QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 |
TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 |
(State or other jurisdiction of incorporation or organization) | (I.R.S. Employer Identification No.) |
Title of each class | Trading Symbol(s) | Name of each exchange on which registered | ||||||||||||
☒ | Accelerated filer | ☐ | ||||||||||||||||||
Non-accelerated filer | ☐ | Smaller reporting company | ||||||||||||||||||
Emerging growth company |
;;; | ||||||||
PART I. | ||||||||
ITEM 1. | ||||||||
ITEM 2. | ||||||||
ITEM 3 | ||||||||
ITEM 4. | ||||||||
ITEM 1. | ||||||||
ITEM 1A. | ||||||||
ITEM 2. | ||||||||
ITEM 3. | ||||||||
ITEM 4. | ||||||||
ITEM 5. | ||||||||
ITEM 6. | ||||||||
September 30, 2020 (unaudited) | December 31, 2019 | ||||||||||
ASSETS | |||||||||||
Current assets: | |||||||||||
Cash and cash equivalents | $ | $ | |||||||||
Restricted cash | |||||||||||
Patient accounts receivable | |||||||||||
Prepaid expenses | |||||||||||
Other current assets | |||||||||||
Total current assets | |||||||||||
Property and equipment, net of accumulated depreciation of $ | |||||||||||
Operating lease right of use assets | |||||||||||
Goodwill | |||||||||||
Intangible assets, net of accumulated amortization of $ | |||||||||||
Deferred income taxes | |||||||||||
Other assets | |||||||||||
Total assets | $ | $ | |||||||||
LIABILITIES AND EQUITY | |||||||||||
Current liabilities: | |||||||||||
Accounts payable | $ | $ | |||||||||
Payroll and employee benefits | |||||||||||
Accrued expenses | |||||||||||
Provider relief fund advance | |||||||||||
Current portion of long-term obligations | |||||||||||
Current portion of operating lease liabilities | |||||||||||
Total current liabilities | |||||||||||
Long-term obligations, less current portion | |||||||||||
Operating lease liabilities, less current portion | |||||||||||
Other long-term obligations | |||||||||||
Total liabilities | |||||||||||
Commitments and Contingencies—Note 5 | |||||||||||
Equity: | |||||||||||
Preferred stock, $ | |||||||||||
Common stock, $ | |||||||||||
Additional paid-in capital | |||||||||||
Treasury stock, at cost | ( | ( | |||||||||
Accumulated other comprehensive income | |||||||||||
Retained earnings | |||||||||||
Total Amedisys, Inc. stockholders’ equity | |||||||||||
Noncontrolling interests | |||||||||||
Total equity | |||||||||||
Total liabilities and equity | $ | $ |
For the Three-Month Periods Ended September 30, | For the Nine-Month Periods Ended September 30, | ||||||||||||||||||||||
2020 | 2019 | 2020 | 2019 | ||||||||||||||||||||
Net service revenue | $ | $ | $ | $ | |||||||||||||||||||
Other operating income | |||||||||||||||||||||||
Cost of service, excluding depreciation and amortization | |||||||||||||||||||||||
General and administrative expenses: | |||||||||||||||||||||||
Salaries and benefits | |||||||||||||||||||||||
Non-cash compensation | |||||||||||||||||||||||
Other | |||||||||||||||||||||||
Depreciation and amortization | |||||||||||||||||||||||
Operating expenses | |||||||||||||||||||||||
Operating income | |||||||||||||||||||||||
Other income (expense): | |||||||||||||||||||||||
Interest income | |||||||||||||||||||||||
Interest expense | ( | ( | ( | ( | |||||||||||||||||||
Equity in earnings from equity method investments | ( | ||||||||||||||||||||||
Miscellaneous, net | ( | ||||||||||||||||||||||
Total other expense, net | ( | ( | ( | ( | |||||||||||||||||||
Income before income taxes | |||||||||||||||||||||||
Income tax benefit (expense) | ( | ( | ( | ||||||||||||||||||||
Net income | |||||||||||||||||||||||
Net income attributable to noncontrolling interests | ( | ( | ( | ( | |||||||||||||||||||
Net income attributable to Amedisys, Inc. | $ | $ | $ | $ | |||||||||||||||||||
Basic earnings per common share: | |||||||||||||||||||||||
Net income attributable to Amedisys, Inc. common stockholders | $ | $ | $ | $ | |||||||||||||||||||
Weighted average shares outstanding | |||||||||||||||||||||||
Diluted earnings per common share: | |||||||||||||||||||||||
Net income attributable to Amedisys, Inc. common stockholders | $ | $ | $ | $ | |||||||||||||||||||
Weighted average shares outstanding |
For the Three-Months Ended September 30, 2020 | |||||||||||||||||||||||||||||||||||||||||||||||
Total | Common Stock | Additional Paid-in Capital | Treasury Stock | Accumulated Other Comprehensive Income | Retained Earnings | Noncontrolling Interests | |||||||||||||||||||||||||||||||||||||||||
Shares | Amount | ||||||||||||||||||||||||||||||||||||||||||||||
Balance, June 30, 2020 | $ | $ | $ | $ | ( | $ | $ | $ | |||||||||||||||||||||||||||||||||||||||
Issuance of stock – employee stock purchase plan | — | — | — | — | — | ||||||||||||||||||||||||||||||||||||||||||
Issuance/(cancellation) of non-vested stock | — | — | — | — | |||||||||||||||||||||||||||||||||||||||||||
Exercise of stock options | — | — | — | — | — | ||||||||||||||||||||||||||||||||||||||||||
Non-cash compensation | — | — | — | — | — | — | |||||||||||||||||||||||||||||||||||||||||
Surrendered shares | ( | — | — | ( | — | — | — | ||||||||||||||||||||||||||||||||||||||||
Noncontrolling interest distribution | ( | — | — | — | — | — | — | ( | |||||||||||||||||||||||||||||||||||||||
Net income | — | — | — | — | — | ||||||||||||||||||||||||||||||||||||||||||
Balance, September 30, 2020 | $ | $ | $ | $ | ( | $ | $ | $ | |||||||||||||||||||||||||||||||||||||||
For the Three-Months Ended September 30, 2019 | |||||||||||||||||||||||||||||||||||||||||||||||
Total | Common Stock | Additional Paid-in Capital | Treasury Stock | Accumulated Other Comprehensive Income | Retained Earnings | Noncontrolling Interests | |||||||||||||||||||||||||||||||||||||||||
Shares | Amount | ||||||||||||||||||||||||||||||||||||||||||||||
Balance, June 30, 2019 | $ | $ | $ | $ | ( | $ | $ | $ | |||||||||||||||||||||||||||||||||||||||
Issuance of stock – employee stock purchase plan | — | — | — | — | — | ||||||||||||||||||||||||||||||||||||||||||
Issuance of stock – 401(k) plan | — | — | — | — | — | ||||||||||||||||||||||||||||||||||||||||||
Issuance/(cancellation) of non-vested stock | ( | — | — | — | — | ||||||||||||||||||||||||||||||||||||||||||
Exercise of stock options | — | — | — | — | — | ||||||||||||||||||||||||||||||||||||||||||
Non-cash compensation | — | — | — | — | — | — | |||||||||||||||||||||||||||||||||||||||||
Surrendered shares | ( | — | — | — | ( | — | — | — | |||||||||||||||||||||||||||||||||||||||
Noncontrolling interest distribution | ( | — | — | — | — | — | — | ( | |||||||||||||||||||||||||||||||||||||||
Net income | — | — | — | — | — | ||||||||||||||||||||||||||||||||||||||||||
Balance, September 30, 2019 | $ | $ | $ | $ | ( | $ | $ | $ | |||||||||||||||||||||||||||||||||||||||
For the Nine-Months Ended September 30, 2020 | |||||||||||||||||||||||||||||||||||||||||||||||
Total | Common Stock | Additional Paid-in Capital | Treasury Stock | Accumulated Other Comprehensive Income | Retained Earnings | Noncontrolling Interests | |||||||||||||||||||||||||||||||||||||||||
Shares | Amount | ||||||||||||||||||||||||||||||||||||||||||||||
Balance, December 31, 2019 | $ | $ | $ | $ | ( | $ | $ | $ | |||||||||||||||||||||||||||||||||||||||
Issuance of stock – employee stock purchase plan | — | — | — | — | — | ||||||||||||||||||||||||||||||||||||||||||
Issuance of stock – 401(k) plan | — | — | — | — | — | ||||||||||||||||||||||||||||||||||||||||||
Issuance/(cancellation) of non-vested stock | — | — | — | — | |||||||||||||||||||||||||||||||||||||||||||
Exercise of stock options | — | — | — | — | — | ||||||||||||||||||||||||||||||||||||||||||
Non-cash compensation | — | — | — | — | — | — | |||||||||||||||||||||||||||||||||||||||||
Surrendered shares | ( | — | — | ( | — | — | — | ||||||||||||||||||||||||||||||||||||||||
Noncontrolling interest distribution | ( | — | — | — | — | — | — | ( | |||||||||||||||||||||||||||||||||||||||
Write-off of other comprehensive income | ( | — | — | — | — | ( | — | — | |||||||||||||||||||||||||||||||||||||||
Net income | — | — | — | — | — | ||||||||||||||||||||||||||||||||||||||||||
Balance, September 30, 2020 | $ | $ | $ | $ | ( | $ | $ | $ | |||||||||||||||||||||||||||||||||||||||
For the Nine-Months Ended September 30, 2019 | |||||||||||||||||||||||||||||||||||||||||||||||
Total | Common Stock | Additional Paid-in Capital | Treasury Stock | Accumulated Other Comprehensive Income | Retained Earnings | Noncontrolling Interests | |||||||||||||||||||||||||||||||||||||||||
Shares | Amount | ||||||||||||||||||||||||||||||||||||||||||||||
Balance, December 31, 2018 | $ | $ | $ | $ | ( | $ | $ | $ | |||||||||||||||||||||||||||||||||||||||
Issuance of stock – employee stock purchase plan | — | — | — | — | — | ||||||||||||||||||||||||||||||||||||||||||
Issuance of stock – 401(k) plan | — | — | — | — | — | ||||||||||||||||||||||||||||||||||||||||||
Issuance/(cancellation) of non-vested stock | ( | — | — | — | — | ||||||||||||||||||||||||||||||||||||||||||
Exercise of stock options | — | — | — | — | — | ||||||||||||||||||||||||||||||||||||||||||
Non-cash compensation | — | — | — | — | — | — | |||||||||||||||||||||||||||||||||||||||||
Surrendered shares | ( | — | — | — | ( | — | — | — | |||||||||||||||||||||||||||||||||||||||
Noncontrolling interest distribution | ( | — | — | — | — | — | — | ( | |||||||||||||||||||||||||||||||||||||||
Net income | — | — | — | — | — | ||||||||||||||||||||||||||||||||||||||||||
Balance, September 30, 2019 | $ | $ | $ | $ | ( | $ | $ | $ |
For the Nine-Month Periods Ended September 30, | |||||||||||
2020 | 2019 | ||||||||||
Cash Flows from Operating Activities: | |||||||||||
Net income | $ | $ | |||||||||
Adjustments to reconcile net income to net cash provided by operating activities: | |||||||||||
Depreciation and amortization | |||||||||||
Non-cash compensation | |||||||||||
Non-cash 401(k) employer match | |||||||||||
Amortization and impairment of operating lease right of use assets | |||||||||||
(Gain) loss on disposal of property and equipment | ( | ||||||||||
Loss on sale of equity method investment | |||||||||||
Write-off of other comprehensive income | ( | ||||||||||
Deferred income taxes | ( | ||||||||||
Equity in earnings from equity method investments | ( | ( | |||||||||
Amortization of deferred debt issuance costs/debt discount | |||||||||||
Return on equity investment | |||||||||||
Changes in operating assets and liabilities, net of impact of acquisitions: | |||||||||||
Patient accounts receivable | ( | ||||||||||
Other current assets | ( | ( | |||||||||
Other assets | ( | ||||||||||
Accounts payable | ( | ( | |||||||||
Accrued expenses | |||||||||||
Other long-term obligations | ( | ||||||||||
Operating lease liabilities | ( | ( | |||||||||
Operating lease right of use assets | ( | ( | |||||||||
Net cash provided by operating activities | |||||||||||
Cash Flows from Investing Activities: | |||||||||||
Proceeds from sale of deferred compensation plan assets | |||||||||||
Proceeds from the sale of property and equipment | |||||||||||
Purchases of property and equipment | ( | ( | |||||||||
Investments in equity method investees | ( | ( | |||||||||
Proceeds from sale of equity method investment | |||||||||||
Acquisitions of businesses, net of cash acquired | ( | ( | |||||||||
Net cash used in investing activities | ( | ( | |||||||||
Cash Flows from Financing Activities: | |||||||||||
Proceeds from issuance of stock upon exercise of stock options | |||||||||||
Proceeds from issuance of stock to employee stock purchase plan | |||||||||||
Shares withheld to pay taxes on non-cash compensation | ( | ( | |||||||||
Noncontrolling interest distribution | ( | ( | |||||||||
Proceeds from borrowings under term loan | |||||||||||
Proceeds from borrowings under revolving line of credit | |||||||||||
Repayments of borrowings under revolving line of credit | ( | ( | |||||||||
Principal payments of long-term obligations | ( | ( | |||||||||
Debt issuance costs | ( | ||||||||||
Provider relief fund advance | |||||||||||
Net cash provided by financing activities | |||||||||||
Net increase in cash, cash equivalents and restricted cash | |||||||||||
Cash, cash equivalents and restricted cash at beginning of period | |||||||||||
Cash, cash equivalents and restricted cash at end of period | $ | $ | |||||||||
Supplemental Disclosures of Cash Flow Information: | |||||||||||
Cash paid for interest | $ | $ | |||||||||
Cash paid for income taxes, net of refunds received | $ | $ | |||||||||
Cash paid for operating lease liabilities | $ | $ | |||||||||
Cash paid for finance lease liabilities | $ | $ | |||||||||
Supplemental Disclosures of Non-Cash Activity: | |||||||||||
Right of use assets obtained in exchange for operating lease liabilities | $ | $ | |||||||||
Right of use assets obtained in exchange for finance lease liabilities | $ | $ | |||||||||
Reductions to right of use assets resulting from reductions to operating lease liabilities | $ | $ |
