AMEDISYS INC, 10-K filed on 2/16/2023
Annual Report
v3.22.4
Document and Entity Information - USD ($)
$ in Billions
 12 Months Ended
Dec. 31, 2022
Feb. 10, 2023
Jun. 30, 2022
Document And Entity Information [Abstract]      
Document Type 10-K    
Document Annual Report true    
Document Period End Date Dec. 31, 2022    
Document Transition Report false    
Entity File Number 0-24260    
Entity Registrant Name AMEDISYS, INC.    
Entity Incorporation, State or Country Code DE    
Entity Tax Identification Number 11-3131700    
Entity Address, Address Line One 3854 American Way, Suite A,    
Entity Address, City or Town Baton Rouge,    
Entity Address, State or Province LA    
Entity Address, Postal Zip Code 70816    
City Area Code 225    
Local Phone Number 292-2031    
Title of 12(b) Security Common Stock, par value $0.001 per share    
Security Exchange Name NASDAQ    
Entity Well-known Seasoned Issuer Yes    
Entity Voluntary Filers No    
Entity Current Reporting Status Yes    
Entity Interactive Data Current Yes    
Entity Filer Category Large Accelerated Filer    
Entity Small Business false    
Entity Emerging Growth Company false    
ICFR Auditor Attestation Flag true    
Entity Shell Company false    
Entity Public Float     $ 3.0
Entity Common Stock, Shares Outstanding   32,550,602  
Amendment Flag false    
Document Fiscal Year Focus 2022    
Document Fiscal Period Focus FY    
Trading Symbol AMED    
Entity Central Index Key 0000896262    
Current Fiscal Year End Date --12-31    
v3.22.4
Audit Information
 12 Months Ended
Dec. 31, 2022
Auditor [Line Items]  
Auditor Name KPMG LLP
Auditor Location Baton Rouge, Louisiana
Auditor Firm ID 185
v3.22.4
CONSOLIDATED BALANCE SHEETS - USD ($)
$ in Thousands
Dec. 31, 2022
Dec. 31, 2021
Current assets:    
Cash and cash equivalents $ 40,540 $ 42,694
Restricted cash 13,593 3,075
Patient accounts receivable 296,785 274,961
Prepaid expenses 11,628 10,356
Other current assets 26,415 25,598
Total current assets 388,961 356,684
Property and equipment, net of accumulated depreciation of $101,364 and $96,937 16,026 18,435
Operating lease right of use assets 102,856 101,257
Goodwill 1,287,399 1,196,090
Intangible assets, net of accumulated amortization of $14,604 and $19,900 101,167 111,190
Deferred income tax assets 0 289
Other assets 79,836 73,023
Total assets 1,976,245 1,856,968
Current liabilities:    
Accounts payable 43,735 38,217
Payroll and employee benefits 125,387 141,001
Accrued expenses 137,390 150,836
Current portion of long-term obligations 15,496 12,995
Current portion of operating lease liabilities 33,521 31,233
Total current liabilities 355,529 374,282
Long-term obligations, less current portion 419,420 432,075
Operating lease liabilities, less current portion 69,504 69,309
Deferred income tax liabilities 20,411 0
Other long-term obligations 4,808 4,979
Total liabilities 869,672 880,645
Commitments and Contingencies
Equity:    
Preferred stock, $0.001 par value, 5,000,000 shares authorized; none issued or outstanding 0 0
Common stock, $0.001 par value, 60,000,000 shares authorized; 37,891,186 and 37,674,868 shares issued; and 32,518,278 and 32,509,969 shares outstanding 38 38
Additional paid-in capital 755,063 728,118
Treasury stock at cost, 5,372,908 and 5,164,899 shares of common stock (461,200) (435,868)
Retained earnings 757,672 639,063
Total Amedisys, Inc. stockholders’ equity 1,051,573 931,351
Noncontrolling interests 55,000 44,972
Total equity 1,106,573 976,323
Total liabilities and equity $ 1,976,245 $ 1,856,968
v3.22.4
CONSOLIDATED BALANCE SHEETS (Parenthetical) - USD ($)
$ in Thousands
Dec. 31, 2022
Dec. 31, 2021
Statement of Financial Position [Abstract]    
Property and equipment, accumulated depreciation $ 101,364 $ 96,937
Intangible assets, accumulated amortization $ 14,604 $ 19,900
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) 37,891,186 37,674,868
Common stock, outstanding (shares) 32,518,278 32,509,969
Treasury stock at cost (shares) 5,372,908 5,164,899
v3.22.4
CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($)
shares in Thousands, $ in Thousands
 12 Months Ended
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2020
Income Statement [Abstract]      
Net service revenue $ 2,223,199 $ 2,214,112 $ 2,071,519
Other operating income 0 13,300 34,372
Cost of service, excluding depreciation and amortization 1,260,425 1,233,356 1,185,369
General and administrative expenses:      
Salaries and benefits 508,791 474,718 449,448
Non-cash compensation 16,560 23,809 26,730
Other 228,707 212,713 192,122
Depreciation and amortization 24,935 30,901 28,802
Impairment charge 3,009 0 4,152
Operating expenses 2,042,427 1,975,497 1,886,623
Operating income 180,772 251,915 219,268
Other income (expense):      
Interest income 178 49 292
Interest expense (22,228) (9,525) (11,038)
Equity in (loss) earnings from equity method investments (45) 4,949 3,966
Gain (loss) on equity method investments 0 31,098 (2,980)
Miscellaneous, net 1,567 1,745 1,311
Total other (expense) income, net (20,528) 28,316 (8,449)
Income before income taxes 160,244 280,231 210,819
Income tax expense (42,545) (70,065) (25,635)
Net income 117,699 210,166 185,184
Net loss (income) attributable to noncontrolling interests 910 (1,094) (1,576)
Net income attributable to Amedisys, Inc. $ 118,609 $ 209,072 $ 183,608
Basic earnings per common share:      
Net income attributable to Amedisys, Inc. common stockholders (usd per share) $ 3.65 $ 6.41 $ 5.64
Weighted average shares outstanding (shares) 32,517 32,642 32,559
Diluted earnings per common share:      
Net income attributable to Amedisys, Inc. common stockholders (usd per share) $ 3.63 $ 6.34 $ 5.52
Weighted average shares outstanding (shares) 32,653 32,972 33,268
v3.22.4
CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (LOSS) - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2020
Statement of Comprehensive Income [Abstract]      
Net income $ 117,699 $ 210,166 $ 185,184
Other comprehensive income 0 0 0
Comprehensive income 117,699 210,166 185,184
Comprehensive loss (income) attributable to non-controlling interests 910 (1,094) (1,576)
Comprehensive income attributable to Amedisys, Inc. $ 118,609 $ 209,072 $ 183,608
v3.22.4
CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY - USD ($)
$ in Thousands
Total
Common Stock
Additional Paid-in Capital
Treasury Stock
Accumulated Other Comprehensive Income
Retained Earnings
Noncontrolling Interests
Balance, Stockholders Equity at Dec. 31, 2019 $ 641,513 $ 37 $ 645,256 $ (251,241) $ 15 $ 246,383 $ 1,063
Balance (in shares) at Dec. 31, 2019   36,638,021          
Increase (Decrease) in Stockholders' Equity [Roll Forward]              
Issuance of stock - employee stock purchase plan 3,562   3,562        
Issuance of stock - employee stock purchase plan (shares)   21,561          
Issuance of stock - 401 (k) plan 3,057   3,057        
Issuance of stock - 401 (k) plan (shares)   18,312          
Issuance/(cancellation) of non-vested stock 0   0        
Issuance/(cancellation) of non-vested stock (shares)   169,489          
Exercise of stock options 6,325 $ 1 6,324        
Exercise of stock options (in shares)   622,829          
Non-cash compensation 26,730   26,730        
Surrendered shares (54,493)   13,358 (67,851)      
Noncontrolling interest distributions (1,122)           (1,122)
Write-off of other comprehensive income (15)       (15)    
Net income 185,184         183,608 1,576
Balance, Stockholders Equity at Dec. 31, 2020 810,741 $ 38 698,287 (319,092) 0 429,991 1,517
Balance (in shares) at Dec. 31, 2020   37,470,212          
Increase (Decrease) in Stockholders' Equity [Roll Forward]              
Issuance of stock - employee stock purchase plan 3,968   3,968        
Issuance of stock - employee stock purchase plan (shares)   20,823          
Issuance/(cancellation) of non-vested stock 0   0        
Issuance/(cancellation) of non-vested stock (shares)   151,365          
Exercise of stock options 2,054   2,054        
Exercise of stock options (in shares)   32,468          
Non-cash compensation 23,809   23,809        
Surrendered shares (16,898)     (16,898)      
Shares repurchased (99,878)     (99,878)      
Noncontrolling interest contributions 250           250
Noncontrolling interest distributions (1,747)           (1,747)
Acquired noncontrolling interest 43,858           43,858
Net income 210,166         209,072 1,094
Balance, Stockholders Equity at Dec. 31, 2021 976,323 $ 38 728,118 (435,868) 0 639,063 44,972
Balance (in shares) at Dec. 31, 2021   37,674,868          
Increase (Decrease) in Stockholders' Equity [Roll Forward]              
Issuance of stock - employee stock purchase plan 3,848   3,848        
Issuance of stock - employee stock purchase plan (shares)   36,206          
Issuance/(cancellation) of non-vested stock 0   0        
Issuance/(cancellation) of non-vested stock (shares)   142,477          
Exercise of stock options $ 2,304   2,304        
Exercise of stock options (in shares) 37,635 37,635          
Non-cash compensation $ 16,560   16,560        
Surrendered shares (7,981)     (7,981)      
Shares repurchased (17,351)     (17,351)      
Noncontrolling interest contributions 12,401           12,401
Noncontrolling interest distributions (1,561)           (1,561)
Sale of noncontrolling interest 4,331   4,233       98
Net income 117,699         118,609 (910)
Balance, Stockholders Equity at Dec. 31, 2022 $ 1,106,573 $ 38 $ 755,063 $ (461,200) $ 0 $ 757,672 $ 55,000
Balance (in shares) at Dec. 31, 2022   37,891,186          
v3.22.4
CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2020
Cash Flows from Operating Activities:      
Net income $ 117,699 $ 210,166 $ 185,184
Adjustments to reconcile net income to net cash provided by operating activities:      
Depreciation and amortization 24,935 30,901 28,802
Non-cash compensation 16,560 23,809 26,730
Amortization and impairment of operating lease right of use assets 46,029 40,364 39,140
Loss (gain) on disposal of property and equipment 519 (124) (30)
(Gain) loss on equity method investments 0 (31,098) 2,980
Write-off of other comprehensive income 0 0 (15)
Deferred income taxes 23,377 44,582 (26,560)
Equity in loss (earnings) from equity method investments 45 (4,949) (3,966)
Amortization of deferred debt issuance costs/debt discount 991 917 869
Return on equity method investments 5,163 5,343 5,444
Impairment charge 3,009 0 4,152
Changes in operating assets and liabilities, net of impact of acquisitions:      
Patient accounts receivable (14,230) (18,030) 2,114
Other current assets (3,525) (12,202) (7,181)
Other assets 438 (1,017) 31
Accounts payable 4,894 (4,353) 1,941
Accrued expenses (39,382) (26,915) 39,839
Other long-term obligations (8,822) (28,796) 27,717
Operating lease liabilities (41,175) (36,645) (34,695)
Operating lease right of use assets (3,242) (3,060) (3,544)
Net cash provided by operating activities 133,283 188,893 288,952
Cash Flows from Investing Activities:      
Proceeds from the sale of deferred compensation plan assets 252 135 101
Proceeds from the sale of property and equipment 66 144 80
Purchases of property and equipment (6,165) (6,302) (5,332)
Investments in technology assets (1,050) (419) 0
Investment in equity method investee (637) (200) (875)
Proceeds from sale of equity method investment 0 0 17,876
Purchase of cost method investment (15,000) (5,000) 0
Acquisitions of businesses, net of cash acquired (71,952) (269,965) (298,958)
Net cash used in investing activities (94,486) (281,607) (287,108)
Cash Flows from Financing Activities:      
Proceeds from issuance of stock upon exercise of stock options 2,304 2,054 6,325
Proceeds from issuance of stock to employee stock purchase plan 3,848 3,968 3,562
Shares withheld to pay taxes on non-cash compensation (7,981) (16,898) (54,493)
Noncontrolling interest contributions 3,501 250 0
Noncontrolling interest distributions (1,561) (1,747) (1,122)
Proceeds from sale of noncontrolling interest 5,817 0 0
Proceeds from borrowings under term loan 0 290,312 0
Proceeds from borrowings under revolving line of credit 534,500 500,700 684,200
Repayments of borrowings under revolving line of credit (534,500) (551,700) (703,200)
Principal payments of long-term obligations (13,296) (9,143) (10,249)
Debt issuance costs 0 (2,792) 0
Provider relief fund advance 0 (60,000) 60,000
Purchase of company stock (17,351) (99,878) 0
Payment of accrued contingent consideration (5,714) 0 0
Net cash (used in) provided by financing activities (30,433) 55,126 (14,977)
Net increase (decrease) in cash, cash equivalents and restricted cash 8,364 (37,588) (13,133)
Cash, cash equivalents and restricted cash at beginning of period 45,769 83,357 96,490
Cash, cash equivalents and restricted cash at end of period 54,133 45,769 83,357
Supplemental Disclosures of Cash Flow Information:      
Cash paid for interest 14,939 5,291 6,207
Cash Paid For Infinity ZPIC Interest 12,755 0 0
Cash paid for income taxes, net of refunds received 24,013 34,097 50,721
Accrued contingent consideration 19,195 0 0
Noncontrolling interest contribution $ 8,900 $ 0 $ 0
v3.22.4
NATURE OF OPERATIONS, CONSOLIDATION AND PRESENTATION OF FINANCIAL STATEMENTS
 12 Months Ended
Dec. 31, 2022
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, personal care and high acuity care services with approximately 74%, 75% and 75% of our consolidated net service revenue derived from Medicare for 2022, 2021 and 2020, respectively. As of December 31, 2022, we owned and operated 347 Medicare-certified home health care centers, 164 Medicare-certified hospice care centers, 13 personal-care care centers and 8 admitting high acuity care joint ventures in 37 states within the United States and the District of Columbia.
Recently Adopted Accounting Pronouncements
During 2021, the Company adopted Accounting Standards Update ("ASU") 2020-10, Codification Improvements, which included minor technical corrections and clarifications to improve consistency and clarify the application of various provisions of the codification by amending the codification to include all disclosure guidance in the appropriate disclosure sections and by amending and adding new headings, cross referencing to other guidance and refining or correcting terminology. Our adoption of this standard did not have a material effect on our consolidated financial statements.
During 2021, the Company adopted ASU 2021-10, Government Assistance (Topic 832): Disclosures by Business Entities about Government Assistance, which was intended to increase transparency around financial reporting regarding government assistance by requiring disclosure of information about (1) the types of government assistance received, (2) an entity's accounting for the government assistance received and (3) the effect of the assistance on an entity's financial statements. The ASU was effective for annual periods beginning after December 15, 2021, with early adoption permitted. See Note 3 – Novel Coronavirus Pandemic ("COVID-19") for the disclosures associated with this standard.
During 2020, the Company adopted ASU 2016-13, Financial Instruments - Credit Losses (Topic 326), which provided guidance for measuring credit losses on financial instruments. Our adoption of this standard did not have a material effect on our consolidated financial statements.
During 2020, the Company adopted ASU 2019-12, Income Taxes (Topic 740) - Simplifying the Accounting for Income Taxes, which eliminated certain exceptions related to the approach for intraperiod tax allocation, the methodology for calculating taxes during the interim periods and the recognition of deferred tax liabilities for outside basis differences. This guidance also simplified aspects of the accounting for franchise taxes, enacted changes in tax laws or rates and clarified the accounting for transactions that result in a step-up in the tax basis of goodwill. The guidance was effective for interim and annual periods beginning after December 15, 2020, with early adoption permitted. Our adoption of this standard on a prospective basis was not material to the Company’s consolidated financial statements.
Recently Issued Accounting Pronouncements
In March 2020, the Financial Accounting Standards Board ("FASB") issued ASU 2020-04, Reference Rate Reform (Topic 848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting, which provides optional expedients and exceptions for applying U.S. Generally Accepted Accounting Principles ("U.S. GAAP") to contract modifications and hedging relationships that reference the London Inter-Bank Offered Rate ("LIBOR") or another reference rate expected to be discontinued, subject to meeting certain criteria. In January 2021, the FASB issued ASU 2021-01, Reference Rate Reform (Topic 848): Scope, which adds implementation guidance to ASU 2020-04 to clarify certain optional expedients in Topic 848. The guidance in ASU 2020-04 and ASU 2021-01 was effective upon issuance and may generally be applied prospectively through December 31, 2022. In December 2022, the FASB issued ASU 2022-06, Reference Rate Reform (Topic 848): Deferral of the Sunset Date of Topic 848, which deferred the sunset date of Topic 848 from December 31, 2022 to December 31, 2024. These standards did not have an effect on our consolidated financial statements.
Use of Estimates
Our accounting and reporting policies conform with U.S. GAAP. In preparing the consolidated financial statements, we are required to make estimates and assumptions that impact the amounts reported in the consolidated financial statements and accompanying notes. Actual results could materially differ from those estimates.
Principles of Consolidation
These 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 consolidated financial
statements, and business combinations accounted for as purchases have been included in our 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 ("VIE") and we are the primary beneficiary or if we have controlling interests in the entity, which is generally ownership in excess of 50%. Third party equity interests in our consolidated joint ventures are reflected as noncontrolling interests in our consolidated financial statements.
We account for investments in entities in which we have the ability to exercise significant influence under the equity method if we hold 50% or less of the voting stock and the entity is not a VIE in which we are the primary beneficiary. The book value of investments that we account for under the equity method of accounting totaled $40.5 million and $48.1 million as of December 31, 2022 and 2021, respectively, and is reflected in other assets within our consolidated balance sheets.
We account for investments in entities in which we have less than 20% ownership interest under the cost method of accounting if we do not have the ability to exercise significant influence over the investee. During 2022, we made a $15.0 million investment in a home health benefit manager, which is accounted for under the cost method. During 2021, we made a $5.0 million investment in ConnectRN, a workforce optimization company, which is accounted for under the cost method. The book value of investments that we account for under the cost method of accounting was $20.0 million and $5.0 million as of December 31, 2022 and 2021, respectively, and is reflected in other assets within our consolidated balance sheets.
During the three-month period ended December 31, 2022, we sold a 49% interest in two of our home health care centers while maintaining a controlling interest in the newly formed joint venture. We are consolidating this joint venture. The total cash consideration received for the 49% noncontrolling interest was $1.9 million. In connection with the transaction, we recorded an after-tax gain of $1.4 million; this gain was recorded to additional paid-in capital within our consolidated balance sheet. During the three-month period ended September 30, 2022, we sold a 30% interest in two of our home health care centers while maintaining a controlling interest in the newly formed joint venture. We are consolidating this joint venture. The total cash consideration received for the 30% noncontrolling interest was $3.9 million. In connection with the transaction, we recorded an after-tax gain of $2.9 million; this gain was recorded to additional paid-in capital within our consolidated balance sheet.
During 2021, a third-party acquired a majority of the issued and outstanding membership interests of one of our equity method investments, Medalogix, for cash, with the remaining membership interests rolling over into a newly formed entity that includes Medalogix as well as another healthcare predictive data and analytics company. We rolled over 100% of our ownership interest in Medalogix to the newly formed entity, and in connection with this transaction, we recognized a $31.1 million gain based on the purchase price of Medalogix, which is reflected in gain on equity method investments within our consolidated statements of operations.
In connection with the acquisition of Contessa Health ("Contessa") on August 1, 2021, we obtained interests in several joint ventures with health system partners and a professional corporation that employs clinicians. Each of these entities meets the criteria to be classified as a VIE. As of December 31, 2022, we are consolidating all of our admitting joint ventures with health system partners as well as the professional corporation as we have concluded that we are the primary beneficiary of these VIEs. We have management agreements in place with each of these entities whereby we manage the entities and run the day-to-day operations. As such, we possess the power to direct the activities that most significantly impact the economic performance of the VIEs. The significant activities include, but are not limited to, negotiating provider and payor contracts, establishing patient care policies and protocols, making employment and compensation decisions, developing the operating and capital budgets, performing marketing activities and providing accounting support. We also have the obligation to absorb any expected losses and the right to receive benefits. Additionally, from time to time we may be required to provide joint venture funding. Our high acuity care segment also includes two non-admitting joint ventures with health system partners that are accounted for under the equity method of accounting. Operations of one of these joint ventures have ceased, and we are currently awaiting claims runout to complete financial reconciliations with our health plan partner; we recorded a $3.0 million impairment charge related to our investment in this joint venture during the three-month period ended September 30, 2022.
The terms of the agreements with each VIE prohibit us from using the assets of the VIE to satisfy the obligations of other entities. The carrying amount of the VIEs’ assets and liabilities included in our consolidated balance sheets are as follows (amounts in millions):
As of December 31, 2022As of December 31, 2021
ASSETS
Current assets:
     Cash and cash equivalents$15.6 $3.1 
     Patient accounts receivable6.1 2.4 
     Other current assets0.6 0.1 
          Total current assets22.3 5.6 
Property and equipment0.1 0.1 
Operating lease right of use assets0.1 — 
Goodwill8.5 — 
Intangible assets0.4 — 
Other assets0.2 — 
          Total assets$31.6 $5.7 
LIABILITIES
Current liabilities:
     Accounts payable$0.1 $— 
     Payroll and employee benefits0.5 0.3 
     Accrued expenses5.8 3.4 
     Operating lease liabilities0.1 — 
     Current portion of long-term obligations0.2 0.8 
          Total liabilities$6.7 $4.5 
During 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 gain (loss) on equity method investments within our consolidated statement of operations for the year ended December 31, 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 capital needs.
v3.22.4
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES
 12 Months Ended
Dec. 31, 2022
Accounting Policies [Abstract]  
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES
Revenue Recognition
We account for revenue from contracts with customers in accordance with ASC 606, Revenue from Contracts with Customers, 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. Our cost of obtaining contracts is not material.
Revenues are recognized as performance obligations are satisfied, which varies based on the nature of the services provided. Our performance obligation is the delivery of patient care services in accordance with the nature and frequency of services outlined in physicians' orders, which are determined by a physician based on a patient's specific goals.
Our performance obligations relate to contracts with a duration of less than one year; therefore, we have elected to apply the optional exemption provided by ASC 606 and are not required to disclose the aggregate amount of the transaction price allocated to performance obligations that are unsatisfied or partially unsatisfied as of the end of the reporting period. The unsatisfied or partially unsatisfied performance obligations are generally completed when the patients are discharged, which generally occurs within days or weeks of the end of the reporting period.
We determine the transaction price based on gross charges for services provided, reduced by estimates for contractual and non-contractual revenue adjustments. Contractual revenue adjustments are recorded for the difference between our standard rates and the contracted rates to be realized from patients, third-party payors and others for services provided. Non-contractual revenue adjustments include discounts provided to self-pay, uninsured patients or other payors, adjustments resulting from payment reviews and adjustments arising from our inability to obtain appropriate billing documentation, authorizations or face-to-face documentation. Subsequent changes to the estimate of the transaction price are recorded as adjustments to net service revenue in the period of change.
Non-contractual revenue adjustments are recorded for self-pay, uninsured patients and other payors by major payor class based on our historical collection experience, aged accounts receivable by payor and current industry conditions. The non-contractual revenue adjustments represent the difference between amounts billed and amounts we expect to collect based on our collection history with similar payors. We assess our ability to collect for the healthcare services provided at the time of patient admission based on our verification of the patient's insurance coverage under Medicare, Medicaid, and other commercial or managed care insurance programs. Medicare represents approximately 74% of our consolidated net service revenue.
Amounts due from third-party payors, primarily commercial health insurers and government programs (Medicare and Medicaid), include variable consideration for retroactive revenue adjustments due to settlements of audits and payment reviews. We determine our estimates for non-contractual revenue adjustments related to audits and payment reviews based on our historical experience and success rates in the claim appeals and adjudication process.
We determine our estimates for non-contractual revenue adjustments related to our inability to obtain appropriate billing documentation, authorizations or face-to-face documentation based on our historical 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:
As of December 31,
202220212020
Home Health:
Medicare40 %41 %41 %
Non-Medicare - Episodic-based8 %8 %7 %
Non-Medicare - Non-episodic based13 %12 %13 %
Hospice:
Medicare33 %34 %34 %
Non-Medicare2 %2 %2 %
Personal Care3 %3 %3 %
High Acuity Care (1)1 %— %— %
100 %100 %100 %
(1) Acquired Contessa Health on August 1, 2021.
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"). 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.
All Medicare contracts are required to have a signed plan of care which represents a single performance obligation, comprised of the delivery of a series of distinct services that are substantially similar and have a similar pattern of transfer to the customer. Accordingly, we account for the series of services ("episode") as a single performance obligation satisfied over time, as the customer simultaneously receives and consumes the benefits of the goods and services provided. An episode starts the first day a billable visit is performed and ends 60 days later or upon discharge, if earlier, with multiple continuous episodes allowed. Each 60-day episode includes two 30-day payment periods.
Net service revenue is recorded based on the established Federal Medicare home health payment rate for a 30-day period of care. ASC 606 notes that if an entity has a right to consideration from a customer in an amount that corresponds directly with the value of the entity’s performance completed to date, the entity may recognize revenue in the amount to which the entity has a right to invoice. We have elected to apply the "right to invoice" practical expedient, and therefore, our revenue recognition is based on the reimbursement we are entitled to for each 30-day period of care. We utilize our historical average length of stay for each 30-day period of care as the measure of progress towards the satisfaction of our performance obligation.
PDGM uses timing, admission source, functional impairment levels and principal and other diagnoses to case-mix adjust payments. The case-mix adjusted payment for a 30-day period of care is subject to additional adjustments based on certain variables, including, but not limited to (a) an outlier payment if our patient's care was unusually costly (capped at 10% of total reimbursement per provider number); (b) a low utilization payment adjustment (“LUPA”) if the number of visits provided was less than the established threshold, which ranges from two to six visits and varies for every case-mix group; (c) a partial payment if a patient transferred to another provider or from another provider before completing the 30-day period of care; and (d) the applicable geographic wage index. Payments for routine and non-routine supplies are included in the 30-day payment rate.
Medicare can also make various adjustments to payments received if we are unable to produce appropriate billing documentation or acceptable authorizations. We estimate the impact of such adjustments based on our historical experience, which primarily includes a historical collection rate of over 99% on Medicare claims, and record this estimate during the period in which services are rendered to revenue with a corresponding reduction to patient accounts receivable.
Amounts due from Medicare include variable consideration for retroactive revenue adjustments due to settlements of audits and payment reviews. We determine our estimates for non-contractual revenue adjustments related to audits and payment reviews based on our historical experience and success rates in the claim appeals and adjudication process.
The Medicare home health benefit requires that beneficiaries be homebound (meaning that the beneficiary is unable to leave his/her home without a considerable and taxing effort), require intermittent skilled nursing, physical therapy or speech therapy services and receive treatment under a plan of care established and periodically reviewed by a physician. In order to provide greater flexibility during the novel coronavirus pandemic ("COVID-19"), CMS relaxed the definition of homebound status through the duration of the public health emergency. 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.
During 2020, 20% of the reimbursement from each Medicare 30-day payment period was billed near the start of each 30-day period of care, referred to as a request for anticipated payment ("RAP"), and cash was typically received before all services were rendered. Any cash received from Medicare for a RAP for a 30-day period of care that exceeded the associated revenue earned was recorded to accrued expenses within our consolidated balance sheets. CMS fully eliminated all upfront payments associated with RAPs effective January 1, 2021. Effective January 1, 2022, CMS implemented a new one-time Notice of Admission ("NOA") process. The NOA process requires a one-time submission that establishes the home health period of care and covers all contiguous 30-day periods of care until the patient is discharged from Medicare home health services. If the NOA is not submitted timely, a payment reduction will be applied equal to 1/30 of the payment amount for each day from the home health start of care date until the date the NOA is submitted.
Non-Medicare Revenue
Payments from non-Medicare payors are either a percentage of Medicare rates, per-visit rates or case rates depending upon the terms and conditions established with such payors. Approximately 30% of our managed care contract volume affords us the opportunity to receive additional payments if we achieve certain quality or process metrics as defined in each contract (e.g. star ratings and acute-care hospitalization rates).
Episodic-based Revenue. We recognize revenue in a similar manner as we recognize Medicare revenue for amounts that are paid by other insurance carriers, including Medicare Advantage programs; however, these amounts can vary based upon the negotiated terms, the majority of which range from 95% to 100% of Medicare rates.
Non-episodic based Revenue. For our per visit contracts, gross revenue is recorded on an accrual basis based upon the date of service at amounts equal to our established or estimated per-visit rates. For our case rate contracts, gross revenue is recorded over our historical average length of stay using the established case rate for each admission. Contractual revenue adjustments are recorded for the difference between our standard rates and the contracted rates to be realized from patients, third parties and others for services provided and are deducted from gross revenue to determine net service revenue. We also make non-contractual revenue adjustments to non-episodic revenue based on our historical experience to reflect the estimated transaction
price. We receive a minimal amount of our net service revenue from patients who are either self-insured or are obligated for an insurance co-payment.
Under our case rate contracts, we may receive reimbursement before all services are rendered. Any cash received that exceeds the associated revenue earned is recorded to deferred revenue in accrued expenses within our consolidated balance sheets.
Hospice Revenue Recognition
Hospice Medicare Revenue
Gross revenue is recorded on an accrual basis based upon the date of service at amounts equal to the estimated payment rates. The estimated payment rates are predetermined daily or hourly rates for each of the four levels of care we deliver. The four levels of care are routine care, general inpatient care, continuous home care and respite care. Routine care accounted for 97% of our total Medicare hospice service revenue for each of 2022, 2021 and 2020, respectively. There are two separate payment rates for routine care: payments for the first 60 days of care and care beyond 60 days. In addition to the two routine rates, we may also receive a service intensity add-on (“SIA”). The SIA is based on visits made in the last seven days of life by a registered nurse or medical social worker for patients in a routine level of care.
The performance obligation is the delivery of hospice services to the patient, as determined by a physician, each day the patient is on hospice care.
We make adjustments to Medicare revenue for non-contractual revenue adjustments, which include our inability to obtain appropriate billing documentation or acceptable authorizations and other reasons unrelated to credit risk. We estimate the impact of these non-contractual revenue adjustments based on our historical experience, which primarily includes a historical collection rate of over 99% on Medicare claims, and record it during the period services are rendered.
Amounts due from Medicare include variable consideration for retroactive revenue adjustments due to settlements of audits and payment reviews. We determine our estimates for non-contractual revenue adjustments related to audits and payment reviews based on our historical experience and success rates in the claim appeals and adjudication process.
Additionally, our hospice service revenue is subject to certain limitations on payments from Medicare which are considered variable consideration. We are subject to an inpatient cap limit and an overall Medicare payment cap for each provider number. We monitor these caps on a provider-by-provider basis and estimate amounts due back to Medicare if we estimate a cap has been exceeded. We record these adjustments as a reduction to revenue and an increase in accrued expenses within our consolidated balance sheets. Providers are required to self-report and pay their estimated cap liability by February 28th of the following year. As of December 31, 2022, we have recorded $4.3 million for estimated amounts due back to Medicare in accrued expenses for the Federal cap years ended October 31, 2016 through September 30, 2023. As of December 31, 2021, we had recorded $4.5 million for estimated amounts due back to Medicare in accrued expenses for the Federal cap years ended October 31, 2016 through September 30, 2022.
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").
High Acuity Care Revenue Recognition
High Acuity Care Revenue
Our revenues are derived from contracts with (1) health insurance plans for the coordination and provision of home recovery care services to clinically-eligible patients who are enrolled members in those insurance plans, (2) health system partners for the coordination and provision of home recovery care services to clinically-eligible patients who are discharged early from a health system facility to complete their inpatient stay at home and (3) Medicare and other payors for the provision of home health services.
Under our health insurance plan contracts, we provide home recovery care services, which include hospital-equivalent ("H@H") and skilled nursing facility ("SNF") equivalent services ("SNF@H"), for high acuity care patients on a full risk basis whereby we assume the financial risk for the coordination and payment of all hospital or SNF replacement medical services necessary to treat the medical condition for which the patient was diagnosed in a home-based setting for a 30-day (H@H) or 60-day (SNF@H) episode of care in exchange for a fixed contracted bundled rate. For H@H programs, the fixed rate is based on the assigned diagnosis related group ("DRG") and the 30-day post-discharge related spend. For SNF@H programs, the fixed rate is based on the 60-day post-discharge related spend. Our performance obligation is the coordination and provision of patient care in accordance with physicians’ orders over either a 30-day or 60-day episode of care. The majority of our care coordination services and direct patient care is provided in the first five to seven days of the episode period (the "acute phase"). Monitoring services and follow-up direct patient care, as deemed necessary by the treating physician, are provided throughout the remainder of the episode. Since the majority of our services are provided during the acute phase, we recognize net service revenues over the acute phase based on gross charges for the services provided per the applicable managed care contract rates, reduced by estimates for revenue adjustments.
Under our contracts with health system partners, we provide home recovery care services for high acuity patients on a limited risk basis whereby we assume the risk for certain healthcare services during the remainder of an inpatient acute stay serviced at the patient’s home in exchange for a contracted per diem rate. The performance obligation is the coordination and provision of required medical services, as determined by the treating physician, for each day the patient receives inpatient-equivalent care at home. As such, revenues are recognized as services are administered and as our performance obligations are satisfied on a per diem basis, reduced by estimates for revenue adjustments.
We recognize adjustments to revenue during the period in which changes to estimates of assigned patient diagnoses or episode terminations become known, in accordance with the applicable managed care contracts. For certain health insurance plans, revenue is reduced by amounts owed by enrollees to healthcare providers under deductible, coinsurance or copay provisions of health insurance plan policies, since those amounts are repaid to the health insurance plans by us as part of a retrospective reconciliation process.
In March 2022, our high acuity care segment entered into a transaction in which one of our health system partners contributed its home health operations to one of our existing high acuity care joint ventures. We recognize Medicare and non-Medicare revenue in a manner that is consistent with our home health segment revenue recognition policy described above.
Government Grants
We account for government grants in accordance with ASU 2021-10, Government Assistance (Topic 832), by applying the grant model 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 3 – 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. Restricted cash includes cash that is not available for ordinary business use. As of December 31, 2022 and 2021, we had $13.6 million and $3.1 million, respectively, classified as restricted cash related to funds placed into escrow accounts in connection with the indemnity, closing payment and other provisions within the purchase agreements of our acquisitions. The increase in restricted cash from December 31, 2021 to December 31, 2022 is related to our acquisitions of Evolution Health, LLC ("Evolution") and Assisted Care Home Health, Inc. and RH Homecare Services, LLC ("Assisted Care") on April 1, 2022. See Note 4 – Acquisitions for additional information.
The following table summarizes the balances related to our cash, cash equivalents and restricted cash (amounts in millions):
As of December 31,
20222021
Cash and cash equivalents$40.5 $42.7 
Restricted cash13.6 3.1 
Cash, cash equivalents and restricted cash$54.1 $45.8 
Patient Accounts Receivable
We report accounts receivable from services rendered at their estimated transaction price, which includes contractual and non-contractual revenue adjustments based on the amounts expected to be due from payors. Our patient accounts receivable are uncollateralized and consist of amounts due from Medicare, Medicaid, other third-party payors and patients. Our non-Medicare third-party payor base is comprised of a diverse group of payors that are geographically dispersed across the country. As of December 31, 2022, 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 represented 67% and 68% of our net patient accounts receivable at December 31, 2022 and 2021, 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 (within both our home health and high acuity care segments), our pre-billing process includes verifying that we are eligible for payment from Medicare for the services that we provide to our patients. Our Medicare billing begins with a process to ensure that our billings are accurate through the utilization of an electronic Medicare claim review. We bill Medicare following the end of each 30-day period of care or upon discharge, if earlier, for the services provided to the patient.
Medicare Hospice
For our hospice patients, our pre-billing process includes verifying that we are eligible for payment from Medicare for the services that we provide to our patients. Our Medicare billing begins with a process to ensure that our billings are accurate through the utilization of an electronic Medicare claim review. We bill Medicare on a monthly basis for the services provided to the patient.
Non-Medicare Home Health, Hospice, Personal Care and High Acuity Care
For our non-Medicare patients, our pre-billing process primarily begins with verifying a patient’s eligibility for services with the applicable payor. Once the patient has been confirmed for eligibility, we will provide services to the patient and bill the applicable payor. Our review and evaluation of non-Medicare accounts receivable includes a detailed review of outstanding balances and special consideration to concentrations of receivables from particular payors or groups of payors with similar characteristics that would subject us to any significant credit risk.
Property and Equipment
Property and equipment is stated at cost and depreciated on a straight-line basis over the estimated useful lives of the assets or life of the lease, if shorter. Additionally, we have internally developed computer software for our own use. Additions and improvements (including interest costs for construction of qualifying long-lived assets) are capitalized. Maintenance and repair expenses are charged to expense as incurred. The cost of property and equipment sold or disposed of and the related accumulated depreciation are eliminated from the property and equipment and related accumulated depreciation accounts, and any gain or loss is credited or charged to other general and administrative expenses.
We assess the impairment of a long-lived asset group whenever events or changes in circumstances indicate that the asset’s carrying value may not be recoverable. Factors we consider important that could trigger an impairment review include but are not limited to the following:
•A significant change in the extent or manner in which the long-lived asset group is being used. 
•A significant change in the business climate that could affect the value of the long-lived asset group.
•A significant change in the market value of the assets included in the asset group.
If we determine that the carrying value of long-lived assets may not be recoverable, we compare the carrying value of the asset group to the undiscounted cash flows expected to be generated by the asset group. If the carrying value exceeds the undiscounted cash flows, an impairment charge is indicated. An impairment charge is recognized to the extent that the carrying value of the asset group exceeds its fair value.
We generally provide for depreciation over the following estimated useful service lives.
Years
Buildings39
Leasehold improvementsLesser of lease term or expected useful life
Equipment and furniture
3 to 7
Vehicles
3 to 5
Computer software
2 to 7
Finance leases3

