, for the three-month period ended March 31, 2024, the relationship between the “effective tax rate drivers” and income before taxes is distorted, resulting in an unusual effective tax rate. |
COMMITMENTS AND CONTINGENCIES
COMMITMENTS AND CONTINGENCIES | 3 Months Ended |
Mar. 31, 2024 | |
Commitments and Contingencies Disclosure [Abstract] | |
COMMITMENTS AND CONTINGENCIES | COMMITMENTS AND CONTINGENCIES Legal Proceedings - Ongoing 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. Third Party Audits - Ongoing From time to time, in the ordinary course of business, we are subject to audits under various governmental programs in which third party firms engaged by CMS, including Recovery Audit Contractors (“RACs”), Zone Program Integrity Contractors (“ZPICs”), Uniform Program Integrity Contractors (“UPICs”), Program Safeguard Contractors (“PSCs”), Medicaid Integrity Contractors (“MICs”), Supplemental Medical Review Contractors (“SMRCs”) and the Office of the Inspector General (“OIG”), 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 covered 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 disputed these findings, and our Florence subsidiary filed appeals through the Original Medicare Standard Appeals Process, in which we sought 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 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 March 31, 2024, 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 sheets. 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 covered 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 were 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 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. As a result of partially successful Level I and Level II Administrative Appeals, the alleged overpayment for the Lakeland Care Centers was reduced to $26.0 million, and the alleged overpayment for the Clearwater Care Center was reduced to $3.3 million. The Company filed Level III Administrative Appeals, and the ALJ hearings regarding the Lakeland Request for Repayment and the Clearwater Request for Repayment were held in April 2022. The Company received the results of the ALJ hearings in June 2022. The ALJ decisions for both the Clearwater Care Center and the Lakeland Care Centers were partially favorable for the claims that were reviewed, but the extrapolations were upheld. As a result, we increased our total accrual related to these matters from $17.4 million to $25.2 million, excluding interest. The repayments for the Lakeland Care Centers totaling $34.3 million ($22.8 million extrapolated repayment plus $11.5 million accrued interest) and the Clearwater Care Center totaling $3.7 million ($2.4 million extrapolated repayment plus $1.2 million accrued interest) were made during the year ended December 31, 2022. Additionally, we wrote off $1.5 million of receivables that were impacted by these matters. We expect to be indemnified by the prior owners, upon exhaustion of the parties' appeal rights, for approximately $10.9 million and have recorded this amount within other assets in our condensed consolidated balance sheets. Insurance We are obligated for certain costs associated with our insurance programs, including employee health, workers’ compensation, professional liability and fleet. 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 $1.5 million for any individual covered life. Our workers’ compensation insurance has a retention limit of $2.0 million per incident. Our professional liability insurance has a retention limit of $0.3 million per incident. Our fleet insurance has an exposure limit of $0.5 million per accident. |
SEGMENT INFORMATION
SEGMENT INFORMATION | 3 Months Ended |
Mar. 31, 2024 | |
Segment Reporting [Abstract] | |
SEGMENT INFORMATION | SEGMENT INFORMATION Our operations involve servicing patients through our three reportable business segments: home health, hospice and high acuity care. We divested our personal care business on March 31, 2023. 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 tasks. Our hospice segment provides palliative care and comfort to terminally ill patients and their families. Our high acuity care segment delivers the essential elements of inpatient hospital, palliative and SNF care to patients in their homes. Our personal care segment provided 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 March 31, 2024 Home Hospice Personal Care (1) High Acuity Care Other (2) Total Net service revenue $ 364.0 $ 201.0 $ — $ 6.4 $ — $ 571.4 Cost of service, inclusive of depreciation 210.4 105.3 — 5.8 — 321.5 General and administrative expenses 91.0 48.1 — 5.9 69.0 214.0 Depreciation and amortization 1.8 0.7 — 0.9 0.9 4.3 Operating expenses 303.2 154.1 — 12.6 69.9 539.8 Operating income (loss) $ 60.8 $ 46.9 $ — $ (6.2) $ (69.9) $ 31.6 For the Three-Month Period Ended March 31, 2023 Home Hospice Personal High Acuity Care Other (2) Total Net service revenue $ 343.3 $ 193.4 $ 15.0 $ 4.7 $ — $ 556.4 Cost of service, inclusive of depreciation 197.0 101.4 11.1 5.5 — 315.0 General and administrative expenses 89.1 47.9 2.3 4.4 50.9 194.6 Depreciation and amortization 1.1 0.6 — 0.8 1.9 4.4 Operating expenses 287.2 149.9 13.4 10.7 52.8 514.0 Operating income (loss) $ 56.1 $ 43.5 $ 1.6 $ (6.0) $ (52.8) $ 42.4 (1) We divested our personal care business on March 31, 2023. (2) General and administrative expenses for our corporate support function includes $20.7 million and $0.7 million in merger-related expenses for the three-month periods ended March 31, 2024 and 2023, respectively. |
RELATED PARTY TRANSACTIONS RELA
RELATED PARTY TRANSACTIONS RELATED PARTY TRANSACTIONS | 3 Months Ended |
Mar. 31, 2024 | |
Related Party Transactions [Abstract] | |
RELATED PARTY TRANSACTIONS | RELATED PARTY TRANSACTIONS We have an investment in Medalogix, a healthcare predictive data and analytics company, which is accounted for under the equity method. We incurred costs of approximately $2.9 million and $2.4 million during the three-month periods ended March 31, 2024 and 2023, respectively, in connection with our usage of Medalogix's analytics platforms. We have an investment in a home health benefit manager, which is accounted for under the cost method. We incurred costs of approximately $0.3 million and $0.1 million during the three-month periods ended March 31, 2024 and 2023, respectively, in connection with our usage of the home health benefit manager's services. |
Pay vs Performance Disclosure
Pay vs Performance Disclosure - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Pay vs Performance Disclosure | ||