For the Three-Month Periods Ended September 30, | For the Nine-Month Periods Ended September 30, | ||||||||||||||||||||||
2020 | 2019 | 2020 | 2019 | ||||||||||||||||||||
Home Health: | |||||||||||||||||||||||
Medicare | % | % | % | % | |||||||||||||||||||
Non-Medicare - Episodic-based | % | % | % | % | |||||||||||||||||||
Non-Medicare - Non-episodic based | % | % | % | % | |||||||||||||||||||
Hospice (1): | |||||||||||||||||||||||
Medicare | % | % | % | % | |||||||||||||||||||
Non-Medicare | % | % | % | % | |||||||||||||||||||
Personal Care | % | % | % | % | |||||||||||||||||||
% | % | % | % | ||||||||||||||||||||
(1) Acquired Compassionate Care Hospice on February 1, 2019, RoseRock Healthcare on April 1, 2019, Asana Hospice on January 1, 2020 and AseraCare on June 1, 2020. |
Fair Value at Reporting Date Using | |||||||||||||||||||||||
Financial Instrument | Carrying Value as of September 30, 2020 | Quoted Prices in Active Markets for Identical Items (Level 1) | Significant Other Observable Inputs (Level 2) | Significant Unobservable Inputs (Level 3) | |||||||||||||||||||
Long-term obligations | $ | $ | $ | $ |
For the Three- Month Periods Ended September 30, | For the Nine- Month Periods Ended September 30, | ||||||||||||||||||||||
2020 | 2019 | 2020 | 2019 | ||||||||||||||||||||
Weighted average number of shares outstanding - basic | |||||||||||||||||||||||
Effect of dilutive securities: | |||||||||||||||||||||||
Stock options | |||||||||||||||||||||||
Non-vested stock and stock units | |||||||||||||||||||||||
Weighted average number of shares outstanding - diluted | |||||||||||||||||||||||
Anti-dilutive securities |
Amount | |||||
Patient accounts receivable | $ | ||||
Property and equipment | |||||
Operating lease right of use assets | |||||
Intangible assets | |||||
Total assets acquired | |||||
Accounts payable | ( | ||||
Payroll and employee benefits | ( | ||||
Accrued expenses | ( | ||||
Operating lease liabilities | ( | ||||
Total liabilities assumed | ( | ||||
Net identifiable assets acquired | |||||
Goodwill | |||||
Total estimated consideration | $ |
Amount | |||||
Patient accounts receivable | $ | ||||
Prepaid expenses | |||||
Property and equipment | |||||
Operating lease right of use assets | |||||
Intangible assets | |||||
Other assets | |||||
Total assets acquired | |||||
Accounts payable | ( | ||||
Payroll and employee benefits | ( | ||||
Accrued expenses | ( | ||||
Operating lease liabilities | ( | ||||
Total liabilities assumed | ( | ||||
Net identifiable assets acquired | |||||
Goodwill | |||||
Total estimated consideration | $ |
For the Three- Month Periods Ended September 30, | For the Nine- Month Periods Ended September 30, | ||||||||||||||||||||||
2020 | 2019 | 2020 | 2019 | ||||||||||||||||||||
Net service revenue | $ | $ | $ | $ | |||||||||||||||||||
Operating income | |||||||||||||||||||||||
Net income attributable to Amedisys Inc. | |||||||||||||||||||||||
Basic earnings per share | |||||||||||||||||||||||
Diluted earnings per share |
September 30, 2020 | December 31, 2019 | ||||||||||
$ | $ | $ | |||||||||
$ | |||||||||||
Promissory notes | |||||||||||
Finance leases | |||||||||||
Principal amount of long-term obligations | |||||||||||
Deferred debt issuance costs | ( | ( | |||||||||
Current portion of long-term obligations | ( | ( | |||||||||
Total | $ | $ |
Pricing Tier | Consolidated Leverage Ratio | Commitment Fee | Letter of Credit Fee | Eurodollar Rate Loans | Base Rate Loans | ||||||||||||
I | ≥ | ||||||||||||||||
II | < | ||||||||||||||||
III | < | ||||||||||||||||
IV | < |
For the Three-Month Period Ended September 30, 2020 | |||||||||||||||||||||||||||||
Home Health | Hospice | Personal Care | Other | Total | |||||||||||||||||||||||||
Net service revenue | $ | $ | $ | $ | $ | ||||||||||||||||||||||||
Other operating income | |||||||||||||||||||||||||||||
Cost of service, excluding depreciation and amortization | 297.6 | ||||||||||||||||||||||||||||
General and administrative expenses | |||||||||||||||||||||||||||||
Depreciation and amortization | |||||||||||||||||||||||||||||
Operating expenses | |||||||||||||||||||||||||||||
Operating income (loss) | $ | $ | $ | $ | ( | $ | |||||||||||||||||||||||
For the Three-Month Period Ended September 30, 2019 | |||||||||||||||||||||||||||||
Home Health | Hospice | Personal Care | Other | Total | |||||||||||||||||||||||||
Net service revenue | $ | $ | $ | $ | $ | ||||||||||||||||||||||||
Cost of service, excluding depreciation and amortization | |||||||||||||||||||||||||||||
General and administrative expenses | |||||||||||||||||||||||||||||
Depreciation and amortization | |||||||||||||||||||||||||||||
Operating expenses | |||||||||||||||||||||||||||||
Operating income (loss) | $ | $ | $ | $ | ( | $ | |||||||||||||||||||||||
For the Nine-Month Period Ended September 30, 2020 | |||||||||||||||||||||||||||||
Home Health | Hospice | Personal Care | Other | Total | |||||||||||||||||||||||||
Net service revenue | $ | $ | $ | $ | $ | ||||||||||||||||||||||||
Other operating income | |||||||||||||||||||||||||||||
Cost of service, excluding depreciation and amortization | |||||||||||||||||||||||||||||
General and administrative expenses | |||||||||||||||||||||||||||||
Depreciation and amortization | 19.9 | ||||||||||||||||||||||||||||
Operating expenses | |||||||||||||||||||||||||||||
Operating income (loss) | $ | $ | $ | $ | ( | $ | |||||||||||||||||||||||
For the Nine-Month Period Ended September 30, 2019 | |||||||||||||||||||||||||||||
Home Health | Hospice | Personal Care | Other | Total | |||||||||||||||||||||||||
Net service revenue | $ | $ | $ | $ | $ | 1,454.9 | |||||||||||||||||||||||
Cost of service, excluding depreciation and amortization | |||||||||||||||||||||||||||||
General and administrative expenses | |||||||||||||||||||||||||||||
Depreciation and amortization | |||||||||||||||||||||||||||||
Operating expenses | |||||||||||||||||||||||||||||
Operating income (loss) | $ | $ | $ | $ | ( | $ |
Amount | |||||
Funds utilized during the nine-month period ended September 30, 2020 | $ | ||||
Estimated funds to be utilized October 2020 through June 2021 | |||||
Estimated funds to be repaid to the government | |||||
Funds received by unconsolidated joint ventures | |||||
$ |
Home Health | Hospice | Personal Care | |||||||||||||||
As of December 31, 2019 | 321 | 138 | 12 | ||||||||||||||
Acquisitions/Startups | 4 | 54 | 2 | ||||||||||||||
Closed/Consolidated | (5) | (10) | — | ||||||||||||||
As of September 30, 2020 | 320 | 182 | 14 |
For the Three-Month Periods Ended September 30, | |||||||||||
2020 | 2019 | ||||||||||
Net service revenue | $ | 544.1 | $ | 494.6 | |||||||
Other operating income | 4.8 | — | |||||||||
Gross margin, excluding depreciation and amortization | 251.3 | 205.9 | |||||||||
% of revenue | 46.2 | % | 41.6 | % | |||||||
Other operating expenses | 179.7 | 154.7 | |||||||||
% of revenue | 33.0 | % | 31.3 | % | |||||||
Depreciation and amortization | 8.3 | 4.4 | |||||||||
Operating income | 63.3 | 46.8 | |||||||||
Total other expense | (1.1) | (2.6) | |||||||||
Income tax benefit (expense) | 10.2 | (9.9) | |||||||||
Effective income tax rate | (16.4 | %) | 22.4 | % | |||||||
Net income | 72.4 | 34.3 | |||||||||
Net income attributable to noncontrolling interests | (0.4) | (0.2) | |||||||||
Net income attributable to Amedisys, Inc. | $ | 72.0 | $ | 34.1 |
For the Three-Month Periods Ended September 30, | |||||||||||
2020 | 2019 | ||||||||||
Financial Information (in millions): | |||||||||||
Medicare | $ | 222.2 | $ | 211.5 | |||||||
Non-Medicare | 103.8 | 100.0 | |||||||||
Net service revenue | 326.0 | 311.5 | |||||||||
Other operating income | 2.6 | — | |||||||||
Cost of service | 180.0 | 188.9 | |||||||||
Gross margin | 148.6 | 122.6 | |||||||||
Other operating expenses | 79.8 | 76.5 | |||||||||
Operating income | $ | 68.8 | $ | 46.1 | |||||||
Same Store Growth (1): | |||||||||||
Medicare revenue | 5 | % | 2 | % | |||||||
Non-Medicare revenue | 4 | % | 16 | % | |||||||
Total admissions | 5 | % | 9 | % | |||||||
Total volume (2) | 6 | % | 6 | % | |||||||
Key Statistical Data - Total (3): | |||||||||||
Admissions | 85,578 | 81,937 | |||||||||
Recertifications | 47,094 | 43,340 | |||||||||
Total volume | 132,672 | 125,277 | |||||||||
Medicare completed episodes (6) | 77,552 | 75,807 | |||||||||
Average Medicare revenue per completed episode (4) (6) | $ | 2,886 | $ | 2,836 | |||||||
Medicare visits per completed episode (5) (6) | 14.4 | 16.9 | |||||||||
Visiting Clinician Cost per Visit | $ | 89.10 | $ | 83.68 | |||||||
Clinical Manager Cost per Visit | $ | 8.91 | $ | 8.09 | |||||||
Total Cost per Visit | $ | 98.01 | $ | 91.77 | |||||||
Visits | 1,836,895 | 2,057,184 |
For the Three-Month Periods Ended September 30, | |||||||||||
2020 | 2019 | ||||||||||
Financial Information (in millions): | |||||||||||
Medicare | $ | 189.0 | $ | 153.5 | |||||||
Non-Medicare | 10.7 | 8.9 | |||||||||
Net service revenue | 199.7 | 162.4 | |||||||||
Other operating income | 1.7 | — | |||||||||
Cost of service | 104.1 | 84.5 | |||||||||
Gross margin | 97.3 | 77.9 | |||||||||
Other operating expenses | 48.4 | 36.2 | |||||||||
Operating income | $ | 48.9 | $ | 41.7 | |||||||
Same Store Growth (1): | |||||||||||
Medicare revenue | 3 | % | 10 | % | |||||||
Hospice admissions | 9 | % | 4 | % | |||||||
Average daily census | — | % | 5 | % | |||||||
Key Statistical Data - Total (2): | |||||||||||
Hospice admissions | 13,026 | 9,914 | |||||||||
Average daily census | 13,953 | 11,565 | |||||||||
Revenue per day, net | $ | 155.57 | $ | 152.67 | |||||||
Cost of service per day | $ | 81.05 | $ | 79.51 | |||||||
Average discharge length of stay | 101 | 98 |
For the Three-Month Periods Ended September 30, | |||||||||||
2020 | 2019 | ||||||||||
Financial Information (in millions): | |||||||||||
Medicare | $ | — | $ | — | |||||||
Non-Medicare | 18.4 | 20.7 | |||||||||
Net service revenue | 18.4 | 20.7 | |||||||||
Other operating income | 0.5 | — | |||||||||
Cost of service | 13.5 | 15.3 | |||||||||
Gross margin | 5.4 | 5.4 | |||||||||
Other operating expenses | 3.2 | 3.1 | |||||||||
Operating income | $ | 2.2 | $ | 2.3 | |||||||
Key Statistical Data - Total (1): | |||||||||||
Billable hours | 673,161 | 824,251 | |||||||||
Clients served | 10,153 | 12,687 | |||||||||
Shifts | 280,470 | 370,451 | |||||||||
Revenue per hour | $ | 27.33 | $ | 25.12 | |||||||
Revenue per shift | $ | 65.59 | $ | 55.90 | |||||||
Hours per shift | 2.4 | 2.2 |
For the Three-Month Periods Ended September 30, | |||||||||||
2020 | 2019 | ||||||||||
Financial Information (in millions): | |||||||||||
Other operating expenses | $ | 49.9 | $ | 40.4 | |||||||
Depreciation and amortization | 6.7 | 2.9 | |||||||||
Total operating expenses | $ | 56.6 | $ | 43.3 |
For the Nine-Month Periods Ended September 30, | |||||||||||
2020 | 2019 | ||||||||||
Net service revenue | $ | 1,520.8 | $ | 1,454.9 | |||||||
Other operating income | 27.6 | — | |||||||||
Gross margin, excluding depreciation and amortization | 669.8 | 600.2 | |||||||||
% of revenue | 44.0 | % | 41.3 | % | |||||||
Other operating expenses | 492.8 | 451.9 | |||||||||
% of revenue | 32.4 | % | 31.1 | % | |||||||
Depreciation and amortization | 19.9 | 12.4 | |||||||||
Operating income | 157.1 | 135.9 | |||||||||
Total other expense | (8.3) | (4.9) | |||||||||
Income tax expense | (9.2) | (31.1) | |||||||||
Effective income tax rate | 6.2 | % | 23.7 | % | |||||||
Net income | 139.6 | 99.9 | |||||||||
Net income attributable to noncontrolling interests | (1.1) | (0.7) | |||||||||
Net income attributable to Amedisys, Inc. | $ | 138.5 | $ | 99.2 |
For the Nine-Month Periods Ended September 30, | |||||||||||
2020 | 2019 | ||||||||||
Financial Information (in millions): | |||||||||||
Medicare | $ | 619.0 | $ | 644.0 | |||||||
Non-Medicare | 300.8 | 296.2 | |||||||||
Net service revenue | 919.8 | 940.2 | |||||||||
Other operating income | 17.7 | — | |||||||||
Cost of service | 543.8 | 562.4 | |||||||||
Gross margin | 393.7 | 377.8 | |||||||||
Other operating expenses | 229.6 | 224.0 | |||||||||
Operating income | $ | 164.1 | $ | 153.8 | |||||||
Same Store Growth (1): | |||||||||||
Medicare revenue | (4 | %) | 4 | % | |||||||
Non-Medicare revenue | 2 | % | 18 | % | |||||||
Total admissions | (1 | %) | 7 | % | |||||||
Total volume (2) | 2 | % | 6 | % | |||||||
Key Statistical Data - Total (3): | |||||||||||
Admissions | 245,880 | 247,669 | |||||||||
Recertifications | 135,263 | 128,496 | |||||||||
Total volume | 381,143 | 376,165 | |||||||||
Medicare completed episodes (6) | 221,848 | 229,229 | |||||||||
Average Medicare revenue per completed episode (4) (6) | $ | 2,811 | $ | 2,853 | |||||||
Medicare visits per completed episode (5) (6) | 15.2 | 17.1 | |||||||||
Visiting Clinician Cost per Visit | $ | 88.64 | $ | 82.23 | |||||||
Clinical Manager Cost per Visit | $ | 9.10 | $ | 7.91 | |||||||
Total Cost per Visit | $ | 97.74 | $ | 90.14 | |||||||
Visits | 5,563,992 | 6,238,758 |
For the Nine-Month Periods Ended September 30, | |||||||||||
2020 | 2019 | ||||||||||