The following table summarizes the balances related to our property and equipment for 2022 and 2021 (amounts in millions):
As of December 31,
20222021
Buildings and leasehold improvements$9.7 $9.1 
Equipment and furniture56.9 54.7 
Finance leases4.1 4.5 
Computer software46.7 47.0 
117.4 115.3 
Less: Accumulated depreciation(101.4)(96.9)
$16.0 $18.4 
Depreciation expense for 2022, 2021 and 2020 was $11.5 million, $12.1 million and $12.1 million, respectively.
Business Combinations
We account for acquisitions using the acquisition method of accounting in accordance with ASC 805, Business Combinations. Acquisitions are accounted for as purchases and are included in our consolidated financial statements from their respective acquisition dates. Assets acquired, liabilities assumed and noncontrolling interests, if any, are measured at fair value on the acquisition date using the appropriate valuation method. Goodwill generated from acquisitions is recognized for the excess of the purchase price over tangible and identifiable intangible assets. In determining the fair value of identifiable intangible assets and any noncontrolling interests, we use various valuation techniques including the income approach, the cost approach and the market approach. These valuation methods require us to make estimates and assumptions surrounding projected revenues and costs, growth rates and discount rates.
Goodwill and Other Intangible Assets
As of December 31, 2022, we had a goodwill balance of $1,287.4 million. Goodwill represents the amount of the purchase price in excess of the fair values assigned to the underlying identifiable net assets of acquired businesses. Goodwill is not amortized, but is subject to an annual impairment test. Tests are performed more frequently if events occur or circumstances change that would more likely than not reduce the fair value of the reporting unit below its carrying amount. These events or circumstances include, but are not limited to, a significant adverse change in the business environment, regulatory environment or legal factors, or a substantial decline in the market capitalization of our stock.
Each of our operating segments described in Note 15 – Segment Information is considered to represent an individual reporting unit for goodwill impairment testing purposes. We consider each of our home health care centers to constitute an individual business for which discrete financial information is available. However, since these care centers have substantially similar operating and economic characteristics and resource allocations and since significant investment decisions concerning these businesses are centralized and the benefits broadly distributed, we have aggregated these care centers and deemed them to constitute a single reporting unit. We have applied this same aggregation principle to our hospice and personal-care care centers and high acuity care joint ventures and have also deemed each of them to be a single reporting unit.
During 2022, we performed a qualitative assessment to determine if it is more likely than not that the fair value of our reporting units are less than their carrying values by evaluating relevant events and circumstances including financial performance, market conditions and share price. Based on this assessment, we concluded that the goodwill associated with our home health, hospice and high acuity care reporting units was not considered at risk of impairment as of October 31, 2022. In addition to the qualitative assessment, we also performed a quantitative analysis for our personal care reporting unit due to the decline in revenues resulting from staffing shortages using an income and market approach. Based on this analysis, we concluded that the goodwill associated with our personal care reporting unit was not considered at risk of impairment as of October 31, 2022. Since the date of our last goodwill impairment analysis, there have been no material developments, events, changes in operating performance or other circumstances that would cause management to believe it is more likely than not that the fair value of any of our reporting units would be less than their carrying amounts.
As of December 31, 2022, we had an other intangibles assets balance of $101.2 million. Intangible assets consist of certificates of need, licenses, acquired names, non-compete agreements and technology. We amortize non-compete agreements and acquired names that we do not intend to use indefinitely on a straight-line basis over their estimated useful lives, which are generally two to three years for non-compete agreements and up to three years for acquired names. We amortize technology over its estimated useful service life, which is generally up to seven years. Our indefinite-lived intangible assets are reviewed for impairment annually or more frequently if events occur or circumstances change that would more likely than not reduce the fair value of the intangible asset below its carrying amount. We performed a qualitative assessment of our indefinite-lived intangible assets during 2022 and determined that there have been no material developments, events, changes in operating performance or other circumstances that would cause management to believe it is more likely than not that the fair value of any of our indefinite-lived intangible assets would be less than their carrying amounts.
Debt Issuance Costs
During 2021, we recorded $2.8 million in deferred debt issuance costs as a reduction to long-term obligations, less current portion in our consolidated balance sheet in connection with our entry into the Second Amended Credit Agreement (See Note 9 - Long-Term Obligations). As of December 31, 2022 and 2021, we had unamortized debt issuance costs of $3.5 million and $4.5 million, respectively, recorded as a reduction to long-term obligations, less current portion in our accompanying consolidated balance sheets. We amortize deferred debt issuance costs related to our long-term obligations over the term of the obligation through interest expense, unless the debt is extinguished, in which case unamortized balances are immediately expensed. The unamortized debt issuance costs of $3.5 million at December 31, 2022 will be amortized over a weighted-average amortization period of 3.6 years.
Fair Value of Financial Instruments
The following details our financial instruments where the carrying value and the fair value differ (amounts in millions):
 Fair Value at Reporting Date Using
Financial InstrumentCarrying Value as of
December 31, 2022		Quoted Prices in Active
Markets for Identical
Items
(Level 1)		Significant Other
Observable Inputs
(Level 2)		Significant
Unobservable Inputs
(Level 3)
Long-term obligations$436.1 $— $428.6 $— 
The fair value hierarchy is based on three levels of inputs, of which the first two are considered observable and the last unobservable, that may be used to measure fair value. The three levels of inputs are as follows:
•Level 1 – Quoted prices in active markets for identical assets and liabilities. 
•Level 2 – Inputs other than Level 1 that are observable, either directly or indirectly, such as quoted prices for similar assets or liabilities, quoted prices in markets that are not active or other inputs that are observable or can be corroborated by observable market data for substantially the full term of the assets or liabilities.
•Level 3 – Unobservable inputs that are supported by little or no market activity and are significant to the fair value of the assets or liabilities.
Our deferred compensation plan assets are recorded at fair value and are considered a level 2 measurement. For our other financial instruments, including our cash and cash equivalents, patient accounts receivable, accounts payable, payroll and employee benefits and accrued expenses, we estimate the carrying amounts approximate fair value.
Income Taxes
We use the asset and liability approach for measuring deferred tax assets and liabilities based on temporary differences existing at each balance sheet date using currently enacted tax rates. Our deferred tax calculation requires us to make certain estimates about future operations. Deferred tax assets are reduced by a valuation allowance when we believe it is more likely than not that some portion or all of the deferred tax assets will not be realized. The effect of a change in tax rate is recognized as income or expense in the period that includes the enactment date. As of December 31, 2022, we had net deferred tax liabilities of $20.4 million. As of December 31, 2021, we had net deferred tax assets of $0.3 million.
Management regularly assesses the ability to realize deferred tax assets recorded in the Company’s entities based upon the weight of available evidence, including such factors as the recent earnings history and expected future taxable income. In the event future taxable income is below management’s estimates or is generated in tax jurisdictions different than projected, we could be required to increase the valuation allowance for deferred tax assets. This would result in an increase in our effective tax rate.
Share-Based Compensation
We record all share-based compensation as expense in the financial statements measured at the fair value of the award. We recognize compensation cost on a straight-line basis over the requisite service period for each separately vesting portion of the award. Share-based compensation expense for 2022, 2021 and 2020 was $16.6 million, $23.8 million and $26.7 million, respectively, and the total income tax benefit recognized for these expenses was $4.3 million, $6.0 million and $4.7 million, respectively, prior to the application of the income tax compensation rules under Internal Revenue Code section 162(m) ("162(m)"). As of December 31, 2022, the income tax benefit recognized for the three-year period was reduced by a cumulative $2.7 million, pursuant to 162(m).
Weighted-Average Shares Outstanding.
Net income per share attributable to Amedisys, Inc. common stockholders, calculated on the treasury stock method, is based on the weighted average number of shares outstanding during the period. The following table sets forth, for the periods indicated, shares used in our computation of weighted-average shares outstanding, which are used to calculate our basic and diluted net income attributable to Amedisys, Inc. common stockholders (amounts in thousands):
For the Years Ended December 31,
202220212020
Weighted average number of shares outstanding – basic32,517 32,642 32,559 
Effect of dilutive securities:
Stock options39 122 420 
Non-vested stock and stock units97 208 289 
Weighted average number of shares outstanding – diluted32,653 32,972 33,268 
Anti-dilutive securities303 114 25 
Advertising Costs
We expense advertising costs as incurred. Advertising expense for 2022, 2021 and 2020 was $7.3 million, $7.4 million and $6.5 million, respectively.
v3.22.4
NOVEL CORONAVIRUS PANDEMIC ("COVID-19")
 12 Months Ended
Dec. 31, 2022
Unusual or Infrequent Items, or Both [Abstract]  
NOVEL CORONAVIRUS PANDEMIC ("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 provided 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 $6 million of PRF funds in connection with the acquisition of AseraCare Hospice ("AseraCare"). Under the terms and conditions for receipt of the payment, we were allowed to use the funds to cover lost revenues and health care costs related to COVID-19 through June 30, 2021, and we were required to properly and fully document the use of these funds in reports to the U.S. Department of Health and Human Services ("HHS"). All required reporting was completed during the three-month period ended September 30, 2021, and our audit report was submitted to HHS on September 26, 2022.
For our wholly-owned subsidiaries, we utilized PRF funds to the extent we had qualifying COVID-19 expenses; we did not use PRF funds to cover lost revenues resulting from COVID-19. The grant income associated with the COVID-19 expenses incurred through June 30, 2021 is reflected in other operating income within our consolidated statements of operations.
We did not fully utilize the funds received; all unutilized funds were repaid in October 2021. In summary, the total funds that we received from the CARES Act PRF were accounted for as follows (amounts in millions):
Amount
Funds utilized through June 30, 2021 by consolidated entities$46.6 
Funds repaid to the government by consolidated entities (excludes $0.2 million of interest repaid)
58.3 
Funds utilized through June 30, 2021 by unconsolidated joint ventures1.3 
Funds repaid to the government by unconsolidated joint ventures0.6 
$106.8 
The CARES Act also provided for the temporary suspension of the automatic 2% reduction of Medicare claim reimbursements ("sequestration") for the period May 1, 2020 through December 31, 2020. During 2020 and 2021, Congress passed additional COVID-19 relief legislation which extended the 2% suspension of sequestration through March 31, 2022; sequestration was reinstated as a 1% reduction to Medicare claim reimbursements effective April 1, 2022 and a 2% reduction to Medicare claim reimbursements effective July 1, 2022. We recognized benefits to net service revenue totaling $13 million, $36 million and $23 million during 2022, 2021 and 2020, respectively.
Additionally, the CARES Act provided for the deferral of the employer share of social security tax (6.2%), effective for payments due after the enactment date through December 31, 2020. During 2020, we deferred approximately $55 million of social security taxes. Approximately $27 million was paid during December 2021; the remaining balance was paid during December 2022.
Our personal care segment did not receive funds under the CARES Act; however, it did receive funds totaling $1 million from the Mass Home Care ASAP COVID-19 Provider Sustainability Program, which were used during 2020 to cover costs related to COVID-19. The grant income associated with the funds received is reflected in other operating income within our consolidated statements of operations.
v3.22.4
ACQUISITIONS
 12 Months Ended
Dec. 31, 2022
Business Combinations [Abstract]  
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, personal care and high acuity care services. The purchase price paid for acquisitions is negotiated through arm’s length transactions, with consideration based on our analysis of, among other things, comparable acquisitions and expected cash flows. Acquisitions are
accounted for as purchases and are included in our 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 and noncontrolling interests, if any, 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 valuation and liabilities assumed.
2022 Acquisitions
On March 23, 2022, we entered into a transaction with one of our high acuity care health system partners in which we contributed cash and our health system partner contributed its home health operations to one of our existing high acuity care joint ventures. As a result of this transaction, we recorded goodwill of $8.5 million, other intangibles of $0.4 million (certificate of need and licenses) and noncontrolling interest of $8.9 million within our consolidated balance sheet. The fair value of noncontrolling interest was determined using an income approach and a market approach.
On April 1, 2022, we acquired 15 home health care centers from Evolution Health, LLC, a division of Envision Healthcare, doing business as Guardian Healthcare, Gem City, and Care Connection of Cincinnati ("Evolution"), for an estimated purchase price of $67.8 million. A portion of the purchase price ($51.1 million) was paid to the seller with cash on hand and proceeds from borrowings under our Revolving Credit Facility. The remainder ($16.7 million) was placed into an escrow account in accordance with the closing payment, indemnity and other provisions within the purchase agreement and recorded as restricted cash within our consolidated balance sheet. Corresponding liabilities were also recorded to accrued expenses and other long-term obligations within our consolidated balance sheet related to these contingent consideration arrangements.
Of the total $16.7 million placed into escrow, $1.0 million was set aside for the closing payment adjustment. The closing payment calculated on the acquisition date included estimates for cash, working capital and various other items. Under the purchase agreement, the purchase price was subject to an adjustment for any differences between estimated amounts included in the closing payment and actual amounts at close. The closing payment adjustment, which was finalized during the three-month period ended September 30, 2022, decreased the purchase price by $1.3 million from $67.8 million to $66.5 million. The remaining $15.7 million placed into escrow relates to certain outstanding matters existing as of the acquisition date as well as potential losses the Company may incur for which the seller has an obligation to indemnify the Company. This amount will either be paid to third parties as outstanding matters are resolved or to the seller at certain intervals in the future. As of December 31, 2022, $5.7 million of the $16.7 million has been released from escrow.
We expect $15 million of goodwill recorded for this acquisition to be deductible for income tax purposes over approximately 15 years.
Evolution contributed $29.4 million in net service revenue and an operating loss of $5.3 million during the year ended December 31, 2022.
The Company is in the process of reviewing the fair value of the assets acquired and liabilities assumed. During the post-acquisition period ended December 31, 2022, total assets acquired decreased by $2.1 million (primarily patient accounts receivable and property and equipment) and total liabilities assumed (specifically, the deferred income tax liability) decreased by $0.3 million as a result of our review. These adjustments, combined with the closing payment adjustment of $1.3 million described above, resulted in a $0.5 million increase in goodwill. Based on the Company's preliminary valuation, which may be revised as additional information becomes available during the measurement period, the total consideration of $66.5 million has been allocated to assets acquired and liabilities assumed as of the acquisition date as follows (amounts in millions):
Amount
ASSETS
Patient accounts receivable$7.6 
Prepaid expenses0.2 
Other current assets0.1 
Property and equipment1.9 
Operating lease right of use assets3.2 
Intangible assets (licenses)1.3 
Other assets0.1 
Total assets acquired
$14.4 
LIABILITIES
Accounts payable$(0.8)
Payroll and employee benefits(2.7)
Accrued expenses(2.4)
Operating lease liabilities(2.8)
Deferred income tax liability(0.1)
Current portion of long-term obligations(0.6)
Total liabilities assumed
(9.4)
Net identifiable assets acquired$5.0 
Goodwill61.5 
Total consideration$66.5 