Net Income (Loss) | $ 14,400 | $ 25,246 |
Insider Trading Arrangements
Insider Trading Arrangements | 3 Months Ended |
Mar. 31, 2024 | |
Trading Arrangements, by Individual | |
Rule 10b5-1 Arrangement Adopted | false |
Non-Rule 10b5-1 Arrangement Adopted | false |
Rule 10b5-1 Arrangement Terminated | false |
Non-Rule 10b5-1 Arrangement Terminated | false |
SUMMARY OF SIGNIFICANT ACCOUN_2
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Policies) | 3 Months Ended |
Mar. 31, 2024 | |
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. |
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. |
Reclassification | Reclassification Certain reclassifications have been made to the prior period's financial statements in order to conform to the current year presentation. In the prior year, the Company combined merger-related expenses with other general and administrative expenses within the condensed consolidated income statement. Merger-related expenses are reflected as a separate line item in the current year. This reclassification had no effect on our previously reported net income. |
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 condensed consolidated financial statements from their respective dates of acquisition. In addition to our wholly owned subsidiaries, we also have certain equity investments that we either consolidate, account for under the equity method of accounting or account for under the cost method of accounting. See Note 3 - Investments for additional information. |
Revenue Recognition | Revenue Recognition We account for service revenue from contracts with customers in accordance with Accounting Standards Codification ("ASC") 606, Revenue from Contracts with Customers , and as such, we recognize service 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. Our 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. Our performance obligations relate to contracts with a duration of less than one year; therefore, we have elected to apply the optional exemption provided by ASC 606 and are 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 audits and 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 industry 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. We assess our ability to collect for the healthcare services provided at the time of patient admission based on our verification of the patient's insurance coverage under Medicare, Medicaid, and other commercial or managed care insurance programs. 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 audits and 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 collection experience. Net service revenue by payor class as a percentage of total net service revenue for each of our operating segments as described in Note 8 - Segment Information is as follows: For the Three-Month Periods Ended March 31, 2024 2023 Home Health: Medicare 38 % 39 % Non-Medicare - Episodic-based 8 % 7 % Non-Medicare - Non-episodic based 18 % 15 % Hospice: Medicare 33 % 33 % Non-Medicare 2 % 2 % Personal Care (1) — % 3 % High Acuity Care 1 % 1 % 100 % 100 % (1) We divested our personal care business on March 31, 2023. Home Health Revenue Recognition Medicare Revenue 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, we account 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. Each 60-day episode includes two 30-day periods of care. Net service revenue is recorded based on the established Federal Medicare home health payment rate for a 30-day period 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 period of care. 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. The Patient-Driven Groupings Model ("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; (c) a partial payment if a patient is transferred to another provider or from another provider before completing the 30-day period of care; and (d) the applicable geographic wage index. Payments for routine and non-routine supplies are 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 collection 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 to revenue with 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 audits and 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 his/her 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. The notice of admission ("NOA") process implemented by the Centers for Medicare and Medicaid Services ("CMS") requires a one-time submission for each patient that establishes the home health period of care and covers all contiguous 30-day periods of care until the patient is discharged from home health services. If the NOA is not submitted timely, a payment reduction is applied equal to 1/30 of the 30-day payment rate for each day from the start of care date until the date the NOA is submitted. Non-Medicare Revenue Payments from non-Medicare payors are either a percentage of Medicare rates, per-visit rates or case rates depending upon the terms and conditions established with such payors. Approximately 30% of our managed care contract volume affords us the opportunity to receive additional payments if we achieve certain quality or process metrics as defined in each contract (e.g. star ratings and acute-care hospitalization rates). We record revenue associated with these metrics at the time the amounts are probable and estimable. 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, the majority of which range from 90% to 100% of Medicare rates. Non-episodic based Revenue. For our per visit contracts, 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. For our case rate contracts, gross revenue is recorded over our historical average length of stay using the established case rate for each admission. 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 our 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. Under our case rate contracts, we may receive reimbursement before all services are rendered. Any cash received that exceeds the associated revenue earned is recorded to deferred revenue in accrued expenses within our condensed consolidated balance sheets. 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 97% of our total Medicare hospice service revenue for the three-month periods ended March 31, 2024 and 2023. 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 or medical social worker 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 collection experience, which primarily includes a historical collection rate of over 99% on Medicare claims, and record it during the period services are rendered. 