Financial Information (in millions): | |||||||||||
Medicare | $ | 516.5 | $ | 430.0 | |||||||
Non-Medicare | 29.7 | 22.6 | |||||||||
Net service revenue | 546.2 | 452.6 | |||||||||
Other operating income | 8.9 | — | |||||||||
Cost of service | 293.1 | 245.9 | |||||||||
Gross margin | 262.0 | 206.7 | |||||||||
Other operating expenses | 129.1 | 100.9 | |||||||||
Operating income | $ | 132.9 | $ | 105.8 | |||||||
Same Store Growth (1): | |||||||||||
Medicare revenue | 4 | % | 6 | % | |||||||
Hospice admissions | 3 | % | 5 | % | |||||||
Average daily census | 1 | % | 6 | % | |||||||
Key Statistical Data - Total (2): | |||||||||||
Hospice admissions | 35,755 | 30,055 | |||||||||
Average daily census | 12,841 | 10,997 | |||||||||
Revenue per day, net | $ | 155.23 | $ | 150.77 | |||||||
Cost of service per day | $ | 83.29 | $ | 81.92 | |||||||
Average discharge length of stay | 98 | 98 |
For the Nine-Month Periods Ended September 30, | |||||||||||
2020 | 2019 | ||||||||||
Financial Information (in millions): | |||||||||||
Medicare | $ | — | $ | — | |||||||
Non-Medicare | 54.8 | 62.1 | |||||||||
Net service revenue | 54.8 | 62.1 | |||||||||
Other operating income | 1.0 | — | |||||||||
Cost of service | 41.7 | 46.4 | |||||||||
Gross margin | 14.1 | 15.7 | |||||||||
Other operating expenses | 9.6 | 9.5 | |||||||||
Operating income | $ | 4.5 | $ | 6.2 | |||||||
Key Statistical Data - Total (1): | |||||||||||
Billable hours | 2,067,958 | 2,506,113 | |||||||||
Clients served | 14,057 | 16,134 | |||||||||
Shifts | 896,141 | 1,128,920 | |||||||||
Revenue per hour | $ | 26.51 | $ | 24.77 | |||||||
Revenue per shift | $ | 61.18 | $ | 55.00 | |||||||
Hours per shift | 2.3 | 2.2 |
For the Nine-Month Periods Ended September 30, | |||||||||||
2020 | 2019 | ||||||||||
Financial Information (in millions): | |||||||||||
Other operating expenses | $ | 129.2 | $ | 122.0 | |||||||
Depreciation and amortization | 15.2 | 7.9 | |||||||||
Total operating expenses | $ | 144.4 | $ | 129.9 |
For the Nine-Month Periods Ended September 30, | |||||||||||
2020 | 2019 | ||||||||||
Cash provided by operating activities | $ | 223.0 | $ | 126.8 | |||||||
Cash used in investing activities | (285.5) | (351.5) | |||||||||
Cash provided by financing activities | 81.5 | 225.3 | |||||||||
Net increase in cash, cash equivalents and restricted cash | 19.0 | 0.6 | |||||||||
Cash, cash equivalents and restricted cash at beginning of period | 96.5 | 20.2 | |||||||||
Cash, cash equivalents and restricted cash at end of period | $ | 115.5 | $ | 20.8 |
0-90 | 91-180 | 181-365 | Over 365 | Total | |||||||||||||||||||||||||
At September 30, 2020: | |||||||||||||||||||||||||||||
Medicare patient accounts receivable | $ | 150.9 | $ | 4.9 | $ | 1.4 | $ | 0.7 | $ | 157.9 | |||||||||||||||||||
Other patient accounts receivable: | |||||||||||||||||||||||||||||
Medicaid | 19.5 | 2.6 | 2.6 | — | 24.7 | ||||||||||||||||||||||||
Private | 59.5 | 5.7 | 3.0 | — | 68.2 | ||||||||||||||||||||||||
Total | $ | 79.0 | $ | 8.3 | $ | 5.6 | $ | — | $ | 92.9 | |||||||||||||||||||
Total patient accounts receivable | $ | 250.8 | |||||||||||||||||||||||||||
Days revenue outstanding (1) | 40.0 | ||||||||||||||||||||||||||||
0-90 | 91-180 | 181-365 | Over 365 | Total | |||||||||||||||||||||||||
At December 31, 2019: | |||||||||||||||||||||||||||||
Medicare patient accounts receivable | $ | 115.2 | $ | 13.8 | $ | 6.8 | $ | 1.0 | $ | 136.8 | |||||||||||||||||||
Other patient accounts receivable: | |||||||||||||||||||||||||||||
Medicaid | 22.6 | 5.7 | 4.0 | — | 32.3 | ||||||||||||||||||||||||
Private | 60.0 | 6.3 | 2.2 | — | 68.5 | ||||||||||||||||||||||||
Total | $ | 82.6 | $ | 12.0 | $ | 6.2 | $ | — | $ | 100.8 | |||||||||||||||||||
Total patient accounts receivable | $ | 237.6 | |||||||||||||||||||||||||||
Days revenue outstanding (1) | 40.9 |
Period | (a) Total Number of Shares (or Units) Purchased | (b) Average Price Paid per Share (or Unit) | (c) Total Number of Shares (or Units) Purchased as Part of Publicly Announced Plans or Programs | (d) Maximum Number (or Approximate Dollar Value) of Shares (or Units) That May Yet Be Purchased Under the Plans or Programs | ||||||||||||||||||||||
July 1, 2020 to July 31, 2020 | 33,971 | $ | 215.18 | — | $ | — | ||||||||||||||||||||
August 1, 2020 to August 31, 2020 | 232,109 | 231.94 | — | — | ||||||||||||||||||||||
September 1, 2020 to September 30, 2020 | — | — | — | — | ||||||||||||||||||||||
266,080 | (1) | $ | 229.80 | — | $ | — |
Exhibit Number | Document Description | Report or Registration Statement | SEC File or Registration Number | Exhibit or Other Reference | ||||||||||||||||||||||
3.1 | The Company’s Quarterly Report on Form 10-Q for the quarter ended June 30, 2007 | 0-24260 | 3.1 | |||||||||||||||||||||||
3.2 | The Company’s Quarterly Report on Form 10-Q for the quarter ended September 30, 2019 | 0-24260 | 3.2 | |||||||||||||||||||||||
†31.1 | ||||||||||||||||||||||||||
†31.2 | ||||||||||||||||||||||||||
††32.1 | ||||||||||||||||||||||||||
††32.2 | ||||||||||||||||||||||||||
†101.INS | Inline XBRL Instance - The instance document does not appear in the Interactive Data File because its XBRL tags are embedded within the Inline XBRL document. | |||||||||||||||||||||||||
†101.SCH | Inline XBRL Taxonomy Extension Schema Document | |||||||||||||||||||||||||
†101.CAL | Inline XBRL Taxonomy Extension Calculation Linkbase Document | |||||||||||||||||||||||||
†101.DEF | Inline XBRL Taxonomy Extension Definition Linkbase | |||||||||||||||||||||||||
†101.LAB | Inline XBRL Taxonomy Extension Labels Linkbase Document | |||||||||||||||||||||||||
†101.PRE | Inline XBRL Taxonomy Extension Presentation Linkbase Document | |||||||||||||||||||||||||
104 | Cover Page Interactive Data File (formatted as Inline XBRL and contained in Exhibit 101) |
AMEDISYS, INC. (Registrant) | ||||||||
By: | /s/ SCOTT G. GINN | |||||||
Scott G. Ginn, | ||||||||
Principal Financial Officer and | ||||||||
Duly Authorized Officer |
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/S/ Paul B. Kusserow | ||
Paul B. Kusserow | ||
President and Chief Executive Officer (Principal Executive Officer) |
/S/ Scott G. Ginn | ||
Scott G. Ginn Chief Financial Officer | ||
(Principal Financial Officer) |
/S/ Paul B. Kusserow | ||
Paul B. Kusserow President and Chief Executive Officer | ||
(Principal Executive Officer) |
/S/ Scott G. Ginn | ||
Scott G. Ginn Chief Financial Officer | ||
(Principal Financial Officer) |
CONSOLIDATED BALANCE SHEETS (Parenthetical) - USD ($) $ in Thousands |
Sep. 30, 2020 |
Dec. 31, 2019 |
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Statement of Financial Position [Abstract] | ||
Property and equipment, accumulated depreciation | $ 101,512 | $ 96,137 |
Intangible assets, accumulated amortization | $ 17,165 | $ 7,044 |
Preferred stock, par value (usd per share) | $ 0.001 | $ 0.001 |
Preferred stock, authorized (shares) | 5,000,000 | 5,000,000 |
Preferred stock, issued (shares) | 0 | 0 |
Preferred stock, outstanding (shares) | 0 | 0 |
Common stock, par value (usd per share) | $ 0.001 | $ 0.001 |
Common stock, authorized (shares) | 60,000,000 | 60,000,000 |
Common stock, issued (shares) | 37,457,444 | 36,638,021 |
Common stock, outstanding (shares) | 32,802,785 | 32,284,051 |
Treasury stock at cost (shares) | 4,654,659 | 4,353,970 |
NATURE OF OPERATIONS, CONSOLIDATION AND PRESENTATION OF FINANCIAL STATEMENTS |
9 Months Ended |
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Sep. 30, 2020 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
NATURE OF OPERATIONS, CONSOLIDATION AND PRESENTATION OF FINANCIAL STATEMENTS | NATURE OF OPERATIONS, CONSOLIDATION AND PRESENTATION OF FINANCIAL STATEMENTS Amedisys, Inc., a Delaware corporation, (together with its consolidated subsidiaries, referred to herein as “Amedisys,” “we,” “us,” or “our”) is a multi-state provider of home health, hospice and personal care services with approximately 76% and 75% of our revenue derived from Medicare for the three and nine-month periods ended September 30, 2020, respectively, and approximately 74% of our revenue derived from Medicare for the three and nine-month periods ended September 30, 2019. As of September 30, 2020, we owned and operated 320 Medicare-certified home health care centers, 182 Medicare-certified hospice care centers and 14 personal-care care centers in 39 states within the United States and the District of Columbia. Basis of Presentation In our opinion, the accompanying unaudited condensed consolidated financial statements contain all adjustments (consisting solely of normal recurring adjustments) necessary to present fairly our financial position, our results of operations and our cash flows in accordance with U.S. generally accepted accounting principles (“U.S. GAAP”) for interim financial reporting. Our results of operations for the interim periods presented are not necessarily indicative of the results of our operations for the entire year and have not been audited by our independent auditors. This report should be read in conjunction with our consolidated financial statements and related notes included in our Annual Report on Form 10-K for the year ended December 31, 2019, as filed with the Securities and Exchange Commission (“SEC”) on February 19, 2020 (the “Form 10-K”), which includes information and disclosures not included herein. Certain information and footnote disclosures normally included in annual financial statements prepared in accordance with U.S. GAAP have been condensed or omitted from the interim financial information presented, as allowed by SEC rules and regulations. Recently Adopted Accounting Pronouncements In June 2016, the Financial Accounting Standards Board ("FASB") issued Accounting Standards Update ("ASU") 2016-13, Financial Instruments - Credit Losses (Topic 326), which provides guidance for measuring credit losses on financial instruments. Our adoption of this standard on January 1, 2020 did not have a material effect on our condensed consolidated financial statements. Recently Issued Accounting Pronouncements In December 2019, the FASB issued ASU 2019-12, Income Taxes (Topic 740) - Simplifying the Accounting for Income Taxes, which simplifies the accounting for income taxes by removing certain exceptions to the general principles in Topic 740 and improves consistent application by clarifying and amending existing guidance. The ASU is effective for annual and interim periods beginning after December 15, 2020. Early adoption is permitted. While the Company does not expect a material impact upon adoption of ASU 2019-12, we are still evaluating the effect the standard will have on our consolidated financial statements and related disclosures and ongoing financial reporting. Use of Estimates Our accounting and reporting policies conform with U.S. GAAP. In preparing the unaudited condensed consolidated financial statements, we are required to make estimates and assumptions that impact the amounts reported in the condensed consolidated financial statements and accompanying notes. Actual results could differ from those estimates. Principles of Consolidation These unaudited condensed consolidated financial statements include the accounts of Amedisys, Inc. and our wholly owned subsidiaries. All significant intercompany accounts and transactions have been eliminated in our accompanying unaudited condensed consolidated financial statements, and business combinations accounted for as purchases have been included in our unaudited condensed consolidated financial statements from their respective dates of acquisition. In addition to our wholly owned subsidiaries, we also have certain equity investments that are accounted for as set forth below. Investments We consolidate investments when the entity is a variable interest entity and we are the primary beneficiary or if we have controlling interests in the entity, which is generally ownership in excess of 50%. Third party equity interests in our consolidated joint ventures are reflected as noncontrolling interests in our condensed consolidated financial statements. 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 variable interest entity in which we are the primary beneficiary. During the three-month period ended June 30, 2020, we sold our investment in the Heritage Healthcare Innovation Fund, LP via a secondary transaction for $17.9 million which resulted in a $3.0 million loss which is reflected in miscellaneous, net within our condensed consolidated statements of operations for the nine-month period ended September 30, 2020. The Company's original investment was made in 2010 and no longer fit within our strategic areas of focus. Proceeds from the sale were used to pay down debt and fund operations. The book value of investments that we account for under the equity method of accounting was $14.2 million and $35.7 million as of September 30, 2020 and December 31, 2019, respectively, and is reflected in other assets within our condensed consolidated balance sheet.