On April 1, 2022, we acquired two home health locations from AssistedCare Home Health, Inc. and RH Homecare Services, LLC, doing business as AssistedCare Home Health and AssistedCare of the Carolinas ("AssistedCare"), respectively, for a purchase price of $24.7 million. A portion of the purchase price ($22.2 million) was paid to the seller with cash on hand and proceeds from borrowings under our Revolving Credit Facility. The remainder ($2.5 million) was placed into an escrow account in accordance with the indemnity provisions within the purchase agreement and is reflected in restricted cash within our consolidated balance sheet. A corresponding liability was also recorded to other long-term obligations within our consolidated balance sheet related to this contingent consideration arrangement. The $2.5 million will either be paid to third parties or to the seller at certain intervals in the future.
Based on the Company's preliminary valuation, we recorded goodwill of $24.0 million and other intangibles of $0.7 million in connection with the acquisition. Intangible assets acquired include licenses ($0.5 million), certificates of need ($0.2 million) and acquired names (less than $0.1 million). The acquired names will be amortized over a weighted average period of one year.
We expect the entire amount of goodwill recorded for this acquisition to be deductible for income tax purposes over approximately 15 years.
AssistedCare contributed $6.1 million in net service revenue and operating income of $0.8 million during the year ended December 31, 2022.
2021 Acquisitions
On May 1, 2021, we acquired the regulatory assets of a home health provider in Randolph County, North Carolina for a purchase price of $2.5 million. The purchase price was paid with cash on hand on the date of the transaction. We recorded goodwill of $2.4 million and other intangibles (certificate of need) of $0.1 million in connection with the acquisition.
On July 1, 2021, we acquired Visiting Nurse Association ("VNA"), a home health and hospice provider with locations in Nebraska and Iowa for a purchase price of $20.1 million. The purchase price was paid with cash on hand on the date of the transaction. We recorded goodwill of $19.7 million and other intangibles (licenses) of $0.4 million in connection with the acquisition. We expect the entire amount of goodwill for this acquisition to be deductible for income tax purposes over approximately 15 years.
On July 12, 2021, we acquired the regulatory assets of a home health provider in New York for a purchase price of $1.5 million. The purchase price was paid with cash on hand on the date of the transaction. We recorded goodwill of $1.4 million and other intangibles (certificate of need) of $0.1 million in connection with the acquisition.
On August 1, 2021, we acquired Contessa, a leader in hospital-at-home and skilled nursing facility at-home services for an estimated purchase price of $240.7 million, net of cash acquired. The Contessa purchase price included estimates for cash, working capital and 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. The closing payment adjustment, which was finalized during the three-month period ended December 31, 2021, increased the purchase price by $0.6 million from $240.7 million to $241.3 million.
The Company has finalized its valuation of the assets acquired, liabilities assumed and noncontrolling interests. During the year ended December 31, 2022, the deferred income tax liability was adjusted downward by $2.8 million resulting in a $2.8 million decrease in goodwill. The total consideration of $241.3 million has been allocated to assets acquired, liabilities assumed and noncontrolling interests as of the acquisition date as follows (amounts in millions):
Amount
ASSETS
Patient accounts receivable$1.5 
Prepaid expenses0.3 
Other current assets0.1 
Property and equipment0.3 
Operating lease right of use assets0.8 
Intangible assets54.3 
Other assets3.1 
Total assets acquired
$60.4 
LIABILITIES AND EQUITY
Accounts payable$(0.1)
Payroll and employee benefits(0.6)
Accrued expenses(3.4)
Operating lease liabilities(0.8)
Deferred income tax liability(0.3)
Current portion of long-term obligations(0.9)
Other long-term obligations(0.2)
Total liabilities assumed
(6.3)
Noncontrolling interests(43.9)
Total equity assumed(43.9)
Total liabilities and equity assumed$(50.2)
Net identifiable assets acquired$10.2 
Goodwill231.1 
Total consideration$241.3 
Intangible assets acquired include acquired names ($28.3 million), technology ($19.8 million) and non-compete agreements ($6.2 million). The non-compete agreements will be amortized over a weighted-average period of 2.0 years, and the technology will be amortized over a weighted-average period of 7.0 years. The fair value of noncontrolling interest ($43.9 million) was determined using an income approach.
We do not expect any of the goodwill recorded for this acquisition to be deductible for income tax purposes.
Contessa contributed $18.5 million in net service revenue and an operating loss of $39.1 million (inclusive of technology intangibles amortization totaling $3.0 million) during the year ended December 31, 2022 and $3.5 million in net service revenue and an operating loss of $10.3 million (inclusive of technology intangibles amortization totaling $1.2 million) during the year ended December 31, 2021.
On October 18, 2021, we acquired the regulatory assets of a home health provider in North Carolina for a purchase price of $4.5 million. The purchase price was paid with cash on hand on the date of the transaction. We recorded goodwill of $4.3 million and other intangibles (certificate of need) of $0.2 million in connection with the acquisition.
v3.22.4
GOODWILL AND OTHER INTANGIBLE ASSETS, NET
 12 Months Ended
Dec. 31, 2022
Goodwill and Intangible Assets Disclosure [Abstract]  
GOODWILL AND OTHER INTANGIBLE ASSETS, NET GOODWILL AND OTHER INTANGIBLE ASSETS, NET
Goodwill
During 2022, 2021 and 2020, we did not record any goodwill impairment charges as a result of our annual impairment test and none of the goodwill associated with our reporting units was considered impaired as of October 31st of each respective year (the date of our annual goodwill impairment test). Since the date of our last annual goodwill impairment test, there have been no material developments, events, changes in operating performance or other circumstances that would cause management to believe it is more likely than not that the fair value of any of our reporting units would be less than their carrying amounts.
The following table summarizes the activity related to our goodwill for 2022 and 2021 (amounts in millions):
Goodwill
Home HealthHospicePersonal CareHigh Acuity CareTotal
Balances at December 31, 2020 (1)$90.4 $799.2 $43.1 $— $932.7 
Additions27.8 1.7 — 233.9 263.4 
Balances at December 31, 2021118.2 800.9 43.1 233.9 1,196.1 
Additions85.6 — — 8.5 94.1 
Adjustments (2)— — — (2.8)(2.8)
Balances at December 31, 2022$203.8 $800.9 $43.1 $239.6 $1,287.4 
(1)Net of prior years' accumulated impairment losses of $733.7 million, which is inclusive of write-offs related to the sale and closure of care centers.
(2)The Company finalized its valuation of the assets acquired, liabilities assumed and noncontrolling interests in connection with the acquisition of Contessa on August 1, 2021. See Note 4 – Acquisitions for additional information.
Other Intangible Assets, Net
During 2022 and 2021, we did not record any impairment charges related to our other intangible assets.
The following table summarizes the activity related to our other intangible assets, net for 2022 and 2021 (amounts in millions):
Other Intangible Assets, Net
Certificates of Need and LicensesAcquired
Names -Unamortizable		Acquired
Names -Amortizable		Non-Compete
Agreements (3)		Technology (3)Total
Balances at December 31, 2020 (1)$47.0 $13.9 $5.5 $7.8 $— $74.2 
Additions0.8 28.3 — 6.2 20.2 55.5 
Reclass to amortizable intangible— (6.6)6.6 — — — 
Amortization (2)(0.7)— (9.0)(7.6)(1.2)(18.5)
Balances at December 31, 202147.1 35.6 3.1 6.4 19.0 111.2 
Additions2.4 — — — 1.1 3.5 
Amortization (2)(2.8)— (3.1)(4.6)(3.0)(13.5)
Balances at December 31, 2022$46.7 $35.6 $— $1.8 $17.1 $101.2 
(1)Net of prior years' accumulated amortization of $11.5 million for acquired names and $9.0 million for non-compete agreements.
(2)Amortization of certificates of need and licenses is related to care centers that were closed during 2021 and 2022.
(3)The weighted average remaining amortization period of our amortizable non-compete agreements and technology is 0.6 years and 5.6 years, respectively.
The estimated aggregate amortization expense related to intangible assets for each of the five succeeding years is as follows (amounts in millions):
Intangible Asset Amortization
2023$4.8 
20243.0 
20253.0 
20263.0 
20273.0 
$16.8 
See Note 4 – Acquisitions for further details on additions to goodwill and other intangible assets, net.
v3.22.4
ASSETS HELD FOR SALE
 12 Months Ended
Dec. 31, 2022
Discontinued Operation, Additional Disclosures [Abstract]  
ASSETS HELD FOR SALE ASSETS HELD FOR SALE
On February 10, 2023, we signed a definitive agreement to sell our personal care business (excluding the Florida operations) for a purchase price of $50 million. The divestment is expected to close during the second quarter of 2023.
The carrying amount of the assets and liabilities associated with our personal care reporting unit (which approximate fair value) included in our consolidated balance sheets are as follows (amounts in millions):
As of December 31, 2022As of December 31, 2021
ASSETS
Current assets:
Patient accounts receivable$9.6 $8.7 
Prepaid expenses0.1 0.1 
Other current assets9.7 8.8 
Property and equipment0.1 0.2 
Operating lease right of use assets2.5 2.8 
Goodwill43.1 43.1 
Intangible assets — 1.8 
Total assets$55.4 $56.7 
LIABILITIES
Current liabilities:
Accounts payable$0.4 $0.3 
Payroll and employee benefits0.6 2.5 
Accrued expenses1.8 0.1 
Current portion of operating lease liabilities0.6 0.7 
Total current liabilities3.4 3.6 
Operating lease liabilities, less current portion1.9 2.2 
Total liabilities$5.3 $5.8 
v3.22.4
DETAILS OF CERTAIN BALANCE SHEET ACCOUNTS
 12 Months Ended
Dec. 31, 2022
Details Of Certain Balance Sheet Accounts [Abstract]  
DETAILS OF CERTAIN BALANCE SHEET ACCOUNTS DETAILS OF CERTAIN BALANCE SHEET ACCOUNTS
Additional information regarding certain balance sheet accounts is presented below (amounts in millions):
As of December 31,
20222021
Other current assets:
Payroll tax escrow$7.6 $7.9 
Income tax receivable8.8 8.2 
Due from joint ventures3.6 3.9 
Other6.4 5.6 
$26.4 $25.6 
Other assets:
Workers’ compensation deposits$0.3 $0.3 
Health insurance deposits0.9 0.9 
Other miscellaneous deposits1.0 1.1 
Indemnity receivable13.6 13.6 
Equity method investments40.5 48.1 
Cost method investments20.0 5.0 
Other3.5 4.0 
$79.8 $73.0 
Accrued expenses:
Health insurance$16.2 $16.2 
Workers’ compensation40.6 40.3 
Florida ZPIC audit, gross liability— 17.4 
Legal settlements and other audits32.1 27.5 
Charity care1.9 1.4 
Estimated Medicare cap liability4.3 4.5 
Hospice accruals (room and board, general in-patient and other)19.1 23.6 
Patient and payor liabilities6.7 6.0 
Accrued contingent consideration10.5 — 
Accrued interest0.2 8.1 
Other5.8 5.8 
$137.4 $150.8 
Other long-term obligations:
Reserve for uncertain tax positions$— $3.4 
Deferred compensation plan liability0.6 1.0 
Accrued contingent consideration3.2 — 
Other1.0 0.6 
$4.8 $5.0 
v3.22.4
LEASES
 12 Months Ended
Dec. 31, 2022
Leases [Abstract]  
LEASES LEASES
We determine whether an arrangement is a lease at inception. We have operating leases, primarily for offices and fleet, that expire at various dates over the next seven years. We have finance leases covering certain office equipment that expire at various dates over the next three years. Our leases do not contain any restrictive covenants.

Our office leases generally contain renewal options for periods ranging from one to five years. Because we are not reasonably certain to exercise these renewal options, the options are not considered in determining the lease term, and payments associated with the option years are excluded from lease payments. Our office leases also generally include termination options, which allow for early termination of the lease after the first one to three years. Because we are not reasonably certain to exercise these termination options, the options are not considered in determining the lease term; payments for the full lease term are included in lease payments. Our office leases do not contain any material residual value guarantees.

Our fleet leases include a term of 367 days with monthly renewal options thereafter. Our fleet leases also include terminal rental adjustment clauses (“TRAC”), which provide for a final rental payment adjustment at the end of the lease, typically based on
the amount realized from the sale of the vehicle. The TRAC is structured such that it will almost always result in a significant payment by us to the lessor if the renewal option is not exercised. Based on the significance of the TRAC adjustment at the initial lease expiration, we believe that it is reasonably certain that we will exercise the monthly renewal options; therefore, the renewal options are considered in determining the lease term, and payments associated with the renewal options are included in lease payments.

For our fleet and office equipment leases, we use the implicit rate in the lease as the discount rate. For our office leases, the implicit rate is typically not available, so we use our incremental borrowing rate as the discount rate. Our lease agreements include both lease and non-lease components. We have elected the practical expedient that allows us to not separate lease and non-lease components for all of our leases.

Payments due under our operating and finance leases include fixed payments as well as variable payments. For our office leases, variable payments include amounts for our proportionate share of operating expenses, utilities, property taxes, insurance, common area maintenance and other facility-related expenses. For our vehicle and equipment leases, variable payments consist of sales tax.

The components of lease cost for the years ended December 31, 2022 and 2021 are as follows (amounts in millions):
For the Years Ended December 31,
20222021
Operating lease cost:
Operating lease cost
$43.9 $40.3 
Impairment of operating lease ROU assets
2.1 0.1 
Total operating lease cost
46.0 40.4 
Finance lease cost:
Loss on termination0.5 — 
Amortization of ROU assets
1.8 2.0 
Interest on lease liabilities
0.1 0.1 
Total finance lease cost
2.4 2.1 
Variable lease cost
3.4 3.3 
Short-term lease cost
— — 
Total lease cost
$51.8 $45.8 

Amounts reported in the consolidated balance sheets as of December 31, 2022 and 2021 for our operating leases are as follows (amounts in millions):
As of December 31,
20222021
Operating lease ROU assets
$102.9 $101.3 
Current portion of operating lease liabilities
33.5 31.2 
Operating lease liabilities, less current portion
69.5 69.3 
Total operating lease liabilities
$103.0 $100.5 

Amounts reported in the consolidated balance sheets as of December 31, 2022 and 2021 for finance leases are included in the table below. The finance lease ROU assets are recorded within property and equipment, net of accumulated depreciation within our consolidated balance sheets. The finance lease liabilities are recorded within current portion of long-term obligations and long-term obligations, less current portion within our consolidated balance sheets.
As of December 31,
20222021
Finance lease ROU assets
$4.1 $4.5 
Accumulated amortization
(1.8)(2.8)
Finance lease ROU assets, net
$2.3 $1.7 
Current installments of obligations under finance leases
$1.2 $0.9 
Long-term portion of obligations under finance leases
1.1 0.7 
Total finance lease liabilities
$2.3 $1.6 

Supplemental cash flow information and non-cash activity related to our leases are as follows (amounts in millions):
For the Years Ended December 31,
20222021
Cash paid for amounts included in the measurement of lease liabilities and ROU assets:
Operating cash flow from operating leases
$(44.4)$(39.7)
Financing cash flow from finance leases
(1.5)(2.0)
ROU assets obtained in exchange for lease obligations:
Operating leases
$45.1 $46.1 
Finance leases
2.1 0.9 
Reductions to ROU assets resulting from reductions to lease obligations:
Operating leases
$(4.2)$(1.7)
Finance leases
(0.6)— 

Amounts disclosed for ROU assets obtained in exchange for lease obligations include amounts added to the carrying amount of ROU assets resulting from lease modifications and reassessments.

Weighted average remaining lease terms and discount rates for our leases as of December 31, 2022 and 2021 are as follows:
As of December 31,
20222021
Weighted average remaining lease term (years):
Operating leases
3.53.7
Finance leases
2.11.7
Weighted average discount rate:
Operating leases
3.4 %2.7 %
Finance leases
5.3 %5.2 %
Maturities of lease liabilities as of December 31, 2022 are as follows (amounts in millions):
Operating
Leases		Finance
Leases
2023$36.1 $1.2 
202430.9 0.9 
202520.8 0.3 
202612.7 — 
20276.7 — 
Thereafter2.4 — 
Total undiscounted lease payments
109.6 2.4 
Less: Imputed interest(6.6)(0.1)
Total lease liabilities
$103.0 $2.3 
v3.22.4
LONG-TERM OBLIGATIONS
 12 Months Ended
Dec. 31, 2022
Debt Disclosure [Abstract]  
LONG-TERM OBLIGATIONS LONG-TERM OBLIGATIONS
Long-term debt consists of the following for the periods indicated (amounts in millions):
As of December 31,
20222021
$450.0 million Term Loan; interest rate at Base Rate plus Applicable Rate or Eurodollar Rate plus Applicable Rate (5.9% at December 31, 2022); due July 30, 2026
$435.9 $447.2 
$550.0 million Revolving Credit Facility; interest only payments; interest rate at Base Rate plus Applicable Rate or Eurodollar Rate plus Applicable Rate; due July 30, 2026
— — 
Promissory notes0.2 0.8 
Finance leases2.3 1.6 
Principal amount of long-term obligations438.4 449.6 
Deferred debt issuance costs(3.5)(4.5)
434.9 445.1 
Current portion of long-term obligations(15.5)(13.0)
Long-term obligations, less current portion$419.4 $432.1 
Maturities of debt as of December 31, 2022 are as follows (amounts in millions):
Long-term
obligations
2023$15.5 
202423.3 
202522.7 
2026376.9 
2027— 
$438.4 
Credit Agreement
On June 29, 2018, we entered into our Amended and Restated Credit Agreement (the "Credit Agreement") which provided for a senior secured revolving credit facility in an initial aggregate principal amount of up to $550.0 million (the "Revolving Credit Facility"). The Revolving Credit Facility provided for and included within its $550.0 million limit a $25.0 million swingline facility and commitments for up to $60.0 million in letters of credit. Upon lender approval, we could increase the aggregate loan amount under the Revolving Credit Facility by $125.0 million plus an unlimited amount subject to a leverage limit of 0.5x under the maximum allowable consolidated leverage ratio which was 3.0x per the Credit Agreement.
The final maturity of the Revolving Credit Facility was June 29, 2023, and there was no mandatory amortization on the outstanding principal balances which were payable in full upon maturity. The Revolving Credit Facility was used to provide
ongoing working capital needs and for general corporate purposes of the Company and our subsidiaries, including permitted acquisitions, as defined in the Credit Agreement.
First Amendment to the Credit Agreement
On February 4, 2019, we entered into the First Amendment to the Credit Agreement (as amended by the First Amendment, the “Amended Credit Agreement”). The Amended Credit Agreement provided for a senior secured credit facility in an initial aggregate principal amount of up to $725.0 million, which included the $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.
Second Amendment to the Credit Agreement
On July 30, 2021, we entered into the Second Amendment to our Credit Agreement (as amended by the Second Amendment, the "Second Amended Credit Agreement"). The Second Amended Credit Agreement provides for a senior secured credit facility in an initial aggregate principal amount of up to $1.0 billion, which includes the $550.0 million Revolving Credit Facility and a term loan facility with a principal amount of up to $450.0 million (the "Amended Term Loan Facility" and collectively with the Revolving Credit Facility, the "Amended Credit Facility").
Net proceeds from the $450.0 million Amended Term Loan Facility were used to fund the Contessa acquisition.
The loans issued under the Amended Credit Facility bear interest on a per annum basis, at our election, at either: (i) the Base Rate plus the Applicable Rate or (ii) the 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, 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 December 31, 2022, the Applicable Rate is 0.50% per annum for Base Rate Loans and 1.50% per annum for Eurodollar Rate Loans. Our Second Amended Credit Agreement provides for the replacement of LIBOR with the daily or term secured overnight financing rate ("SOFR") whenever LIBOR is discontinued. We are also subject to a commitment fee and letter of credit fee under the terms of the Second Amended Credit Agreement, as presented in the table below.
Pricing TierConsolidated Leverage RatioBase Rate LoansEurodollar Rate Loans and Daily Floating LIBOR Rate LoansCommitment
Fee		Letter of
Credit Fee
I
> 3.00 to 1.0
1.00 %2.00 %0.30 %1.75 %
II
< 3.00 to 1.0 but > 2.00 to 1.0
0.75 %1.75 %0.25 %1.50 %
III
< 2.00 to 1.0 but > 0.75 to 1.0
0.50 %1.50 %0.20 %1.25 %
IV
< 0.75 to 1.0
0.25 %1.25 %0.15 %1.00 %

The final maturity date of the Amended Credit Facility is July 30, 2026. The Revolving Credit Facility will terminate and be due and payable as of the final maturity date. The Amended Term Loan Facility, however, is subject to quarterly amortization of principal in the amount of (i) 0.625% for the period commencing on July 30, 2021 and ending on September 30, 2023, and (ii) 1.250% for the period commencing on October 1, 2023 and ending on July 30, 2026. The remaining balance of the Amended Term Loan Facility must be paid upon the final maturity date. In addition to the scheduled amortization of the Amended Term Loan Facility, and subject to customary exceptions and reinvestment rights, we are required to prepay the Amended Term Loan Facility first and the Revolving Credit Facility second with 100% of all net cash proceeds received by any loan party or any subsidiary thereof in connection with (a) any asset sale or disposition where such loan party receives net cash proceeds in excess of $5 million or (b) any debt issuance that is not permitted under the Second Amended Credit Agreement.
The Second 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 Second Amended Credit Agreement, and (ii) a consolidated interest coverage ratio of EBITDA to cash interest charges, as defined in the Second Amended Credit Agreement. Each of these covenants is calculated over rolling four-quarter periods and also is subject to certain exceptions and baskets. The Second 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 Second Amended Credit Agreement. In connection with our entry into the Second Amended Credit Agreement during the year ended December 31, 2021, we recorded $2.8 million in deferred debt issuance costs as long-term obligations, less current portion within our consolidated balance sheet.
The Revolving Credit Facility is guaranteed by substantially all of our wholly-owned direct and indirect subsidiaries. The Second 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 Amended Term Loan Facility was 3.2% for the year ended December 31, 2022 and 1.6% for the year ended December 31, 2021. Our weighted average interest rate for borrowings under our $550.0 million Revolving Credit Facility was 3.4% for the year ended December 31, 2022 and 1.9% for the year ended December 31, 2021.
As of December 31, 2022, our consolidated leverage ratio was 1.7, our consolidated interest coverage ratio was 11.6 and we are in compliance with our covenants under the Second 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 December 31, 2022, our availability under our $550.0 million Revolving Credit Facility was $520.4 million as we have no outstanding borrowings and $29.6 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 (now the Second Amended Credit Agreement), the Amended and Restated Security Agreement, dated as of June 29, 2018 (the “Amended and Restated Security Agreement”), and the Amended and Restated Pledge Agreement, dated as of June 29, 2018 (the “Amended and Restated Pledge Agreement”). In connection with the AseraCare acquisition, we entered into a Joinder Agreement, dated as of June 12, 2020, pursuant to which the AseraCare entities were made parties to, and became subject to the terms and conditions of, the Amended Credit Agreement (now the Second Amended Credit Agreement), the Amended and Restated Security Agreement and the Amended and Restated Pledge Agreement (the “AseraCare Joinder"). In connection with the Contessa acquisition and the Second Amendment, we entered into a Joinder Agreement, dated as of September 3, 2021, pursuant to which Contessa and its subsidiaries and Asana, which we acquired on January 1, 2020, and its subsidiaries were made parties to, and became subject to the terms and conditions of, the Second Amended Credit Agreement, the Amended and Restated Security Agreement and the Amended and Restated Pledge Agreement (the “Contessa and Asana Joinder,” and together with the CCH Joinder and the AseraCare Joinder, the “Joinders”).
Pursuant to the Joinders, the Amended and Restated Security Agreement and the Amended and Restated Pledge Agreement, CCH and its subsidiaries, the AseraCare entities, Contessa and its subsidiaries and Asana and its subsidiaries granted in favor of the Administrative Agent a first lien security interest in substantially all of their personal property assets and pledged to the Administrative Agent each of their respective subsidiaries' issued and outstanding equity interests. CCH and its subsidiaries, the AseraCare entities, Contessa and its subsidiaries and Asana and its subsidiaries also guaranteed our obligations, whether now existing or arising after the respective effective dates of the Joinders, under the Second Amended Credit Agreement pursuant to the terms of the Joinders and the Second Amended Credit Agreement.
Promissory Notes
Our outstanding promissory note totaling $0.2 million, obtained through the acquisition of Contessa on August 1, 2021, bears an interest rate of 6.5%.
Finance Leases
Our outstanding finance leases totaling $2.3 million relate to leased equipment and bear interest rates ranging from 2.1% to 5.3%.
v3.22.4
INCOME TAXES
 12 Months Ended
Dec. 31, 2022
Income Tax Disclosure [Abstract]  
INCOME TAXES INCOME TAXES
Income taxes attributable to continuing operations consist of the following (amounts in millions):
For the Years Ended December 31,
202220212020
Current income tax expense/(benefit):
Federal$12.2 $20.3 $41.6 
State and local7.0 5.2 10.6 
19.2 25.5 52.2 
Deferred income tax expense/(benefit):
Federal20.4 35.9 (22.5)
State and local2.9 8.7 (4.1)
23.3 44.6 (26.6)
Income tax expense$42.5 $70.1 $25.6 