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 audits and payment reviews based on our historical experience and success rates in the claim appeals and adjudication process. 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 sheets. Providers are required to self-report and pay their estimated cap liability by February 28 th of the following year. As of March 31, 2024 and December 31, 2023, we had recorded $2.3 million for estimated amounts due back to Medicare in accrued expenses for the Federal cap years ended October 31, 2017 through September 30, 2024. 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 our historical experience to reflect the estimated transaction price. Personal Care Revenue Recognition Personal Care Revenue For the periods prior to the divestiture of our personal care line of business on March 31, 2023, we generated net service revenue by providing our services directly to patients based on authorized hours, visits or units determined by the relevant agency, at a rate that was either contractual or fixed by legislation. Net service revenue was recognized at the time services were rendered based on gross charges for the services provided, reduced by estimates for contractual and non-contractual revenue adjustments. We received payment for providing such services from payors, including state and local governmental agencies, managed care organizations, commercial insurers and private consumers. Payors included 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"). High Acuity Care Revenue Recognition High Acuity Care Revenue Our revenues are primarily derived from contracts with (1) health insurance plans for the coordination and provision of home recovery care services to clinically-eligible patients who are enrolled members in those insurance plans and (2) health system partners for the coordination and provision of home recovery care services to clinically-eligible patients who are discharged early from a health system facility to complete their inpatient stay at home. Under our health insurance plan contracts, we provide home recovery care services, which include hospital-equivalent ("H H") and skilled nursing facility ("SNF") equivalent services ("SNF H"), for high acuity care patients on a full risk basis whereby we assume the financial risk for the coordination and payment of all hospital or SNF replacement medical services necessary to treat the medical condition for which the patient was diagnosed in a home-based setting for a 30-day (H H) or 60-day (SNF H) episode of care in exchange for a fixed contracted bundled rate. For H H programs, the fixed rate is based on the assigned diagnosis related group ("DRG") and the 30-day post-discharge related spend. For SNF H programs, the fixed rate is based on the 60-day post-discharge related spend. Our performance obligation is the coordination and provision of patient care in accordance with physicians’ orders over either a 30-day or 60-day episode of care. The majority of our care coordination services and direct patient care is provided in the first five seven Under our contracts with health system partners, we provide home recovery care services for high acuity patients on a limited risk basis whereby we assume the risk for certain healthcare services during the remainder of an inpatient acute stay serviced at the patient’s home (completing H H - "CH H") in exchange for a contracted per diem rate. The performance obligation is the coordination and provision of required medical services, as determined by the treating physician, for each day the patient receives inpatient-equivalent care at home. As such, net service revenue is recognized as services are administered and as our performance obligations are satisfied on a per diem basis, reduced by estimates for revenue adjustments. We recognize adjustments to revenue during the period in which changes to estimates of assigned patient diagnoses or episode terminations become known, in accordance with the applicable managed care contracts. For certain health insurance plans, revenue is reduced by amounts owed by enrollees to healthcare providers under deductible, coinsurance or copay provisions of health insurance plan policies, since those amounts are repaid to the health insurance plans by us as part of a retrospective reconciliation process. |
Cash, Cash Equivalents and Restricted Cash | Cash, Cash Equivalents and Restricted Cash Cash and cash equivalents include money market funds, certificates of deposit and all highly liquid debt instruments with maturities of three months or less when purchased. The Company maintains cash with commercial banks, which are insured by the Federal Deposit Insurance Corporation (“FDIC”). At various times, the Company has deposits in these financial institutions in excess of the amount insured by the FDIC. The Company has not experienced any losses related to these balances and believes its credit risk to be minimal. The carrying amounts of our cash and cash equivalents approximate their fair values, which are primarily based on Level 1 inputs. Restricted cash includes cash that is not available for ordinary business use. As of March 31, 2024 and December 31, 2023, we had $12.5 million and $12.4 million, respectively, classified as restricted cash related to funds placed into escrow accounts in connection with the indemnity, closing payment and other provisions within the purchase agreements of our Evolution Health LLC acquisition and our personal care line of business divestiture. The following table summarizes the balances related to our cash, cash equivalents and restricted cash (amounts in millions): As of March 31, 2024 As of December 31, 2023 Cash and cash equivalents $ 108.2 $ 126.5 Restricted cash 12.5 12.4 Cash, cash equivalents and restricted cash $ 120.7 $ 138.9 |