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SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES |
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SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES | SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES Revenue Recognition We account for revenue from contracts with customers in accordance with ASU 2014-09, Revenue from Contracts with Customers (Topic 606) and ASU 2015-14, Revenue from Contracts with Customers (Topic 606): Deferral of the Effective Date (collectively, "ASC 606"), and as such, we recognize revenue in the period in which we satisfy our performance obligations under our contracts by transferring our promised services to our customers in amounts that reflect the consideration to which we expect to be entitled in exchange for providing patient care, which are the transaction prices allocated to the distinct services. The Company's cost of obtaining contracts is not material. Revenues are recognized as performance obligations are satisfied, which varies based on the nature of the services provided. Our performance obligation is the delivery of patient care services in accordance with the nature and frequency of services outlined in physicians' orders, which are determined by a physician based on a patient's specific goals. The Company's performance obligations relate to contracts with a duration of less than one year; therefore, the Company has elected to apply the optional exemption provided by ASC 606 and is not required to disclose the aggregate amount of the transaction price allocated to performance obligations that are unsatisfied or partially unsatisfied as of the end of the reporting period. The unsatisfied or partially unsatisfied performance obligations are generally completed when the patients are discharged, which generally occurs within days or weeks of the end of the reporting period. We determine the transaction price based on gross charges for services provided, reduced by estimates for contractual and non-contractual revenue adjustments. Contractual revenue adjustments are recorded for the difference between our standard rates and the contracted rates to be realized from patients, third party payors and others for services provided. Non-contractual revenue adjustments include discounts provided to self-pay, uninsured patients or other payors, adjustments resulting from payment reviews and adjustments arising from our inability to obtain appropriate billing documentation, authorizations or face-to-face documentation. Subsequent changes to the estimate of the transaction price are recorded as adjustments to net service revenue in the period of change. Non-contractual revenue adjustments are recorded for self-pay, uninsured patients and other payors by major payor class based on our historical collection experience, aged accounts receivable by payor and current economic conditions. The non-contractual revenue adjustments represent the difference between amounts billed and amounts we expect to collect based on our collection history with similar payors. The Company assesses its ability to collect for the healthcare services provided at the time of patient admission based on the Company's verification of the patient's insurance coverage under Medicare, Medicaid, and other commercial or managed care insurance programs. Medicare represents approximately 76% and 75% of the Company's consolidated net service revenue for the three and nine-month periods ended September 30, 2020, respectively, and 74% of the Company's consolidated net service revenue for the three and nine-month periods ended September 30, 2019. Amounts due from third-party payors, primarily commercial health insurers and government programs (Medicare and Medicaid), include variable consideration for retroactive revenue adjustments due to settlements of audits and payment reviews. We determine our estimates for non-contractual revenue adjustments related to payment reviews based on our historical experience and success rates in the claim appeals and adjudication process. We determine our estimates for non-contractual revenue adjustments related to our inability to obtain appropriate billing documentation, authorizations or face-to-face documentation based on our historical experience, which primarily includes a historical collection rate of over 99% on Medicare claims. Revenue is recorded at amounts we estimate to be realizable for services provided. Revenue by payor class as a percentage of total net service revenue is as follows:
Home Health Revenue Recognition Medicare Revenue Effective January 1, 2020, the Centers for Medicare and Medicaid Services ("CMS") implemented a revised case-mix adjustment methodology, the Patient-Driven Groupings Model ("PDGM"), to better align payment with patient care needs and ensure that clinically complex and ill beneficiaries have adequate access to home health care. PDGM uses 30-day periods of care rather than 60-day episodes of care as the unit of payment, eliminates the use of the number of therapy visits provided in determining payment and relies more heavily on clinical characteristics and other patient information. Net service revenue is recorded based on the established Federal Medicare home health payment rate for a 30-day period of care. PDGM uses timing, admission source, functional impairment levels and principal and other diagnoses to case-mix adjust payments. The case-mix adjusted payment for a 30-day period of care is subject to additional adjustments based on certain variables, including, but not limited to (a) an outlier payment if our patient's care was unusually costly (capped at 10% of total reimbursement per provider number); (b) a low utilization payment adjustment (“LUPA”) if the number of visits provided was less than the established threshold, which ranges from two to six visits and varies for every case-mix group under PDGM; (c) a partial payment if a patient transferred to another provider or from another provider before completing the 30-day period of care; and (d) the applicable geographic wage index. Payment for non-routine supplies are now included in the 30-day payment rate. Medicare can also make various adjustments to payments received if we are unable to produce appropriate billing documentation or acceptable authorizations. We estimate the impact of such adjustments based on our historical experience, which primarily includes a historical collection rate of over 99% on Medicare claims, and record this estimate during the period in which services are rendered as a reduction to revenue and a corresponding reduction to patient accounts receivable. Amounts due from Medicare include variable consideration for retroactive revenue adjustments due to settlements of audits and payment reviews. We determine our estimates for non-contractual revenue adjustments related to payment reviews based on our historical experience and success rates in the claim appeals and adjudication process. The Medicare home health benefit requires that beneficiaries be homebound (meaning that the beneficiary is unable to leave their home without a considerable and taxing effort), require intermittent skilled nursing, physical therapy or speech therapy services, and receive treatment under a plan of care established and periodically reviewed by a physician. In order to provide greater flexibility during the novel coronavirus pandemic ("COVID-19"), CMS has relaxed the definition of homebound status. During the pandemic, a beneficiary is considered homebound if they have been instructed by a physician not to leave their home because of a confirmed or suspected COVID-19 diagnosis or if the patient has a condition that makes them more susceptible to contracting COVID-19. Therefore, if a beneficiary is homebound due to COVID-19 and requires skilled services, the services will be covered under the Medicare home health benefit. All Medicare contracts are required to have a signed plan of care which represents a single performance obligation, comprised of the delivery of a series of distinct services that are substantially similar and have a similar pattern of transfer to the customer. Accordingly, the Company accounts for the series of services ("episode") as a single performance obligation satisfied over time, as the customer simultaneously receives and consumes the benefits of the goods and services provided. An episode starts the first day a billable visit is performed and ends 60 days later or upon discharge, if earlier, with multiple continuous episodes allowed. As noted above, under PDGM, we are now reimbursed for 30-day periods of care rather than 60-day episodes of care. ASC 606 notes that if an entity has a right to consideration from a customer in an amount that corresponds directly with the value of the entity’s performance completed to date, the entity may recognize revenue in the amount to which the entity has a right to invoice. We have elected to apply the "right to invoice” practical expedient and therefore, our revenue recognition is based on the reimbursement we are entitled to for each 30-day payment period. We utilize our historical average length of stay for each 30-day period of care as the measure of progress towards the satisfaction of our performance obligation. A portion of reimbursement from each Medicare episode is billed near the start of each 30-day period of care, and cash is typically received before all services are rendered. Any cash received from Medicare for a request for anticipated payment (“RAP”) for a 30-day period of care that exceeds the associated revenue earned is recorded to accrued expenses within our condensed consolidated balance sheets. Non-Medicare Revenue Episodic-based Revenue. We recognize revenue in a similar manner as we recognize Medicare revenue for amounts that are paid by other insurance carriers, including Medicare Advantage programs; however, these amounts can vary based upon the negotiated terms which generally range from 90% to 100% of Medicare rates. Non-episodic based Revenue. Gross revenue is recorded on an accrual basis based upon the date of service at amounts equal to our established or estimated per-visit rates. Contractual revenue adjustments are recorded for the difference between our standard rates and the contracted rates to be realized from patients, third parties and others for services provided and are deducted from gross revenue to determine net service revenue. We also make non-contractual revenue adjustments to non-episodic revenue based on 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. 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 net Medicare hospice service revenue for the three and nine-month periods ended September 30, 2020 and 99% of our total net Medicare hospice service revenue for the three and nine-month periods ended September 30, 2019. There are two separate payment rates for routine care: payments for the first 60 days of care and care beyond 60 days. In addition to the two routine rates, we may also receive a service intensity add-on (“SIA”). The SIA is based on visits made in the last seven days of life by a registered nurse (“RN”) or medical social worker (“MSW”) for patients in a routine level of care. The performance obligation is the delivery of hospice services to the patient, as determined by a physician, each day the patient is on hospice care. We make adjustments to Medicare revenue for non-contractual revenue adjustments, which include our inability to obtain appropriate billing documentation or acceptable authorizations and other reasons unrelated to credit risk. We estimate the impact of these non-contractual revenue adjustments based on our historical experience, which primarily includes a historical collection rate of over 99% on Medicare claims, and record it during the period services are rendered. Additionally, our hospice service revenue is subject to certain limitations on payments from Medicare which are considered variable consideration. We are subject to an inpatient cap limit and an overall Medicare payment cap for each provider number. We monitor these caps on a provider-by-provider basis and estimate amounts due back to Medicare if we estimate a cap has been exceeded. We record these adjustments as a reduction to revenue and an increase in accrued expenses within our condensed consolidated balance sheets. Providers are required to self-report and pay their estimated cap liability by February 28th of the following year. As of September 30, 2020, we have recorded $9.9 million for estimated amounts due back to Medicare in accrued expenses for the Federal cap years ended October 31, 2013 through September 30, 2020; $2.6 million of this balance was acquired with the AseraCare acquisition. As of December 31, 2019, we had recorded $5.7 million for estimated amounts due back to Medicare in accrued expenses for the Federal cap years ended October 31, 2013 through September 30, 2020. Hospice Non-Medicare Revenue Gross revenue is recorded on an accrual basis based upon the date of service at amounts equal to our established rates or estimated per day rates, as applicable. Contractual revenue adjustments are recorded for the difference between our standard rates and the contractual rates to be realized from patients, third party payors and others for services provided and are deducted from gross revenue to determine our net service revenue. We also make non-contractual adjustments to non-Medicare revenue based on our historical experience, to reflect the estimated transaction price. Personal Care Revenue Recognition Personal Care Revenue We generate net service revenues by providing our services directly to patients based on authorized hours, visits or units determined by the relevant agency, at a rate that is either contractual or fixed by legislation. Net service revenue is recognized at the time services are rendered based on gross charges for the services provided, reduced by estimates for contractual and non-contractual revenue adjustments. We receive payment for providing such services from payors, including state and local governmental agencies, managed care organizations, commercial insurers and private consumers. Payors include the following elder service agencies: Aging Services Access Points (ASAPs), Senior Care Options (SCOs), Program of All-Inclusive Care for the Elderly (PACE) and the Veterans Administration (VA). Government Grants In the absence of specific guidance to account for government grants under U.S. GAAP, we have decided to account for government grants in accordance with International Accounting Standard ("IAS") 20, Accounting for Government Grants and Disclosure of Government Assistance, and as such, we recognize grant income on a systematic basis in line with the recognition of expenses or the loss of revenues for which the grants are intended to compensate. We recognize grants once both of the following conditions are met: (1) we are able to comply with the relevant conditions of the grant and (2) the grant will be received. See Note 10 - Novel Coronavirus Pandemic ("COVID-19") for additional information on our accounting for government funds received under the Coronavirus Aid, Relief and Economic Security Act ("CARES Act") and the Mass Home Care ASAP COVID-19 Provider Sustainability Program. Cash, Cash Equivalents and Restricted Cash Cash and cash equivalents include certificates of deposit and all highly liquid debt instruments with maturities of three months or less when purchased. Our cash balance as of September 30, 2020 includes approximately $81 million associated with the CARES Act Provider Relief Fund ("PRF"). We separated the PRF funds into their own account during the three-month period ended June 30, 2020. As of September 30, 2020, we have only transferred funds used during the six-month period ended June 30, 2020 to our operating account. We will transfer funds used during the three-month period ended September 30, 2020 to our operating account in the fourth quarter. Restricted cash includes cash that is not available for ordinary business use. As of September 30, 2020, we had $2.5 million of restricted cash that was placed into escrow accounts related to the indemnity and closing payment adjustment provisions within the Asana Hospice and AseraCare Hospice purchase agreements ($1.5 million and $1.0 million, respectively). Patient Accounts Receivable We report accounts receivable from services rendered at their estimated transaction price, which includes contractual and non-contractual revenue adjustments based on the amounts expected to be due from payors. Our patient accounts receivable are uncollateralized and consist of amounts due from Medicare, Medicaid, other third-party payors and patients. As of September 30, 2020, there is no single payor, other than Medicare, that accounts for more than 10% of our total outstanding patient receivables. 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 represent 63% and 58% of our patient accounts receivable at September 30, 2020 and December 31, 2019, respectively, is limited due to our historical collection rate of over 99% from Medicare and the fact that Medicare is a U.S. government payor. We do not believe there are any significant concentrations of revenues from any payor that would subject us to any significant credit risk in the collection of our accounts receivable. Medicare Home Health For our home health patients, our pre-billing process includes verifying that we are eligible for payment from Medicare for the services that we provide to our patients. Our Medicare billing begins with a process to ensure that our billings are accurate through the utilization of an electronic Medicare claim review. We submit a RAP for 20% of our estimated payment for each 30-day period of care. The full amount of the payment for each 30-day period of care is billed after the period of care has been completed (“final billed”). The RAP received for that billing period is then deducted from our final payment. If a final bill is not submitted within the greater of 90 days from the start of the 30-day period of care, or 60 days from the date the RAP was paid, any RAPs received for that billing period will be recouped by Medicare from any other claims in process for that particular provider number. The RAP claim must then be resubmitted. CMS has mandated the full elimination of RAPs in 2021. Medicare Hospice For our hospice patients, our pre-billing process includes verifying that we are eligible for payment from Medicare for the services that we provide to our patients. Our Medicare billing begins with a process to ensure that our billings are accurate through the utilization of an electronic Medicare claim review. We bill Medicare on a monthly basis for the services provided to the patient. Non-Medicare Home Health, Hospice and Personal Care For our non-Medicare patients, our pre-billing process primarily begins with verifying a patient’s eligibility for services with the applicable payor. Once the patient has been confirmed for eligibility, we will provide services to the patient and bill the applicable payor. Our review and evaluation of non-Medicare accounts receivable includes a detailed review of outstanding balances and special consideration to concentrations of receivables from particular payors or groups of payors with similar characteristics that would subject us to any significant credit risk. Fair Value of Financial Instruments The following details our financial instruments where the carrying value and the fair value differ (amounts in millions):
The fair value hierarchy is based on three levels of inputs, of which the first two are considered observable and the last unobservable, that may be used to measure fair value. The three levels of inputs are as follows: •Level 1 – Quoted prices in active markets for identical assets and liabilities. •Level 2 – Inputs other than Level 1 that are observable, either directly or indirectly, such as quoted prices for similar assets or liabilities; quoted prices in markets that are not active; or other inputs that are observable or can be corroborated by observable market data for substantially the full term of the assets or liabilities. •Level 3 – Unobservable inputs that are supported by little or no market activity and are significant to the fair value of the assets or liabilities. Our deferred compensation plan assets are recorded at fair value and are considered a level 2 measurement. For our other financial instruments, including our cash and cash equivalents, patient accounts receivable, accounts payable, payroll and employee benefits and accrued expenses, we estimate the carrying amounts approximate fair value. Weighted-Average Shares Outstanding Net income per share attributable to Amedisys, Inc. common stockholders, calculated on the treasury stock method, is based on the weighted average number of shares outstanding during the period. The following table sets forth, for the periods indicated, shares used in our computation of the weighted-average shares outstanding, which are used to calculate our basic and diluted net income attributable to Amedisys, Inc. common stockholders (amounts in thousands):
Business Combinations We account for acquisitions using the acquisition method of accounting in accordance with Accounting Standards Codification (“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 and liabilities assumed, 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.