Total income tax expense for the years ended December 31, 2022, 2021 and 2020 was allocated as follows (amounts in millions):
For the Years Ended December 31,
202220212020
Income from continuing operations$42.5 $70.1 $25.6 
Interest expense(0.7)0.1 0.2 
Goodwill(2.7)3.1 — 
Tax expense recorded to additional paid-in-capital1.5 — — 
Total$40.6 $73.3 $25.8 
A reconciliation of significant differences between the reported amount of income tax expense and the expected amount of income tax expense that would result from applying the U.S. federal statutory income tax rate of 21% to income before income taxes is as follows:
For the Years Ended December 31,
202220212020
Income tax expense at U.S. federal statutory rate21.0 %21.0 %21.0 %
State and local income taxes, net of federal income tax benefit (1)5.6 5.0 2.4 
Excess tax benefits from share-based compensation (1)0.3 (2.1)(12.7)
Non-deductible executive compensation0.8 1.2 2.1 
Unrecognized tax benefits (2)(1.7)— — 
Other items, net (3)0.5 (0.1)(0.6)
Income tax expense26.5 %25.0 %12.2 %
(1)On August 10, 2020, Paul B. Kusserow, 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. 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 U.S. GAAP purposes. If the tax deduction exceeds the cumulative U.S. 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, resulting in a reduction of the effective tax rate. Mr. Kusserow's stock option exercise produced a $92.1 million tax deduction in excess of U.S. GAAP compensation expense, resulting in a $19.4 million federal income tax benefit and a $4.6 million state and local income tax benefit for the year ended December 31, 2020.
(2)For the year ended December 31, 2022, the Company recognized $2.7 million of federal uncertain tax positions due to a lapse of the statute of limitations.
(3)Includes various items such as non-deductible expenses, non-taxable income, tax credits, valuation allowance, uncertain tax positions and return-to-accrual adjustments.
As of December 31, 2022 and 2021, the Company had income taxes receivable of $8.8 million and $8.2 million, respectively, included in other current assets within our consolidated balance sheets.
Deferred tax assets (liabilities) consist of the following components (amounts in millions):
As of December 31,
20222021
Deferred tax assets:
Accrued payroll & employee benefits$14.1 $13.2 
Workers’ compensation10.6 10.5 
Share-based compensation5.7 6.2 
Legal & compliance matters4.7 6.2 
Lease liability27.8 27.3 
Deferred social security taxes (1)— 6.9 
Net operating loss carryforwards11.6 13.6 
Tax credit carryforwards2.9 2.5 
Other assets0.2 0.5 
Gross deferred tax assets77.6 86.9 
Less: valuation allowance(5.2)(3.3)
Net deferred tax assets72.4 83.6 
Deferred tax liabilities:
Property and equipment(6.6)(8.1)
Amortization of intangible assets(48.5)(32.3)
Deferred revenue— (4.5)
Investment in partnerships(10.0)(10.8)
Right-of-use asset(27.0)(26.7)
Other liabilities(0.7)(0.9)
Gross deferred tax liabilities(92.8)(83.3)
Deferred income taxes$(20.4)$0.3 
(1)The CARES Act provided for the deferral of the employer share of social security tax (6.2%), effective for payments due after the enactment date through December 31, 2020. Fifty percent of the deferred payroll taxes were due on December 31, 2021 with the remaining amounts due on December 31, 2022. As of December 31, 2021, the Company had a remaining balance of deferred social security taxes of $27 million, reflected within our consolidated balance sheets, which was paid in December 2022. For income tax purposes, the deferred social security taxes are deductible when paid, leaving no remaining deferred tax asset as of December 31, 2022.
As of December 31, 2022, we have U.S. net operating loss (“NOL”) carryforwards of $20.9 million that are available to reduce future taxable income and may be carried forward indefinitely. While the NOL carryforwards are not subject to expiration, the annual NOL amount that is available to offset future taxable income is subject to limitation. The NOL carryforwards were acquired as part of the stock purchase of Contessa on August 1, 2021. Under Section 382 of the Internal Revenue Code of 1986, as amended ("Section 382"), substantial changes in a Company’s ownership may limit the amount of NOL carryforwards that can be utilized annually to offset future taxable income. As a result of the ownership change, the Company determined that there is an annual limitation, pursuant to Section 382, on the amount of NOL carryforwards that may be utilized to offset future taxable income.
As of December 31, 2022, we have state NOL carryforwards of $144.7 million that are available to reduce future taxable income and various state tax credits totaling $3.7 million available to reduce future state income taxes. The state NOL and tax credit carryforwards expire at various times.
As of December 31, 2022 and 2021, the valuation allowance for deferred tax assets, which is related to certain state NOLs, was $5.2 million and $3.3 million, respectively. The net change in the total valuation allowance for the years ended December 31, 2022 and 2021 was an increase of $1.9 million and an increase of $3.2 million, respectively. The $1.9 million increase in the valuation allowance for the year ended December 31, 2022 is due to Contessa's creation of state NOL carryforwards in jurisdictions that require separate company reporting and where the Company does not expect to have sufficient separate company future taxable income available to offset the state NOL carryforwards.
In assessing the realizability of deferred tax assets, management considers whether it is more likely than not that some portion or all of the deferred tax assets will not be realized. The ultimate realization of deferred tax assets is dependent upon the generation of future taxable income in those jurisdictions during the periods in which those temporary differences become deductible. Management considers the scheduled reversal of deferred tax liabilities (including the impact of available carryback and carryforward periods), projected future taxable income and tax-planning strategies in making this assessment. In order to fully realize the deferred tax assets, the Company will need to generate future taxable income before the expiration of the carryforwards governed by the tax code. Based on the current level of pre-tax earnings, the Company will generate the minimum amount of future taxable income needed to support the realization of the deferred tax assets. As a result, as of December 31, 2022, management believes that it is more likely than not that we will realize the benefits of these deferred tax assets, net of the existing valuation allowances. The amount of the deferred tax asset considered realizable, however, could be reduced in the near term if estimates of future taxable income during the carryforward period are reduced.
Uncertain Tax Positions
We account for uncertain tax positions in accordance with the authoritative guidance for uncertain tax positions. A reconciliation of the beginning and ending amount of unrecognized tax benefits is as follows (amounts in millions):
For the Years Ended December 31,
202220212020
Balance at beginning of period$2.7 $2.7 $2.7 
Additions for tax positions related to current year— — — 
Additions for tax positions related to prior year— — — 
Reductions for tax positions related to prior years— — — 
Lapse of statute of limitations(2.7)— — 
Settlements— — — 
Balance at end of period$— $2.7 $2.7 
As of December 31, 2021, there was $2.7 million of unrecognized tax benefits recorded in other long-term obligations within the consolidated balance sheets. During 2022, the statute of limitations lapsed, ultimately removing the uncertainty surrounding the Company's ability to recognize the tax positions, if challenged under audit. As a result, the Company recognized a $2.7 million income tax benefit and corresponding reduction in our effective tax rate for the period ended December 31, 2022.
We recognized $0.1 million and $0.2 million of interest as components of interest expense in connection with our reserve for uncertain tax positions during the years ended December 31, 2021 and 2020, respectively. For the period ended December 31, 2022, the Company recorded a $0.7 million benefit as a component of interest expense, as a result of the lapse of the statute of limitations and corresponding release of the reserve for uncertain tax positions. Accrued interest related to uncertain tax positions included in the consolidated balance sheet at December 31, 2021 was $0.7 million. There was no accrued interest related to uncertain tax positions included in the consolidated balance sheet at December 31, 2022.
We are subject to income taxes in the U.S. and in many individual states, with significant operations in Louisiana, South Carolina, Alabama, Georgia, Massachusetts and Tennessee. We are open to examination in the U.S. and in various individual states for the tax years ended December 31, 2014 through December 31, 2022. We are also open to examination in various states for the years ended 2007 through 2022 resulting from NOLs generated and available for carryforward from those years.
v3.22.4
CAPITAL STOCK AND SHARE-BASED COMPENSATION
 12 Months Ended
Dec. 31, 2022
Share-Based Payment Arrangement [Abstract]  
CAPITAL SOCK AND SHARE-BASED COMPENSATION CAPITAL STOCK AND SHARE-BASED COMPENSATION
We are authorized by our Certificate of Incorporation to issue 60,000,000 shares of common stock, $0.001 par value and 5,000,000 shares of preferred stock, $0.001 par value. As of December 31, 2022, there were 37,891,186 and 32,518,278 shares of common stock issued and outstanding, respectively, and no shares of preferred stock issued or outstanding. Our Board of Directors is authorized to fix the dividend rights and terms, conversion and voting rights, redemption rights and other privileges and restrictions applicable to our preferred stock.
Share-Based Awards
On March 29, 2018, our Board of Directors and the Compensation Committee approved, subject to stockholder approval, the Amedisys, Inc. 2018 Omnibus Incentive Compensation Plan (the “2018 Plan”). On June 6, 2018, our stockholders approved the 2018 Plan at the Company's annual meeting of stockholders. The 2018 Plan replaces our 2008 Omnibus Incentive Compensation Plan (the “2008 Plan”), which terminated on June 6, 2018 when the stockholders approved the 2018 Plan. The 2018 Plan, as amended to date, authorizes the grant of various types of equity-based awards, such as stock awards, restricted stock units, stock appreciation rights and stock options to eligible participants, which include all of our employees and all employees of our 50% or more owned subsidiaries, our non-employee directors and certain consultants. The vesting terms of the awards may be tied to continued employment (or, for our non-employee directors, continued service on the Board of Directors) and/or achievement of certain pre-determined performance goals. We refer to restricted stock units subject to service-based or a combination of service-based and performance-based vesting conditions as “non-vested stock units.” The 2018 Plan is administered by the Compensation Committee of our Board of Directors, which determines, within the provisions of the 2018 Plan, those eligible participants to whom, and the times at which, awards shall be granted. The Compensation Committee, in its discretion, may delegate its authority and duties under the 2018 Plan to specified officers; however, only the Compensation Committee may approve the terms of awards to our executive officers.
Equity-based awards may be granted for a number of shares not to exceed, in the aggregate, approximately 2.5 million shares of common stock. We had approximately 1.7 million shares available at December 31, 2022. The price per share for stock options shall be no less than the greater of (a) 100% of the fair value of a share of common stock on the date the option is granted or (b) the aggregate par value of the shares of our common stock on the date the option is granted. If a stock option is granted to any owner of 10% or more of the total combined voting power of us and our subsidiaries, the price is to be at least 110% of the fair value of a share of our common stock on the date the award is granted. Each equity-based award vests ratably over a one year to four year period, with the exception of those issued under contractual arrangements that specify otherwise, and may be exercised during a period as determined by our Compensation Committee or as otherwise approved by our Compensation Committee. The contractual terms of stock options exercised shall not exceed ten years from the date such option is granted. The Company analyzes historical data of forfeited awards to develop an estimated forfeiture rate that is applied to the Company's non-cash compensation expense; however, all non-cash compensation expense is adjusted to reflect actual vestings and forfeitures.
Employee Stock Purchase Plan (“ESPP”)
We have a plan whereby our eligible employees may purchase our common stock at 85% of the market price at the time of purchase. The total number of shares of our common stock authorized for issuance under our ESPP is 4,500,000, and as of December 31, 2022, there were 1,264,302 shares available for future issuance. The following is a detail of the purchases that have been made under the plan:
Employee Stock Purchase Plan PeriodShares IssuedPrice
2020 and Prior3,171,373 $17.89 
January 1, 2021 to March 31, 20214,060 225.07 
April 1, 2021 to June 30, 20215,095 208.19 
July 1, 2021 to September 30, 20217,466 126.74 
October 1, 2021 to December 31, 20217,161 137.60 
January 1, 2022 to March 31, 20226,184 146.45 
April 1, 2022 to June 30, 202210,814 89.35 
July 1, 2022 to September 30, 202212,047 82.27 
October 1, 2022 to December 31, 202211,498 71.01 
3,235,698 
ESPP expense included in general and administrative expense in our accompanying consolidated statements of operations was $0.7 million, $0.7 million and $0.6 million for 2022, 2021 and 2020, respectively.
Stock Options
On August 10, 2020, Paul B. Kusserow, Chief Executive Officer and Chairman of the Board of Amedisys, exercised 500,000 stock options previously awarded to him under the 2008 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 consolidated statement of cash flows, related to the remittance of tax withholding obligations. In addition, Mr. Kusserow's stock option exercise resulted in a $24.0 million income tax benefit that was recorded in our consolidated statement of operations during the year ended December 31, 2020. See Note 10 – Income Taxes for additional details.
We use the Black-Scholes option pricing model to estimate the fair value of our stock options. There were 33,656, 40,788 and 43,249 options granted during 2022, 2021 and 2020, respectively. Stock option compensation expense included in general and administrative expense in our accompanying consolidated statements of operations was $1.7 million, $3.6 million and $4.3 million for 2022, 2021 and 2020, respectively.
The fair values of the stock option awards were estimated using the following assumptions for 2022, 2021 and 2020:
For the Years Ended December 31,
202220212020
Risk Free Rate
1.91%
0.80% - 1.35%
0.38% - 1.51%
Expected Volatility
40.97%
39.84% - 41.40%
40.15% - 42.80%
Expected Term6.25 years
6.25 years
6.25 years
Weighted Average Fair Value$61.31$107.45$86.72
Dividend Yield—%—%—%
We used the simplified method to estimate the expected term for the stock options granted during 2022, 2021 and 2020 as adequate historical experience is not available to provide a reasonable estimate.
The following table presents our stock option activity for 2022:
Number of
Shares		Weighted
Average Exercise
Price		Weighted
Average Contractual
Life (Years)
Outstanding options at January 1, 2022273,973 $137.54 7.21
Granted33,656 143.25 
Exercised(37,635)61.23 
Canceled, forfeited or expired(51,382)174.57 
Outstanding options at December 31, 2022218,612 $142.86 6.56
Exercisable options at December 31, 2022163,286 $122.54 6.04
The aggregate intrinsic value of our outstanding options and exercisable options at December 31, 2022 was $0.7 million and $0.7 million, respectively. Total intrinsic value of options exercised was $1.5 million, $5.1 million and $121.1 million for 2022, 2021 and 2020, respectively. The tax benefit from stock options exercised during the period amounted to $0.4 million, $1.0 million and $27.9 million for 2022, 2021 and 2020, respectively.
The following table presents our non-vested stock option activity for 2022:
Number of
Shares		Weighted Average
Grant Date Fair Value
Non-vested stock options at January 1, 2022129,439 $182.45 
Granted33,656 143.25 
Vested(64,496)150.79 
Forfeited(43,273)173.11 
Non-vested stock options at December 31, 202255,326 $202.81 
At December 31, 2022, there was $2.0 million of unrecognized compensation cost related to stock options that we expect to be recognized over a weighted-average period of 1.8 years.
Non-Vested Stock Units
We issue non-vested stock unit awards that are service-based, performance-based or a combination of both with vesting terms ranging from one to four years. Based on the terms and conditions of these awards, we determine if the awards should be recorded as either equity or liability instruments. The compensation expense is determined based on the market price of our common stock at the date of grant, applied to the total number of units that are anticipated to vest, unless the award specifies differently. Shares of stock are not issued to the recipient until the stock unit awards have vested and after the pre-determined delivery date has occurred.
Non-Vested Stock Units – Service-Based ("Service-Based Non-Vested Stock Units")
Service-based non-vested stock unit compensation expense included in general and administrative expenses in our accompanying consolidated statements of operations was $12.1 million, $9.4 million and $7.5 million for 2022, 2021 and 2020, respectively.
The following table presents our service-based non-vested stock units activity for 2022:
Number of 
Shares		Weighted Average
Grant Date Fair
Value
Non-vested stock units at January 1, 2022180,823 $195.25 
Granted211,361 115.07 
Vested(59,006)146.76 
Canceled, forfeited or expired(70,025)194.68 
Non-vested stock units at December 31, 2022263,153 $141.62 
The weighted average grant date fair value of service-based non-vested stock units granted was $115.07, $234.42 and $206.10 in 2022, 2021 and 2020, respectively.
At December 31, 2022, there was $22.6 million of unrecognized compensation cost related to our service-based non-vested stock units that we expect to be recognized over a weighted average period of 2.2 years.
Non-Vested Stock Units – Service-Based and Performance-Based Awards ("Performance-Based Non-Vested Stock Units")
During 2022, we awarded performance-based awards to certain employees. The target level established by the award, which is based on the Company’s 2022 adjusted earnings before interest, taxes, depreciation and amortization (“Adjusted EBITDA”), provided for the recipients to receive an aggregate of 71,349 non-vested stock units if the target was achieved. For a select group of employees, if the target objective was surpassed to the point of achieving the projected maximum payout, the recipients would receive an additional aggregate of 32,048 non-vested stock units during 2023. The target number of shares to be potentially awarded was reduced by forfeitures as indicated in the table below. On February 1, 2023, the Compensation Committee determined that the 2022 performance-based objective established by the award was not satisfied, and as a result, the target number of non-vested stock units will be forfeited. Performance-based non-vested stock units compensation expense included in general and administrative expenses in our consolidated statements of operations was $2.2 million, $10.2 million and $13.5 million for 2022, 2021 and 2020, respectively.
The following table presents our performance-based non-vested stock units activity for 2022:
Number of 
Shares		Weighted Average
Grant Date Fair
Value
Non-vested stock units at January 1, 2022186,951 $206.36 
Granted71,349 133.70 
Vested(85,767)156.18 
Canceled, forfeited or expired(104,486)237.30 
Non-vested stock units at December 31, 202268,047 $144.55 
The weighted average grant date fair value of performance-based non-vested stock units granted was $133.70, $262.67 and $201.90 in 2022, 2021 and 2020, respectively.
At December 31, 2022, there was $1.1 million in unrecognized compensation costs related to our performance-based non-vested stock units that we expect to be recognized over a weighted average period of 1.1 years.
v3.22.4
COMMITMENTS AND CONTINGENCIES
 12 Months Ended
Dec. 31, 2022
Commitments and Contingencies Disclosure [Abstract]  
COMMITMENTS AND CONTINGENCIES COMMITMENTS AND CONTINGENCIES
Legal Proceedings – Ongoing
We are involved in legal actions in the normal course of business, some of which seek monetary damages, including claims for punitive damages. Based on information available to us as of the date of this filing, we do not believe that these normal course actions, when finally concluded and determined, will have a material impact on our consolidated financial condition, results of operations or cash flows.
Legal fees related to all legal matters are expensed as incurred.
Legal Proceedings - Completed
Subpoena Duces Tecum and Civil Investigative Demands Issued by the U.S. Department of Justice
On May 7, 2021, the U.S. Department of Justice notified the Company that they were closing their investigation into the below-referenced Subpoena Duces Tecum ("Subpoena") and civil investigative demands ("CIDs"). At the time, we had $6.5 million recorded to accrued expenses in our consolidated balance sheets related to these matters. We reversed this accrual during the three-month period ended June 30, 2021.
On May 21, 2015, we received a Subpoena issued by the U.S. Department of Justice. The Subpoena requested the delivery of information regarding 53 identified hospice patients to the United States Attorney’s Office for the District of Massachusetts. It also requested the delivery of documents relating to our hospice clinical and business operations and related compliance activities. The Subpoena generally covered the period from January 1, 2011 through May 21, 2015.
On November 3, 2015, 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 Morgantown, West Virginia area. The CID requested 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 covered the period from January 1, 2009 through August 31, 2015.
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 requested 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 covered the period from January 1, 2011 through June 20, 2016.
Third Party Audits – Ongoing
From time to time, in the ordinary course of business, we are subject to audits under various governmental programs in which third party firms engaged by CMS, including Recovery Audit Contractors (“RACs”), Zone Program Integrity Contractors (“ZPICs”), Uniform Program Integrity Contractors (“UPICs”), Program Safeguard Contractors (“PSCs”), Medicaid Integrity Contractors (“MICs”), Supplemental Medical Review Contractors (“SMRCs”) and the Office of the Inspector General ("OIG"), conduct extensive reviews of claims data to identify potential improper payments. We cannot predict the ultimate outcome of any regulatory reviews or other governmental audits and investigations.
In July 2010, our subsidiary that provides hospice services in Florence, South Carolina received from a ZPIC a request for records regarding a sample of 30 beneficiaries who received services from the subsidiary during the period of January 1, 2008 through March 31, 2010 (the “Review Period”) to determine whether the underlying services met pertinent Medicare payment requirements. We acquired the hospice operations subject to this review on August 1, 2009; the Review Period 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 December 31, 2022, 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 consolidated balance sheets.
In July 2016, the Company received a request for medical records from SafeGuard Services, L.L.C (“SafeGuard”), a ZPIC, related to services provided by some of the care centers that the Company acquired from Infinity Home Care, L.L.C. The review period covered time periods both before and after our ownership of the care centers, which were acquired on December 31, 2015. In August 2017, the Company received Requests for Repayment from Palmetto GBA, LLC (“Palmetto”) regarding Infinity Home Care of Lakeland, LLC, (“Lakeland Care Centers”) and Infinity Home Care of Pinellas, LLC, (“Clearwater Care Center”). The Palmetto letters were based on a statistical extrapolation performed by SafeGuard which alleged an overpayment of $34.0 million for the Lakeland Care Centers on a universe of 72 Medicare claims totaling $0.2 million in actual claims payments 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 covered claims between January 2, 2014 and September 13, 2016. The Clearwater Request for Repayment covered 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 was reduced to $26.0 million and the alleged overpayment for the Clearwater Care Center was reduced to $3.3 million. The Company filed Level III Administrative Appeals, and the ALJ hearings regarding the Lakeland Request for Repayment and the Clearwater Request for Repayment were held in April 2022.
The Company received the results of the ALJ hearings for the Clearwater Care Center and the Lakeland Care Centers on June 23, 2022 and June 30, 2022, respectively. The ALJ decisions for both the Clearwater Care Center and the Lakeland Care Centers were partially favorable for the claims that were reviewed, but the extrapolations were upheld. As a result, we increased our total accrual related to these matters from $17.4 million to $25.8 million during the three-month period ended June 30, 2022. The net of these two amounts, $8.4 million, was recorded as a reduction to net service revenue in our consolidated statement of operations during the three-month period ended June 30, 2022. We received demands for repayment from Palmetto for both the Clearwater Care Center and the Lakeland Care Centers during the three-month period ended September 30, 2022. The demands were slightly less than our estimated accrual of $25.8 million. During the three-month period ended September 30, 2022, we adjusted our accrual to $25.2 million to reflect the final amounts owed, excluding interest. The repayment for the Lakeland Care Centers totaling $34.3 million ($22.8 million extrapolated repayment plus $11.5 million accrued interest) was made during the three-month period ended September 30, 2022. The repayment for the Clearwater Care Center totaling $3.7 million ($2.4 million extrapolated repayment plus $1.2 million accrued interest) was made during the three-month period ended December 31, 2022. Additionally, we wrote off $1.5 million of receivables that were impacted by these matters. We expect to be indemnified by the prior owners, upon exhaustion of the parties' appeal rights, for approximately $10.9 million and have recorded this amount within other assets in our consolidated balance sheets.
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.
The following table presents details of our insurance programs, including amounts recorded, for the periods indicated within accrued expenses in our consolidated balance sheets. The amounts below represent our total estimated liability for individual
claims that are less than our noted insurance coverage amounts, which can include outstanding claims and claims incurred but not reported (amounts in millions).
As of December 31,
Type of Insurance20222021
Health insurance$16.2 $16.2 
Workers’ compensation40.8 40.5 
Professional liability5.0 5.2 
62.0 61.9 
Less: long-term portion(0.2)(0.2)
$61.8 $61.7 
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 $2.0 million per incident, and our professional liability insurance has a retention limit of $0.3 million per incident.
Severance
We have commitments related to our severance plans applicable to a number of our senior executives and senior management, which generally commit us to pay severance benefits under certain circumstances.
Other
We are subject to various other types of claims and disputes arising in the ordinary course of our business. While the resolution of such issues is not presently determinable, we believe that the ultimate resolution of such matters will not have a significant effect on our consolidated financial condition, results of operations or cash flows.
v3.22.4
EMPLOYEE BENEFIT PLANS
 12 Months Ended
Dec. 31, 2022
Retirement Benefits [Abstract]  
EMPLOYEE BENEFIT PLANS EMPLOYEE BENEFIT PLANS
401(k) Benefit Plan
We maintain a plan qualified under Section 401(k) of the Internal Revenue Code for all employees who have reached 21 years of age, effective the first month after their hire date. Under the plan, eligible employees may elect to defer a portion of their compensation, subject to Internal Revenue Service limits.
Our match of contributions to be made to each eligible employee contribution is $0.44 for every $1.00 contributed up to the first 6% of the employee's salary. The match is discretionary and thus is subject to change at the discretion of management. Our match of contributions is made in the form of cash. We expensed approximately $18.6 million, $17.0 million and $12.9 million related to our 401(k) benefit plan for 2022, 2021 and 2020, respectively.
Deferred Compensation Plan
We had a Deferred Compensation Plan for additional tax-deferred savings for a select group of management or highly compensated employees. Amounts credited under the Deferred Compensation Plan were funded into a rabbi trust, which is managed by a trustee. The trustee has the discretion to manage the assets of the Deferred Compensation Plan as deemed fit, thus, the assets are not necessarily reflective of the same investment choices that would have been made by the participants.
Effective January 1, 2015, all prospective salary deferrals ceased. Participants are allowed to make transactions with any remaining account balances as they wish per plan guidelines.
v3.22.4
SHARE REPURCHASE
 12 Months Ended
Dec. 31, 2022
Equity [Abstract]  
SHARE REPURCHASE SHARE REPURCHASES On December 23, 2020, we announced that our Board of Directors authorized a stock repurchase program, under which we could repurchase up to $100 million of our outstanding common stock through December 31, 2021 (the "2021 Share Repurchase Program"). Pursuant to this program, we repurchased 446,832 shares of our common stock at a weighted average price of $223.49 per share and a total cost of approximately $100 million during the year ended December 31, 2021. We did not repurchase any shares pursuant to this stock repurchase program during the year ended December 31, 2020. The repurchased shares were classified as treasury shares. The 2021 Share Repurchase Program expired on December 31, 2021.
On August 2, 2021, our Board of Directors authorized a share repurchase program, under which we could repurchase up to $100 million of our outstanding common stock through December 31, 2022 to commence upon the completion of the Company's 2021 Share Repurchase Program (the "New Share Repurchase Program"). Pursuant to this program, we repurchased 150,000 shares of our common stock at a weighted average price of $115.64 per share and a total cost of approximately $17 million during the year ended December 31, 2022. The repurchased shares were classified as treasury shares. The New Share Repurchase Program expired on December 31, 2022.
Under the terms of the 2021 Share Repurchase Program and the New Share Repurchase Program, we were allowed to repurchase shares from time to time through open market purchases, unsolicited or solicited privately negotiated transactions, an accelerated stock repurchase program, and/or a trading plan in compliance with Exchange Act Rule 10b5-1. The timing and the amount of the repurchases were determined by management based on a number of factors, including but not limited to share price, trading volume and general market conditions, as well as on working capital requirements, general business conditions and other factors.
On February 2, 2023, our Board of Directors authorized a share repurchase program, under which we may repurchase up to $100 million of our outstanding common stock through December 31, 2023 ("the 2023 Share Repurchase Program"). See Note 17 - Subsequent Events for additional information on the newly authorized share repurchase program.
Under the terms of the 2023 Share Repurchase Program, we are allowed to repurchase shares from time to time through open market purchases, unsolicited or solicited privately negotiated transactions, an accelerated stock repurchase program, and/or a trading plan in compliance with Exchange Act Rule 10b5-1. The timing and the amount of the repurchases will be determined by management based on a number of factors, including but not limited to share price, trading volume and general market conditions, as well as on working capital requirements, general business conditions and other factors.
v3.22.4
SEGMENT INFORMATION
 12 Months Ended
Dec. 31, 2022
Segment Reporting [Abstract]  
SEGMENT INFORMATION SEGMENT INFORMATION
Our operations involve servicing patients through our four reportable business segments: home health, hospice, personal care and high acuity care. Our home health segment delivers a wide range of services in the homes of individuals who may be recovering from an illness, injury or surgery. Our hospice segment provides care that is designed to provide comfort and support for those who are facing a terminal illness. Our personal care segment provides patients with assistance with the essential activities of daily living. Our high acuity care segment, which was established with the acquisition of Contessa on August 1, 2021, delivers the essential elements of inpatient hospital and SNF care to patients in their homes. 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 attributable to the specific segment and includes revenues and all other costs directly attributable to the specific segment. Segment assets are not reviewed by the company’s chief operating decision maker and therefore are not disclosed below (amounts in millions).
For the Year Ended December 31, 2022
Home HealthHospicePersonal CareHigh Acuity CareOtherTotal
Net service revenue$1,355.5 $787.8 $61.4 $18.5 $— $2,223.2 
Cost of service, excluding depreciation and amortization769.0 426.5 46.7 18.2 — 1,260.4 
General and administrative expenses, excluding depreciation and amortization and impairment charge348.5 203.3 9.2 33.1 160.0 754.1 
Depreciation and amortization4.0 2.3 0.1 3.3 15.2 24.9 
Impairment charge— — — 3.0 — 3.0 
Operating expenses1,121.5 632.1 56.0 57.6 175.2 2,042.4 
Operating income (loss)$234.0 $155.7 $5.4 $(39.1)$(175.2)$180.8 
For the Year Ended December 31, 2021
Home HealthHospicePersonal CareHigh Acuity CareOtherTotal
Net service revenue$1,353.8 $791.8 $65.0 $3.5 $— $2,214.1 
Other operating income7.3 6.0 — — — 13.3 
Cost of service, excluding depreciation and amortization756.6 425.2 49.1 2.5 — 1,233.4 