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. Our non-Medicare third-party payor base is comprised of a diverse group of payors that are geographically dispersed across the country. As of March 31, 2024, there is one single payor, other than Medicare, that accounts for more than 10% of our total outstanding patient receivables (approximately 13%). 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 collectability risk associated with our Medicare accounts, which represented 55% and 69% of our patient accounts receivable at March 31, 2024 and December 31, 2023, 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. The Company uses Change Healthcare, a subsidiary of UnitedHealth Group, to submit patient claims to Medicare and all other payors for reimbursement. On February 22, 2024, UnitedHealth Group announced that on February 21, 2024, Change Healthcare’s information technology systems were impacted by a cybersecurity incident. The Change Healthcare cybersecurity incident did not impact our day-to-day operations; however, we were delayed in submitting patient claims to certain non-Medicare payors. There was minimal impact to our Medicare claim submissions as we were able to quickly redirect our Medicare claims to an alternative clearinghouse. As of the date of this filing, we are substantially caught up with our non-Medicare claim submissions; however, the delays in submitting non-Medicare claims resulted in a reduction of our operating cash flow and an estimated increase to our accounts receivable of approximately $60 million during the three month-period ended March 31, 2024. 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 bill Medicare following the end of each 30-day period of care or upon discharge, if earlier, for the services provided to the patient. 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 High Acuity 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. |
Business Combinations | Business Combinations We account for acquisitions using the acquisition method of accounting in accordance with ASC 805, Business Combinations . Acquisitions are accounted for as purchases and are included in our condensed consolidated financial statements from their respective acquisition dates. Assets acquired, liabilities assumed and noncontrolling interests, if any, are measured at fair value on the acquisition date using the appropriate valuation method. Goodwill generated from acquisitions is recognized for the excess of the purchase price over tangible and identifiable intangible assets. In determining the fair value of identifiable intangible assets and any noncontrolling interests, we use various valuation techniques including the income approach, the cost approach and the market approach. These valuation methods require us to make estimates and assumptions surrounding projected revenues and costs, growth rates and discount rates. |
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 March 31, 2024 Quoted Prices in Active Significant Other Significant $450 million Term Loan $ 366.3 $ — $ 361.6 $ — 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 Outstanding |
SUMMARY OF SIGNIFICANT ACCOUN_3
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
Accounting Policies [Abstract] | |
Schedule Of Revenue Sources Health Care Organization Table Text Block | Net service revenue by payor class as a percentage of total net service revenue for each of our operating segments as described in Note 8 - Segment Information is as follows: For the Three-Month Periods Ended March 31, 2024 2023 Home Health: Medicare 38 % 39 % Non-Medicare - Episodic-based 8 % 7 % Non-Medicare - Non-episodic based 18 % 15 % Hospice: Medicare 33 % 33 % Non-Medicare 2 % 2 % Personal Care (1) — % 3 % High Acuity Care 1 % 1 % 100 % 100 % (1) We divested our personal care business on March 31, 2023. |
Schedule of Cash Cash Equivalents and Restricted Cash | The following table summarizes the balances related to our cash, cash equivalents and restricted cash (amounts in millions): As of March 31, 2024 As of December 31, 2023 Cash and cash equivalents $ 108.2 $ 126.5 Restricted cash 12.5 12.4 Cash, cash equivalents and restricted cash $ 120.7 $ 138.9 |
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 March 31, 2024 Quoted Prices in Active Significant Other Significant $450 million Term Loan $ 366.3 $ — $ 361.6 $ — |
Schedule of Weighted-Average Shares Outstanding | The following table sets forth, for the periods indicated, shares used in our computation of 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-Month Periods 2024 2023 Weighted average number of shares outstanding - basic 32,670 32,558 Effect of dilutive securities: Stock options 10 13 Non-vested stock and stock units 299 72 Weighted average number of shares outstanding - diluted 32,979 32,643 Anti-dilutive securities 388 323 |
INVESTMENTS (Tables)
INVESTMENTS (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
Equity Method Investments and Joint Ventures [Abstract] | |
Schedule of Variable Interest Entities | The terms of the agreements with each VIE prohibit us from using the assets of the VIE to satisfy the obligations of other entities. The carrying amount of the VIEs’ assets and liabilities included in our condensed consolidated balance sheets are as follows (amounts in millions): As of March 31, 2024 As of December 31, 2023 ASSETS Current assets: Cash and cash equivalents $ 9.1 $ 8.8 Patient accounts receivable 7.8 9.0 Other current assets — 0.1 Total current assets 16.9 17.9 Property and equipment — 0.1 Operating lease right of use assets — 0.1 Goodwill 8.5 8.5 Intangible assets 0.4 0.4 Other assets 0.4 0.3 Total assets $ 26.2 $ 27.3 LIABILITIES Current liabilities: Accounts payable $ 0.5 $ 0.5 Payroll and employee benefits 0.9 0.9 Accrued expenses 8.2 7.9 Total liabilities $ 9.6 $ 9.3 |
LONG-TERM OBLIGATIONS LONG-TERM
LONG-TERM OBLIGATIONS LONG-TERM OBLIGATIONS (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
Debt Disclosure [Abstract] | |
Schedule of Long-Term Debt | Long-term debt consists of the following for the periods indicated (amounts in millions): March 31, 2024 December 31, 2023 $450.0 million Term Loan; interest rate at Base Rate plus Applicable Rate or Term SOFR plus Applicable Rate ( 7.2 $ 366.3 $ 371.9 $550.0 million Revolving Credit Facility; interest only payments; interest rate at Base Rate plus Applicable Rate or Term SOFR plus Applicable Rate; due July 30, 2026 — — Finance leases 29.3 28.9 Principal amount of long-term obligations 395.6 400.8 Deferred debt issuance costs (2.3) (2.6) 393.3 398.2 Current portion of long-term obligations (37.2) (36.3) Long-term obligations, less current portion $ 356.1 $ 361.9 |
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 Third Amended Credit Agreement, as presented in the table below. Pricing Tier Consolidated Leverage Ratio Base Rate Loans Term SOFR Loans and SOFR Daily Floating Rate Loans Commitment Fee Letter of Credit Fee I > 3.00 to 1.0 1.00% 2.00% 0.30% 1.75% II < 3.00 to 1.0 but > 2.00 to 1.0 0.75% 1.75% 0.25% 1.50% III < 2.00 to 1.0 but > 0.75 to 1.0 0.50% 1.50% 0.20% 1.25% IV < 0.75 to 1.0 0.25% 1.25% 0.15% 1.00% |
SEGMENT INFORMATION (Tables)
SEGMENT INFORMATION (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