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ACQUISITIONS |
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ACQUISITIONS | ACQUISITIONSWe complete acquisitions from time to time in order to pursue our strategy of increasing our market presence by expanding our service base and enhancing our position in certain geographic areas as a leading provider of home health, hospice and personal care services. The purchase price paid for acquisitions is negotiated through arm’s length transactions, with consideration based on our analysis of, among other things, comparable acquisitions and expected cash flows. Acquisitions are accounted for as purchases and are included in our condensed consolidated financial statements from their respective acquisition dates. Goodwill generated from acquisitions is recognized for the excess of the purchase price over tangible and identifiable intangible assets because of the expected contributions of the acquisitions to our overall corporate strategy. We typically engage outside appraisal firms to assist in the fair value determination of identifiable intangible assets for significant acquisitions. The preliminary purchase price allocation is adjusted, as necessary, up to one year after the acquisition closing date if management obtains more information regarding asset valuations and liabilities assumed. Home Health Division On March 1, 2020, we acquired the regulatory assets of a home health provider in Washington for a purchase price of $3.0 million. The purchase price was paid with cash on hand on the date of the transaction. Based on the Company's preliminary valuation, we recorded goodwill of $2.8 million and other intangibles (certificate of need) of $0.2 million in connection with the acquisition. On April 18, 2020, we acquired the regulatory assets of a home health provider in Kentucky for a purchase price of $0.7 million. The purchase price was paid with cash on hand on the date of the transaction. Based on the Company's preliminary valuation, we recorded goodwill of $0.5 million and other intangibles (certificate of need) of $0.2 million in connection with the acquisition. Hospice Division On January 1, 2020, we acquired Asana Hospice ("Asana"), a hospice provider with locations in Pennsylvania, Ohio, Texas, Missouri and Kansas for a purchase price of $66.3 million, net of cash acquired of $0.7 million. Under the purchase agreement, the purchase price was subject to a net working capital adjustment, whereby the purchase price would be adjusted to the extent the actual net working capital of Asana as of the closing differed from the required net working capital under the purchase agreement. The net working capital adjustment, which was finalized during the three-month period ended June 30, 2020, reduced the purchase price by $0.7 million, from $66.3 million to $65.6 million. The Company is in the process of finalizing its valuation of the assets acquired and liabilities assumed. During the three-month period ended September 30, 2020, we recorded measurement period adjustments based on changes to management's estimates and assumptions related to the assets acquired and liabilities assumed. Based on the Company's preliminary valuation, the total estimated consideration of $65.6 million has been allocated to assets acquired and liabilities assumed as of the acquisition date as follows (amounts in millions):
Intangible assets acquired include licenses ($2.0 million), acquired names ($1.3 million) and non-compete agreements ($2.3 million). The acquired names and non-compete agreements will be amortized over a weighted-average period of 2.0 years. Asana contributed approximately $4.6 million in net service revenue and an operating loss of $1.0 million (inclusive of acquisition and integration costs totaling $0.3 million and intangibles amortization totaling $0.7 million) during the three-month period ended September 30, 2020 and $19.0 million in net service revenue and an operating loss of $3.2 million (inclusive of acquisition and integration costs totaling $1.8 million and intangibles amortization totaling $2.1 million) during the nine-month period ended September 30, 2020. On June 1, 2020, we acquired Homecare Preferred Choice, Inc., doing business as AseraCare Hospice ("AseraCare"), a national hospice care provider with 44 locations, for an estimated purchase price of $230.4 million, net of cash acquired and inclusive of a $32 million tax asset. The closing payment for the purchase price included estimates for cash, working capital and various other items. Under the purchase agreement, the purchase price was subject to a closing payment adjustment for any differences between estimated amounts included in the closing payment and actual amounts at close, not to exceed $1.0 million. The closing payment adjustment, which was finalized during October 2020, reduced the purchase price by $0.8 million, from $230.4 million to $229.6 million. The Company is in the process of reviewing the fair value of the assets acquired and liabilities assumed. During the three-month period ended September 30, 2020, we recorded measurement period adjustments based on changes to management's estimates and assumptions related to the assets acquired and liabilities assumed. Based on the Company's preliminary valuation, the total estimated consideration of $229.6 million has been allocated to assets acquired and liabilities assumed as of the acquisition date as follows (amounts in millions):
Intangible assets acquired include licenses ($9.4 million), acquired names ($5.7 million) and non-compete agreements ($9.2 million). The acquired names will be amortized over a weighted-average period of 2.0 years and the non-compete agreements will be amortized over a weighted-average period of 1.7 years. AseraCare contributed approximately $28.2 million in net service revenue and an operating loss of $3.8 million (inclusive of acquisition and integration costs totaling $3.2 million and intangibles amortization totaling $2.7 million) during the three-month period ended September 30, 2020 and $37.4 million in net service revenue and an operating loss of $6.8 million (inclusive of acquisition and integration costs totaling $6.5 million and intangibles amortization totaling $2.9 million) during the nine-month period ended September 30, 2020. The following table contains unaudited pro forma condensed consolidated statement of operations information for the three and nine-month periods ended September 30, 2020 and 2019 assuming that the AseraCare acquisition closed on January 1, 2019 (amounts in millions, except per share data). The pro forma financial information includes various assumptions, including those related to the preliminary purchase price allocation of assets acquired and liabilities assumed. The pro forma financial information may vary in future quarters based on the final valuations and analysis of the fair value of the assets acquired and liabilities assumed.
The pro forma information presented above includes adjustments for (i) amortization of identifiable intangible assets, (ii) interest on additional debt required to fund the acquisition, (iii) non-recurring transaction costs and (iv) income taxes based on the Company's statutory tax rate. This pro forma information is presented for illustrative purposes only and may not be indicative of the results of operations that would have actually occurred. In addition, future results may vary significantly from the results reflected in the pro forma information.
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LONG-TERM OBLIGATIONS |
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Debt Disclosure [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
LONG-TERM OBLIGATIONS | LONG-TERM OBLIGATIONS Long-term debt consists of the following for the periods indicated (amounts in millions):
First Amendment to Amended and Restated Credit Agreement On February 4, 2019, we entered into the First Amendment to our Credit Agreement (as amended by the First Amendment, the "Amended Credit Agreement"). The Amended Credit Agreement provides for a senior secured credit facility in an initial aggregate principal amount of up to $725.0 million, which includes a $550.0 million Revolving Credit Facility under the Credit Agreement and a term loan facility with a principal amount of up to $175.0 million (the "Term Loan Facility" and collectively with the Revolving Credit Facility, the "Credit Facility"), which was added by the First Amendment. We borrowed the entire principal amount of the Term Loan Facility on February 4, 2019 in order to fund a portion of the purchase price of the Compassionate Care Hospice ("CCH") acquisition, with the remainder of the purchase price and associated transactional fees and expenses funded by proceeds from the Revolving Credit Facility. The loans issued under the Credit Facility bear interest on a per annum basis, at our election, at either: (i) the Base Rate plus the Applicable Rate or (ii) the Eurodollar Rate plus the Applicable Rate. The “Base Rate” means a fluctuating rate per annum equal to the highest of (a) the federal funds rate plus 0.50% per annum, (b) the prime rate of interest established by the Administrative Agent, and (c) the Eurodollar Rate plus 1% per annum. The “Eurodollar Rate” means the quoted rate per annum equal to the London Interbank Offered Rate (“LIBOR”) or a comparable successor rate approved by the Administrative Agent for an interest period of one, two, three or six months (as selected by us). The “Applicable Rate” is based on the consolidated leverage ratio and is presented in the table below. As of September 30, 2020, the Applicable Rate is 0.50% per annum for Base Rate loans and 1.50% per annum for Eurodollar Rate loans. We are also subject to a commitment fee and letter of credit fee under the terms of the Amended Credit Agreement, as presented in the table below.
The final maturity date of the Credit Facility is February 4, 2024. The Revolving Credit Facility will terminate and be due and payable as of the final maturity date. The Term Loan Facility, however, is subject to quarterly amortization of principal in the amount of (i) 0.625% for the period commencing on February 4, 2019 and ending on March 31, 2020, (ii) 1.250% for the period commencing on April 1, 2020 and ending on March 31, 2023, and (iii) 1.875% for the period commencing on April 1, 2023 and ending on February 4, 2024. The remaining balance of the Term Loan Facility must be paid upon the final maturity date. In addition to the scheduled amortization of the Term Loan Facility, and subject to customary exceptions and reinvestment rights, we are required to prepay the Term Loan Facility, first, and the Revolving Credit Facility, second, with 100% of all net cash proceeds received by any loan party or any subsidiary thereof in connection with (a) any asset sale or disposition where such loan party receives net cash proceeds in excess of $5 million or (b) any debt issuance that is not permitted under the Amended Credit Agreement. The Amended Credit Agreement requires maintenance of two financial covenants: (i) a consolidated leverage ratio of funded indebtedness to Earnings Before Interest, Taxes, Depreciation and Amortization ("EBITDA"), as defined in the Amended Credit Agreement, and (ii) a consolidated interest coverage ratio of EBITDA to cash interest charges, as defined in the Amended Credit Agreement. Each of these covenants is calculated over rolling four-quarter periods and also is subject to certain exceptions and baskets. The Amended Credit Agreement also contains customary covenants, including, but not limited to, restrictions on: incurrence of liens, incurrence of additional debt, sales of assets and other fundamental corporate changes, investments, and declarations of dividends. These covenants contain customary exclusions and baskets as detailed in the Amended Credit Agreement. In connection with our entry into the Amended Credit Agreement, we recorded $0.8 million in deferred debt issuance costs as long-term obligations, less current portion within our condensed consolidated balance sheet during the year ended December 31, 2019. The Revolving Credit Facility is guaranteed by substantially all of our wholly-owned direct and indirect subsidiaries. The Amended Credit Agreement requires at all times that we (i) provide guarantees from wholly-owned subsidiaries that in the aggregate represent not less than 95% of our consolidated net revenues and adjusted EBITDA from all wholly-owned subsidiaries and (ii) provide guarantees from subsidiaries that in the aggregate represent not less than 70% of consolidated adjusted EBITDA, subject to certain exceptions. Our weighted average interest rate for borrowings under our $550.0 million Revolving Credit Facility was 1.8% and 2.2% for the three and nine-month periods ended September 30, 2020, respectively, and 3.8% and 3.9% for the three and nine-month periods ended September 30, 2019, respectively. Our weighted average interest rate for borrowings under our $175.0 million Term Loan Facility was 1.7% and 2.3% for the three and nine-month periods ended September 30, 2020, respectively, and 3.7% and 3.9% for the three-month period ended September 30, 2019 and for the period February 4, 2019 to September 30, 2019, respectively. As of September 30, 2020, our consolidated leverage ratio was 1.0, our consolidated interest coverage ratio was 18.9 and we are in compliance with our covenants under the Amended Credit Agreement. In the event we are not in compliance with our debt covenants in the future, we would pursue various alternatives in an attempt to successfully resolve the non-compliance, which might include, among other things, seeking debt covenant waivers or amendments. As of September 30, 2020, our availability under our $550.0 million Revolving Credit Facility was $376.2 million as we have $145.0 million outstanding in borrowings and $28.8 million outstanding in letters of credit. Joinder Agreements In connection with the CCH acquisition, we entered into a Joinder Agreement, dated as of February 4, 2019 (the “CCH Joinder”), pursuant to which CCH and its subsidiaries were made parties to, and became subject to the terms and conditions of, the Amended Credit Agreement, the Amended and Restated Security Agreement, dated as of June 29, 2018 (the “Amended and Restated Security Agreement”), and the Amended and Restated Pledge Agreement, dated as of June 29, 2018 (the “Amended and Restated Pledge Agreement”). In connection with the AseraCare acquisition, we entered into a Joinder Agreement, dated as of June 12, 2020, pursuant to which the AseraCare entities were made parties to, and became subject to the terms and conditions of, the Amended Credit Agreement, the Amended and Restated Security Agreement and the Amended and Restated Pledge Agreement (the “AseraCare Joinder,” and together with the CCH Joinder, the “Joinders”). Pursuant to the Joinders, the Amended and Restated Security Agreement and the Amended and Restated Pledge Agreement, CCH and its subsidiaries and the AseraCare entities granted in favor of the Administrative Agent a first lien security interest in substantially all of their personal property assets and pledged to the Administrative Agent each of their respective subsidiaries' issued and outstanding equity interests. CCH and its subsidiaries and the AseraCare entities also guaranteed our obligations, whether now existing or arising after the respective effective dates of the Joinders, under the Amended Credit Agreement pursuant to the terms of the Joinders and the Amended Credit Agreement.