General and administrative expenses, excluding depreciation and amortization and impairment charge328.5 198.4 11.2 10.0 163.1 711.2 
Depreciation and amortization4.3 2.7 0.2 1.3 22.4 30.9 
Operating expenses1,089.4 626.3 60.5 13.8 185.5 1,975.5 
Operating income (loss)$271.7 $171.5 $4.5 $(10.3)$(185.5)$251.9 
For the Year Ended December 31, 2020
Home HealthHospicePersonal CareHigh Acuity CareOtherTotal
Net service revenue$1,249.2 $750.1 $72.2 $— $— $2,071.5 
Other operating income20.2 13.1 1.1 — — 34.4 
Cost of service, excluding depreciation and amortization729.9 400.6 54.9 — — 1,185.4 
General and administrative expenses, excluding depreciation and amortization and impairment charge307.2 175.4 12.4 — 173.2 668.2 
Depreciation and amortization3.9 2.2 0.2 — 22.5 28.8 
Impairment charge3.4 0.8 — — — 4.2 
Operating expenses1,044.4 579.0 67.5 — 195.7 1,886.6 
Operating income (loss)$225.0 $184.2 $5.8 $— $(195.7)$219.3 
v3.22.4
RELATED PARTY TRANSACTIONS
 12 Months Ended
Dec. 31, 2022
Related Party Transactions [Abstract]  
RELATED PARTY TRANSACTIONS RELATED PARTY TRANSACTIONSWe have an investment in Medalogix, a healthcare predictive data and analytics company, which is accounted for under the equity method. During the years ended December 31, 2022, 2021 and 2020, we incurred costs of approximately $9.4 million,$5.7 million and $3.9 million, respectively, in connection with our usage of Medalogix's analytics platforms. We believe that the terms of these transactions are consistent with those negotiated at arm’s length.
v3.22.4
SUBSEQUENT EVENTS
 12 Months Ended
Dec. 31, 2022
Subsequent Events [Abstract]  
SUBSEQUENT EVENTS
2023 Share Repurchase Program
On February 2, 2023, our Board of Directors authorized a share repurchase program, under which we may repurchase up to $100 million of our outstanding common stock through December 31, 2023 (the "2023 Share Repurchase Program"). Under the terms of the 2023 Share Repurchase Program, we are allowed to repurchase shares from time to time through open market purchases, unsolicited or solicited privately negotiated transactions, an accelerated stock repurchase program, and/or a trading plan in compliance with Exchange Act Rule 10b5-1. The timing and the amount of the repurchases will be determined by management based on a number of factors, including but not limited to share price, trading volume and general market conditions, as well as on working capital requirements, general business conditions and other factors. Effective January 1, 2023, repurchases are subject to a 1% excise tax under the Inflation Reduction Act.
Assets Held For Sale
On February 10, 2023, we signed a definitive agreement to sell our personal care business (excluding the Florida operations). The divestment is expected to close during the second quarter of 2023. See Note 6 - Assets Held For Sale for additional information.
v3.22.4
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Policies)
 12 Months Ended
Dec. 31, 2022
Accounting Policies [Abstract]  
Recently Adopted Accounting Pronouncements
Recently Adopted Accounting Pronouncements
During 2021, the Company adopted Accounting Standards Update ("ASU") 2020-10, Codification Improvements, which included minor technical corrections and clarifications to improve consistency and clarify the application of various provisions of the codification by amending the codification to include all disclosure guidance in the appropriate disclosure sections and by amending and adding new headings, cross referencing to other guidance and refining or correcting terminology. Our adoption of this standard did not have a material effect on our consolidated financial statements.
During 2021, the Company adopted ASU 2021-10, Government Assistance (Topic 832): Disclosures by Business Entities about Government Assistance, which was intended to increase transparency around financial reporting regarding government assistance by requiring disclosure of information about (1) the types of government assistance received, (2) an entity's accounting for the government assistance received and (3) the effect of the assistance on an entity's financial statements. The ASU was effective for annual periods beginning after December 15, 2021, with early adoption permitted. See Note 3 – Novel Coronavirus Pandemic ("COVID-19") for the disclosures associated with this standard.
During 2020, the Company adopted ASU 2016-13, Financial Instruments - Credit Losses (Topic 326), which provided guidance for measuring credit losses on financial instruments. Our adoption of this standard did not have a material effect on our consolidated financial statements.
During 2020, the Company adopted ASU 2019-12, Income Taxes (Topic 740) - Simplifying the Accounting for Income Taxes, which eliminated certain exceptions related to the approach for intraperiod tax allocation, the methodology for calculating taxes during the interim periods and the recognition of deferred tax liabilities for outside basis differences. This guidance also simplified aspects of the accounting for franchise taxes, enacted changes in tax laws or rates and clarified the accounting for transactions that result in a step-up in the tax basis of goodwill. The guidance was effective for interim and annual periods beginning after December 15, 2020, with early adoption permitted. Our adoption of this standard on a prospective basis was not material to the Company’s consolidated financial statements.
Recently Issued Accounting Pronouncements
In March 2020, the Financial Accounting Standards Board ("FASB") issued ASU 2020-04, Reference Rate Reform (Topic 848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting, which provides optional expedients and exceptions for applying U.S. Generally Accepted Accounting Principles ("U.S. GAAP") to contract modifications and hedging relationships that reference the London Inter-Bank Offered Rate ("LIBOR") or another reference rate expected to be discontinued, subject to meeting certain criteria. In January 2021, the FASB issued ASU 2021-01, Reference Rate Reform (Topic 848): Scope, which adds implementation guidance to ASU 2020-04 to clarify certain optional expedients in Topic 848. The guidance in ASU 2020-04 and ASU 2021-01 was effective upon issuance and may generally be applied prospectively through December 31, 2022. In December 2022, the FASB issued ASU 2022-06, Reference Rate Reform (Topic 848): Deferral of the Sunset Date of Topic 848, which deferred the sunset date of Topic 848 from December 31, 2022 to December 31, 2024. These standards did not have an effect on our consolidated financial statements.
Use of Estimates
Use of Estimates
Our accounting and reporting policies conform with U.S. GAAP. In preparing the consolidated financial statements, we are required to make estimates and assumptions that impact the amounts reported in the consolidated financial statements and accompanying notes. Actual results could materially differ from those estimates.
Principles of Consolidation
Principles of Consolidation
These 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 consolidated financial
statements, and business combinations accounted for as purchases have been included in our consolidated financial statements from their respective dates of acquisition. In addition to our wholly owned subsidiaries, we also have certain equity investments that are accounted for as set forth below.
Investments
Investments
We consolidate investments when the entity is a variable interest entity ("VIE") and we are the primary beneficiary or if we have controlling interests in the entity, which is generally ownership in excess of 50%. Third party equity interests in our consolidated joint ventures are reflected as noncontrolling interests in our consolidated financial statements.
We account for investments in entities in which we have the ability to exercise significant influence under the equity method if we hold 50% or less of the voting stock and the entity is not a VIE in which we are the primary beneficiary. The book value of investments that we account for under the equity method of accounting totaled $40.5 million and $48.1 million as of December 31, 2022 and 2021, respectively, and is reflected in other assets within our consolidated balance sheets.
We account for investments in entities in which we have less than 20% ownership interest under the cost method of accounting if we do not have the ability to exercise significant influence over the investee. During 2022, we made a $15.0 million investment in a home health benefit manager, which is accounted for under the cost method. During 2021, we made a $5.0 million investment in ConnectRN, a workforce optimization company, which is accounted for under the cost method. The book value of investments that we account for under the cost method of accounting was $20.0 million and $5.0 million as of December 31, 2022 and 2021, respectively, and is reflected in other assets within our consolidated balance sheets.
During the three-month period ended December 31, 2022, we sold a 49% interest in two of our home health care centers while maintaining a controlling interest in the newly formed joint venture. We are consolidating this joint venture. The total cash consideration received for the 49% noncontrolling interest was $1.9 million. In connection with the transaction, we recorded an after-tax gain of $1.4 million; this gain was recorded to additional paid-in capital within our consolidated balance sheet. During the three-month period ended September 30, 2022, we sold a 30% interest in two of our home health care centers while maintaining a controlling interest in the newly formed joint venture. We are consolidating this joint venture. The total cash consideration received for the 30% noncontrolling interest was $3.9 million. In connection with the transaction, we recorded an after-tax gain of $2.9 million; this gain was recorded to additional paid-in capital within our consolidated balance sheet.
During 2021, a third-party acquired a majority of the issued and outstanding membership interests of one of our equity method investments, Medalogix, for cash, with the remaining membership interests rolling over into a newly formed entity that includes Medalogix as well as another healthcare predictive data and analytics company. We rolled over 100% of our ownership interest in Medalogix to the newly formed entity, and in connection with this transaction, we recognized a $31.1 million gain based on the purchase price of Medalogix, which is reflected in gain on equity method investments within our consolidated statements of operations.
In connection with the acquisition of Contessa Health ("Contessa") on August 1, 2021, we obtained interests in several joint ventures with health system partners and a professional corporation that employs clinicians. Each of these entities meets the criteria to be classified as a VIE. As of December 31, 2022, we are consolidating all of our admitting joint ventures with health system partners as well as the professional corporation as we have concluded that we are the primary beneficiary of these VIEs. We have management agreements in place with each of these entities whereby we manage the entities and run the day-to-day operations. As such, we possess the power to direct the activities that most significantly impact the economic performance of the VIEs. The significant activities include, but are not limited to, negotiating provider and payor contracts, establishing patient care policies and protocols, making employment and compensation decisions, developing the operating and capital budgets, performing marketing activities and providing accounting support. We also have the obligation to absorb any expected losses and the right to receive benefits. Additionally, from time to time we may be required to provide joint venture funding. Our high acuity care segment also includes two non-admitting joint ventures with health system partners that are accounted for under the equity method of accounting. Operations of one of these joint ventures have ceased, and we are currently awaiting claims runout to complete financial reconciliations with our health plan partner; we recorded a $3.0 million impairment charge related to our investment in this joint venture during the three-month period ended September 30, 2022.
The terms of the agreements with each VIE prohibit us from using the assets of the VIE to satisfy the obligations of other entities. The carrying amount of the VIEs’ assets and liabilities included in our consolidated balance sheets are as follows (amounts in millions):
As of December 31, 2022As of December 31, 2021
ASSETS
Current assets:
     Cash and cash equivalents$15.6 $3.1 
     Patient accounts receivable6.1 2.4 
     Other current assets0.6 0.1 
          Total current assets22.3 5.6 
Property and equipment0.1 0.1 
Operating lease right of use assets0.1 — 
Goodwill8.5 — 
Intangible assets0.4 — 
Other assets0.2 — 
          Total assets$31.6 $5.7 
LIABILITIES
Current liabilities:
     Accounts payable$0.1 $— 
     Payroll and employee benefits0.5 0.3 
     Accrued expenses5.8 3.4 
     Operating lease liabilities0.1 — 
     Current portion of long-term obligations0.2 0.8 
          Total liabilities$6.7 $4.5 
During 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 gain (loss) on equity method investments within our consolidated statement of operations for the year ended December 31, 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 capital needs.
Revenue Recognition
Revenue Recognition
We account for revenue from contracts with customers in accordance with ASC 606, Revenue from Contracts with Customers, 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. Our cost of obtaining contracts is not material.
Revenues are recognized as performance obligations are satisfied, which varies based on the nature of the services provided. Our performance obligation is the delivery of patient care services in accordance with the nature and frequency of services outlined in physicians' orders, which are determined by a physician based on a patient's specific goals.
Our performance obligations relate to contracts with a duration of less than one year; therefore, we have elected to apply the optional exemption provided by ASC 606 and are not required to disclose the aggregate amount of the transaction price allocated to performance obligations that are unsatisfied or partially unsatisfied as of the end of the reporting period. The unsatisfied or partially unsatisfied performance obligations are generally completed when the patients are discharged, which generally occurs within days or weeks of the end of the reporting period.
We determine the transaction price based on gross charges for services provided, reduced by estimates for contractual and non-contractual revenue adjustments. Contractual revenue adjustments are recorded for the difference between our standard rates and the contracted rates to be realized from patients, third-party payors and others for services provided. Non-contractual revenue adjustments include discounts provided to self-pay, uninsured patients or other payors, adjustments resulting from payment reviews and adjustments arising from our inability to obtain appropriate billing documentation, authorizations or face-to-face documentation. Subsequent changes to the estimate of the transaction price are recorded as adjustments to net service revenue in the period of change.
Non-contractual revenue adjustments are recorded for self-pay, uninsured patients and other payors by major payor class based on our historical collection experience, aged accounts receivable by payor and current industry conditions. The non-contractual revenue adjustments represent the difference between amounts billed and amounts we expect to collect based on our collection history with similar payors. We assess our ability to collect for the healthcare services provided at the time of patient admission based on our verification of the patient's insurance coverage under Medicare, Medicaid, and other commercial or managed care insurance programs. Medicare represents approximately 74% of our consolidated net service revenue.
Amounts due from third-party payors, primarily commercial health insurers and government programs (Medicare and Medicaid), include variable consideration for retroactive revenue adjustments due to settlements of audits and payment reviews. We determine our estimates for non-contractual revenue adjustments related to audits and payment reviews based on our historical experience and success rates in the claim appeals and adjudication process.
We determine our estimates for non-contractual revenue adjustments related to our inability to obtain appropriate billing documentation, authorizations or face-to-face documentation based on our historical 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:
As of December 31,
202220212020
Home Health:
Medicare40 %41 %41 %
Non-Medicare - Episodic-based8 %8 %7 %
Non-Medicare - Non-episodic based13 %12 %13 %
Hospice:
Medicare33 %34 %34 %
Non-Medicare2 %2 %2 %
Personal Care3 %3 %3 %
High Acuity Care (1)1 %— %— %
100 %100 %100 %
(1) Acquired Contessa Health on August 1, 2021.
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"). 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.
All Medicare contracts are required to have a signed plan of care which represents a single performance obligation, comprised of the delivery of a series of distinct services that are substantially similar and have a similar pattern of transfer to the customer. Accordingly, we account for the series of services ("episode") as a single performance obligation satisfied over time, as the customer simultaneously receives and consumes the benefits of the goods and services provided. An episode starts the first day a billable visit is performed and ends 60 days later or upon discharge, if earlier, with multiple continuous episodes allowed. Each 60-day episode includes two 30-day payment periods.
Net service revenue is recorded based on the established Federal Medicare home health payment rate for a 30-day period of care. ASC 606 notes that if an entity has a right to consideration from a customer in an amount that corresponds directly with the value of the entity’s performance completed to date, the entity may recognize revenue in the amount to which the entity has a right to invoice. We have elected to apply the "right to invoice" practical expedient, and therefore, our revenue recognition is based on the reimbursement we are entitled to for each 30-day period of care. We utilize our historical average length of stay for each 30-day period of care as the measure of progress towards the satisfaction of our performance obligation.
PDGM uses timing, admission source, functional impairment levels and principal and other diagnoses to case-mix adjust payments. The case-mix adjusted payment for a 30-day period of care is subject to additional adjustments based on certain variables, including, but not limited to (a) an outlier payment if our patient's care was unusually costly (capped at 10% of total reimbursement per provider number); (b) a low utilization payment adjustment (“LUPA”) if the number of visits provided was less than the established threshold, which ranges from two to six visits and varies for every case-mix group; (c) a partial payment if a patient transferred to another provider or from another provider before completing the 30-day period of care; and (d) the applicable geographic wage index. Payments for routine and non-routine supplies are included in the 30-day payment rate.
Medicare can also make various adjustments to payments received if we are unable to produce appropriate billing documentation or acceptable authorizations. We estimate the impact of such adjustments based on our historical experience, which primarily includes a historical collection rate of over 99% on Medicare claims, and record this estimate during the period in which services are rendered to revenue with a corresponding reduction to patient accounts receivable.
Amounts due from Medicare include variable consideration for retroactive revenue adjustments due to settlements of audits and payment reviews. We determine our estimates for non-contractual revenue adjustments related to audits and payment reviews based on our historical experience and success rates in the claim appeals and adjudication process.
The Medicare home health benefit requires that beneficiaries be homebound (meaning that the beneficiary is unable to leave his/her home without a considerable and taxing effort), require intermittent skilled nursing, physical therapy or speech therapy services and receive treatment under a plan of care established and periodically reviewed by a physician. In order to provide greater flexibility during the novel coronavirus pandemic ("COVID-19"), CMS relaxed the definition of homebound status through the duration of the public health emergency. 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.
During 2020, 20% of the reimbursement from each Medicare 30-day payment period was billed near the start of each 30-day period of care, referred to as a request for anticipated payment ("RAP"), and cash was typically received before all services were rendered. Any cash received from Medicare for a RAP for a 30-day period of care that exceeded the associated revenue earned was recorded to accrued expenses within our consolidated balance sheets. CMS fully eliminated all upfront payments associated with RAPs effective January 1, 2021. Effective January 1, 2022, CMS implemented a new one-time Notice of Admission ("NOA") process. The NOA process requires a one-time submission that establishes the home health period of care and covers all contiguous 30-day periods of care until the patient is discharged from Medicare home health services. If the NOA is not submitted timely, a payment reduction will be applied equal to 1/30 of the payment amount for each day from the home health start of care date until the date the NOA is submitted.
Non-Medicare Revenue
Payments from non-Medicare payors are either a percentage of Medicare rates, per-visit rates or case rates depending upon the terms and conditions established with such payors. Approximately 30% of our managed care contract volume affords us the opportunity to receive additional payments if we achieve certain quality or process metrics as defined in each contract (e.g. star ratings and acute-care hospitalization rates).
Episodic-based Revenue. We recognize revenue in a similar manner as we recognize Medicare revenue for amounts that are paid by other insurance carriers, including Medicare Advantage programs; however, these amounts can vary based upon the negotiated terms, the majority of which range from 95% to 100% of Medicare rates.
Non-episodic based Revenue. For our per visit contracts, gross revenue is recorded on an accrual basis based upon the date of service at amounts equal to our established or estimated per-visit rates. For our case rate contracts, gross revenue is recorded over our historical average length of stay using the established case rate for each admission. Contractual revenue adjustments are recorded for the difference between our standard rates and the contracted rates to be realized from patients, third parties and others for services provided and are deducted from gross revenue to determine net service revenue. We also make non-contractual revenue adjustments to non-episodic revenue based on our historical experience to reflect the estimated transaction
price. We receive a minimal amount of our net service revenue from patients who are either self-insured or are obligated for an insurance co-payment.
Under our case rate contracts, we may receive reimbursement before all services are rendered. Any cash received that exceeds the associated revenue earned is recorded to deferred revenue in accrued expenses within our consolidated balance sheets.
Hospice Revenue Recognition
Hospice Medicare Revenue
Gross revenue is recorded on an accrual basis based upon the date of service at amounts equal to the estimated payment rates. The estimated payment rates are predetermined daily or hourly rates for each of the four levels of care we deliver. The four levels of care are routine care, general inpatient care, continuous home care and respite care. Routine care accounted for 97% of our total Medicare hospice service revenue for each of 2022, 2021 and 2020, respectively. There are two separate payment rates for routine care: payments for the first 60 days of care and care beyond 60 days. In addition to the two routine rates, we may also receive a service intensity add-on (“SIA”). The SIA is based on visits made in the last seven days of life by a registered nurse or medical social worker for patients in a routine level of care.
The performance obligation is the delivery of hospice services to the patient, as determined by a physician, each day the patient is on hospice care.
We make adjustments to Medicare revenue for non-contractual revenue adjustments, which include our inability to obtain appropriate billing documentation or acceptable authorizations and other reasons unrelated to credit risk. We estimate the impact of these non-contractual revenue adjustments based on our historical experience, which primarily includes a historical collection rate of over 99% on Medicare claims, and record it during the period services are rendered.
Amounts due from Medicare include variable consideration for retroactive revenue adjustments due to settlements of audits and payment reviews. We determine our estimates for non-contractual revenue adjustments related to audits and payment reviews based on our historical experience and success rates in the claim appeals and adjudication process.
Additionally, our hospice service revenue is subject to certain limitations on payments from Medicare which are considered variable consideration. We are subject to an inpatient cap limit and an overall Medicare payment cap for each provider number. We monitor these caps on a provider-by-provider basis and estimate amounts due back to Medicare if we estimate a cap has been exceeded. We record these adjustments as a reduction to revenue and an increase in accrued expenses within our consolidated balance sheets. Providers are required to self-report and pay their estimated cap liability by February 28th of the following year. As of December 31, 2022, we have recorded $4.3 million for estimated amounts due back to Medicare in accrued expenses for the Federal cap years ended October 31, 2016 through September 30, 2023. As of December 31, 2021, we had recorded $4.5 million for estimated amounts due back to Medicare in accrued expenses for the Federal cap years ended October 31, 2016 through September 30, 2022.
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").
High Acuity Care Revenue Recognition
High Acuity Care Revenue
Our revenues are derived from contracts with (1) health insurance plans for the coordination and provision of home recovery care services to clinically-eligible patients who are enrolled members in those insurance plans, (2) health system partners for the coordination and provision of home recovery care services to clinically-eligible patients who are discharged early from a health system facility to complete their inpatient stay at home and (3) Medicare and other payors for the provision of home health services.
Under our health insurance plan contracts, we provide home recovery care services, which include hospital-equivalent ("H@H") and skilled nursing facility ("SNF") equivalent services ("SNF@H"), for high acuity care patients on a full risk basis whereby we assume the financial risk for the coordination and payment of all hospital or SNF replacement medical services necessary to treat the medical condition for which the patient was diagnosed in a home-based setting for a 30-day (H@H) or 60-day (SNF@H) episode of care in exchange for a fixed contracted bundled rate. For H@H programs, the fixed rate is based on the assigned diagnosis related group ("DRG") and the 30-day post-discharge related spend. For SNF@H programs, the fixed rate is based on the 60-day post-discharge related spend. Our performance obligation is the coordination and provision of patient care in accordance with physicians’ orders over either a 30-day or 60-day episode of care. The majority of our care coordination services and direct patient care is provided in the first five to seven days of the episode period (the "acute phase"). Monitoring services and follow-up direct patient care, as deemed necessary by the treating physician, are provided throughout the remainder of the episode. Since the majority of our services are provided during the acute phase, we recognize net service revenues over the acute phase based on gross charges for the services provided per the applicable managed care contract rates, reduced by estimates for revenue adjustments.
Under our contracts with health system partners, we provide home recovery care services for high acuity patients on a limited risk basis whereby we assume the risk for certain healthcare services during the remainder of an inpatient acute stay serviced at the patient’s home in exchange for a contracted per diem rate. The performance obligation is the coordination and provision of required medical services, as determined by the treating physician, for each day the patient receives inpatient-equivalent care at home. As such, revenues are recognized as services are administered and as our performance obligations are satisfied on a per diem basis, reduced by estimates for revenue adjustments.
We recognize adjustments to revenue during the period in which changes to estimates of assigned patient diagnoses or episode terminations become known, in accordance with the applicable managed care contracts. For certain health insurance plans, revenue is reduced by amounts owed by enrollees to healthcare providers under deductible, coinsurance or copay provisions of health insurance plan policies, since those amounts are repaid to the health insurance plans by us as part of a retrospective reconciliation process.
In March 2022, our high acuity care segment entered into a transaction in which one of our health system partners contributed its home health operations to one of our existing high acuity care joint ventures. We recognize Medicare and non-Medicare revenue in a manner that is consistent with our home health segment revenue recognition policy described above.
Government Grants
Government Grants
We account for government grants in accordance with ASU 2021-10, Government Assistance (Topic 832), by applying the grant model 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 3 – 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, Cash Equivalents and Restricted CashCash and cash equivalents include certificates of deposit and all highly liquid debt instruments with maturities of three months or less when purchased. Restricted cash includes cash that is not available for ordinary business use.
Patient Accounts Receivable
Patient Accounts Receivable
We report accounts receivable from services rendered at their estimated transaction price, which includes contractual and non-contractual revenue adjustments based on the amounts expected to be due from payors. Our patient accounts receivable are uncollateralized and consist of amounts due from Medicare, Medicaid, other third-party payors and patients. Our non-Medicare third-party payor base is comprised of a diverse group of payors that are geographically dispersed across the country. As of December 31, 2022, 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 represented 67% and 68% of our net patient accounts receivable at December 31, 2022 and 2021, 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 (within both our home health and high acuity care segments), our pre-billing process includes verifying that we are eligible for payment from Medicare for the services that we provide to our patients. Our Medicare billing begins with a process to ensure that our billings are accurate through the utilization of an electronic Medicare claim review. We bill Medicare following the end of each 30-day period of care or upon discharge, if earlier, for the services provided to the patient.
Medicare Hospice
For our hospice patients, our pre-billing process includes verifying that we are eligible for payment from Medicare for the services that we provide to our patients. Our Medicare billing begins with a process to ensure that our billings are accurate through the utilization of an electronic Medicare claim review. We bill Medicare on a monthly basis for the services provided to the patient.
Non-Medicare Home Health, Hospice, Personal Care and High Acuity Care
For our non-Medicare patients, our pre-billing process primarily begins with verifying a patient’s eligibility for services with the applicable payor. Once the patient has been confirmed for eligibility, we will provide services to the patient and bill the applicable payor. Our review and evaluation of non-Medicare accounts receivable includes a detailed review of outstanding balances and special consideration to concentrations of receivables from particular payors or groups of payors with similar characteristics that would subject us to any significant credit risk.
Property and Equipment
Property and Equipment
Property and equipment is stated at cost and depreciated on a straight-line basis over the estimated useful lives of the assets or life of the lease, if shorter. Additionally, we have internally developed computer software for our own use. Additions and improvements (including interest costs for construction of qualifying long-lived assets) are capitalized. Maintenance and repair expenses are charged to expense as incurred. The cost of property and equipment sold or disposed of and the related accumulated depreciation are eliminated from the property and equipment and related accumulated depreciation accounts, and any gain or loss is credited or charged to other general and administrative expenses.
We assess the impairment of a long-lived asset group whenever events or changes in circumstances indicate that the asset’s carrying value may not be recoverable. Factors we consider important that could trigger an impairment review include but are not limited to the following:
•A significant change in the extent or manner in which the long-lived asset group is being used. 
•A significant change in the business climate that could affect the value of the long-lived asset group.
•A significant change in the market value of the assets included in the asset group.
If we determine that the carrying value of long-lived assets may not be recoverable, we compare the carrying value of the asset group to the undiscounted cash flows expected to be generated by the asset group. If the carrying value exceeds the undiscounted cash flows, an impairment charge is indicated. An impairment charge is recognized to the extent that the carrying value of the asset group exceeds its fair value.
We generally provide for depreciation over the following estimated useful service lives.
Years
Buildings39
Leasehold improvementsLesser of lease term or expected useful life
Equipment and furniture
3 to 7
Vehicles
3 to 5
Computer software
2 to 7
Finance leases3