Segment Reporting [Abstract] | |
Schedule of Operating Income of Reportable Segments | 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 March 31, 2024 Home Hospice Personal Care (1) High Acuity Care Other (2) Total Net service revenue $ 364.0 $ 201.0 $ — $ 6.4 $ — $ 571.4 Cost of service, inclusive of depreciation 210.4 105.3 — 5.8 — 321.5 General and administrative expenses 91.0 48.1 — 5.9 69.0 214.0 Depreciation and amortization 1.8 0.7 — 0.9 0.9 4.3 Operating expenses 303.2 154.1 — 12.6 69.9 539.8 Operating income (loss) $ 60.8 $ 46.9 $ — $ (6.2) $ (69.9) $ 31.6 For the Three-Month Period Ended March 31, 2023 Home Hospice Personal High Acuity Care Other (2) Total Net service revenue $ 343.3 $ 193.4 $ 15.0 $ 4.7 $ — $ 556.4 Cost of service, inclusive of depreciation 197.0 101.4 11.1 5.5 — 315.0 General and administrative expenses 89.1 47.9 2.3 4.4 50.9 194.6 Depreciation and amortization 1.1 0.6 — 0.8 1.9 4.4 Operating expenses 287.2 149.9 13.4 10.7 52.8 514.0 Operating income (loss) $ 56.1 $ 43.5 $ 1.6 $ (6.0) $ (52.8) $ 42.4 (1) We divested our personal care business on March 31, 2023. (2) General and administrative expenses for our corporate support function includes $20.7 million and $0.7 million in merger-related expenses for the three-month periods ended March 31, 2024 and 2023, respectively. |
NATURE OF OPERATIONS, CONSOLI_2
NATURE OF OPERATIONS, CONSOLIDATION AND PRESENTATION OF FINANCIAL STATEMENTS - Narrative (Details) | 3 Months Ended | |
Mar. 31, 2024 state care_center numberOfJointVentures | Mar. 31, 2023 | |
Organization, Consolidation and Presentation of Financial Statements [Line Items] | ||
Number of states with facilities | state | 37 | |
Home Health [Member] | ||
Organization, Consolidation and Presentation of Financial Statements [Line Items] | ||
Number of owned and operated care centers | 346 | |
Hospice [Member] | ||
Organization, Consolidation and Presentation of Financial Statements [Line Items] | ||
Number of owned and operated care centers | 165 | |
High Acuity Care | ||
Organization, Consolidation and Presentation of Financial Statements [Line Items] | ||
Number of Joint Ventures | numberOfJointVentures | 9 | |
Revenue from Contract with Customer [Member] | Product Concentration Risk | Medicare Revenue [Member] | ||
Organization, Consolidation and Presentation of Financial Statements [Line Items] | ||
Percent of net services revenue | 71% | 72% |
SUMMARY OF SIGNIFICANT ACCOUN_4
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Revenue Recognition Narrative (Details) $ in Millions | 3 Months Ended | ||
Mar. 31, 2024 USD ($) visit | Mar. 31, 2023 | Dec. 31, 2023 USD ($) | |
Revenue Recognition, Multiple-deliverable Arrangements [Line Items] | |||
Net service revenue period of care payment rate (days) | 30 days | ||
Percentage of total reimbursement of outlier payment | 10% | ||
Historical collection rate from Medicare | 99% | ||
Hospice Medicare revenue rate accounted for routine care | 97% | 97% | |
Net service revenue episode payment rate | 60 days | ||
Home Health [Member] | |||
Revenue Recognition, Multiple-deliverable Arrangements [Line Items] | |||
Historical collection rate from Medicare | 99% | ||
Percentage Managed Care Contract Volume Able To Receive Additional Payments | 30% | ||
Home Health [Member] | Minimum [Member] | |||
Revenue Recognition, Multiple-deliverable Arrangements [Line Items] | |||
Low utilization payment adjustment, maximum number of visits | 2 | ||
Non-Medicare revenue term rates | 90% | ||
Home Health [Member] | Maximum [Member] | |||
Revenue Recognition, Multiple-deliverable Arrangements [Line Items] | |||
Low utilization payment adjustment, maximum number of visits | 6 | ||
Non-Medicare revenue term rates | 100% | ||
Hospice [Member] | |||
Revenue Recognition, Multiple-deliverable Arrangements [Line Items] | |||
Historical collection rate from Medicare | 99% | ||
High Acuity Care | Minimum [Member] | |||
Revenue Recognition, Multiple-deliverable Arrangements [Line Items] | |||
Net service revenue episode payment rate | 30 days | ||
Acute Phase for High Acuity Care Services | 5 days | ||
High Acuity Care | Maximum [Member] | |||
Revenue Recognition, Multiple-deliverable Arrangements [Line Items] | |||
Net service revenue episode payment rate | 60 days | ||
Acute Phase for High Acuity Care Services | 7 days | ||
Cap Year 2017 Through 2024 | |||
Revenue Recognition, Multiple-deliverable Arrangements [Line Items] | |||
Estimated amounts due back to Medicare | $ | $ 2.3 | $ 2.3 |
SUMMARY OF SIGNIFICANT ACCOUN_5
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Revenue by Payor Class (Details) | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Revenue Recognition, Multiple-deliverable Arrangements [Line Items] | ||
Revenue by payor class as a percentage of total net service revenue | 100% | 100% |
Home Health Medicare [Member] | ||
Revenue Recognition, Multiple-deliverable Arrangements [Line Items] | ||
Revenue by payor class as a percentage of total net service revenue | 38% | 39% |
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 | 8% | 7% |
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 | 18% | 15% |
Hospice Medicare [Member] | ||
Revenue Recognition, Multiple-deliverable Arrangements [Line Items] | ||
Revenue by payor class as a percentage of total net service revenue | 33% | 33% |
Hospice Non-Medicare [Member] | ||
Revenue Recognition, Multiple-deliverable Arrangements [Line Items] | ||
Revenue by payor class as a percentage of total net service revenue | 2% | 2% |
Personal Care [Member] | ||
Revenue Recognition, Multiple-deliverable Arrangements [Line Items] | ||
Revenue by payor class as a percentage of total net service revenue | 0% | 3% |
High Acuity Care | ||
Revenue Recognition, Multiple-deliverable Arrangements [Line Items] | ||
Revenue by payor class as a percentage of total net service revenue | 1% | 1% |
SUMMARY OF SIGNIFICANT ACCOUN_6
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Cash and Cash Equivalents (Details) - USD ($) $ in Thousands | Mar. 31, 2024 | Dec. 31, 2023 | Mar. 31, 2023 | Dec. 31, 2022 |
Restricted Cash and Cash Equivalents Items [Line Items] | ||||
Cash and cash equivalents | $ 108,234 | $ 126,450 | ||
Restricted cash | 12,470 | 12,413 | ||
Cash, Cash Equivalents and Restricted Cash | 120,704 | 138,863 | $ 69,100 | $ 54,133 |
Various acquisitions and divestiture [Member] | ||||
Restricted Cash and Cash Equivalents Items [Line Items] | ||||
Restricted cash | $ 12,500 | $ 12,400 |
SUMMARY OF SIGNIFICANT ACCOUN_7