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COMMITMENTS AND CONTINGENCIES |
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Commitments and Contingencies Disclosure [Abstract] | |
COMMITMENTS AND CONTINGENCIES | COMMITMENTS AND CONTINGENCIES Legal Proceedings - Ongoing We are involved in the following legal actions: Subpoena Duces Tecum and Civil Investigative Demands Issued by the U.S. Department of Justice On May 21, 2015, we received a Subpoena Duces Tecum (“Subpoena”) issued by the U.S. Department of Justice. The Subpoena requests the delivery of information regarding 53 identified hospice patients to the United States Attorney’s Office for the District of Massachusetts. It also requests the delivery of documents relating to our hospice clinical and business operations and related compliance activities. The Subpoena generally covers the period from January 1, 2011 through May 21, 2015. We are fully cooperating with the U.S. Department of Justice with respect to this investigation. On November 3, 2015, we received a civil investigative demand (“CID”) issued by the U.S. Department of Justice pursuant to the federal False Claims Act relating to claims submitted to Medicare and/or Medicaid for hospice services provided through designated facilities in the Morgantown, West Virginia area. The CID requests the delivery of information to the United States Attorney’s Office for the Northern District of West Virginia regarding 66 identified hospice patients, as well as documents relating to our hospice clinical and business operations in the Morgantown area. The CID generally covers the period from January 1, 2009 through August 31, 2015. We are fully cooperating with the U.S. Department of Justice with respect to this investigation. On June 27, 2016, we received a CID issued by the U.S. Department of Justice pursuant to the federal False Claims Act relating to claims submitted to Medicare and/or Medicaid for hospice services provided through designated facilities in the Parkersburg, West Virginia area. The CID requests the delivery of information to the United States Attorney’s Office for the Southern District of West Virginia regarding 68 identified hospice patients, as well as documents relating to our hospice clinical and business operations in the Parkersburg area. The CID generally covers the period from January 1, 2011 through June 20, 2016. We are fully cooperating with the U.S. Department of Justice with respect to this investigation. Based on our analysis of sample claims data in connection with preliminary settlement discussions with the U.S. Department of Justice regarding the above matters, we have recorded a total of $6.5 million to accrued expenses in our condensed consolidated balance sheets related to these matters. Due to the ongoing nature of the investigations and current stage of the settlement discussions, we are unable to estimate a range of potential loss at this time, and we cannot predict the timing or outcome of these investigations. In addition to the matters referenced in this note, we are involved in legal actions in the normal course of business, some of which seek monetary damages, including claims for punitive damages. Based on information available to us as of the date of this filing, we do not believe that these normal course actions, when finally concluded and determined, will have a material impact on our consolidated financial condition, results of operations or cash flows. Legal fees related to all legal matters are expensed as incurred. Other Investigative Matters - Ongoing Compassionate Care Hospice Corporate Integrity Agreement On January 30, 2015, CCH entered into a corporate integrity agreement ("CIA") with the Office of Inspector General-HHS (“OIG”). The CIA required that CCH provide annual on-site compliance training; develop and implement policies to ensure compliance with federal health care program requirements; screen new and current employees to ensure that they are eligible to participate in federal health care programs; establish a compliance committee that contains both a Compliance Officer and a Chief Quality Officer; retain a Governing Authority expert who will periodically complete a compliance program review; and retain an independent review organization ("IRO") to complete claims reviews for hospice services rendered in New York. The OIG waived the claims review for the final year of the CCH CIA based on the closure of the New York operations. Additionally, the CIA required that CCH report substantial overpayments that CCH discovered it had received from federal health care programs, as well as probable violations of federal criminal, civil or administrative health care laws. Upon breach of the CIA, CCH could have become liable for payment of certain stipulated penalties, or could have been excluded from participation in federal health care programs. The CIA had a term of five years that ended on January 30, 2020. We filed our final annual report on March 25, 2020. Other Investigative Matters - Completed Corporate Integrity Agreement On April 23, 2014, with no admissions of liability on our part, we entered into a settlement agreement with the U.S. Department of Justice relating to certain of our clinical and business operations. Concurrently with our entry into this agreement, we entered into a CIA with the OIG. The CIA formalized various aspects of our already existing ethics and compliance programs and contained other requirements designed to help ensure our ongoing compliance with federal health care program requirements. Among other things, the CIA required us to maintain our existing compliance program, executive compliance committee and compliance committee of the Board of Directors; provide certain compliance training; continue screening new and current employees to ensure they are eligible to participate in federal health care programs; engage an IRO to perform certain auditing and reviews and prepare certain reports regarding our compliance with federal health care programs, our billing submissions to federal health care programs and our compliance and risk mitigation programs; and provide certain reports and management certifications to the OIG. Additionally, the CIA specifically required that we report substantial overpayments that we discovered we had received from federal health care programs, as well as probable violations of federal health care laws. The corporate integrity agreement had a term of five years that ended on April 21, 2019. We filed our final annual report on July 19, 2019. On May 5, 2020, the Company received notice from the OIG that the Company's five-year CIA with the OIG has been completed. Third Party Audits - Ongoing From time to time, in the ordinary course of business, we are subject to audits under various governmental programs including Recovery Audit Contractors (“RACs”), Zone Program Integrity Contractors (“ZPICs”), Uniform Program Integrity Contractors ("UPICs"), Program Safeguard Contractors (“PSCs”) and Medicaid Integrity Contributors (“MICs”) in which third party firms engaged by CMS conduct extensive reviews of claims data to identify potential improper payments. We cannot predict the ultimate outcome of any regulatory reviews or other governmental audits and investigations. In July 2010, our subsidiary that provides hospice services in Florence, South Carolina received from a ZPIC a request for records regarding a sample of 30 beneficiaries who received services from the subsidiary during the period of January 1, 2008 through March 31, 2010 (the “Review Period”) to determine whether the underlying services met pertinent Medicare payment requirements. We acquired the hospice operations subject to this review on August 1, 2009; the Review Period covers time periods both before and after our ownership of these hospice operations. Based on the ZPIC’s findings for 16 beneficiaries, which were extrapolated to all claims for hospice services provided by the Florence subsidiary billed during the Review Period, on June 6, 2011, the Medicare Administrative Contractor (“MAC”) for the subsidiary issued a notice of overpayment seeking recovery from our subsidiary of an alleged overpayment. We dispute these findings, and our Florence subsidiary has filed appeals through the Original Medicare Standard Appeals Process, in which we are seeking to have those findings overturned. An administrative law judge ("ALJ") hearing was held in early January 2015. On January 18, 2016, we received a letter dated January 6, 2016 referencing the ALJ hearing decision for the overpayment issued on June 6, 2011. The decision was partially favorable with a new overpayment amount of $3.7 million with a balance owed of $5.6 million, including interest, based on 9 disputed claims (originally 16). We filed an appeal to the Medicare Appeals Council on the remaining 9 disputed claims and also argued that the statistical method used to select the sample was not valid. No assurances can be given as to the timing or outcome of the Medicare Appeals Council decision. As of September 30, 2020, Medicare has withheld payments of $5.7 million (including additional interest) as part of their standard procedures once this level of the appeal process has been reached. In the event we are not able to recoup this alleged overpayment, we are entitled to be indemnified by the prior owners of the hospice operations for amounts relating to the period prior to August 1, 2009. On January 10, 2019, an arbitration panel from the American Health Lawyers Association determined that the prior owners' liability for their indemnification obligation was $2.8 million. This amount is recorded as an indemnity receivable within other assets in our condensed consolidated balance 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 covers time periods both before and after our ownership of the care centers, which were acquired on December 31, 2015. In August 2017, the Company received Requests for Repayment from Palmetto GBA, LLC ("Palmetto") regarding Infinity Home Care of Lakeland, LLC ("Lakeland Care Centers") and Infinity Home Care of Pinellas, LLC ("Clearwater Care Center"). The Palmetto letters are based on a statistical extrapolation performed by SafeGuard which alleged an overpayment of $34.0 million for the Lakeland Care Centers on a universe of 72 Medicare claims totaling $0.2 million in actual claims payments using a 100% error rate and an overpayment of $4.8 million for the Clearwater Care Center on a universe of 70 Medicare claims totaling $0.2 million in actual claims payments using a 100% error rate. The Lakeland Request for Repayment covers claims between January 2, 2014 and September 13, 2016. The Clearwater Request for Repayment covers claims between January 2, 2015 and December 9, 2016. As a result of partially successful Level I and Level II Administrative Appeals, the alleged overpayment for the Lakeland Care Centers has been reduced to $26.0 million and the alleged overpayment for the Clearwater Care Center has been reduced to $3.3 million. The Company has now filed Level III Administrative Appeals, and will continue to vigorously pursue its appeal rights, which include contesting the methodology used by the ZPIC contractor to perform statistical extrapolation. The Company is contractually entitled to indemnification by the prior owners for all claims prior to December 31, 2015, for up to $12.6 million. At this stage of the review, based on the information currently available to the Company, the Company cannot predict the timing or outcome of this review. The Company estimates a low-end potential range of loss related to this review of $6.5 million (assuming the Company is successful in seeking indemnity from the prior owners and unsuccessful in demonstrating that the extrapolation method used by SafeGuard was erroneous). The Company has reduced its high-end potential range of loss from $38.8 million (the maximum amount Palmetto claims has been overpaid for both the Lakeland Care Centers and the Clearwater Care Center, of which amount $12.6 million is subject to indemnification by the prior owners) to $29.3 million based on the partial success achieved by the Company in prosecuting its Level I and II Administrative Appeals. As of September 30, 2020, we have an accrued liability of approximately $17.4 million related to this matter. We expect to be indemnified by the prior owners for approximately $10.9 million of the total $12.6 million available indemnification related to this matter and have recorded this amount within other assets in our condensed consolidated balance sheets. The net of these two amounts, $6.5 million, was recorded as a reduction in revenue in our condensed consolidated statements of operations during 2017. As of September 30, 2020, $1.5 million of receivables have been impacted by this payment suspension. Insurance We are obligated for certain costs associated with our insurance programs, including employee health, workers’ compensation and professional liability. While we maintain various insurance programs to cover these risks, we are self-insured for a substantial portion of our potential claims. We recognize our obligations associated with these costs, up to specified deductible limits in the period in which a claim is incurred, including with respect to both reported claims and claims incurred but not reported. These costs have generally been estimated based on historical data of our claims experience. Such estimates, and the resulting reserves, are reviewed and updated by us on a quarterly basis. Our health insurance has an exposure limit of $1.3 million for any individual covered life. Our workers’ compensation insurance has a retention limit of $1.0 million per incident and our professional liability insurance has a retention limit of $0.3 million per incident.
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SEGMENT INFORMATION |
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Segment Reporting [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
SEGMENT INFORMATION | SEGMENT INFORMATIONOur operations involve servicing patients through our three reportable business segments: home health, hospice and personal care. Our home health segment delivers a wide range of services in the homes of individuals who may be recovering from surgery, have a chronic disability or terminal illness or need assistance with completing important personal tasks. Our hospice segment provides palliative care and comfort to terminally ill patients and their families. Our personal care segment provides patients with assistance with the essential activities of daily living. The “other” column in the following tables consists of costs relating to executive management and administrative support functions, primarily information services, accounting, finance, billing and collections, legal, compliance, risk management, procurement, marketing, clinical administration, training, human resources and administration. Management evaluates performance and allocates resources based on the operating income of the reportable segments, which includes an allocation of corporate expenses directly attributable to the specific segment and includes revenues and all other costs directly attributable to the specific segment. Segment assets are not reviewed by the company’s chief operating decision maker and therefore are not disclosed below (amounts in millions).
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Compensation Related Costs, Share Based Payments |
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Sep. 30, 2020 | |
Share-based Payment Arrangement [Abstract] | |
CAPITAL STOCK AND SHARE-BASED COMPENSATION | CAPITAL STOCK AND SHARE-BASED COMPENSATIONOn August 10, 2020, Paul B. Kusserow, President, Chief Executive Officer and Chairman of the Board of Amedisys, exercised 500,000 stock options previously awarded to him under our 2008 Omnibus Incentive Compensation Plan. In connection with the exercise, Mr. Kusserow surrendered 231,683 shares of common stock to us to satisfy tax withholding and strike price obligations and elected to hold the net 268,317 shares issued to him. The surrendered shares are classified as treasury shares. This transaction resulted in a cash outflow of $40.4 million, reflected within financing activities in our condensed consolidated statement of cashflows, related to the remittance of tax withholding obligations on Mr. Kusserow's behalf. In addition, Mr. Kusserow's stock option exercise resulted in a $24.0 million income tax benefit that was recorded in our condensed consolidated statement of operations during the three-month period ended September 30, 2020. We recognize compensation expense for stock option awards on a straight-line basis over the requisite service period for each separately vesting portion of the award in accordance with ASC 718, Compensation: Stock Compensation; however, the income tax deduction related to stock options is not recognized until the stock option exercise date. As a result, for awards that are expected to result in a tax deduction, a deferred tax asset is created as the entity recognizes compensation expense for GAAP purposes. If the tax deduction exceeds the cumulative GAAP compensation expense for the award, the tax benefit associated with any excess deduction is recognized as an income tax benefit in the statement of operations. |
SHARE REPURCHASE SHARE REPURCHASE |
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Sep. 30, 2020 | |
Equity [Abstract] | |
SHARE REPURCHASE | SHARE REPURCHASE 2019 Stock Repurchase Program On February 25, 2019, we announced that our Board of Directors authorized a stock repurchase program, under which we could have repurchased up to $100 million of our outstanding common stock through March 1, 2020. We did not repurchase any shares pursuant to this stock repurchase program during 2020. The stock repurchase program expired on March 1, 2020.
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RELATED PARTY TRANSACTIONS RELATED PARTY TRANSACTIONS |
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Sep. 30, 2020 | |
Related Party Transactions [Abstract] | |
RELATED PARTY TRANSACTIONS | RELATED PARTY TRANSACTIONSDuring 2018, we made a $7.0 million investment in Medalogix, a healthcare predictive data and analytics company; this investment is accounted for under the equity method. We incurred costs of approximately $1.1 million and $2.2 million during the three and nine-month periods ended September 30, 2020, respectively, and approximately $0.1 million and $0.2 million during the three and nine-month periods ended September 30, 2019, respectively, in connection with the usage of Medalogix's analytics platforms. We believe that the terms of these transactions are consistent with those negotiated at arm's length. |
Extraordinary and Unusual Items |
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COVID-19 | NOVEL CORONAVIRUS PANDEMIC ("COVID-19") In March 2020, the World Health Organization declared COVID-19 a pandemic. As a healthcare at home company, we have been and will continue to be impacted by the effects of COVID-19; however, we remain committed to carrying out our mission of caring for our patients. We will continue to closely monitor the impact of COVID-19 on all aspects of our business, including the impacts to our employees, patients and suppliers; however, at this time, we are unable to estimate the ultimate impact the pandemic will have on our consolidated financial condition, results of operations or cash flows. On March 27, 2020, the CARES Act was signed into legislation. The CARES Act provides for $175 billion to healthcare providers, including hospitals on the front lines of the COVID-19 pandemic. Of this total allocated amount, $30 billion was distributed immediately to providers based on their proportionate share of Medicare fee-for-service reimbursements in 2019. Healthcare providers were required to sign an attestation confirming receipt of the Provider Relief Fund ("PRF") funds and agree to the terms and conditions of payment. Our home health and hospice segments received approximately $100 million from the first $30 billion of funds distributed to healthcare providers in April 2020, which is inclusive of $2 million related to our joint venture care centers (equity method investments). We also acquired approximately $5 million of PRF funds in connection with the acquisition of AseraCare. Consistent with the terms and conditions for receipt of the payment, we are allowed to use the funds to cover lost revenues (defined as a negative change in year over year net patient care revenue) and health care costs related to COVID-19, and we are required to properly and fully document the use of these funds in reports to the U.S. Department of Health and Human Services ("HHS"). For our wholly-owned subsidiaries, we have decided to only utilize PRF funds to the extent we have qualifying COVID-19 expenses, which totaled $5 million and $27 million for our home health and hospice segments during the three and nine-month periods ended September 30, 2020, respectively. Accordingly, for our wholly-owned subsidiaries, we will not be using PRF funds to cover lost revenues resulting from COVID-19. The grant income associated with the COVID-19 expenses incurred to date is reflected in other operating income within our condensed consolidated statement of operations. HHS issued new guidance in September 2020 noting that PRF funds can be used towards lost revenues or expenses attributable to COVID-19 through June 30, 2021. Our estimate as of the end of the second quarter only reflected usage of the funds through December 31, 2020. As a result, we have increased our estimate of the funds that we intend to use going forward by $10 million to cover the additional six month period. Consistent with prior quarter, we do not believe that we will fully utilize the funds received; therefore, we recorded a liability related to the funds that we do not expect to utilize totaling $60 million which is reflected in the Provider Relief Fund Advance account in current liabilities within our condensed consolidated balance sheet. Funds that we intend to use in the future to cover COVID-19 expenses, which we have estimated to be approximately $17 million, have been recorded to a deferred liability account within accrued expenses in our condensed consolidated balance sheet. These estimates may change as our ability to utilize and retain the funds will depend on the magnitude, timing and nature of the impact of the pandemic. In summary, the total funds that we have received from the CARES Act PRF have been accounted for as follows as of September 30, 2020 (amounts in millions):
On April 24, 2020, HHS distributed an additional $18 billion in funds to healthcare providers. We did not receive, nor apply, for any additional funds from this second distribution. On October 1, 2020, HHS announced $20 billion in new funding to healthcare providers under the Phase 3 general distribution. We have not applied for any additional funds from this distribution. The CARES Act also provides for the temporary suspension of the automatic 2% reduction of Medicare claim reimbursements (sequestration) for the period May 1 through December 31, 2020 and the deferral of the employer share of social security tax (6.2%), effective for payments due after the enactment date. Fifty percent of the deferred payroll taxes are due on December 31, 2021 with the remaining amounts due on December 31, 2022. As of September 30, 2020, we have deferred $38.5 million of social security taxes; this amount is included in other long-term obligations within our condensed consolidated balance sheet. Our personal care segment did not receive funds under the CARES Act; however, they did receive funds from the Mass Home Care ASAP COVID-19 Provider Sustainability Program, which are intended to cover costs related to the public health emergency. The grant income associated with the funds received, which totaled less than $1 million and $1 million during the three and nine-month periods ended September 30, 2020, respectively, is reflected in other operating income within our condensed consolidated statement of operations.