The following table summarizes the balances related to our property and equipment for 2022 and 2021 (amounts in millions):
As of December 31,
20222021
Buildings and leasehold improvements$9.7 $9.1 
Equipment and furniture56.9 54.7 
Finance leases4.1 4.5 
Computer software46.7 47.0 
117.4 115.3 
Less: Accumulated depreciation(101.4)(96.9)
$16.0 $18.4 
Depreciation expense for 2022, 2021 and 2020 was $11.5 million, $12.1 million and $12.1 million, respectively.
Business Combinations
Business Combinations
We account for acquisitions using the acquisition method of accounting in accordance with ASC 805, Business Combinations. Acquisitions are accounted for as purchases and are included in our consolidated financial statements from their respective acquisition dates. Assets acquired, liabilities assumed and noncontrolling interests, if any, are measured at fair value on the acquisition date using the appropriate valuation method. Goodwill generated from acquisitions is recognized for the excess of the purchase price over tangible and identifiable intangible assets. In determining the fair value of identifiable intangible assets and any noncontrolling interests, we use various valuation techniques including the income approach, the cost approach and the market approach. These valuation methods require us to make estimates and assumptions surrounding projected revenues and costs, growth rates and discount rates.
Goodwill and Other Intangible Assets
Goodwill and Other Intangible Assets
As of December 31, 2022, we had a goodwill balance of $1,287.4 million. Goodwill represents the amount of the purchase price in excess of the fair values assigned to the underlying identifiable net assets of acquired businesses. Goodwill is not amortized, but is subject to an annual impairment test. Tests are performed more frequently if events occur or circumstances change that would more likely than not reduce the fair value of the reporting unit below its carrying amount. These events or circumstances include, but are not limited to, a significant adverse change in the business environment, regulatory environment or legal factors, or a substantial decline in the market capitalization of our stock.
Each of our operating segments described in Note 15 – Segment Information is considered to represent an individual reporting unit for goodwill impairment testing purposes. We consider each of our home health care centers to constitute an individual business for which discrete financial information is available. However, since these care centers have substantially similar operating and economic characteristics and resource allocations and since significant investment decisions concerning these businesses are centralized and the benefits broadly distributed, we have aggregated these care centers and deemed them to constitute a single reporting unit. We have applied this same aggregation principle to our hospice and personal-care care centers and high acuity care joint ventures and have also deemed each of them to be a single reporting unit.
During 2022, we performed a qualitative assessment to determine if it is more likely than not that the fair value of our reporting units are less than their carrying values by evaluating relevant events and circumstances including financial performance, market conditions and share price. Based on this assessment, we concluded that the goodwill associated with our home health, hospice and high acuity care reporting units was not considered at risk of impairment as of October 31, 2022. In addition to the qualitative assessment, we also performed a quantitative analysis for our personal care reporting unit due to the decline in revenues resulting from staffing shortages using an income and market approach. Based on this analysis, we concluded that the goodwill associated with our personal care reporting unit was not considered at risk of impairment as of October 31, 2022. Since the date of our last goodwill impairment analysis, there have been no material developments, events, changes in operating performance or other circumstances that would cause management to believe it is more likely than not that the fair value of any of our reporting units would be less than their carrying amounts.
As of December 31, 2022, we had an other intangibles assets balance of $101.2 million. Intangible assets consist of certificates of need, licenses, acquired names, non-compete agreements and technology. We amortize non-compete agreements and acquired names that we do not intend to use indefinitely on a straight-line basis over their estimated useful lives, which are generally two to three years for non-compete agreements and up to three years for acquired names. We amortize technology over its estimated useful service life, which is generally up to seven years. Our indefinite-lived intangible assets are reviewed for impairment annually or more frequently if events occur or circumstances change that would more likely than not reduce the fair value of the intangible asset below its carrying amount. We performed a qualitative assessment of our indefinite-lived intangible assets during 2022 and determined that there have been no material developments, events, changes in operating performance or other circumstances that would cause management to believe it is more likely than not that the fair value of any of our indefinite-lived intangible assets would be less than their carrying amounts.
Debt Issuance Costs Debt Issuance CostsDuring 2021, we recorded $2.8 million in deferred debt issuance costs as a reduction to long-term obligations, less current portion in our consolidated balance sheet in connection with our entry into the Second Amended Credit Agreement (See Note 9 - Long-Term Obligations). As of December 31, 2022 and 2021, we had unamortized debt issuance costs of $3.5 million and $4.5 million, respectively, recorded as a reduction to long-term obligations, less current portion in our accompanying consolidated balance sheets. We amortize deferred debt issuance costs related to our long-term obligations over the term of the obligation through interest expense, unless the debt is extinguished, in which case unamortized balances are immediately expensed.
Fair Value of Financial Instruments
Fair Value of Financial Instruments
The following details our financial instruments where the carrying value and the fair value differ (amounts in millions):
 Fair Value at Reporting Date Using
Financial InstrumentCarrying Value as of
December 31, 2022		Quoted Prices in Active
Markets for Identical
Items
(Level 1)		Significant Other
Observable Inputs
(Level 2)		Significant
Unobservable Inputs
(Level 3)
Long-term obligations$436.1 $— $428.6 $— 
The fair value hierarchy is based on three levels of inputs, of which the first two are considered observable and the last unobservable, that may be used to measure fair value. The three levels of inputs are as follows:
•Level 1 – Quoted prices in active markets for identical assets and liabilities. 
•Level 2 – Inputs other than Level 1 that are observable, either directly or indirectly, such as quoted prices for similar assets or liabilities, quoted prices in markets that are not active or other inputs that are observable or can be corroborated by observable market data for substantially the full term of the assets or liabilities.
•Level 3 – Unobservable inputs that are supported by little or no market activity and are significant to the fair value of the assets or liabilities.
Our deferred compensation plan assets are recorded at fair value and are considered a level 2 measurement. For our other financial instruments, including our cash and cash equivalents, patient accounts receivable, accounts payable, payroll and employee benefits and accrued expenses, we estimate the carrying amounts approximate fair value.
Income Taxes
Income Taxes
We use the asset and liability approach for measuring deferred tax assets and liabilities based on temporary differences existing at each balance sheet date using currently enacted tax rates. Our deferred tax calculation requires us to make certain estimates about future operations. Deferred tax assets are reduced by a valuation allowance when we believe it is more likely than not that some portion or all of the deferred tax assets will not be realized. The effect of a change in tax rate is recognized as income or expense in the period that includes the enactment date. As of December 31, 2022, we had net deferred tax liabilities of $20.4 million. As of December 31, 2021, we had net deferred tax assets of $0.3 million.
Management regularly assesses the ability to realize deferred tax assets recorded in the Company’s entities based upon the weight of available evidence, including such factors as the recent earnings history and expected future taxable income. In the event future taxable income is below management’s estimates or is generated in tax jurisdictions different than projected, we could be required to increase the valuation allowance for deferred tax assets. This would result in an increase in our effective tax rate.
Share-Based Compensation Share-Based CompensationWe record all share-based compensation as expense in the financial statements measured at the fair value of the award. We recognize compensation cost on a straight-line basis over the requisite service period for each separately vesting portion of the award.
Weighted-Average Shares Outstanding 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.
Advertising Costs Advertising CostsWe expense advertising costs as incurred.
v3.22.4
NATURE OF OPERATIONS, CONSOLIDATION AND PRESENTATION OF FINANCIAL STATEMENTS - (Tables)
 12 Months Ended
Dec. 31, 2022
Organization, Consolidation and Presentation of Financial Statements [Abstract]  
Schedule of Variable Interest Entities The carrying amount of the VIEs’ assets and liabilities included in our consolidated balance sheets are as follows (amounts in millions):
As of December 31, 2022As of December 31, 2021
ASSETS
Current assets:
     Cash and cash equivalents$15.6 $3.1 
     Patient accounts receivable6.1 2.4 
     Other current assets0.6 0.1 
          Total current assets22.3 5.6 
Property and equipment0.1 0.1 
Operating lease right of use assets0.1 — 
Goodwill8.5 — 
Intangible assets0.4 — 
Other assets0.2 — 
          Total assets$31.6 $5.7 
LIABILITIES
Current liabilities:
     Accounts payable$0.1 $— 
     Payroll and employee benefits0.5 0.3 
     Accrued expenses5.8 3.4 
     Operating lease liabilities0.1 — 
     Current portion of long-term obligations0.2 0.8 
          Total liabilities$6.7 $4.5 
v3.22.4
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Tables)
 12 Months Ended
Dec. 31, 2022
Accounting Policies [Abstract]  
Schedule of Revenue by Payor Class
Revenue by payor class as a percentage of total net service revenue is as follows:
As of December 31,
202220212020
Home Health:
Medicare40 %41 %41 %
Non-Medicare - Episodic-based8 %8 %7 %
Non-Medicare - Non-episodic based13 %12 %13 %
Hospice:
Medicare33 %34 %34 %
Non-Medicare2 %2 %2 %
Personal Care3 %3 %3 %
High Acuity Care (1)1 %— %— %
100 %100 %100 %
(1) Acquired Contessa Health on August 1, 2021.
Schedule of Cash Cash Equivalents and Restricted Cash
The following table summarizes the balances related to our cash, cash equivalents and restricted cash (amounts in millions):
As of December 31,
20222021
Cash and cash equivalents$40.5 $42.7 
Restricted cash13.6 3.1 
Cash, cash equivalents and restricted cash$54.1 $45.8 
Schedule of Estimated Useful Lives of Property and Equipment
We generally provide for depreciation over the following estimated useful service lives.
Years
Buildings39
Leasehold improvementsLesser of lease term or expected useful life
Equipment and furniture
3 to 7
Vehicles
3 to 5
Computer software
2 to 7
Finance leases3
Schedule of Property and Equipment
The following table summarizes the balances related to our property and equipment for 2022 and 2021 (amounts in millions):
As of December 31,
20222021
Buildings and leasehold improvements$9.7 $9.1 
Equipment and furniture56.9 54.7 
Finance leases4.1 4.5 
Computer software46.7 47.0 
117.4 115.3 
Less: Accumulated depreciation(101.4)(96.9)
$16.0 $18.4 
Schedule of Fair Value of Financial Instruments
The following details our financial instruments where the carrying value and the fair value differ (amounts in millions):
 Fair Value at Reporting Date Using
Financial InstrumentCarrying Value as of
December 31, 2022		Quoted Prices in Active
Markets for Identical
Items
(Level 1)		Significant Other
Observable Inputs
(Level 2)		Significant
Unobservable Inputs
(Level 3)
Long-term obligations$436.1 $— $428.6 $— 
Schedule of Weighted-Average Shares Outstanding The following table sets forth, for the periods indicated, shares used in our computation of weighted-average shares outstanding, which are used to calculate our basic and diluted net income attributable to Amedisys, Inc. common stockholders (amounts in thousands):
For the Years Ended December 31,
202220212020
Weighted average number of shares outstanding – basic32,517 32,642 32,559 
Effect of dilutive securities:
Stock options39 122 420 
Non-vested stock and stock units97 208 289 
Weighted average number of shares outstanding – diluted32,653 32,972 33,268 
Anti-dilutive securities303 114 25 
v3.22.4
NOVEL CORONAVIRUS PANDEMIC ("COVID-19") (Tables)
 12 Months Ended
Dec. 31, 2022
Unusual or Infrequent Items, or Both [Abstract]  
Schedule Of Cares Act Provider Relief Funds In summary, the total funds that we received from the CARES Act PRF were accounted for as follows (amounts in millions):
Amount
Funds utilized through June 30, 2021 by consolidated entities$46.6 
Funds repaid to the government by consolidated entities (excludes $0.2 million of interest repaid)
58.3 
Funds utilized through June 30, 2021 by unconsolidated joint ventures1.3 
Funds repaid to the government by unconsolidated joint ventures0.6 
$106.8 
v3.22.4
ACQUISITIONS (Tables)
 12 Months Ended
Dec. 31, 2022
Business Combinations [Abstract]  
Schedule of Business Acquisitions, Contessa Health The total consideration of $241.3 million has been allocated to assets acquired, liabilities assumed and noncontrolling interests as of the acquisition date as follows (amounts in millions):
Amount
ASSETS
Patient accounts receivable$1.5 
Prepaid expenses0.3 
Other current assets0.1 
Property and equipment0.3 
Operating lease right of use assets0.8 
Intangible assets54.3 
Other assets3.1 
Total assets acquired
$60.4 
LIABILITIES AND EQUITY
Accounts payable$(0.1)
Payroll and employee benefits(0.6)
Accrued expenses(3.4)
Operating lease liabilities(0.8)
Deferred income tax liability(0.3)
Current portion of long-term obligations(0.9)
Other long-term obligations(0.2)
Total liabilities assumed
(6.3)
Noncontrolling interests(43.9)
Total equity assumed(43.9)
Total liabilities and equity assumed$(50.2)
Net identifiable assets acquired$10.2 
Goodwill231.1 
Total consideration$241.3 
Schedule of Business Acquisitions, Evolution Health Based on the Company's preliminary valuation, which may be revised as additional information becomes available during the measurement period, the total consideration of $66.5 million has been allocated to assets acquired and liabilities assumed as of the acquisition date as follows (amounts in millions):
Amount
ASSETS
Patient accounts receivable$7.6 
Prepaid expenses0.2 
Other current assets0.1 
Property and equipment1.9 
Operating lease right of use assets3.2 
Intangible assets (licenses)1.3 
Other assets0.1 
Total assets acquired
$14.4 
LIABILITIES
Accounts payable$(0.8)
Payroll and employee benefits(2.7)
Accrued expenses(2.4)
Operating lease liabilities(2.8)
Deferred income tax liability(0.1)
Current portion of long-term obligations(0.6)
Total liabilities assumed
(9.4)
Net identifiable assets acquired$5.0 
Goodwill61.5 
Total consideration$66.5 
v3.22.4
GOODWILL AND OTHER INTANGIBLE ASSETS, NET (Tables)
 12 Months Ended
Dec. 31, 2022
Goodwill and Intangible Assets Disclosure [Abstract]  
Summary of Activity Related to Goodwill and Other Intangible Assets Net
The following table summarizes the activity related to our goodwill for 2022 and 2021 (amounts in millions):
Goodwill
Home HealthHospicePersonal CareHigh Acuity CareTotal
Balances at December 31, 2020 (1)$90.4 $799.2 $43.1 $— $932.7 
Additions27.8 1.7 — 233.9 263.4 
Balances at December 31, 2021118.2 800.9 43.1 233.9 1,196.1 
Additions85.6 — — 8.5 94.1 
Adjustments (2)— — — (2.8)(2.8)
Balances at December 31, 2022$203.8 $800.9 $43.1 $239.6 $1,287.4 
(1)Net of prior years' accumulated impairment losses of $733.7 million, which is inclusive of write-offs related to the sale and closure of care centers.
(2)The Company finalized its valuation of the assets acquired, liabilities assumed and noncontrolling interests in connection with the acquisition of Contessa on August 1, 2021. See Note 4 – Acquisitions for additional information.
Other Intangible Assets, Net
During 2022 and 2021, we did not record any impairment charges related to our other intangible assets.
The following table summarizes the activity related to our other intangible assets, net for 2022 and 2021 (amounts in millions):
Other Intangible Assets, Net
Certificates of Need and LicensesAcquired
Names -Unamortizable		Acquired
Names -Amortizable		Non-Compete
Agreements (3)		Technology (3)Total
Balances at December 31, 2020 (1)$47.0 $13.9 $5.5 $7.8 $— $74.2 
Additions0.8 28.3 — 6.2 20.2 55.5 
Reclass to amortizable intangible— (6.6)6.6 — — — 
Amortization (2)(0.7)— (9.0)(7.6)(1.2)(18.5)
Balances at December 31, 202147.1 35.6 3.1 6.4 19.0 111.2 
Additions2.4 — — — 1.1 3.5 
Amortization (2)(2.8)— (3.1)(4.6)(3.0)(13.5)
Balances at December 31, 2022$46.7 $35.6 $— $1.8 $17.1 $101.2 
(1)Net of prior years' accumulated amortization of $11.5 million for acquired names and $9.0 million for non-compete agreements.
(2)Amortization of certificates of need and licenses is related to care centers that were closed during 2021 and 2022.
(3)The weighted average remaining amortization period of our amortizable non-compete agreements and technology is 0.6 years and 5.6 years, respectively.
Schedule of Estimated Aggregate Future Amortization Expense
The estimated aggregate amortization expense related to intangible assets for each of the five succeeding years is as follows (amounts in millions):
Intangible Asset Amortization
2023$4.8 
20243.0 
20253.0 
20263.0 
20273.0 
$16.8 
See Note 4 – Acquisitions for further details on additions to goodwill and other intangible assets, net.
v3.22.4
ASSETS HELD FOR SALE (Tables)
 12 Months Ended
Dec. 31, 2022
Discontinued Operation, Additional Disclosures [Abstract]  
Schedule of Carrying Amount of Assets and Liabilities for Disposal Group The carrying amount of the assets and liabilities associated with our personal care reporting unit (which approximate fair value) included in our consolidated balance sheets are as follows (amounts in millions):
As of December 31, 2022As of December 31, 2021
ASSETS
Current assets:
Patient accounts receivable$9.6 $8.7 
Prepaid expenses0.1 0.1 
Other current assets9.7 8.8 
Property and equipment0.1 0.2 
Operating lease right of use assets2.5 2.8 
Goodwill43.1 43.1 
Intangible assets — 1.8 
Total assets$55.4 $56.7 
LIABILITIES
Current liabilities:
Accounts payable$0.4 $0.3 
Payroll and employee benefits0.6 2.5 
Accrued expenses1.8 0.1 
Current portion of operating lease liabilities0.6 0.7 
Total current liabilities3.4 3.6 
Operating lease liabilities, less current portion1.9 2.2 
Total liabilities$5.3 $5.8 
v3.22.4
DETAILS OF CERTAIN BALANCE SHEET ACCOUNTS (Tables)
 12 Months Ended
Dec. 31, 2022
Details Of Certain Balance Sheet Accounts [Abstract]  
Schedule of Other Current Assets
Additional information regarding certain balance sheet accounts is presented below (amounts in millions):
As of December 31,
20222021
Other current assets:
Payroll tax escrow$7.6 $7.9 
Income tax receivable8.8 8.2 
Due from joint ventures3.6 3.9 
Other6.4 5.6 
$26.4 $25.6 
Other assets:
Workers’ compensation deposits$0.3 $0.3 
Health insurance deposits0.9 0.9 
Other miscellaneous deposits1.0 1.1 
Indemnity receivable13.6 13.6 
Equity method investments40.5 48.1 
Cost method investments20.0 5.0 
Other3.5 4.0 
$79.8 $73.0 
Accrued expenses:
Health insurance$16.2 $16.2 
Workers’ compensation40.6 40.3 
Florida ZPIC audit, gross liability— 17.4 
Legal settlements and other audits32.1 27.5 
Charity care1.9 1.4 
Estimated Medicare cap liability4.3 4.5 
Hospice accruals (room and board, general in-patient and other)19.1 23.6 
Patient and payor liabilities6.7 6.0 
Accrued contingent consideration10.5 — 
Accrued interest0.2 8.1 
Other5.8 5.8 
$137.4 $150.8 
Other long-term obligations:
Reserve for uncertain tax positions$— $3.4 
Deferred compensation plan liability0.6 1.0 
Accrued contingent consideration3.2 — 
Other1.0 0.6 
$4.8 $5.0 
Schedule of Other Assets
Additional information regarding certain balance sheet accounts is presented below (amounts in millions):
As of December 31,
20222021
Other current assets:
Payroll tax escrow$7.6 $7.9 
Income tax receivable8.8 8.2 
Due from joint ventures3.6 3.9 
Other6.4 5.6 
$26.4 $25.6 
Other assets:
Workers’ compensation deposits$0.3 $0.3 
Health insurance deposits0.9 0.9 
Other miscellaneous deposits1.0 1.1 
Indemnity receivable13.6 13.6 
Equity method investments40.5 48.1 
Cost method investments20.0 5.0 
Other3.5 4.0 
$79.8 $73.0 
Accrued expenses:
Health insurance$16.2 $16.2 
Workers’ compensation40.6 40.3 
Florida ZPIC audit, gross liability— 17.4 
Legal settlements and other audits32.1 27.5 
Charity care1.9 1.4 
Estimated Medicare cap liability4.3 4.5 
Hospice accruals (room and board, general in-patient and other)19.1 23.6 
Patient and payor liabilities6.7 6.0 
Accrued contingent consideration10.5 — 
Accrued interest0.2 8.1 
Other5.8 5.8 
$137.4 $150.8 
Other long-term obligations:
Reserve for uncertain tax positions$— $3.4 
Deferred compensation plan liability0.6 1.0 
Accrued contingent consideration3.2 — 
Other1.0 0.6 
$4.8 $5.0 
Schedule of Accrued Expenses
Additional information regarding certain balance sheet accounts is presented below (amounts in millions):
As of December 31,
20222021
Other current assets:
Payroll tax escrow$7.6 $7.9 
Income tax receivable8.8 8.2 
Due from joint ventures3.6 3.9 
Other6.4 5.6 
$26.4 $25.6 
Other assets:
Workers’ compensation deposits$0.3 $0.3 
Health insurance deposits0.9 0.9 
Other miscellaneous deposits1.0 1.1 
Indemnity receivable13.6 13.6 
Equity method investments40.5 48.1 
Cost method investments20.0 5.0 
Other3.5 4.0 
$79.8 $73.0 
Accrued expenses:
Health insurance$16.2 $16.2 
Workers’ compensation40.6 40.3 
Florida ZPIC audit, gross liability— 17.4 
Legal settlements and other audits32.1 27.5 
Charity care1.9 1.4 
Estimated Medicare cap liability4.3 4.5 
Hospice accruals (room and board, general in-patient and other)19.1 23.6 
Patient and payor liabilities6.7 6.0 
Accrued contingent consideration10.5 — 
Accrued interest0.2 8.1 
Other5.8 5.8 
$137.4 $150.8 
Other long-term obligations:
Reserve for uncertain tax positions$— $3.4 
Deferred compensation plan liability0.6 1.0 
Accrued contingent consideration3.2 — 
Other1.0 0.6 
$4.8 $5.0 
Schedule of Other Long-Term Obligations
Additional information regarding certain balance sheet accounts is presented below (amounts in millions):
As of December 31,
20222021
Other current assets:
Payroll tax escrow$7.6 $7.9 
Income tax receivable8.8 8.2 
Due from joint ventures3.6 3.9 
Other6.4 5.6 
$26.4 $25.6 
Other assets:
Workers’ compensation deposits$0.3 $0.3 
Health insurance deposits0.9 0.9 
Other miscellaneous deposits1.0 1.1 
Indemnity receivable13.6 13.6 
Equity method investments40.5 48.1 
Cost method investments20.0 5.0 
Other3.5 4.0 
$79.8 $73.0 
Accrued expenses:
Health insurance$16.2 $16.2 
Workers’ compensation40.6 40.3 
Florida ZPIC audit, gross liability— 17.4 
Legal settlements and other audits32.1 27.5 
Charity care1.9 1.4 
Estimated Medicare cap liability4.3 4.5 
Hospice accruals (room and board, general in-patient and other)19.1 23.6 
Patient and payor liabilities6.7 6.0 
Accrued contingent consideration10.5 — 
Accrued interest0.2 8.1 
Other5.8 5.8 
$137.4 $150.8 
Other long-term obligations:
Reserve for uncertain tax positions$— $3.4 
Deferred compensation plan liability0.6 1.0 
Accrued contingent consideration3.2 — 
Other1.0 0.6 
$4.8 $5.0 
v3.22.4
LEASES (Tables)
 12 Months Ended
Dec. 31, 2022
Leases [Abstract]  
Schedule of Lease Cost
The components of lease cost for the years ended December 31, 2022 and 2021 are as follows (amounts in millions):
For the Years Ended December 31,
20222021
Operating lease cost:
Operating lease cost
$43.9 $40.3 
Impairment of operating lease ROU assets
2.1 0.1 
Total operating lease cost
46.0 40.4 
Finance lease cost:
Loss on termination0.5 — 
Amortization of ROU assets
1.8 2.0 
Interest on lease liabilities
0.1 0.1 
Total finance lease cost
2.4 2.1 
Variable lease cost
3.4 3.3 
Short-term lease cost
— — 
Total lease cost
$51.8 $45.8 
Schedule of Operating Leases
Amounts reported in the consolidated balance sheets as of December 31, 2022 and 2021 for our operating leases are as follows (amounts in millions):
As of December 31,
20222021
Operating lease ROU assets
$102.9 $101.3 
Current portion of operating lease liabilities
33.5 31.2 
Operating lease liabilities, less current portion
69.5 69.3 
Total operating lease liabilities
$103.0 $100.5 
Schedule of Finance Leases Amounts reported in the consolidated balance sheets as of December 31, 2022 and 2021 for finance leases are included in the table below. The finance lease ROU assets are recorded within property and equipment, net of accumulated depreciation within our consolidated balance sheets. The finance lease liabilities are recorded within current portion of long-term obligations and long-term obligations, less current portion within our consolidated balance sheets.
As of December 31,
20222021
Finance lease ROU assets
$4.1 $4.5 
Accumulated amortization
(1.8)(2.8)
Finance lease ROU assets, net
$2.3 $1.7 
Current installments of obligations under finance leases
$1.2 $0.9 
Long-term portion of obligations under finance leases
1.1 0.7 
Total finance lease liabilities
$2.3 $1.6 
Schedule of Supplemental CashFlow Information and NonCash Activity for Leases
Supplemental cash flow information and non-cash activity related to our leases are as follows (amounts in millions):
For the Years Ended December 31,
20222021
Cash paid for amounts included in the measurement of lease liabilities and ROU assets:
Operating cash flow from operating leases
$(44.4)$(39.7)
Financing cash flow from finance leases
(1.5)(2.0)
ROU assets obtained in exchange for lease obligations:
Operating leases
$45.1 $46.1 
Finance leases
2.1 0.9 
Reductions to ROU assets resulting from reductions to lease obligations:
Operating leases
$(4.2)$(1.7)
Finance leases
(0.6)— 
Schedule of Weighted Average Remaining Lease Term and Discount Rate
Weighted average remaining lease terms and discount rates for our leases as of December 31, 2022 and 2021 are as follows:
As of December 31,
20222021
Weighted average remaining lease term (years):
Operating leases
3.53.7
Finance leases
2.11.7
Weighted average discount rate:
Operating leases
3.4 %2.7 %
Finance leases
5.3 %5.2 %
Schedule of Lease Liability Maturity
Maturities of lease liabilities as of December 31, 2022 are as follows (amounts in millions):
Operating
Leases		Finance
Leases
2023$36.1 $1.2 
202430.9 0.9 
202520.8 0.3 
202612.7 — 
20276.7 — 
Thereafter2.4 — 
Total undiscounted lease payments
109.6 2.4 
Less: Imputed interest(6.6)(0.1)
Total lease liabilities
$103.0 $2.3 
v3.22.4
LONG-TERM OBLIGATIONS (Tables)
 12 Months Ended
Dec. 31, 2022
Debt Disclosure [Abstract]  
Schedule of Long-Term Debt
Long-term debt consists of the following for the periods indicated (amounts in millions):
As of December 31,
20222021
$450.0 million Term Loan; interest rate at Base Rate plus Applicable Rate or Eurodollar Rate plus Applicable Rate (5.9% at December 31, 2022); due July 30, 2026
$435.9 $447.2 
$550.0 million Revolving Credit Facility; interest only payments; interest rate at Base Rate plus Applicable Rate or Eurodollar Rate plus Applicable Rate; due July 30, 2026
— — 
Promissory notes0.2 0.8 
Finance leases2.3 1.6 
Principal amount of long-term obligations438.4 449.6 
Deferred debt issuance costs(3.5)(4.5)
434.9 445.1 
Current portion of long-term obligations(15.5)(13.0)
Long-term obligations, less current portion$419.4 $432.1 
Schedule of Maturities of Long-Term Debt
Maturities of debt as of December 31, 2022 are as follows (amounts in millions):
Long-term
obligations
2023$15.5 
202423.3 
202522.7 
2026376.9 
2027— 
$438.4 
Schedule of Commitment Fee Under Credit Facilities The “Applicable Rate” is based on the consolidated leverage ratio and is presented in the table below. As of December 31, 2022, the Applicable Rate is 0.50% per annum for Base Rate Loans and 1.50% per annum for Eurodollar Rate Loans. Our Second Amended Credit Agreement provides for the replacement of LIBOR with the daily or term secured overnight financing rate ("SOFR") whenever LIBOR is discontinued. We are also subject to a commitment fee and letter of credit fee under the terms of the Second Amended Credit Agreement, as presented in the table below.
Pricing TierConsolidated Leverage RatioBase Rate LoansEurodollar Rate Loans and Daily Floating LIBOR Rate LoansCommitment
Fee		Letter of
Credit Fee
I
> 3.00 to 1.0
1.00 %2.00 %0.30 %1.75 %
II
< 3.00 to 1.0 but > 2.00 to 1.0
0.75 %1.75 %0.25 %1.50 %
III
< 2.00 to 1.0 but > 0.75 to 1.0
0.50 %1.50 %0.20 %1.25 %
IV
< 0.75 to 1.0
0.25 %1.25 %0.15 %1.00 %
v3.22.4
INCOME TAXES (Tables)
 12 Months Ended
Dec. 31, 2022
Income Tax Disclosure [Abstract]  
Schedule of Income Tax Provision
Income taxes attributable to continuing operations consist of the following (amounts in millions):
For the Years Ended December 31,
202220212020
Current income tax expense/(benefit):
Federal$12.2 $20.3 $41.6 
State and local7.0 5.2 10.6 
19.2 25.5 52.2 
Deferred income tax expense/(benefit):
Federal20.4 35.9 (22.5)
State and local2.9 8.7 (4.1)
23.3 44.6 (26.6)
Income tax expense$42.5 $70.1 $25.6 