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Patient Accounts Receivable Narrative (Details) - USD ($) $ in Millions | 3 Months Ended | |
Mar. 31, 2024 | Dec. 31, 2023 | |
Concentration Risk [Line Items] | ||
Accounts receivable derived from Medicare | 55% | 69% |
Net service revenue period of care payment rate (days) | 30 days | |
Percentage of patient receivables outstanding | 10% | |
Historical collection rate from Medicare | 99% | |
Change Healthcare | ||
Concentration Risk [Line Items] | ||
Increase (Decrease) in Accounts and Other Receivables | $ 60 | |
Payor Concentration Risk | Accounts Receivable | Single Payor | ||
Concentration Risk [Line Items] | ||
Concentration risk (percent) | 13% |
SUMMARY OF SIGNIFICANT ACCOUN_8
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Fair Value of Financial Instruments (Details) | Mar. 31, 2024 USD ($) |
Four Hundred Fifty Million Term Loan Facility | Term Loan [Member] | |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | |
Principal amount | $ 366,300,000 |
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 | 361,600,000 |
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 ACCOUN_9
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Weighted-Average Shares Outstanding (Details) - shares shares in Thousands | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Accounting Policies [Abstract] | ||
Weighted average number of shares outstanding - basic (shares) | 32,670 | 32,558 |
Effect of dilutive securities: | ||
Stock options (shares) | 10 | 13 |
Non-vested stock and stock units (shares) | 299 | 72 |
Weighted average number of shares outstanding - diluted (shares) | 32,979 | 32,643 |
Anti-dilutive securities (shares) | 388 | 323 |
INVESTMENTS (Details)
INVESTMENTS (Details) - USD ($) $ in Thousands | Mar. 31, 2024 | Dec. 31, 2023 |
Variable Interest Entity [Line Items] | ||
Minimum ownership percentage for controlling interest (percent) | 50% | |
Maximum ownership percentage for equity method investment (percent) | 50% | |
Equity method investment, aggregate cost | $ 47,000 | $ 46,100 |
Maximum ownership percentage for cost method investment (percent) | 20% | |
Investment Owned, at Cost | $ 20,000 | 20,000 |
Cash and cash equivalents | 108,234 | 126,450 |
Patient accounts receivable | 359,359 | 313,373 |
Other current assets | 26,053 | 30,060 |
Total current assets | 526,448 | 496,935 |
Property and equipment | 42,684 | 41,845 |
Operating lease right of use assets | 88,425 | 88,939 |
Goodwill | 1,244,679 | 1,244,679 |
Intangible assets | 101,778 | 102,675 |
Other assets | 85,857 | 85,097 |
Total assets | 2,089,871 | 2,060,170 |
Accounts payable | 36,249 | 28,237 |
Payroll and employee benefits | 131,631 | 136,835 |
Accrued expenses | 147,464 | 140,049 |
Operating lease liabilities | 26,284 | 26,286 |
Total liabilities | 947,217 | 940,387 |
Variable Interest Entity, Primary Beneficiary | ||
Variable Interest Entity [Line Items] | ||
Cash and cash equivalents | 9,100 | 8,800 |
Patient accounts receivable | 7,800 | 9,000 |
Other current assets | 0 | 100 |
Total current assets | 16,900 | 17,900 |
Property and equipment | 0 | 100 |
Operating lease right of use assets | 0 | 100 |
Goodwill | 8,500 | 8,500 |
Intangible assets | 400 | 400 |
Other assets | 400 | 300 |
Total assets | 26,200 | 27,300 |
Accounts payable | 500 | 500 |
Payroll and employee benefits | 900 | 900 |
Accrued expenses | 8,200 | 7,900 |
Total liabilities | $ 9,600 | $ 9,300 |
MERGERS AND ACQUISITIONS - Narr
MERGERS AND ACQUISITIONS - Narrative (Details) - USD ($) | 3 Months Ended | ||
Jun. 26, 2023 | Mar. 31, 2024 | Dec. 31, 2023 | |
Business Acquisition [Line Items] | |||
Termination fee paid by UnitedHealth Group | $ 106,000,000 | $ 106,000,000 | |
Restricted cash | 12,470,000 | 12,413,000 | |
Option Care Health | |||
Business Acquisition [Line Items] | |||
Business Acquisition, Termination Fee | $ 106,000,000 | ||
UnitedHealth Group | |||
Business Acquisition [Line Items] | |||
Business Acquisition, Termination Fee | $ 125,000,000 | ||
UnitedHealth Group | |||
Business Acquisition [Line Items] | |||
Business Acquisition, Share Exchange Ratio | $ 101 |
Discontinued Operations and Dis
Discontinued Operations and Disposal Groups (Details) - USD ($) $ in Thousands | 3 Months Ended | 12 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | Dec. 31, 2023 | |
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] | |||
Restricted cash | $ 12,470 | $ 12,413 | |
Proceeds from personal care divestiture | 0 | $ 47,787 | |
Loss on personal care divestiture | $ 0 | (2,186) | |
Closing Payment Adjustment Paid By Buyer | 100 | ||
Personal Care [Member] | |||
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] | |||
Restricted cash | 6,000 | ||
Proceeds from personal care divestiture | 47,800 | ||
Loss on personal care divestiture | $ 2,200 | ||
Disposition, Closing Payment Adjustment | 1,000 | ||
Escrow Amount for Potential Losses | 5,000 | ||
Goodwill, Period Decrease | 43,100 | ||
Amount Released From Escrow | $ 1,000 |
LONG-TERM OBLIGATIONS - Schedul
LONG-TERM OBLIGATIONS - Schedule of Long-Term Debt (Details) - USD ($) $ in Millions | Mar. 31, 2024 | Dec. 31, 2023 |
Debt Instrument [Line Items] | ||
Principal amount | $ 395.6 | $ 400.8 |
Deferred debt issuance costs | (2.3) | (2.6) |
Long-term obligations, including current portion | 393.3 | 398.2 |
Current portion of long-term obligations | (37.2) | (36.3) |
Long-term obligations, less current portion | 356.1 | 361.9 |
Term Loan [Member] | Four Hundred Fifty Million Term Loan Facility | ||
Debt Instrument [Line Items] | ||
Principal amount | 366.3 | 371.9 |
Revolving Credit Facility [Member] | Five Hundred Fifty Million Revolving Credit Facility [Member] | ||
Debt Instrument [Line Items] | ||
Principal amount | 0 | 0 |
Finance leases [Member] | ||
Debt Instrument [Line Items] | ||
Principal amount | $ 29.3 | $ 28.9 |
LONG-TERM OBLIGATIONS - Sched_2
LONG-TERM OBLIGATIONS - Schedule of Long-Term Debt Additional Information (Details) - USD ($) $ in Millions | 3 Months Ended | |
Mar. 31, 2024 | Dec. 31, 2023 | |
Debt Instrument [Line Items] | ||
Principal amount | $ 395.6 | $ 400.8 |
Term Loan [Member] | Four Hundred Fifty Million Term Loan Facility | ||
Debt Instrument [Line Items] | ||
Debt instrument, face amount | $ 450 | |
Debt Instrument Interest Rate at Period End | Term SOFR [Member] | |
Maturity Date | Jul. 30, 2026 | |
Principal amount | $ 366.3 | 371.9 |
Revolving Credit Facility [Member] | Five Hundred Fifty Million Revolving Credit Facility [Member] | ||
Debt Instrument [Line Items] | ||