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SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Policies) |
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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. This report should be read in conjunction with our consolidated financial statements and related notes included in our Annual Report on Form 10-K for the year ended December 31, 2019, as filed with the Securities and Exchange Commission (“SEC”) on February 19, 2020 (the “Form 10-K”), which includes information and disclosures not included herein.
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Recent Accounting Pronouncements | Recently Adopted Accounting Pronouncements In June 2016, the Financial Accounting Standards Board ("FASB") issued Accounting Standards Update ("ASU") 2016-13, Financial Instruments - Credit Losses (Topic 326), which provides guidance for measuring credit losses on financial instruments. Our adoption of this standard on January 1, 2020 did not have a material effect on our condensed consolidated financial statements. Recently Issued Accounting Pronouncements In December 2019, the FASB issued ASU 2019-12, Income Taxes (Topic 740) - Simplifying the Accounting for Income Taxes, which simplifies the accounting for income taxes by removing certain exceptions to the general principles in Topic 740 and improves consistent application by clarifying and amending existing guidance. The ASU is effective for annual and interim periods beginning after December 15, 2020. Early adoption is permitted. While the Company does not expect a material impact upon adoption of ASU 2019-12, we are still evaluating the effect the standard will have on our consolidated financial statements and related disclosures and ongoing financial reporting.
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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.
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Principles of Consolidation | Principles of Consolidation These unaudited condensed consolidated financial statements include the accounts of Amedisys, Inc. and our wholly owned subsidiaries. All significant intercompany accounts and transactions have been eliminated in our accompanying unaudited condensed consolidated financial statements, and business combinations accounted for as purchases have been included in our unaudited condensed consolidated financial statements from their respective dates of acquisition. In addition to our wholly owned subsidiaries, we also have certain equity investments that are accounted for as set forth below.
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Investments | Investments We consolidate investments when the entity is a variable interest entity and we are the primary beneficiary or if we have controlling interests in the entity, which is generally ownership in excess of 50%. Third party equity interests in our consolidated joint ventures are reflected as noncontrolling interests in our condensed consolidated financial statements. 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 variable interest entity in which we are the primary beneficiary. During the three-month period ended June 30, 2020, we sold our investment in the Heritage Healthcare Innovation Fund, LP via a secondary transaction for $17.9 million which resulted in a $3.0 million loss which is reflected in miscellaneous, net within our condensed consolidated statements of operations for the nine-month period ended September 30, 2020. The Company's original investment was made in 2010 and no longer fit within our strategic areas of focus. Proceeds from the sale were used to pay down debt and fund operations. The book value of investments that we account for under the equity method of accounting was $14.2 million and $35.7 million as of September 30, 2020 and December 31, 2019, respectively, and is reflected in other assets within our condensed consolidated balance sheet.
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Revenue Recognition | Revenue Recognition We account for revenue from contracts with customers in accordance with ASU 2014-09, Revenue from Contracts with Customers (Topic 606) and ASU 2015-14, Revenue from Contracts with Customers (Topic 606): Deferral of the Effective Date (collectively, "ASC 606"), and as such, we recognize revenue in the period in which we satisfy our performance obligations under our contracts by transferring our promised services to our customers in amounts that reflect the consideration to which we expect to be entitled in exchange for providing patient care, which are the transaction prices allocated to the distinct services. The Company's cost of obtaining contracts is not material. Revenues are recognized as performance obligations are satisfied, which varies based on the nature of the services provided. Our performance obligation is the delivery of patient care services in accordance with the nature and frequency of services outlined in physicians' orders, which are determined by a physician based on a patient's specific goals. The Company's performance obligations relate to contracts with a duration of less than one year; therefore, the Company has elected to apply the optional exemption provided by ASC 606 and is not required to disclose the aggregate amount of the transaction price allocated to performance obligations that are unsatisfied or partially unsatisfied as of the end of the reporting period. The unsatisfied or partially unsatisfied performance obligations are generally completed when the patients are discharged, which generally occurs within days or weeks of the end of the reporting period. We determine the transaction price based on gross charges for services provided, reduced by estimates for contractual and non-contractual revenue adjustments. Contractual revenue adjustments are recorded for the difference between our standard rates and the contracted rates to be realized from patients, third party payors and others for services provided. Non-contractual revenue adjustments include discounts provided to self-pay, uninsured patients or other payors, adjustments resulting from payment reviews and adjustments arising from our inability to obtain appropriate billing documentation, authorizations or face-to-face documentation. Subsequent changes to the estimate of the transaction price are recorded as adjustments to net service revenue in the period of change. Non-contractual revenue adjustments are recorded for self-pay, uninsured patients and other payors by major payor class based on our historical collection experience, aged accounts receivable by payor and current economic conditions. The non-contractual revenue adjustments represent the difference between amounts billed and amounts we expect to collect based on our collection history with similar payors. The Company assesses its ability to collect for the healthcare services provided at the time of patient admission based on the Company's verification of the patient's insurance coverage under Medicare, Medicaid, and other commercial or managed care insurance programs. Medicare represents approximately 76% and 75% of the Company's consolidated net service revenue for the three and nine-month periods ended September 30, 2020, respectively, and 74% of the Company's consolidated net service revenue for the three and nine-month periods ended September 30, 2019. Amounts due from third-party payors, primarily commercial health insurers and government programs (Medicare and Medicaid), include variable consideration for retroactive revenue adjustments due to settlements of audits and payment reviews. We determine our estimates for non-contractual revenue adjustments related to payment reviews based on our historical experience and success rates in the claim appeals and adjudication process. We determine our estimates for non-contractual revenue adjustments related to our inability to obtain appropriate billing documentation, authorizations or face-to-face documentation based on our historical experience, which primarily includes a historical collection rate of over 99% on Medicare claims. Revenue is recorded at amounts we estimate to be realizable for services provided. Revenue by payor class as a percentage of total net service revenue is as follows:
Home Health Revenue Recognition Medicare Revenue Effective January 1, 2020, the Centers for Medicare and Medicaid Services ("CMS") implemented a revised case-mix adjustment methodology, the Patient-Driven Groupings Model ("PDGM"), to better align payment with patient care needs and ensure that clinically complex and ill beneficiaries have adequate access to home health care. PDGM uses 30-day periods of care rather than 60-day episodes of care as the unit of payment, eliminates the use of the number of therapy visits provided in determining payment and relies more heavily on clinical characteristics and other patient information. Net service revenue is recorded based on the established Federal Medicare home health payment rate for a 30-day period of care. PDGM uses timing, admission source, functional impairment levels and principal and other diagnoses to case-mix adjust payments. The case-mix adjusted payment for a 30-day period of care is subject to additional adjustments based on certain variables, including, but not limited to (a) an outlier payment if our patient's care was unusually costly (capped at 10% of total reimbursement per provider number); (b) a low utilization payment adjustment (“LUPA”) if the number of visits provided was less than the established threshold, which ranges from two to six visits and varies for every case-mix group under PDGM; (c) a partial payment if a patient transferred to another provider or from another provider before completing the 30-day period of care; and (d) the applicable geographic wage index. Payment for non-routine supplies are now included in the 30-day payment rate. Medicare can also make various adjustments to payments received if we are unable to produce appropriate billing documentation or acceptable authorizations. We estimate the impact of such adjustments based on our historical experience, which primarily includes a historical collection rate of over 99% on Medicare claims, and record this estimate during the period in which services are rendered as a reduction to revenue and a corresponding reduction to patient accounts receivable. Amounts due from Medicare include variable consideration for retroactive revenue adjustments due to settlements of audits and payment reviews. We determine our estimates for non-contractual revenue adjustments related to payment reviews based on our historical experience and success rates in the claim appeals and adjudication process. The Medicare home health benefit requires that beneficiaries be homebound (meaning that the beneficiary is unable to leave their home without a considerable and taxing effort), require intermittent skilled nursing, physical therapy or speech therapy services, and receive treatment under a plan of care established and periodically reviewed by a physician. In order to provide greater flexibility during the novel coronavirus pandemic ("COVID-19"), CMS has relaxed the definition of homebound status. During the pandemic, a beneficiary is considered homebound if they have been instructed by a physician not to leave their home because of a confirmed or suspected COVID-19 diagnosis or if the patient has a condition that makes them more susceptible to contracting COVID-19. Therefore, if a beneficiary is homebound due to COVID-19 and requires skilled services, the services will be covered under the Medicare home health benefit. All Medicare contracts are required to have a signed plan of care which represents a single performance obligation, comprised of the delivery of a series of distinct services that are substantially similar and have a similar pattern of transfer to the customer. Accordingly, the Company accounts for the series of services ("episode") as a single performance obligation satisfied over time, as the customer simultaneously receives and consumes the benefits of the goods and services provided. An episode starts the first day a billable visit is performed and ends 60 days later or upon discharge, if earlier, with multiple continuous episodes allowed. As noted above, under PDGM, we are now reimbursed for 30-day periods of care rather than 60-day episodes of care. ASC 606 notes that if an entity has a right to consideration from a customer in an amount that corresponds directly with the value of the entity’s performance completed to date, the entity may recognize revenue in the amount to which the entity has a right to invoice. We have elected to apply the "right to invoice” practical expedient and therefore, our revenue recognition is based on the reimbursement we are entitled to for each 30-day payment period. We utilize our historical average length of stay for each 30-day period of care as the measure of progress towards the satisfaction of our performance obligation. A portion of reimbursement from each Medicare episode is billed near the start of each 30-day period of care, and cash is typically received before all services are rendered. Any cash received from Medicare for a request for anticipated payment (“RAP”) for a 30-day period of care that exceeds the associated revenue earned is recorded to accrued expenses within our condensed consolidated balance sheets. Non-Medicare Revenue Episodic-based Revenue. We recognize revenue in a similar manner as we recognize Medicare revenue for amounts that are paid by other insurance carriers, including Medicare Advantage programs; however, these amounts can vary based upon the negotiated terms which generally range from 90% to 100% of Medicare rates. Non-episodic based Revenue. Gross revenue is recorded on an accrual basis based upon the date of service at amounts equal to our established or estimated per-visit rates. Contractual revenue adjustments are recorded for the difference between our standard rates and the contracted rates to be realized from patients, third parties and others for services provided and are deducted from gross revenue to determine net service revenue. We also make non-contractual revenue adjustments to non-episodic revenue based on 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. 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 net Medicare hospice service revenue for the three and nine-month periods ended September 30, 2020 and 99% of our total net Medicare hospice service revenue for the three and nine-month periods ended September 30, 2019. There are two separate payment rates for routine care: payments for the first 60 days of care and care beyond 60 days. In addition to the two routine rates, we may also receive a service intensity add-on (“SIA”). The SIA is based on visits made in the last seven days of life by a registered nurse (“RN”) or medical social worker (“MSW”) for patients in a routine level of care. The performance obligation is the delivery of hospice services to the patient, as determined by a physician, each day the patient is on hospice care. We make adjustments to Medicare revenue for non-contractual revenue adjustments, which include our inability to obtain appropriate billing documentation or acceptable authorizations and other reasons unrelated to credit risk. We estimate the impact of these non-contractual revenue adjustments based on our historical experience, which primarily includes a historical collection rate of over 99% on Medicare claims, and record it during the period services are rendered. Additionally, our hospice service revenue is subject to certain limitations on payments from Medicare which are considered variable consideration. We are subject to an inpatient cap limit and an overall Medicare payment cap for each provider number. We monitor these caps on a provider-by-provider basis and estimate amounts due back to Medicare if we estimate a cap has been exceeded. We record these adjustments as a reduction to revenue and an increase in accrued expenses within our condensed consolidated balance sheets. Providers are required to self-report and pay their estimated cap liability by February 28th of the following year. As of September 30, 2020, we have recorded $9.9 million for estimated amounts due back to Medicare in accrued expenses for the Federal cap years ended October 31, 2013 through September 30, 2020; $2.6 million of this balance was acquired with the AseraCare acquisition. As of December 31, 2019, we had recorded $5.7 million for estimated amounts due back to Medicare in accrued expenses for the Federal cap years ended October 31, 2013 through September 30, 2020. Hospice Non-Medicare Revenue Gross revenue is recorded on an accrual basis based upon the date of service at amounts equal to our established rates or estimated per day rates, as applicable. Contractual revenue adjustments are recorded for the difference between our standard rates and the contractual rates to be realized from patients, third party payors and others for services provided and are deducted from gross revenue to determine our net service revenue. We also make non-contractual adjustments to non-Medicare revenue based on our historical experience, to reflect the estimated transaction price. Personal Care Revenue Recognition Personal Care Revenue We generate net service revenues by providing our services directly to patients based on authorized hours, visits or units determined by the relevant agency, at a rate that is either contractual or fixed by legislation. Net service revenue is recognized at the time services are rendered based on gross charges for the services provided, reduced by estimates for contractual and non-contractual revenue adjustments. We receive payment for providing such services from payors, including state and local governmental agencies, managed care organizations, commercial insurers and private consumers. Payors include the following elder service agencies: Aging Services Access Points (ASAPs), Senior Care Options (SCOs), Program of All-Inclusive Care for the Elderly (PACE) and the Veterans Administration (VA).