Total income tax expense for the years ended December 31, 2022, 2021 and 2020 was allocated as follows (amounts in millions):
For the Years Ended December 31,
202220212020
Income from continuing operations$42.5 $70.1 $25.6 
Interest expense(0.7)0.1 0.2 
Goodwill(2.7)3.1 — 
Tax expense recorded to additional paid-in-capital1.5 — — 
Total$40.6 $73.3 $25.8 
Schedule of Sources of Tax Effects
A reconciliation of significant differences between the reported amount of income tax expense and the expected amount of income tax expense that would result from applying the U.S. federal statutory income tax rate of 21% to income before income taxes is as follows:
For the Years Ended December 31,
202220212020
Income tax expense at U.S. federal statutory rate21.0 %21.0 %21.0 %
State and local income taxes, net of federal income tax benefit (1)5.6 5.0 2.4 
Excess tax benefits from share-based compensation (1)0.3 (2.1)(12.7)
Non-deductible executive compensation0.8 1.2 2.1 
Unrecognized tax benefits (2)(1.7)— — 
Other items, net (3)0.5 (0.1)(0.6)
Income tax expense26.5 %25.0 %12.2 %
(1)On August 10, 2020, Paul B. Kusserow, 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. 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 U.S. GAAP purposes. If the tax deduction exceeds the cumulative U.S. 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, resulting in a reduction of the effective tax rate. Mr. Kusserow's stock option exercise produced a $92.1 million tax deduction in excess of U.S. GAAP compensation expense, resulting in a $19.4 million federal income tax benefit and a $4.6 million state and local income tax benefit for the year ended December 31, 2020.
(2)For the year ended December 31, 2022, the Company recognized $2.7 million of federal uncertain tax positions due to a lapse of the statute of limitations.
(3)Includes various items such as non-deductible expenses, non-taxable income, tax credits, valuation allowance, uncertain tax positions and return-to-accrual adjustments.
Schedule of Net Deferred Tax Assets and Liabilities
Deferred tax assets (liabilities) consist of the following components (amounts in millions):
As of December 31,
20222021
Deferred tax assets:
Accrued payroll & employee benefits$14.1 $13.2 
Workers’ compensation10.6 10.5 
Share-based compensation5.7 6.2 
Legal & compliance matters4.7 6.2 
Lease liability27.8 27.3 
Deferred social security taxes (1)— 6.9 
Net operating loss carryforwards11.6 13.6 
Tax credit carryforwards2.9 2.5 
Other assets0.2 0.5 
Gross deferred tax assets77.6 86.9 
Less: valuation allowance(5.2)(3.3)
Net deferred tax assets72.4 83.6 
Deferred tax liabilities:
Property and equipment(6.6)(8.1)
Amortization of intangible assets(48.5)(32.3)
Deferred revenue— (4.5)
Investment in partnerships(10.0)(10.8)
Right-of-use asset(27.0)(26.7)
Other liabilities(0.7)(0.9)
Gross deferred tax liabilities(92.8)(83.3)
Deferred income taxes$(20.4)$0.3 
(1)The CARES Act provided for the deferral of the employer share of social security tax (6.2%), effective for payments due after the enactment date through December 31, 2020. Fifty percent of the deferred payroll taxes were due on December 31, 2021 with the remaining amounts due on December 31, 2022. As of December 31, 2021, the Company had a remaining balance of deferred social security taxes of $27 million, reflected within our consolidated balance sheets, which was paid in December 2022. For income tax purposes, the deferred social security taxes are deductible when paid, leaving no remaining deferred tax asset as of December 31, 2022.
Schedule of Uncertain Tax Positions A reconciliation of the beginning and ending amount of unrecognized tax benefits is as follows (amounts in millions):
For the Years Ended December 31,
202220212020
Balance at beginning of period$2.7 $2.7 $2.7 
Additions for tax positions related to current year— — — 
Additions for tax positions related to prior year— — — 
Reductions for tax positions related to prior years— — — 
Lapse of statute of limitations(2.7)— — 
Settlements— — — 
Balance at end of period$— $2.7 $2.7 
v3.22.4
CAPITAL STOCK AND SHARE-BASED COMPENSATION (Tables)
 12 Months Ended
Dec. 31, 2022
Share-Based Payment Arrangement [Abstract]  
Schedule of Employee Stock Purchase Plan Activity The following is a detail of the purchases that have been made under the plan:
Employee Stock Purchase Plan PeriodShares IssuedPrice
2020 and Prior3,171,373 $17.89 
January 1, 2021 to March 31, 20214,060 225.07 
April 1, 2021 to June 30, 20215,095 208.19 
July 1, 2021 to September 30, 20217,466 126.74 
October 1, 2021 to December 31, 20217,161 137.60 
January 1, 2022 to March 31, 20226,184 146.45 
April 1, 2022 to June 30, 202210,814 89.35 
July 1, 2022 to September 30, 202212,047 82.27 
October 1, 2022 to December 31, 202211,498 71.01 
3,235,698 
Schedule of Share-based Payment Award Valuation Assumptions
The fair values of the stock option awards were estimated using the following assumptions for 2022, 2021 and 2020:
For the Years Ended December 31,
202220212020
Risk Free Rate
1.91%
0.80% - 1.35%
0.38% - 1.51%
Expected Volatility
40.97%
39.84% - 41.40%
40.15% - 42.80%
Expected Term6.25 years
6.25 years
6.25 years
Weighted Average Fair Value$61.31$107.45$86.72
Dividend Yield—%—%—%
Schedule of Stock Options Activity
The following table presents our stock option activity for 2022:
Number of
Shares		Weighted
Average Exercise
Price		Weighted
Average Contractual
Life (Years)
Outstanding options at January 1, 2022273,973 $137.54 7.21
Granted33,656 143.25 
Exercised(37,635)61.23 
Canceled, forfeited or expired(51,382)174.57 
Outstanding options at December 31, 2022218,612 $142.86 6.56
Exercisable options at December 31, 2022163,286 $122.54 6.04
Shared-based Payment Arrangement, Non-vested Option, Activity
The following table presents our non-vested stock option activity for 2022:
Number of
Shares		Weighted Average
Grant Date Fair Value
Non-vested stock options at January 1, 2022129,439 $182.45 
Granted33,656 143.25 
Vested(64,496)150.79 
Forfeited(43,273)173.11 
Non-vested stock options at December 31, 202255,326 $202.81 
Schedule of Non-Vested Stock Unit Activity
The following table presents our service-based non-vested stock units activity for 2022:
Number of 
Shares		Weighted Average
Grant Date Fair
Value
Non-vested stock units at January 1, 2022180,823 $195.25 
Granted211,361 115.07 
Vested(59,006)146.76 
Canceled, forfeited or expired(70,025)194.68 
Non-vested stock units at December 31, 2022263,153 $141.62 
Schedule of Non-Vested Performance-based Units Activity
The following table presents our performance-based non-vested stock units activity for 2022:
Number of 
Shares		Weighted Average
Grant Date Fair
Value
Non-vested stock units at January 1, 2022186,951 $206.36 
Granted71,349 133.70 
Vested(85,767)156.18 
Canceled, forfeited or expired(104,486)237.30 
Non-vested stock units at December 31, 202268,047 $144.55 
v3.22.4
COMMITMENTS AND CONTINGENCIES (Tables)
 12 Months Ended
Dec. 31, 2022
Commitments and Contingencies Disclosure [Abstract]  
Schedule of Insurance Programs The following table presents details of our insurance programs, including amounts recorded, for the periods indicated within accrued expenses in our consolidated balance sheets. The amounts below represent our total estimated liability for individual
claims that are less than our noted insurance coverage amounts, which can include outstanding claims and claims incurred but not reported (amounts in millions).
As of December 31,
Type of Insurance20222021
Health insurance$16.2 $16.2 
Workers’ compensation40.8 40.5 
Professional liability5.0 5.2 
62.0 61.9 
Less: long-term portion(0.2)(0.2)
$61.8 $61.7 
v3.22.4
SEGMENT INFORMATION (Tables)
 12 Months Ended
Dec. 31, 2022
Segment Reporting [Abstract]  
Schedule of Operating Income of Reportable Segments
Management evaluates performance and allocates resources based on the operating income of the reportable segments, which includes an allocation of corporate expenses attributable to the specific segment and includes revenues and all other costs directly attributable to the specific segment. Segment assets are not reviewed by the company’s chief operating decision maker and therefore are not disclosed below (amounts in millions).
For the Year Ended December 31, 2022
Home HealthHospicePersonal CareHigh Acuity CareOtherTotal
Net service revenue$1,355.5 $787.8 $61.4 $18.5 $— $2,223.2 
Cost of service, excluding depreciation and amortization769.0 426.5 46.7 18.2 — 1,260.4 
General and administrative expenses, excluding depreciation and amortization and impairment charge348.5 203.3 9.2 33.1 160.0 754.1 
Depreciation and amortization4.0 2.3 0.1 3.3 15.2 24.9 
Impairment charge— — — 3.0 — 3.0 
Operating expenses1,121.5 632.1 56.0 57.6 175.2 2,042.4 
Operating income (loss)$234.0 $155.7 $5.4 $(39.1)$(175.2)$180.8 
For the Year Ended December 31, 2021
Home HealthHospicePersonal CareHigh Acuity CareOtherTotal
Net service revenue$1,353.8 $791.8 $65.0 $3.5 $— $2,214.1 
Other operating income7.3 6.0 — — — 13.3 
Cost of service, excluding depreciation and amortization756.6 425.2 49.1 2.5 — 1,233.4 
General and administrative expenses, excluding depreciation and amortization and impairment charge328.5 198.4 11.2 10.0 163.1 711.2 
Depreciation and amortization4.3 2.7 0.2 1.3 22.4 30.9 
Operating expenses1,089.4 626.3 60.5 13.8 185.5 1,975.5 
Operating income (loss)$271.7 $171.5 $4.5 $(10.3)$(185.5)$251.9 
For the Year Ended December 31, 2020
Home HealthHospicePersonal CareHigh Acuity CareOtherTotal
Net service revenue$1,249.2 $750.1 $72.2 $— $— $2,071.5 
Other operating income20.2 13.1 1.1 — — 34.4 
Cost of service, excluding depreciation and amortization729.9 400.6 54.9 — — 1,185.4 
General and administrative expenses, excluding depreciation and amortization and impairment charge307.2 175.4 12.4 — 173.2 668.2 
Depreciation and amortization3.9 2.2 0.2 — 22.5 28.8 
Impairment charge3.4 0.8 — — — 4.2 
Operating expenses1,044.4 579.0 67.5 — 195.7 1,886.6 
Operating income (loss)$225.0 $184.2 $5.8 $— $(195.7)$219.3 
v3.22.4
NATURE OF OPERATIONS, CONSOLIDATION AND PRESENTATION OF FINANCIAL STATEMENTS - Narrative (Details)
$ in Thousands
 3 Months Ended 12 Months Ended
Dec. 31, 2022
USD ($)
care_center
numberOfJointVentures
state
Sep. 30, 2022
USD ($)
Dec. 31, 2022
USD ($)
care_center
numberOfJointVentures
state
Dec. 31, 2021
USD ($)
Dec. 31, 2020
USD ($)
Organization And Nature Of Operations [Line Items]          
Number of states with facilities | state 37   37    
Minimum percent ownership for controlling interest (percent) 50.00%   50.00%    
Maximum ownership percentage for equity method investment (percent) 50.00%   50.00%    
Equity method investments $ 40,500   $ 40,500 $ 48,100  
Maximum ownership percentage for cost method investment (percent) 20.00%   20.00%    
Cost method investments $ 20,000   $ 20,000 5,000  
Proceeds from sale of equity method investment     0 0 $ 17,876
Cash and cash equivalents 40,540   40,540 42,694  
Patient accounts receivable 296,785   296,785 274,961  
Other current assets 26,415   26,415 25,598  
Total current assets 388,961   388,961 356,684  
Property and equipment 16,026   16,026 18,435  
Operating lease right of use assets 102,856   102,856 101,257  
Goodwill 1,287,399   1,287,399 1,196,090 932,700
Intangible Assets 101,167   101,167 111,190 74,200
Other assets 79,836   79,836 73,023  
Total assets 1,976,245   1,976,245 1,856,968  
Accounts payable 43,735   43,735 38,217  
Payroll and employee benefits 125,387   125,387 141,001  
Accrued expenses 137,390   137,390 150,836  
Current portion of long-term obligations 15,496   15,496 12,995  
Total current liabilities 355,529   355,529 374,282  
Other long-term obligations 4,808   4,808 4,979  
Current portion of operating lease liabilities 33,521   33,521 31,233  
Total liabilities 869,672   869,672 880,645  
Proceeds from sale of noncontrolling interest     5,817 0 0
Gain (Loss) on equity method investments     0 31,098 (2,980)
Impairment charge     3,009 0 $ 4,152
30% Interest Sold in Two Care Centers          
Organization And Nature Of Operations [Line Items]          
Proceeds from sale of noncontrolling interest   $ 3,900      
Gain Related To Sale Of Noncontrolling Interest Net Of Tax   2,900      
49% Interest Sold in Two Care Centers          
Organization And Nature Of Operations [Line Items]          
Proceeds from sale of noncontrolling interest 1,900        
Gain Related To Sale Of Noncontrolling Interest Net Of Tax 1,400        
Medalogix [Member]          
Organization And Nature Of Operations [Line Items]          
Gain (Loss) on equity method investments       31,100  
Variable Interest Entity, Primary Beneficiary [Member]          
Organization And Nature Of Operations [Line Items]          
Cash and cash equivalents 15,600   15,600 3,100  
Patient accounts receivable 6,100   6,100 2,400  
Other current assets 600   600 100  
Total current assets 22,300   22,300 5,600  
Property and equipment 100   100 100  
Operating lease right of use assets 100   100 0  
Goodwill 8,500   8,500 0  
Intangible Assets 400   400 0  
Other assets 200   200 0  
Total assets 31,600   31,600 5,700  
Accounts payable 100   100 0  
Payroll and employee benefits 500   500 300  
Accrued expenses 5,800   5,800 3,400  
Current portion of long-term obligations 200   200 800  
Current portion of operating lease liabilities 100   100 0  
Total liabilities $ 6,700   $ 6,700 $ 4,500  
Revenue Benchmark [Member] | Product Concentration Risk [Member] | Medicare Revenue [Member]          
Organization And Nature Of Operations [Line Items]          
Percent of net services revenue provided by Medicare     74.00% 75.00% 75.00%
Home Health [Member]          
Organization And Nature Of Operations [Line Items]          
Number of owned and operated care centers | care_center 347   347    
Goodwill $ 203,800   $ 203,800 $ 118,200 $ 90,400
Hospice [Member]          
Organization And Nature Of Operations [Line Items]          
Number of owned and operated care centers | care_center 164   164    
Goodwill $ 800,900   $ 800,900 800,900 799,200
Personal Care [Member]          
Organization And Nature Of Operations [Line Items]          
Number of owned and operated care centers | care_center 13   13    
Goodwill $ 43,100   $ 43,100 43,100 43,100
High Acuity Care [Member]          
Organization And Nature Of Operations [Line Items]          
Number Of Admitting Joint Ventures | numberOfJointVentures 8   8    
Goodwill $ 239,600   $ 239,600 233,900 0
High Acuity Care [Member] | Contessa Health          
Organization And Nature Of Operations [Line Items]          
Impairment charge   $ 3,000      
Heritage Healthcare Innovation Fund LP [Member]          
Organization And Nature Of Operations [Line Items]          
Proceeds from sale of equity method investment         17,900
Gain (Loss) on equity method investments         $ (3,000)
ConnectRN [Member]          
Organization And Nature Of Operations [Line Items]          
Purchase of investment       $ 5,000  
Home health benefit manager          
Organization And Nature Of Operations [Line Items]          
Purchase of investment     $ 15,000    
v3.22.4
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Revenue Recognition Narrative (Details)
$ in Millions
 12 Months Ended
Dec. 31, 2022
USD ($)
Number_of_Visits
Dec. 31, 2021
USD ($)
Dec. 31, 2020
Revenue Recognition, Multiple-deliverable Arrangements [Line Items]      
Net service revenue episode payment rate 60 days    
Percentage of total reimbursement of outlier payment 10.00%    
Historical collection rate from Medicare 99.00%    
Hospice Medicare revenue rate accounted for routine care 97.00% 97.00% 97.00%
Rate of request for anticipated payment submitted for the initial period of care     20.00%
Net Service Revenue Period Of Care Payment Rate Duration 30 days    
Revenue Benchmark [Member] | Product Concentration Risk [Member] | Medicare Revenue [Member]      
Revenue Recognition, Multiple-deliverable Arrangements [Line Items]      
Percent of net services revenue provided by Medicare 74.00% 75.00% 75.00%
Home Health [Member]      
Revenue Recognition, Multiple-deliverable Arrangements [Line Items]      
Historical collection rate from Medicare 99.00%    
Percentage Managed Care Contract Volume Able To Receive Additional Payments 30.00%    
Hospice [Member]      
Revenue Recognition, Multiple-deliverable Arrangements [Line Items]      
Historical collection rate from Medicare 99.00%    
Minimum [Member] | Home Health [Member]      
Revenue Recognition, Multiple-deliverable Arrangements [Line Items]      
Low utilization payment adjustment, maximum number of visits | Number_of_Visits 2    
Non-medicare revenue term rates 95.00%    
Minimum [Member] | High Acuity Care [Member]      
Revenue Recognition, Multiple-deliverable Arrangements [Line Items]      
Net service revenue episode payment rate 30 days    
Maximum [Member] | Home Health [Member]      
Revenue Recognition, Multiple-deliverable Arrangements [Line Items]      
Low utilization payment adjustment, maximum number of visits | Number_of_Visits 6    
Non-medicare revenue term rates 100.00%    
Maximum [Member] | High Acuity Care [Member]      
Revenue Recognition, Multiple-deliverable Arrangements [Line Items]      
Net service revenue episode payment rate 60 days    
Cap Year 2016 Through 2023 [Member]      
Revenue Recognition, Multiple-deliverable Arrangements [Line Items]      
Estimated amounts due back to Medicare | $ $ 4.3    
Cap Year 2016 Through 2022 [Member]      
Revenue Recognition, Multiple-deliverable Arrangements [Line Items]      
Estimated amounts due back to Medicare | $   $ 4.5  
v3.22.4
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Revenue Recognition by Payor Class (Details)
 12 Months Ended
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2020
Revenue Recognition, Multiple-deliverable Arrangements [Line Items]      
Revenue by payor class as a percentage of total net service revenue 100.00% 100.00% 100.00%
High Acuity Care [Member]      
Revenue Recognition, Multiple-deliverable Arrangements [Line Items]      
Revenue by payor class as a percentage of total net service revenue 1.00% 0.00% 0.00%
Home Health Medicare [Member]      
Revenue Recognition, Multiple-deliverable Arrangements [Line Items]      
Revenue by payor class as a percentage of total net service revenue 40.00% 41.00% 41.00%
Home Health Non-Medicare - Episodic Based [Member]      
Revenue Recognition, Multiple-deliverable Arrangements [Line Items]      
Revenue by payor class as a percentage of total net service revenue 8.00% 8.00% 7.00%
Home Health Non-Medicare - Non-Episodic Based [Member]      
Revenue Recognition, Multiple-deliverable Arrangements [Line Items]      
Revenue by payor class as a percentage of total net service revenue 13.00% 12.00% 13.00%
Hospice Medicare [Member]      
Revenue Recognition, Multiple-deliverable Arrangements [Line Items]      
Revenue by payor class as a percentage of total net service revenue 33.00% 34.00% 34.00%
Hospice Non-Medicare [Member]      
Revenue Recognition, Multiple-deliverable Arrangements [Line Items]      
Revenue by payor class as a percentage of total net service revenue 2.00% 2.00% 2.00%
Personal Care [Member]      
Revenue Recognition, Multiple-deliverable Arrangements [Line Items]      
Revenue by payor class as a percentage of total net service revenue 3.00% 3.00% 3.00%
v3.22.4
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Cash, Cash Equivalents and Restricted Cash (Details) - USD ($)
$ in Thousands
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Cash and Cash Equivalents [Line Items]        
Cash and cash equivalents $ 40,540 $ 42,694    
Restricted cash 13,593 3,075    
Cash, Cash Equivalents and Restricted Cash 54,133 45,769 $ 83,357 $ 96,490
Various Acquisitions [Member]        
Cash and Cash Equivalents [Line Items]        
Restricted cash $ 13,600 $ 3,100    
v3.22.4
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Patient Accounts Receivable Narrative (Details)
 12 Months Ended
Dec. 31, 2022
Dec. 31, 2021
Accounting Policies [Abstract]    
Percentage of patient receivables outstanding 10.00%  
Historical collection rate from Medicare 99.00%  
Portion of accounts receivable derived from Medicare 67.00% 68.00%
Net Service Revenue Period Of Care Payment Rate Duration 30 days  
v3.22.4
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Additional Information Narrative (Details) - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2020
Accounting Policies [Abstract]      
Goodwill $ 1,287,399 $ 1,196,090 $ 932,700
Intangible Assets 101,167 111,190 74,200
Payments of Financing Costs 0 2,792 0
Depreciation 11,500 12,100 12,100
Unamortized debt issuance costs $ 3,500 4,500  
Unamortized debt issuance costs, weighted average amortization period, years 3 years 7 months 6 days    
Deferred income tax assets $ 0 289  
Non-cash compensation 16,560 23,809 26,730
Share-based compensation, tax benefit recognized 4,300 6,000 4,700
Advertising expense 7,300 7,400 6,500
Deferred income tax liabilities 20,411 0  
Recognized Tax Benefit that Impacts Effective Tax Rate 2,700    
Personal Care [Member]      
Accounting Policies [Abstract]      
Goodwill 43,100 43,100 43,100
Noncompete Agreements [Member]      
Accounting Policies [Abstract]      
Intangible Assets $ 1,800 6,400 7,800
Noncompete Agreements [Member] | Minimum [Member]      
Finite-Lived Intangible Assets [Line Items]      
Estimated useful life of intangible assets 2 years    
Noncompete Agreements [Member] | Maximum [Member]      
Finite-Lived Intangible Assets [Line Items]      
Estimated useful life of intangible assets 3 years    
Acquired Names [Member]      
Finite-Lived Intangible Assets [Line Items]      
Estimated useful life of intangible assets 3 years    
Technology-Based Intangible Assets      
Accounting Policies [Abstract]      
Intangible Assets $ 17,100 $ 19,000 $ 0
Finite-Lived Intangible Assets [Line Items]      
Estimated useful life of intangible assets 7 years    
v3.22.4
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Estimated Useful Lives of Property and Equipment (Details)
 12 Months Ended
Dec. 31, 2022
Building [Member]  
Property, Plant and Equipment [Line Items]  
Useful Life 39 years
Leasehold Improvements [Member]  
Property, Plant and Equipment [Line Items]  
Estimated Useful Life Lesser of lease term or expected useful life
Equipment and Furniture [Member] | Minimum [Member]  
Property, Plant and Equipment [Line Items]  
Useful Life 3 years
Equipment and Furniture [Member] | Maximum [Member]  
Property, Plant and Equipment [Line Items]  
Useful Life 7 years
Vehicles [Member] | Minimum [Member]  
Property, Plant and Equipment [Line Items]  
Useful Life 3 years
Vehicles [Member] | Maximum [Member]  
Property, Plant and Equipment [Line Items]  
Useful Life 5 years
Computer Software [Member] | Minimum [Member]  
Property, Plant and Equipment [Line Items]  
Useful Life 2 years
Computer Software [Member] | Maximum [Member]  
Property, Plant and Equipment [Line Items]  
Useful Life 7 years
Finance Leases [Member]  
Property, Plant and Equipment [Line Items]  
Useful Life 3 years
v3.22.4
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Balances Related to Property and Equipment (Details) - USD ($)
$ in Thousands
Dec. 31, 2022
Dec. 31, 2021
Property, Plant and Equipment [Line Items]    
Property and equipment, gross $ 117,400 $ 115,372
Less accumulated depreciation (101,364) (96,937)
Property and equipment, net 16,026 18,435
Building and Leasehold Improvements [Member]    
Property, Plant and Equipment [Line Items]    
Property and equipment, gross 9,700 9,100
Equipment and Furniture [Member]    
Property, Plant and Equipment [Line Items]    
Property and equipment, gross 56,900 54,700
Finance Leases [Member]    
Property, Plant and Equipment [Line Items]    
Property and equipment, gross 4,100 4,500
Property and equipment, net 2,300 1,700
Computer Software [Member]    
Property, Plant and Equipment [Line Items]    
Property and equipment, gross $ 46,700 $ 47,000
v3.22.4
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Financial Instruments Where Carrying Value and Fair Value Differ (Details)
$ in Millions
Dec. 31, 2022
USD ($)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]  
Debt Instrument Carrying Amount Excluding Finance Leases $ 436.1
Fair Value, Inputs, Level 1 [Member]  
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]  
Long-term obligations, fair value 0.0
Fair Value, Inputs, Level 2 [Member]  
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]  
Long-term obligations, fair value 428.6
Fair Value, Inputs, Level 3 [Member]  
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]  
Long-term obligations, fair value $ 0.0
v3.22.4
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Weighted Average Shares Outstanding (Details) - shares
shares in Thousands
 12 Months Ended
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2020
Accounting Policies [Abstract]      
Weighted average number of shares outstanding – basic 32,517 32,642 32,559
Effect of dilutive securities:      
Stock options 39 122 420
Non-vested stock and stock units 97 208 289
Weighted average number of shares outstanding – diluted 32,653 32,972 33,268
Anti-dilutive securities 303 114 25
v3.22.4
NOVEL CORONAVIRUS PANDEMIC ("COVID-19") (Details) - USD ($)
$ in Thousands
 1 Months Ended 12 Months Ended 15 Months Ended
Apr. 30, 2020
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2020
Jun. 30, 2021
Oct. 31, 2021
Mar. 27, 2020
NOVEL CORONAVIRUS PANDEMIC ("COVID-19") [Line Items]              
Funding For Healthcare Providers Including Hospitals             $ 175,000,000
Funding Immediately Distributed To Healthcare Providers Based On Their 2019 Medicare Fee For Service Reimbursements             $ 30,000,000
Funding Received From CARES Act $ 100,000            
CARES Act Provider Relief Funds Utilized         $ 46,600    
CARES Act Interest Repaid to Government           $ 200  
CARES Act Provider Relief Funds Repaid           58,300  
CARES Act Provider Relief Funds Utilized By Unconsolidated Joint Ventures         $ 1,300    
CARES Act Provider Relief Funds Repaid By Unconsolidated Joint Ventures           $ 600  
Total CARES Act Provider Relief Funds Received     $ 106,800        
Extension Of Temporary Suspension Of Sequestration Revenue Impact   $ 13,000 36,000 $ 23,000      
CARES Act Deferral Of Employer Share Social Security Tax     27,000        
Other operating income   0 13,300 34,372      
COVID-19 Deferral of Social Security Taxes [Member]              
NOVEL CORONAVIRUS PANDEMIC ("COVID-19") [Line Items]              
CARES Act Deferral Of Employer Share Social Security Tax       55,000      
Payment of Deferred Social Security Tax Under CARES Act   $ 27,000 $ 27,000        
Personal Care [Member]              
NOVEL CORONAVIRUS PANDEMIC ("COVID-19") [Line Items]              
Other operating income       1,000      
Funding Received From Mass HomeCare ASAP COVID19 Provider Sustainability Program       $ 1,000      
AseraCare Hospice [Member]              
NOVEL CORONAVIRUS PANDEMIC ("COVID-19") [Line Items]              
Funding Received From CARES Act 6,000            
Equity Method Investments [Member]              
NOVEL CORONAVIRUS PANDEMIC ("COVID-19") [Line Items]              
Funding Received From CARES Act $ 2,000            
v3.22.4
ACQUISITIONS - Narrative (Details)
$ in Thousands
 3 Months Ended 12 Months Ended
Apr. 01, 2022
USD ($)
care_center
Oct. 18, 2021
USD ($)
Aug. 01, 2021
USD ($)
Jul. 12, 2021
USD ($)
Jul. 01, 2021
USD ($)
May 01, 2021
USD ($)
Sep. 30, 2022
USD ($)
Dec. 31, 2021
USD ($)
Dec. 31, 2022
USD ($)
Dec. 31, 2021
USD ($)
Dec. 31, 2020
USD ($)
Mar. 23, 2022
USD ($)
Schedule of Business Acquisitions, Purchase Price Allocation [Line Items]                        
Goodwill recorded during period                 $ 94,100 $ 263,400    
Net service revenue                 2,223,199 2,214,112 $ 2,071,519  
Operating income (loss)                 180,772 251,915 219,268  
Depreciation and amortization                 24,935 30,901 28,802  
Restricted cash               $ 3,075 13,593 3,075    
Accrued contingent consideration                 $ 19,195 0 $ 0  
Noncompete Agreements [Member]                        
Schedule of Business Acquisitions, Purchase Price Allocation [Line Items]                        
Weighted-average amortization period                 7 months 6 days      
Technology-Based Intangible Assets                        
Schedule of Business Acquisitions, Purchase Price Allocation [Line Items]                        
Weighted-average amortization period                 5 years 7 months 6 days      
Home Health [Member]                        
Schedule of Business Acquisitions, Purchase Price Allocation [Line Items]                        
Goodwill recorded during period                 $ 85,600 27,800    
Home Health [Member] | NORTH CAROLINA                        
Schedule of Business Acquisitions, Purchase Price Allocation [Line Items]                        
Payments to Acquire Businesses, Gross   $ 4,500                    
Goodwill recorded during period                   4,300    
Home Health [Member] | NORTH CAROLINA | Certificate of Need [Member]                        
Schedule of Business Acquisitions, Purchase Price Allocation [Line Items]                        
Acquisition, other intangibles recorded   $ 200                    
Home Health [Member] | NEW YORK                        
Schedule of Business Acquisitions, Purchase Price Allocation [Line Items]                        
Payments to Acquire Businesses, Gross       $ 1,500                
Goodwill recorded during period                   1,400    
Home Health [Member] | NEW YORK | Certificate of Need [Member]                        
Schedule of Business Acquisitions, Purchase Price Allocation [Line Items]                        
Acquisition, other intangibles recorded       $ 100                
Home Health [Member] | Randolph County, North Carolina                        
Schedule of Business Acquisitions, Purchase Price Allocation [Line Items]                        
Payments to Acquire Businesses, Gross           $ 2,500            
Goodwill recorded during period                   2,400    
Home Health [Member] | Randolph County, North Carolina | Certificate of Need [Member]                        
Schedule of Business Acquisitions, Purchase Price Allocation [Line Items]                        
Acquisition, other intangibles recorded           $ 100            
Personal Care [Member]                        
Schedule of Business Acquisitions, Purchase Price Allocation [Line Items]                        
Goodwill recorded during period                 0 0    
High Acuity Care [Member]                        
Schedule of Business Acquisitions, Purchase Price Allocation [Line Items]                        
Goodwill recorded during period                 8,500 233,900    
2022 New Joint Venture                        
Schedule of Business Acquisitions, Purchase Price Allocation [Line Items]                        
Goodwill recorded during period                 8,500      
Business Combination Acquired Noncontrolling Interest                       $ 8,900
2022 New Joint Venture | Certificates of Need and Licenses [Member]                        
Schedule of Business Acquisitions, Purchase Price Allocation [Line Items]                        
Acquisition, other intangibles recorded                       $ 400
Evolution Health | Home Health [Member]                        
Schedule of Business Acquisitions, Purchase Price Allocation [Line Items]                        
Acquisition, number of care centers acquired | care_center 15                      
Acquisition, total purchase price $ 67,800                      
Payments to Acquire Businesses, Gross 51,100                      
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Assets, Receivables                 7,600      
Business Combination Recognized Identifiable Assets Acquired and Liabilities Assumed Current Assets Prepaid Expense                 200      
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Assets, Other                 100      
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Property, Plant, and Equipment                 1,900      
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Operating Lease Right of Use Assets                 3,200      
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Other Noncurrent Assets                 100      
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Assets                 14,400      
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Liabilities, Accounts Payable                 (800)      
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Liabilities, Payroll and Employee Benefits                 (2,700)      
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Liabilities, Accrued Expenses                 (2,400)      
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Operating Lease Liabilities                 (2,800)      
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Deferred Tax Liabilities                 (100)      
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Liabilities, Long-term Debt                 (600)      
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Liabilities                 (9,400)      
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Net                 5,000      
Goodwill recorded during period                 61,500      
Business Combination, Recognized Identifiable Assets Acquired, Goodwill, and Liabilities Assumed, Net             $ 66,500   66,500      
Goodwill deductible for income tax purposes $ 15,000                      
Period of time goodwill is expected to be deductible for income tax purposes 15 years                      
Business Acquisition Closing Payment Adjustment             $ 1,300          
Net service revenue                 29,400      
Operating income (loss)                 (5,300)      
Increase Decrease In Assets Acquired                 (2,100)      
Increase Decrease In Liabilities Assumed                 (300)      
Reduction in goodwill                 (500)      
Restricted cash $ 16,700                      
Accrued contingent consideration 15,700                      
Amount Released From Escrow                 5,700      
Evolution Health | Home Health [Member] | Potential Closing Payment Adjustment                        
Schedule of Business Acquisitions, Purchase Price Allocation [Line Items]                        
Accrued contingent consideration $ 1,000                      
Evolution Health | Home Health [Member] | Licenses [Member]                        
Schedule of Business Acquisitions, Purchase Price Allocation [Line Items]                        
Acquisition, other intangibles recorded                 1,300      
AssistedCare Home Health | Home Health [Member]                        
Schedule of Business Acquisitions, Purchase Price Allocation [Line Items]                        
Acquisition, number of care centers acquired | care_center 2                      
Acquisition, total purchase price $ 24,700                      
Payments to Acquire Businesses, Gross 22,200                      
Acquisition, other intangibles recorded 700                      
Goodwill recorded during period                 24,000      