Debt instrument, face amount | $ 550 | |
Maturity Date | Jul. 30, 2026 | |
Principal amount | $ 0 | $ 0 |
LONG-TERM OBLIGATIONS - Fees an
LONG-TERM OBLIGATIONS - Fees and Rates Under Credit Facilities (Details) | 3 Months Ended |
Mar. 31, 2024 | |
Consolidated Leverage Ratio: Greater Than 3.00 to 1.0 | |
Line of Credit Facility [Line Items] | |
Commitment fee percentage | 0.30% |
Letter Of Credit Fee | 1.75% |
Consolidated Leverage Ratio: Greater Than 3.00 to 1.0 | Term SOFR [Member] | |
Line of Credit Facility [Line Items] | |
Basis spread on variable rate | 2% |
Consolidated Leverage Ratio: Greater Than 3.00 to 1.0 | Base Rate [Member] | |
Line of Credit Facility [Line Items] | |
Basis spread on variable rate | 1% |
Consolidated Leverage Ratio: Less Than Equal To 3.00 to 1.0 but Greater Than 2.00 to 1.0 | |
Line of Credit Facility [Line Items] | |
Commitment fee percentage | 0.25% |
Letter Of Credit Fee | 1.50% |
Consolidated Leverage Ratio: Less Than Equal To 3.00 to 1.0 but Greater Than 2.00 to 1.0 | Term SOFR [Member] | |
Line of Credit Facility [Line Items] | |
Basis spread on variable rate | 1.75% |
Consolidated Leverage Ratio: Less Than Equal To 3.00 to 1.0 but Greater Than 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 Equal To 2.00 to 1.0 but Greater Than 0.75 to 1.0 | |
Line of Credit Facility [Line Items] | |
Commitment fee percentage | 0.20% |
Letter Of Credit Fee | 1.25% |
Consolidated Leverage Ratio: Less Than Equal To 2.00 to 1.0 but Greater Than 0.75 to 1.0 | Term SOFR [Member] | |
Line of Credit Facility [Line Items] | |
Basis spread on variable rate | 1.50% |
Consolidated Leverage Ratio: Less Than Equal To 2.00 to 1.0 but Greater Than 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 Equal To 0.75 to 1.0 | |
Line of Credit Facility [Line Items] | |
Commitment fee percentage | 0.15% |
Letter Of Credit Fee | 1% |
Consolidated Leverage Ratio: Less Than Equal To 0.75 to 1.0 | Term SOFR [Member] | |
Line of Credit Facility [Line Items] | |
Basis spread on variable rate | 1.25% |
Consolidated Leverage Ratio: Less Than Equal To 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 3.00 to 1.0 | |
Line of Credit Facility [Line Items] | |
Consolidated Leverage Ratio | 3 |
Minimum [Member] | Consolidated Leverage Ratio: Less Than Equal To 3.00 to 1.0 but Greater Than 2.00 to 1.0 | |
Line of Credit Facility [Line Items] | |
Consolidated Leverage Ratio | 2 |
Minimum [Member] | Consolidated Leverage Ratio: Less Than Equal To 2.00 to 1.0 but Greater Than 0.75 to 1.0 | |
Line of Credit Facility [Line Items] | |
Consolidated Leverage Ratio | 0.75 |
Maximum [Member] | Consolidated Leverage Ratio: Less Than Equal To 3.00 to 1.0 but Greater Than 2.00 to 1.0 | |
Line of Credit Facility [Line Items] | |
Consolidated Leverage Ratio | 3 |
Maximum [Member] | Consolidated Leverage Ratio: Less Than Equal To 2.00 to 1.0 but Greater Than 0.75 to 1.0 | |
Line of Credit Facility [Line Items] | |
Consolidated Leverage Ratio | 2 |
Maximum [Member] | Consolidated Leverage Ratio: Less Than Equal To 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 ($) $ in Millions | 3 Months Ended | 26 Months Ended | 34 Months Ended | 60 Months Ended | ||||
Mar. 10, 2023 | Mar. 31, 2024 | Mar. 31, 2023 | Sep. 30, 2023 | Jul. 30, 2026 | Jul. 30, 2026 | Dec. 31, 2023 | Jul. 30, 2021 | |
Debt Instrument [Line Items] | ||||||||
Principal amount | $ 395.6 | $ 400.8 | ||||||
Term Loan [Member] | Four Hundred Fifty Million Term Loan Facility | ||||||||
Debt Instrument [Line Items] | ||||||||
Debt instrument, face amount | $ 450 | |||||||
Weighted average interest rate (percent) | 7.30% | 6.10% | ||||||
Maturity Date | Jul. 30, 2026 | |||||||
Principal amount | $ 366.3 | 371.9 | ||||||
Revolving Credit Facility [Member] | Five Hundred Fifty Million Revolving Credit Facility [Member] | ||||||||
Debt Instrument [Line Items] | ||||||||
Debt instrument, face amount | $ 550 | |||||||
Maturity Date | Jul. 30, 2026 | |||||||
Remaining availability under revolving credit facility | $ 514.2 | |||||||
Principal amount | 0 | 0 | ||||||
Line of Credit [Member] | Five Hundred Fifty Million Revolving Credit Facility [Member] | ||||||||
Debt Instrument [Line Items] | ||||||||
Outstanding letters of credit | 35.8 | |||||||
Third Amended Credit Agreement | ||||||||
Debt Instrument [Line Items] | ||||||||
Additional interest rate above Federal Fund rate | 0.50% | |||||||
Additional interest rate above Term SOFR | 1% | |||||||
Percentage of consolidated revenue and adjusted EBITDA that guarantor wholly-owned subsidiaries represent | 95% | |||||||
Percentage of adjusted EBITDA that guarantor subsidiaries represent | 70% | |||||||
SOFR Adjustment | 0.10% | |||||||
Third Amended Credit Agreement | Four Hundred Fifty Million Term Loan Facility | ||||||||
Debt Instrument [Line Items] | ||||||||
Debt Instrument Periodic Payment Percentage | 0.625% | |||||||
Finance leases [Member] | ||||||||
Debt Instrument [Line Items] | ||||||||
Principal amount | $ 29.3 | $ 28.9 | ||||||
Second Amended Credit Agreement | ||||||||
Debt Instrument [Line Items] | ||||||||
Credit facility, maximum borrowing capacity | $ 1,000 | |||||||
Second Amended Credit Agreement | Five Hundred Fifty Million Revolving Credit Facility [Member] | ||||||||
Debt Instrument [Line Items] | ||||||||
Debt instrument, face amount | 550 | |||||||
Second Amended Credit Agreement | Four Hundred Fifty Million Term Loan Facility | ||||||||
Debt Instrument [Line Items] | ||||||||
Debt instrument, face amount | $ 450 | |||||||
Base Rate [Member] | Third Amended Credit Agreement | ||||||||
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 Term SOFR for an interest period of one month plus 1% per annum. | |||||||
Base Rate [Member] | Third Amended Credit Agreement | ||||||||
Debt Instrument [Line Items] | ||||||||
Basis spread on variable rate | 0.75% | |||||||
Term SOFR [Member] | Third Amended Credit Agreement | ||||||||
Debt Instrument [Line Items] | ||||||||
Description of variable rate basis | Quoted rate per annum equal to the SOFR for an interest period of one or three months (as selected by us) plus the SOFR adjustment of 0.10% | |||||||
Term SOFR [Member] | Third Amended Credit Agreement | ||||||||
Debt Instrument [Line Items] | ||||||||
Basis spread on variable rate | 1.75% | |||||||
Minimum [Member] | Third Amended Credit Agreement | ||||||||
Debt Instrument [Line Items] | ||||||||
Proceeds Received From Loan Party Of Subsidiary | $ 5 | |||||||
Minimum [Member] | Finance leases [Member] | ||||||||
Debt Instrument [Line Items] | ||||||||