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Government Grants | Government Grants In the absence of specific guidance to account for government grants under U.S. GAAP, we have decided to account for government grants in accordance with International Accounting Standard ("IAS") 20, Accounting for Government Grants and Disclosure of Government Assistance, and as such, we recognize grant income on a systematic basis in line with the recognition of expenses or the loss of revenues for which the grants are intended to compensate. We recognize grants once both of the following conditions are met: (1) we are able to comply with the relevant conditions of the grant and (2) the grant will be received. See Note 10 - Novel Coronavirus Pandemic ("COVID-19") for additional information on our accounting for government funds received under the Coronavirus Aid, Relief and Economic Security Act ("CARES Act") and the Mass Home Care ASAP COVID-19 Provider Sustainability Program.
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Cash, Cash Equivalents and Restricted Cash | Cash, Cash Equivalents and Restricted Cash Cash and cash equivalents include certificates of deposit and all highly liquid debt instruments with maturities of three months or less when purchased. Our cash balance as of September 30, 2020 includes approximately $81 million associated with the CARES Act Provider Relief Fund ("PRF"). We separated the PRF funds into their own account during the three-month period ended June 30, 2020. As of September 30, 2020, we have only transferred funds used during the six-month period ended June 30, 2020 to our operating account. We will transfer funds used during the three-month period ended September 30, 2020 to our operating account in the fourth quarter. Restricted cash includes cash that is not available for ordinary business use. As of September 30, 2020, we had $2.5 million of restricted cash that was placed into escrow accounts related to the indemnity and closing payment adjustment provisions within the Asana Hospice and AseraCare Hospice purchase agreements ($1.5 million and $1.0 million, respectively).
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Patient Accounts Receivable | Patient Accounts Receivable We report accounts receivable from services rendered at their estimated transaction price, which includes contractual and non-contractual revenue adjustments based on the amounts expected to be due from payors. Our patient accounts receivable are uncollateralized and consist of amounts due from Medicare, Medicaid, other third-party payors and patients. As of September 30, 2020, there is no single payor, other than Medicare, that accounts for more than 10% of our total outstanding patient receivables. 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 represent 63% and 58% of our patient accounts receivable at September 30, 2020 and December 31, 2019, respectively, is limited due to our historical collection rate of over 99% from Medicare and the fact that Medicare is a U.S. government payor. We do not believe there are any significant concentrations of revenues from any payor that would subject us to any significant credit risk in the collection of our accounts receivable. Medicare Home Health For our home health patients, our pre-billing process includes verifying that we are eligible for payment from Medicare for the services that we provide to our patients. Our Medicare billing begins with a process to ensure that our billings are accurate through the utilization of an electronic Medicare claim review. We submit a RAP for 20% of our estimated payment for each 30-day period of care. The full amount of the payment for each 30-day period of care is billed after the period of care has been completed (“final billed”). The RAP received for that billing period is then deducted from our final payment. If a final bill is not submitted within the greater of 90 days from the start of the 30-day period of care, or 60 days from the date the RAP was paid, any RAPs received for that billing period will be recouped by Medicare from any other claims in process for that particular provider number. The RAP claim must then be resubmitted. CMS has mandated the full elimination of RAPs in 2021. Medicare Hospice For our hospice patients, our pre-billing process includes verifying that we are eligible for payment from Medicare for the services that we provide to our patients. Our Medicare billing begins with a process to ensure that our billings are accurate through the utilization of an electronic Medicare claim review. We bill Medicare on a monthly basis for the services provided to the patient. Non-Medicare Home Health, Hospice and Personal Care For our non-Medicare patients, our pre-billing process primarily begins with verifying a patient’s eligibility for services with the applicable payor. Once the patient has been confirmed for eligibility, we will provide services to the patient and bill the applicable payor. Our review and evaluation of non-Medicare accounts receivable includes a detailed review of outstanding balances and special consideration to concentrations of receivables from particular payors or groups of payors with similar characteristics that would subject us to any significant credit risk.
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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):
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.
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Weighted-Average Shares Outstanding | Weighted-Average Shares OutstandingNet income per share attributable to Amedisys, Inc. common stockholders, calculated on the treasury stock method, is based on the weighted average number of shares outstanding during the period. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Business Combinations | Business CombinationsWe account for acquisitions using the acquisition method of accounting in accordance with Accounting Standards Codification (“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 and liabilities assumed, 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. |
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Tables) |
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Accounting Policies [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Schedule of Revenue by Payor Class | Revenue by payor class as a percentage of total net service revenue is as follows:
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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):
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Schedule of Weighted-Average Shares Outstanding | The following table sets forth, for the periods indicated, shares used in our computation of the weighted-average shares outstanding, which are used to calculate our basic and diluted net income attributable to Amedisys, Inc. common stockholders (amounts in thousands):
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ACQUISITIONS (Tables) |
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Schedule of Business Acquisitions, Asana Hospice | The Company is in the process of finalizing its valuation of the assets acquired and liabilities assumed. During the three-month period ended September 30, 2020, we recorded measurement period adjustments based on changes to management's estimates and assumptions related to the assets acquired and liabilities assumed. Based on the Company's preliminary valuation, the total estimated consideration of $65.6 million has been allocated to assets acquired and liabilities assumed as of the acquisition date as follows (amounts in millions):
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Schedule of Business Acquisitions, AseraCare Hospice | The Company is in the process of reviewing the fair value of the assets acquired and liabilities assumed. During the three-month period ended September 30, 2020, we recorded measurement period adjustments based on changes to management's estimates and assumptions related to the assets acquired and liabilities assumed. Based on the Company's preliminary valuation, the total estimated consideration of $229.6 million has been allocated to assets acquired and liabilities assumed as of the acquisition date as follows (amounts in millions):
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Business Acquisition, Pro Forma Information | The following table contains unaudited pro forma condensed consolidated statement of operations information for the three and nine-month periods ended September 30, 2020 and 2019 assuming that the AseraCare acquisition closed on January 1, 2019 (amounts in millions, except per share data). The pro forma financial information includes various assumptions, including those related to the preliminary purchase price allocation of assets acquired and liabilities assumed. The pro forma financial information may vary in future quarters based on the final valuations and analysis of the fair value of the assets acquired and liabilities assumed.
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LONG-TERM OBLIGATIONS LONG-TERM OBLIGATIONS (Tables) |
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Schedule of Long-Term Debt | Long-term debt consists of the following for the periods indicated (amounts in millions):
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Schedule of Commitment Fee Under Credit Facilities | We are also subject to a commitment fee and letter of credit fee under the terms of the Amended Credit Agreement, as presented in the table below.
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SEGMENT INFORMATION (Tables) |
9 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Segment Reporting [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Schedule of Operating Income of Reportable Segments |
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Extraordinary and Unusual Items (Tables) |
9 Months Ended | ||||||||||||||||||||||||||||||||||||||||||
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Sep. 30, 2020 | |||||||||||||||||||||||||||||||||||||||||||
Unusual or Infrequent Items, or Both [Abstract] | |||||||||||||||||||||||||||||||||||||||||||
Schedule of Cares Act Provider Relief Funds | In summary, the total funds that we have received from the CARES Act PRF have been accounted for as follows as of September 30, 2020 (amounts in millions):
|
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Cash and Cash Equivalents (Details) - USD ($) $ in Thousands |
Sep. 30, 2020 |
Dec. 31, 2019 |
---|---|---|
Restricted Cash and Cash Equivalents Items [Line Items] | ||
Restricted cash | $ 2,549 | $ 66,196 |
Cash Balance Associated with Provider Relief Fund | 81,000 | |
Asana Hospice Aquisition [Member] | ||
Restricted Cash and Cash Equivalents Items [Line Items] | ||
Restricted cash | 1,500 | |
AseraCare Hospice [Member] | ||
Restricted Cash and Cash Equivalents Items [Line Items] | ||
Restricted cash | $ 1,000 |
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Patient Accounts Receivable Narrative (Details) - day |
9 Months Ended | |
---|---|---|
Sep. 30, 2020 |
Dec. 31, 2019 |
|
Concentration Risk [Line Items] | ||
Accounts receivable derived from Medicare | 63.00% | 58.00% |
Percentage of patient receivables outstanding | 10.00% | |
Historical collection rate from Medicare | 99.00% | |
Rate of request for anticipated payment submitted for the initial episode of care | 20.00% | |
Maximum days to submit final bill from the start of episode | 90 | |
Maximum days to submit final bill from the date the request for anticipated payment was paid | 60 |
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Fair Value of Financial Instruments (Details) |
Sep. 30, 2020
USD ($)
|
---|---|
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | |
Debt Instrument Carrying Amount Excluding Finance Leases | $ 311,500,000 |
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 | 317,200,000 |
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 ACCOUNTING POLICIES - Weighted-Average Shares Outstanding (Details) - shares shares in Thousands |
3 Months Ended | 9 Months Ended | ||
---|---|---|---|---|
Sep. 30, 2020 |
Sep. 30, 2019 |
Sep. 30, 2020 |
Sep. 30, 2019 |
|
Accounting Policies [Abstract] | ||||
Weighted average number of shares outstanding - basic (shares) | 32,662 | 32,211 | 32,469 | 32,096 |
Effect of dilutive securities: | ||||
Stock options (shares) | 336 | 532 | 506 | 543 |
Non-vested stock and stock units (shares) | 262 | 259 | 292 | 305 |
Weighted average number of shares outstanding - diluted (shares) | 33,260 | 33,002 | 33,267 | 32,944 |
Anti-dilutive securities (shares) | 36 | 133 | 31 | 154 |
ACQUISITIONS - Pro Forma (Details) - Hospice [Member] - AseraCare Hospice [Member] - USD ($) $ / shares in Units, $ in Millions |
3 Months Ended | 9 Months Ended | ||
---|---|---|---|---|
Sep. 30, 2020 |
Sep. 30, 2019 |
Sep. 30, 2020 |
Sep. 30, 2019 |
|
Business Acquisition [Line Items] | ||||
Net service revenue | $ 544.1 | $ 525.5 | $ 1,569.4 | $ 1,546.0 |
Operating income | 63.8 | 45.4 | 155.9 | 131.3 |
Net income | $ 72.3 | $ 31.3 | $ 135.5 | $ 90.2 |
Basic earnings per share | $ 2.21 | $ 0.97 | $ 4.17 | $ 2.81 |
Diluted earnings per share | $ 2.18 | $ 0.95 | $ 4.07 | $ 2.74 |
LONG-TERM OBLIGATIONS - Schedule of Long-Term Debt (Details) - USD ($) $ in Millions |
Sep. 30, 2020 |
Dec. 31, 2019 |
---|---|---|
Debt Instrument [Line Items] | ||
Principal amount | $ 314.2 | $ 245.7 |
Deferred debt issuance costs | (2.9) | (3.5) |
Long-term obligations, including current portion | 311.3 | 242.2 |
Current portion of long-term obligations | (10.7) | (9.9) |
Long-term obligations, less current portion | 300.6 | 232.3 |
Term Loan [Member] | One Hundred Seventy Five Million Term Loan Facility [Member] | ||
Debt Instrument [Line Items] | ||
Principal amount | 166.3 | 171.7 |
Revolving Credit Facility [Member] | 550 Million Revolving Credit Facility [Member] | ||
Debt Instrument [Line Items] | ||
Principal amount | 145.0 | 70.0 |
Promissory Notes [Member] | ||
Debt Instrument [Line Items] | ||
Principal amount | 0.2 | 0.6 |
Finance leases [Member] | ||
Debt Instrument [Line Items] | ||
Principal amount | $ 2.7 | $ 3.4 |
LONG-TERM OBLIGATIONS - Schedule of Long-Term Debt Additional Information (Details) |
9 Months Ended |
---|---|
Sep. 30, 2020
USD ($)
| |
Term Loan [Member] | One Hundred Seventy Five Million Term Loan Facility [Member] | |
Debt Instrument [Line Items] | |
Debt instrument, face amount | $ 175,000,000.0 |
Maturity Date | Feb. 04, 2024 |
Term Loan [Member] | One Hundred Seventy Five Million Term Loan Facility [Member] | Eurodollar [Member] | |
Debt Instrument [Line Items] | |
Debt Instrument Interest Rate at Period End | 1.70% |
Revolving Credit Facility [Member] | 550 Million Revolving Credit Facility [Member] | |
Debt Instrument [Line Items] | |
Debt instrument, face amount | $ 550,000,000.0 |
Maturity Date | Feb. 04, 2024 |
Revolving Credit Facility [Member] | 550 Million Revolving Credit Facility [Member] | Eurodollar [Member] | |
Debt Instrument [Line Items] | |
Debt Instrument Interest Rate at Period End | 1.70% |
SEGMENT INFORMATION - Narrative (Details) |
9 Months Ended |
---|---|
Sep. 30, 2020
Segments
| |
Segment Reporting [Abstract] | |
Number of reportable business segments | 3 |
CAPITAL STOCK AND SHARE-BASED COMPENSATION (Details) - USD ($) |
3 Months Ended | 9 Months Ended | ||
---|---|---|---|---|
Aug. 10, 2020 |
Sep. 30, 2020 |
Sep. 30, 2020 |
Sep. 30, 2019 |
|
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||||
Payment, Tax Withholding, Share-based Payment Arrangement | $ 54,172,000 | $ 9,385,000 | ||
Executive Stock Option Exercise [Member] | ||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||||
Issuance/(cancellation) of non-vested stock (shares) | 268,317 | |||
Surrendered Shares (in shares) | 231,683 | |||
Share-based Payment Arrangement, Exercise of Option, Tax Benefit | $ 24,000,000.0 | |||
Exercise of stock options (in shares) | 500,000 | |||
Payment, Tax Withholding, Share-based Payment Arrangement | $ 40,400,000 |
SHARE REPURCHASE Narrative (Details) $ in Millions |
Feb. 25, 2019
USD ($)
|
---|---|
Share Repurchase [Line Items] | |
Stock Repurchase Program, Authorized Amount | $ 100 |
Stock Repurchase Program Expiration Date | Mar. 01, 2020 |
RELATED PARTY TRANSACTIONS Narrative (Details) - USD ($) $ in Thousands |
3 Months Ended | 9 Months Ended | 12 Months Ended | ||
---|---|---|---|---|---|
Sep. 30, 2020 |
Sep. 30, 2019 |
Sep. 30, 2020 |
Sep. 30, 2019 |
Dec. 31, 2018 |
|
Related Party Transaction [Line Items] | |||||
Payments to Acquire Investments | $ 875 | $ 210 | |||
Medalogix [Member] | |||||
Related Party Transaction [Line Items] | |||||
Payments to Acquire Investments | $ 7,000 | ||||
Related Party Transaction, Amounts of Transaction | $ 1,100 | $ 100 | $ 2,200 | $ 200 |
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