Debt Instrument, Interest Rate, Stated Percentage | 3.10% | |||||||
Maximum [Member] | Finance leases [Member] | ||||||||
Debt Instrument [Line Items] | ||||||||
Debt Instrument, Interest Rate, Stated Percentage | 8.10% | |||||||
Subsequent Event | Third Amended Credit Agreement | ||||||||
Debt Instrument [Line Items] | ||||||||
Maturity Date | Jul. 30, 2026 | |||||||
Subsequent Event | Third Amended Credit Agreement | Four Hundred Fifty Million Term Loan Facility | ||||||||
Debt Instrument [Line Items] | ||||||||
Debt Instrument Periodic Payment Percentage | 1.25% |
Income Taxes (Details)
Income Taxes (Details) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Income Tax Examination [Line Items] | ||
Merger-related expenses | $ 20,667 | $ 720 |
Non-Deductible Expense | $ 17,000 |
COMMITMENTS AND CONTINGENCIES -
COMMITMENTS AND CONTINGENCIES - Narrative (Details) $ in Millions | 1 Months Ended | 3 Months Ended | 12 Months Ended | 27 Months Ended | ||||||
Jan. 18, 2016 USD ($) claim | Jun. 06, 2011 beneficiary | Aug. 31, 2017 USD ($) claim | Mar. 31, 2024 USD ($) | Dec. 31, 2022 USD ($) | Mar. 31, 2010 beneficiary | Dec. 31, 2023 USD ($) | Sep. 30, 2022 USD ($) | Jan. 10, 2019 USD ($) | Dec. 31, 2017 USD ($) | |
Loss Contingencies [Line Items] | ||||||||||
Health insurance retention limit | $ 1.5 | |||||||||
Workers compensation insurance retention limit | 2 | |||||||||
Professional liability insurance retention limit | 0.3 | |||||||||
Fleet Insurance Exposure Limit | 0.5 | |||||||||
South Carolina | Hospice [Member] | ||||||||||
Loss Contingencies [Line Items] | ||||||||||
Number of beneficiaries | beneficiary | 30 | |||||||||
Indemnity receivable | 2.8 | |||||||||
Indemnification amount | $ 2.8 | |||||||||
South Carolina | Hospice [Member] | Extrapolated [Member] | ||||||||||
Loss Contingencies [Line Items] | ||||||||||
Number of beneficiaries | beneficiary | 16 | |||||||||
South Carolina | Hospice [Member] | Unfavorable [Member] | ||||||||||
Loss Contingencies [Line Items] | ||||||||||
Recovery amount of overpayment made to subsidiary | $ 3.7 | |||||||||
Recovery amount of overpayment made to subsidiary including interest | $ 5.6 | |||||||||
Number of claims submitted by subsidiary | claim | 9 | |||||||||
Recovery amount of over payment made to subsidiary including interest withheld | 5.7 | |||||||||
Safeguard Zone Program Integrity Contractor | Florida | ||||||||||
Loss Contingencies [Line Items] | ||||||||||
Loss contingency accrual | $ 25.2 | $ 17.4 | ||||||||
Indemnity receivable | $ 10.9 | $ 10.9 | ||||||||
Accounts Receivable, Allowance for Credit Loss, Writeoff | 1.5 | |||||||||
Safeguard Zone Program Integrity Contractor | Lakeland, Florida | Home Health [Member] | ||||||||||
Loss Contingencies [Line Items] | ||||||||||
Recovery amount of overpayment made to subsidiary | $ 34 | $ 26 | ||||||||
Number of claims submitted by subsidiary | claim | 72 | |||||||||
Actual claims payment | $ 0.2 | |||||||||
Total Legal Settlement Payment | 34.3 | |||||||||
Legal Settlement Payment Less Interest | 22.8 | |||||||||
Litigation Settlement Interest | 11.5 | |||||||||
Safeguard Zone Program Integrity Contractor | Clearwater, Florida | Home Health [Member] | ||||||||||
Loss Contingencies [Line Items] | ||||||||||
Recovery amount of overpayment made to subsidiary | $ 4.8 | $ 3.3 | ||||||||
Number of claims submitted by subsidiary | claim | 70 | |||||||||
Actual claims payment | $ 0.2 | |||||||||
Total Legal Settlement Payment | 3.7 | |||||||||
Legal Settlement Payment Less Interest | 2.4 | |||||||||
Litigation Settlement Interest | $ 1.2 |
SEGMENT INFORMATION - Narrative
SEGMENT INFORMATION - Narrative (Details) $ in Thousands | 3 Months Ended | |
Mar. 31, 2024 USD ($) Segments | Mar. 31, 2023 USD ($) | |
Segment Reporting [Abstract] | ||
Number of reportable business segments | Segments | 3 | |
Merger-related expenses | $ | $ 20,667 | $ 720 |
SEGMENT INFORMATION - Operating
SEGMENT INFORMATION - Operating Income of Reportable Segments (Details) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Segment Reporting Information [Line Items] | ||
Revenues | $ 571,414 | $ 556,389 |
Cost of service, inclusive of depreciation | 321,537 | 315,010 |
General and administrative expenses | 214,000 | 194,600 |
Depreciation and amortization | 4,271 | 4,443 |
Operating expenses | 539,795 | 514,010 |
Operating income (loss) | 31,619 | 42,379 |
Home Health [Member] | ||
Segment Reporting Information [Line Items] | ||
Revenues | 364,000 | 343,300 |
Cost of service, inclusive of depreciation | 210,400 | 197,000 |
General and administrative expenses | 91,000 | 89,100 |
Depreciation and amortization | 1,800 | 1,100 |
Operating expenses | 303,200 | 287,200 |
Operating income (loss) | 60,800 | 56,100 |
Hospice [Member] | ||
Segment Reporting Information [Line Items] | ||
Revenues | 201,000 | 193,400 |
Cost of service, inclusive of depreciation | 105,300 | 101,400 |
General and administrative expenses | 48,100 | 47,900 |
Depreciation and amortization | 700 | 600 |
Operating expenses | 154,100 | 149,900 |
Operating income (loss) | 46,900 | 43,500 |
Personal Care [Member] | ||
Segment Reporting Information [Line Items] | ||
Revenues | 0 | 15,000 |
Cost of service, inclusive of depreciation | 0 | 11,100 |
General and administrative expenses | 0 | 2,300 |
Depreciation and amortization | 0 | 0 |
Operating expenses | 0 | 13,400 |
Operating income (loss) | 0 | 1,600 |
High Acuity Care | ||
Segment Reporting Information [Line Items] | ||
Revenues | 6,400 | 4,700 |
Cost of service, inclusive of depreciation | 5,800 | 5,500 |
General and administrative expenses | 5,900 | 4,400 |
Depreciation and amortization | 900 | 800 |
Operating expenses | 12,600 | 10,700 |
Operating income (loss) | (6,200) | (6,000) |
Other | ||
Segment Reporting Information [Line Items] | ||
Revenues | 0 | 0 |
Cost of service, inclusive of depreciation | 0 | 0 |
General and administrative expenses | 69,000 | 50,900 |
Depreciation and amortization | 900 | 1,900 |
Operating expenses | 69,900 | 52,800 |
Operating income (loss) | $ (69,900) | $ (52,800) |
RELATED PARTY TRANSACTIONS Narr
RELATED PARTY TRANSACTIONS Narrative (Details) - USD ($) $ in Millions | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Medalogix [Member] | ||
Related Party Transaction [Line Items] | ||
Related Party Transaction, Amounts of Transaction | $ 2.9 | $ 2.4 |
Home Health Benefit Manager [Member] | ||
Related Party Transaction [Line Items] | ||
Related Party Transaction, Amounts of Transaction | $ 0.3 | $ 0.1 |