Goodwill deductible for income tax purposes $ 24,000                      
Period of time goodwill is expected to be deductible for income tax purposes 15 years                      
Net service revenue                 6,100      
Operating income (loss)                 800      
Restricted cash $ 2,500                      
AssistedCare Home Health | Home Health [Member] | Certificates Of Need [Member]                        
Schedule of Business Acquisitions, Purchase Price Allocation [Line Items]                        
Acquisition, other intangibles recorded 200                      
AssistedCare Home Health | Home Health [Member] | Licenses [Member]                        
Schedule of Business Acquisitions, Purchase Price Allocation [Line Items]                        
Acquisition, other intangibles recorded 500                      
AssistedCare Home Health | Home Health [Member] | Acquired Names [Member]                        
Schedule of Business Acquisitions, Purchase Price Allocation [Line Items]                        
Acquisition, other intangibles recorded $ 100                      
Weighted-average amortization period 1 year                      
Visiting Nurse Association | Home Health And Hospice [Member]                        
Schedule of Business Acquisitions, Purchase Price Allocation [Line Items]                        
Payments to Acquire Businesses, Gross         $ 20,100              
Goodwill recorded during period                   19,700    
Period of time goodwill is expected to be deductible for income tax purposes         15 years              
Visiting Nurse Association | Home Health And Hospice [Member] | Licenses [Member]                        
Schedule of Business Acquisitions, Purchase Price Allocation [Line Items]                        
Acquisition, other intangibles recorded         $ 400              
Contessa Health | High Acuity Care [Member]                        
Schedule of Business Acquisitions, Purchase Price Allocation [Line Items]                        
Acquisition, total purchase price     $ 240,700                  
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Assets, Receivables                 1,500      
Business Combination Recognized Identifiable Assets Acquired and Liabilities Assumed Current Assets Prepaid Expense                 300      
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Assets, Other                 100      
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Property, Plant, and Equipment                 300      
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Operating Lease Right of Use Assets                 800      
Acquisition, other intangibles recorded                 54,300      
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Other Noncurrent Assets                 3,100      
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Assets                 60,400      
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Liabilities, Accounts Payable                 (100)      
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Liabilities, Payroll and Employee Benefits                 (600)      
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Liabilities, Accrued Expenses                 (3,400)      
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Operating Lease Liabilities                 (800)      
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Deferred Tax Liabilities                 (300)      
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Liabilities, Long-term Debt                 (900)      
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Noncurrent Liabilities, Other                 (200)      
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Liabilities                 (6,300)      
Business Combination, Acquisition of Less than 100 Percent, Noncontrolling Interest, Fair Value                 (43,900)      
Business Combination Recognized Identifiable Assets Acquired And Liabilities Assumed Equity                 (43,900)      
Business Combination Recognized Identifiable Assets Acquired And Liabilities Assumed Liabilities And Equity                 (50,200)      
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Net                 10,200      
Business Combination, Recognized Identifiable Assets Acquired, Goodwill, and Liabilities Assumed, Less Noncontrolling Interest                 241,300      
Goodwill recorded during period                 231,100      
Business Acquisition Closing Payment Adjustment               $ 600        
Net service revenue                 18,500 3,500    
Operating income (loss)                 (39,100) (10,300)    
Increase Decrease In Liabilities Assumed                 (2,800)      
Reduction in goodwill                 2,800      
Depreciation and amortization                 $ 3,000 $ 1,200    
Contessa Health | High Acuity Care [Member] | Noncompete Agreements [Member]                        
Schedule of Business Acquisitions, Purchase Price Allocation [Line Items]                        
Acquisition, other intangibles recorded     $ 6,200                  
Weighted-average amortization period     2 years                  
Contessa Health | High Acuity Care [Member] | Acquired Names [Member]                        
Schedule of Business Acquisitions, Purchase Price Allocation [Line Items]                        
Acquisition, other intangibles recorded     $ 28,300                  
Contessa Health | High Acuity Care [Member] | Technology-Based Intangible Assets                        
Schedule of Business Acquisitions, Purchase Price Allocation [Line Items]                        
Acquisition, other intangibles recorded     $ 19,800                  
Weighted-average amortization period     7 years                  
v3.22.4
GOODWILL AND OTHER INTANGIBLE ASSETS, NET - Activity Related to Goodwill (Details) - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2020
Goodwill [Line Items]      
Goodwill, Impaired, Accumulated Impairment Loss     $ 733,700
Goodwill [Roll Forward]      
Beginning balance $ 1,196,090 $ 932,700  
Additions 94,100 263,400  
Adjustments related to acquisitions (2,800)    
Ending balance 1,287,399 1,196,090  
Home Health [Member]      
Goodwill [Roll Forward]      
Beginning balance 118,200 90,400  
Additions 85,600 27,800  
Adjustments related to acquisitions 0    
Ending balance 203,800 118,200  
Hospice [Member]      
Goodwill [Roll Forward]      
Beginning balance 800,900 799,200  
Additions 0 1,700  
Adjustments related to acquisitions 0    
Ending balance 800,900 800,900  
Personal Care [Member]      
Goodwill [Roll Forward]      
Beginning balance 43,100 43,100  
Additions 0 0  
Adjustments related to acquisitions 0    
Ending balance 43,100 43,100  
High Acuity Care [Member]      
Goodwill [Roll Forward]      
Beginning balance 233,900 0  
Additions 8,500 233,900  
Adjustments related to acquisitions (2,800)    
Ending balance $ 239,600 $ 233,900  
v3.22.4
GOODWILL AND OTHER INTANGIBLE ASSETS, NET - Goodwill and Intangibles (Details) - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2020
Intangible Assets [Line Items]      
Intangible assets, accumulated amortization $ 14,604 $ 19,900  
Noncompete Agreements [Member]      
Intangible Assets [Line Items]      
Weighted-average amortization period 7 months 6 days    
Intangible assets, accumulated amortization     $ 9,000
Technology-Based Intangible Assets      
Intangible Assets [Line Items]      
Weighted-average amortization period 5 years 7 months 6 days    
Amortizable acquired names [Member]      
Intangible Assets [Line Items]      
Intangible assets, accumulated amortization     $ 11,500
v3.22.4
GOODWILL AND OTHER INTANGIBLE ASSETS, NET - Activity Related to Other Intangible Assets, Net (Details) - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2022
Dec. 31, 2021
Intangible Assets [Roll Forward]    
Beginning balance $ 111,190 $ 74,200
Additions 3,500 55,500
Reclass to amortizable intangible   0
Amortization (13,500) (18,500)
Ending balance 101,167 111,190
Amortizable acquired names [Member]    
Intangible Assets [Roll Forward]    
Beginning balance 3,100 5,500
Additions 0 0
Reclass to amortizable intangible   6,600
Amortization (3,100) (9,000)
Ending balance 0 3,100
Noncompete Agreements [Member]    
Intangible Assets [Roll Forward]    
Beginning balance 6,400 7,800
Additions 0 6,200
Reclass to amortizable intangible   0
Amortization (4,600) (7,600)
Ending balance 1,800 6,400
Technology-Based Intangible Assets    
Intangible Assets [Roll Forward]    
Beginning balance 19,000 0
Additions 1,100 20,200
Reclass to amortizable intangible   0
Amortization (3,000) (1,200)
Ending balance 17,100 19,000
Certificates of Need and Licenses [Member]    
Intangible Assets [Roll Forward]    
Beginning balance 47,100 47,000
Additions 2,400 800
Reclass to amortizable intangible   0
Amortization (2,800) (700)
Ending balance 46,700 47,100
Unamortizable acquired names [Member]    
Intangible Assets [Roll Forward]    
Beginning balance 35,600 13,900
Additions 0 28,300
Reclass to amortizable intangible   (6,600)
Amortization 0 0
Ending balance $ 35,600 $ 35,600
v3.22.4
GOODWILL AND OTHER INTANGIBLE ASSETS, NET - Estimated Future Amortization Expense (Details)
$ in Millions
Dec. 31, 2022
USD ($)
Finite-Lived Intangible Assets, Net, Amortization Expense, Fiscal Year Maturity [Abstract]  
2023 $ 4.8
2024 3.0
2025 3.0
2026 3.0
2027 3.0
Total $ 16.8
v3.22.4
Discontinued Operations and Assets Held For Sale - Additional Information (Detail)
$ in Millions
Feb. 10, 2023
USD ($)
Personal Care [Member] | Subsequent Event [Member]  
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]  
Disposal Group, Including Discontinued Operation, Consideration $ 50.0
v3.22.4
Assets Held For Sale - Assets and Liabilities (Detail) - Personal Care [Member] - USD ($)
$ in Millions
Dec. 31, 2022
Dec. 31, 2021
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]    
Patient accounts receivable $ 9.6 $ 8.7
Prepaid expenses 0.1 0.1
Other current assets 9.7 8.8
Property and equipment 0.1 0.2
Disposal Group Including Discontinued Operation Operating Lease Right Of Use Assets Noncurrent 2.5 2.8
Goodwill 43.1 43.1
Intangible assets 0.0 1.8
Total assets 55.4 56.7
Accounts payable 0.4 0.3
Payroll and employee benefits 0.6 2.5
Accrued expenses 1.8 0.1
Current portion of operating lease liabilities 0.6 0.7
Total current liabilities 3.4 3.6
Operating lease liabilities, less current portion 1.9 2.2
Total liabilities $ 5.3 $ 5.8
v3.22.4
DETAILS OF CERTAIN BALANCE SHEET ACCOUNTS - Balances (Details) - USD ($)
$ in Thousands
Dec. 31, 2022
Dec. 31, 2021
Other current assets:    
Payroll tax escrow $ 7,600 $ 7,900
Income tax receivable 8,800 8,200
Due from joint ventures 3,600 3,900
Other 6,400 5,600
Other current assets 26,415 25,598
Other assets:    
Workers’ compensation deposits 300 300
Health insurance deposits 900 900
Other miscellaneous deposits 1,000 1,100
Indemnity receivable 13,600 13,600
Equity method investments 40,500 48,100
Cost method investments 20,000 5,000
Other 3,500 4,000
Other assets 79,836 73,023
Accrued expenses:    
Health insurance 16,200 16,200
Workers’ compensation 40,600 40,300
Florida ZPIC audit, gross liability 0 17,400
Legal settlements and other audits 32,100 27,500
Charity care 1,900 1,400
Estimated Medicare cap liability 4,300 4,500
Hospice accruals (room and board, general in-patient and other) 19,100 23,600
Patient and payor liabilities 6,700 6,000
Accrued contingent consideration 10,500 0
Accrued Interest 200 8,100
Other 5,800 5,800
Accrued expenses 137,390 150,836
Other long-term obligations:    
Reserve for uncertain tax positions 0 3,400
Deferred compensation plan liability 600 1,000
Accrued contingent consideration 3,200 0
Other 1,000 600
Other long-term obligations $ 4,808 $ 4,979
v3.22.4
LEASES (Details)
 12 Months Ended
Dec. 31, 2022
Lessee, Lease, Description [Line Items]  
Lessee, Operating Lease, Term of Contract 7 years
Lessee, Finance Lease, Term of Contract 3 years
Telehealth Kits  
Lessee, Lease, Description [Line Items]  
Lessee, Finance Lease, Term of Contract 1 year
Fleet Lease [Member]  
Lessee, Lease, Description [Line Items]  
Lessee, Operating Lease, Term of Contract 367 days
Minimum [Member]  
Lessee, Lease, Description [Line Items]  
Lessee, Operating Lease, Option to Terminate Option for early termination of lease after one year
Lessee, Operating Lease, Renewal Term 1 year
Maximum [Member]  
Lessee, Lease, Description [Line Items]  
Lessee, Operating Lease, Option to Terminate Option for early termination of lease after three years
Lessee, Operating Lease, Renewal Term 5 years
v3.22.4
LEASES - Lease Cost (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2022
Dec. 31, 2021
Leases [Abstract]    
Operating lease cost $ 43.9 $ 40.3
Impairment of operating lease ROU assets 2.1 0.1
Total operating lease cost 46.0 40.4
Finance Lease, Loss on Termination 0.5 0.0
Finance Lease, Amortization of ROU assets 1.8 2.0
Finance Lease, Interest Expense 0.1 0.1
Finance Lease Cost 2.4 2.1
Variable lease cost 3.4 3.3
Short-term lease cost 0.0 0.0
Total lease cost $ 51.8 $ 45.8
v3.22.4
LEASES - Operating Lease (Details) - USD ($)
$ in Thousands
Dec. 31, 2022
Dec. 31, 2021
Leases [Abstract]    
Operating lease ROU assets $ 102,856 $ 101,257
Current portion of operating lease liabilities 33,521 31,233
Operating lease liabilities, less current portion 69,504 69,309
Operating lease liabilities $ 103,000 $ 100,500
v3.22.4
LEASES - Finance Leases (Details) - USD ($)
$ in Thousands
Dec. 31, 2022
Dec. 31, 2021
Lessee, Lease, Description [Line Items]    
Finance lease ROU assets $ 4,100 $ 4,500
Finance Lease, ROU Asset, Accumulated Amortization (1,800) (2,800)
Property and equipment 16,026 18,435
Finance Leases [Member]    
Lessee, Lease, Description [Line Items]    
Property and equipment $ 2,300 $ 1,700
Current portion of long-term obligations    
Lessee, Lease, Description [Line Items]    
Finance Lease, Liability, Current, Statement of Financial Position [Extensible Enumeration] Current portion of long-term obligations Current portion of long-term obligations
Long-Term obligations, less current portion    
Lessee, Lease, Description [Line Items]    
Finance Lease, Liability, Noncurrent, Statement of Financial Position [Extensible Enumeration] Long-term obligations, less current portion Long-term obligations, less current portion
Current and Long-Term obligations    
Lessee, Lease, Description [Line Items]    
Finance Lease, Liability, Statement of Financial Position [Extensible Enumeration] Other Liabilities Other Liabilities
v3.22.4
LEASES - Supplemental Cashflow Information (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2022
Dec. 31, 2021
Leases [Abstract]    
Operating cash flow from operating leases $ (44.4) $ (39.7)
Financing cash flow from finance leases (1.5) (2.0)
Right-of-Use Asset Obtained in Exchange for Operating Lease Liability 45.1 46.1
Right-of-Use Asset Obtained in Exchange for Finance Lease Liability 2.1 0.9
Lessee Operating lease Reductions to ROU assets resulting from reductions to lease obligations (4.2) (1.7)
Lessee Finance lease Reduction to ROU assets resulting from reductions to lease obligations $ (0.6) $ 0.0
v3.22.4
LEASES- Weighted Average Remaining Term and Discount Rate (Details)
Dec. 31, 2022
Dec. 31, 2021
Leases [Abstract]    
Operating Lease, Weighted Average Remaining Lease Term 3 years 6 months 3 years 8 months 12 days
Finance Lease, Weighted Average Remaining Lease Term 2 years 1 month 6 days 1 year 8 months 12 days
Operating Lease, Weighted Average Discount Rate, Percent 3.40% 2.70%
Finance Lease, Weighted Average Discount Rate, Percent 5.30% 5.20%
v3.22.4
LEASES - Maturities (Details) - USD ($)
$ in Millions
Dec. 31, 2022
Dec. 31, 2021
Lessee, Lease, Description [Line Items]    
Operating Lease - 2023 $ 36.1  
Operating Lease - 2024 30.9  
Operating Lease - 2025 20.8  
Operating Lease - 2026 12.7  
Operating Lease - 2027 6.7  
Operating Lease - Thereafter 2.4  
Operating Lease - Total undiscounted lease payments 109.6  
Operating Lease - Less: Imputed Interest (6.6)  
Operating lease liabilities 103.0 $ 100.5
Finance Lease - 2023 1.2  
Finance Lease - 2024 0.9  
Finance Lease - 2025 0.3  
Finance Lease - 2026 0.0  
Finance Lease - 2027 0.0  
Finance Lease - Thereafter 0.0  
Finance Lease - Total undiscounted lease payments 2.4  
Finance Lease - Less: Imputed Interest $ (0.1)  
Current and Long-Term obligations    
Lessee, Lease, Description [Line Items]    
Finance Lease, Liability, Statement of Financial Position [Extensible Enumeration] Other Liabilities Other Liabilities
v3.22.4
LONG-TERM OBLIGATIONS - Summary of Long-Term Debt (Details) - USD ($)
$ in Millions
Dec. 31, 2022
Dec. 31, 2021
Debt Instrument [Line Items]    
Principal amount $ 438.4 $ 449.6
Deferred debt issuance costs (3.5) (4.5)
Long-term obligations, including current portion 434.9 445.1
Current portion of long-term obligations (15.5) (13.0)
Long-term obligations, less current portion 419.4 432.1
Term Loan [Member] | Four Hundred Fifty Million Term Loan Facility [Member]    
Debt Instrument [Line Items]    
Principal amount 435.9 447.2
Revolving Credit Facility [Member] | Five Hundred Fifty Million Revolving Credit Facility [Member]    
Debt Instrument [Line Items]    
Principal amount 0.0 0.0
Promissory Notes [Member]    
Debt Instrument [Line Items]    
Principal amount 0.2 0.8
Finance Leases [Member]    
Debt Instrument [Line Items]    
Principal amount $ 2.3 $ 1.6
v3.22.4
LONG-TERM OBLIGATIONS - Summary of Long-Term Debt Additional Information (Details)
$ in Thousands
 12 Months Ended
Dec. 31, 2022
USD ($)
Term Loan [Member] | Four Hundred Fifty Million Term Loan Facility [Member]  
Debt Instrument [Line Items]  
Debt Instrument, face amount $ 450,000
Maturity date Jul. 30, 2026
Term Loan [Member] | Four Hundred Fifty Million Term Loan Facility [Member] | Eurodollar [Member]  
Debt Instrument [Line Items]  
Debt Instrument Interest Rate at Period End 5.90%
Revolving Credit Facility [Member] | Five Hundred Fifty Million Revolving Credit Facility [Member]  
Debt Instrument [Line Items]  
Debt Instrument, face amount $ 550,000
Maturity date Jul. 30, 2026
v3.22.4
LONG-TERM OBLIGATIONS - Maturities of Debt (Details) - USD ($)
$ in Millions
Dec. 31, 2022
Dec. 31, 2021
Long-Term Obligations, Fiscal Year Maturity    
2023 $ 15.5  
2024 23.3  
2025 22.7  
2026 376.9  
2027 0.0  
Total $ 438.4 $ 449.6
v3.22.4
LONG-TERM OBLIGATIONS - Fees and Rates Under Credit Facilities (Details)
 12 Months Ended
Dec. 31, 2022
Consolidated Leverage Ratio: Greater Than 3.00 to 1.0  
Line of Credit Facility [Line Items]  
Commitment Fee 0.30%
Letter of Credit Fee 1.75%
Consolidated Leverage Ratio: Greater Than 3.00 to 1.0 | Minimum [Member]  
Line of Credit Facility [Line Items]  
Consolidated Leverage Ratio 3.00
Consolidated Leverage Ratio: Greater Than 3.00 to 1.0 | Base Rate [Member]  
Line of Credit Facility [Line Items]  
Margin on Loans 1.00%
Consolidated Leverage Ratio: Greater Than 3.00 to 1.0 | Eurodollar [Member]  
Line of Credit Facility [Line Items]  
Margin on Loans 2.00%
Consolidated Leverage Ratio: Less Than Equal To 3.00 to 1.0 but Greater Than 2.00 to 1.0  
Line of Credit Facility [Line Items]  
Commitment Fee 0.25%
Letter of Credit Fee 1.50%
Consolidated Leverage Ratio: Less Than Equal To 3.00 to 1.0 but Greater Than 2.00 to 1.0 | Maximum [Member]  
Line of Credit Facility [Line Items]  
Consolidated Leverage Ratio 3.00
Consolidated Leverage Ratio: Less Than Equal To 3.00 to 1.0 but Greater Than 2.00 to 1.0 | Minimum [Member]  
Line of Credit Facility [Line Items]  
Consolidated Leverage Ratio 2.00
Consolidated Leverage Ratio: Less Than Equal To 3.00 to 1.0 but Greater Than 2.00 to 1.0 | Base Rate [Member]  
Line of Credit Facility [Line Items]  
Margin on Loans 0.75%
Consolidated Leverage Ratio: Less Than Equal To 3.00 to 1.0 but Greater Than 2.00 to 1.0 | Eurodollar [Member]  
Line of Credit Facility [Line Items]  
Margin on Loans 1.75%
Consolidated Leverage Ratio: Less Than Equal To 2.00 to 1.0 but Greater Than 0.75 to 1.0  
Line of Credit Facility [Line Items]  
Commitment Fee 0.20%
Letter of Credit Fee 1.25%
Consolidated Leverage Ratio: Less Than Equal To 2.00 to 1.0 but Greater Than 0.75 to 1.0 | Maximum [Member]  
Line of Credit Facility [Line Items]  
Consolidated Leverage Ratio 2.00
Consolidated Leverage Ratio: Less Than Equal To 2.00 to 1.0 but Greater Than 0.75 to 1.0 | Minimum [Member]  
Line of Credit Facility [Line Items]  
Consolidated Leverage Ratio 0.75
Consolidated Leverage Ratio: Less Than Equal To 2.00 to 1.0 but Greater Than 0.75 to 1.0 | Base Rate [Member]  
Line of Credit Facility [Line Items]  
Margin on Loans 0.50%
Consolidated Leverage Ratio: Less Than Equal To 2.00 to 1.0 but Greater Than 0.75 to 1.0 | Eurodollar [Member]  
Line of Credit Facility [Line Items]  
Margin on Loans 1.50%
Consolidated Leverage Ratio: Less Than Equal To 0.75 to 1.0  
Line of Credit Facility [Line Items]  
Commitment Fee 0.15%
Letter of Credit Fee 1.00%
Consolidated Leverage Ratio: Less Than Equal To 0.75 to 1.0 | Maximum [Member]  
Line of Credit Facility [Line Items]  
Consolidated Leverage Ratio 0.75
Consolidated Leverage Ratio: Less Than Equal To 0.75 to 1.0 | Base Rate [Member]  
Line of Credit Facility [Line Items]  
Margin on Loans 0.25%
Consolidated Leverage Ratio: Less Than Equal To 0.75 to 1.0 | Eurodollar [Member]  
Line of Credit Facility [Line Items]  
Margin on Loans 1.25%
v3.22.4
LONG-TERM OBLIGATIONS - Narrative (Details)
$ in Thousands
 12 Months Ended 26 Months Ended 34 Months Ended 60 Months Ended
Jul. 30, 2021
USD ($)
Jun. 29, 2018
USD ($)
Dec. 31, 2022
USD ($)
Dec. 31, 2021
USD ($)
Dec. 31, 2020
USD ($)
Sep. 30, 2023
Jul. 30, 2026
Jul. 30, 2026
Feb. 04, 2019
USD ($)
Debt Instrument [Line Items]                  
Principal payments of long-term obligations     $ 13,296 $ 9,143 $ 10,249        
Consolidated leverage ratio     1.7            
Consolidated interest coverage ratio     11.6            
Principal amount     $ 438,400 449,600          
Payments of Financing Costs     0 2,792 $ 0        
Credit Agreement [Member]                  
Debt Instrument [Line Items]                  
Swing Line Facility   $ 25,000              
Letters of Credit, maximum commitment   60,000              
Finance Leases [Member]                  
Debt Instrument [Line Items]                  
Principal amount     $ 2,300 1,600          
Finance Leases [Member] | Minimum [Member]                  
Debt Instrument [Line Items]                  
Interest rate (percent)     2.10%            
Finance Leases [Member] | Maximum [Member]                  
Debt Instrument [Line Items]                  
Interest rate (percent)     5.30%            
Second Amended Credit Agreement                  
Debt Instrument [Line Items]                  
Additional interest rate above Federal Fund rate (percent) 0.50%                
Additional interest rate above Eurodollar Rate (percent) 1.00%                
Percentage of consolidated revenue and adjusted EBITDA that guarantor wholly-owned subsidiaries represent 95.00%                
Percentage of adjusted EBITDA that guarantor subsidiaries represent 70.00%                
Payments of Financing Costs       2,800          
Second Amended Credit Agreement | Subsequent Event [Member]                  
Debt Instrument [Line Items]                  
Maturity date               Jul. 30, 2026  
Second Amended Credit Agreement | Minimum [Member]                  
Debt Instrument [Line Items]                  
Proceeds Received From Loan Party Of Subsidiary $ 5,000                
Second Amended Credit Agreement | Base Rate [Member]                  
Debt Instrument [Line Items]                  
Description of variable rate basis Fluctuating rate per annum equal to the highest of (a) the federal funds rate plus 0.50% per annum, (b) the prime rate of interest established by the Administrative Agent, and (c) the Eurodollar Rate for an interest period of one month plus 1% per annum.                
Basis spread on variable rate (percent)     0.50%            
Second Amended Credit Agreement | Eurodollar [Member]                  
Debt Instrument [Line Items]                  
Description of variable rate basis Rate at which Eurodollar deposits in the London interbank market for an interest period of one, two, three or six months                
Basis spread on variable rate (percent)     1.50%            
Promissory Notes [Member]                  
Debt Instrument [Line Items]                  
Principal amount     $ 200 $ 800          
Interest rate (percent)     6.50%            
Five Hundred Fifty Million Revolving Credit Facility [Member] | Revolving Credit Facility [Member]                  
Debt Instrument [Line Items]                  
Debt Instrument, face amount     $ 550,000            
Weighted Average Interest Rate     3.40% 1.90%          
Maturity date     Jul. 30, 2026            
Remaining availability under the revolving credit facility     $ 520,400            
Principal amount     0 $ 0          
Five Hundred Fifty Million Revolving Credit Facility [Member] | Letter of Credit [Member]                  
Debt Instrument [Line Items]                  
Outstanding letters of credit     29,600            
Five Hundred Fifty Million Revolving Credit Facility [Member] | Credit Agreement [Member]                  
Debt Instrument [Line Items]                  
Debt Instrument, face amount   550,000              
Credit facility, maximum additional borrowing capacity   $ 125,000              
Credit facility, maximum allowable consolidated leverage ratio multiple   0.5              
Credit facility maximum allowable consolidated leverage ratio   3.0              
Maturity date   Jun. 29, 2023              
Five Hundred Fifty Million Revolving Credit Facility [Member] | Amended Credit Agreement [Member]                  
Debt Instrument [Line Items]                  
Credit facility, maximum borrowing capacity                 $ 725,000
Debt Instrument, face amount                 550,000
Five Hundred Fifty Million Revolving Credit Facility [Member] | Second Amended Credit Agreement                  
Debt Instrument [Line Items]                  
Credit facility, maximum borrowing capacity $ 1,000,000                
Debt Instrument, face amount 550,000                
One Hundred Seventy Five Million Term Loan Facility [Member] | Amended Credit Agreement [Member]                  
Debt Instrument [Line Items]                  
Debt Instrument, face amount                 $ 175,000
Four Hundred Fifty Million Term Loan Facility [Member] | Term Loan [Member]                  
Debt Instrument [Line Items]                  
Debt Instrument, face amount     $ 450,000            
Weighted Average Interest Rate     3.20% 1.60%          
Maturity date     Jul. 30, 2026            
Principal amount     $ 435,900 $ 447,200          
Four Hundred Fifty Million Term Loan Facility [Member] | Second Amended Credit Agreement                  
Debt Instrument [Line Items]                  
Debt Instrument, face amount $ 450,000                
Four Hundred Fifty Million Term Loan Facility [Member] | Second Amended Credit Agreement | Subsequent Event [Member]                  
Debt Instrument [Line Items]                  
Debt Instrument Periodic Payment Percentage           0.625% 1.25%    
v3.22.4
INCOME TAXES - Narrative (Details) - USD ($)
$ in Thousands
 12 Months Ended
Aug. 10, 2020
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Income Tax Disclosure [Line Items]          
Unrecognized Tax Benefits, Reduction Resulting from Lapse of Applicable Statute of Limitations   $ (2,700) $ 0 $ 0  
Income tax receivable   8,800 8,200    
Recognized Tax Benefit that Impacts Effective Tax Rate   2,700      
Uncertain tax benefits accrued   0 2,700 2,700 $ 2,700
Benefit as Component of Interest Expense   700      
Valuation allowance   5,200 3,300    
Net change in total valuation allowance   $ 1,900 3,200    
Unrecognized Tax Benefits, Income Tax Penalties and Interest Expense     100 200  
Interest and penalties accrued related to uncertain income tax positions     700    
CARES Act Deferral Of Employer Share Social Security Tax     27,000    
Share-based Compensation Arrangement by Share-based Payment Award, Options, Exercises in Period   37,635      
Deferred income taxes   $ 23,377 44,582 (26,560)  
COVID-19 Deferral of Social Security Taxes [Member]          
Income Tax Disclosure [Line Items]          
CARES Act Deferral Of Employer Share Social Security Tax       55,000  
Payment of Deferred Social Security Tax Under CARES Act   $ 27,000 $ 27,000    
Executive Stock Option Exercise [Member]          
Income Tax Disclosure [Line Items]          
Recognized share-based compensation tax benefit       92,100  
Share-based Compensation Arrangement by Share-based Payment Award, Options, Exercises in Period 500,000        
Minimum [Member]          
Income Tax Disclosure [Line Items]          
Tax years open to examination   2007      
Maximum [Member]          
Income Tax Disclosure [Line Items]          
Tax years open to examination   2022      
State Tax Credit [Member]          
Income Tax Disclosure [Line Items]          
Tax credits   $ 3,700      
Federal [Member] | Executive Stock Option Exercise [Member]          
Income Tax Disclosure [Line Items]          
Recognized share-based compensation tax benefit       19,400  
Federal [Member] | Net Operating Loss [Member]          
Income Tax Disclosure [Line Items]          
Net operating loss carryforwards   20,900      
State and Local Jurisdiction [Member] | Executive Stock Option Exercise [Member]          
Income Tax Disclosure [Line Items]          
Recognized share-based compensation tax benefit       $ 4,600  
State and Local Jurisdiction [Member] | Net Operating Loss [Member]          
Income Tax Disclosure [Line Items]          
Net operating loss carryforwards   $ 144,700      
v3.22.4
INCOME TAXES - Components of Tax Provision by Jurisdiction (Details) - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2020
Current income tax expense/(benefit):      
Federal $ 12,200 $ 20,300 $ 41,600
State and local 7,000 5,200 10,600
Current income tax expense (benefit) 19,200 25,500 52,200
Deferred income tax expense/(benefit):      
Federal 20,400 35,900 (22,500)
State and local 2,900 8,700 (4,100)
Deferred income tax expense (benefit) 23,377 44,582 (26,560)
Income tax expense $ 42,545 $ 70,065 $ 25,635
v3.22.4
INCOME TAXES - Income Tax Expense Allocation (Details) - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2020
Income Tax Disclosure [Abstract]      
Income from continuing operations $ 42,545 $ 70,065 $ 25,635
Interest expense (700) 100 200
Goodwill (2,700) 3,100 0
Tax expense recorded to additional paid-in-capital 1,500 0 0
Total income tax expense allocation $ 40,600 $ 73,300 $ 25,800
v3.22.4
INCOME TAXES - Reconciliation of Effective Tax Rate (Details)
 12 Months Ended
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2020
Income Tax Disclosure [Abstract]      
Income tax expense at U.S. federal statutory rate 21.00% 21.00% 21.00%
State and local income taxes, net of federal income tax benefit (1) 5.60% 5.00% 2.40%
Excess tax benefits from share-based compensation (1) 0.30% (2.10%) (12.70%)
Non-deductible executive compensation 0.80% 1.20% 2.10%
Unrecognized tax benefits (2) (1.70%) 0.00% 0.00%
Other items, net (3) 0.50% (0.10%) (0.60%)
Income tax expense 26.50% 25.00% 12.20%
v3.22.4
INCOME TAXES - Components of Deferred Tax Assets (Liabilities) (Details) - USD ($)
$ in Thousands
Dec. 31, 2022
Dec. 31, 2021
Deferred tax assets:    
Accrued payroll & employee benefits $ 14,100 $ 13,200
Workers’ compensation 10,600 10,500
Share-based compensation 5,700 6,200
Legal & compliance matters 4,700 6,200
Lease liability 27,800 27,300
Deferred social security taxes (1) 0 6,900
Net operating loss carryforwards 11,600 13,600
Tax credit carryforwards 2,900 2,500
Other assets 200 500
Gross deferred tax assets 77,600 86,900
Less: valuation allowance (5,200) (3,300)
Net deferred tax assets 72,400 83,600
Deferred tax liabilities:    
Property and equipment (6,600) (8,100)
Amortization of intangible assets (48,500) (32,300)
Deferred revenue 0 (4,500)
Investment in partnerships (10,000) (10,800)
Right-of-use asset (27,000) (26,700)
Other liabilities (700) (900)
Gross deferred tax liabilities (92,800) (83,300)
Deferred Income Tax Liabilities, Net (20,411) 0
Deferred income tax assets $ 0 $ 289
v3.22.4
INCOME TAXES - Reconciliation of Unrecognized Tax Benefits (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2020
Reconciliation of Unrecognized Tax Benefits, Excluding Amounts Pertaining to Examined Tax Returns [Roll Forward]      
Uncertain tax benefits, beginning balance $ 2.7 $ 2.7 $ 2.7
Additions for tax positions related to current year 0.0 0.0 0.0
Additions for tax positions related to prior year 0.0 0.0 0.0
Reductions for tax positions related to prior years 0.0 0.0 0.0
Unrecognized Tax Benefits, Reduction Resulting from Lapse of Applicable Statute of Limitations (2.7) 0.0 0.0
Settlements 0.0 0.0 0.0
Uncertain tax benefits, ending balance $ 0.0 $ 2.7 $ 2.7
v3.22.4
CAPITAL STOCK AND SHARE-BASED COMPENSATION - Narrative (Details) - USD ($)
$ / shares in Units, $ in Millions
 12 Months Ended
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2020
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Common stock, authorized (shares) 60,000,000 60,000,000  
Common stock, par value (usd per share) $ 0.001 $ 0.001  
Preferred stock, authorized (shares) 5,000,000 5,000,000  
Preferred stock, par value (usd per share) $ 0.001 $ 0.001  
Common stock, issued (shares) 37,891,186 37,674,868  
Common stock, outstanding (shares) 32,518,278 32,509,969  
Preferred stock, issued (shares) 0 0  
Percentage of ownership in subsidiaries 50.00%    
Equity-based awards, number of shares authorized (shares) 2,500,000    
Equity-based awards, shares available for grant (shares) 1,700,000    
Percentage of total combined voting power of the Company and subsidiaries 10.00%    
Percentage of market value for purchases under Employee Stock Purchase Program (percent) 85.00%    
Common stock available for issuance under Employee Stock Purchase Plan (shares) 1,264,302    
Employee Stock Purchase Plan expense $ 0.7 $ 0.7 $ 0.6
Options granted (shares) 33,656    
Maximum [Member]      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Vesting period of equity-based awards 4 years    
Common Stock Shares Authorized For Issuance To Employee Stock Purchase Plan 4,500,000    
Minimum [Member]      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Vesting period of equity-based awards 12 months    
Share-Based Awards [Member]      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Fair value of share of common stock (percent) 100.00%    
Share Based Awards to More Than Ten Percent Owner [Member]      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Fair value of share of common stock (percent) 110.00%    
Stock Option [Member]      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Options granted (shares) 33,656 40,788 43,249
Stock compensation expense $ 1.7 $ 3.6 $ 4.3
Tax benefit from stock option exercise 0.4 1.0 27.9
Intrinsic value of options outstanding 0.7    
Intrinsic value of options exerciseable 0.7    
Intrinsic value of options exercised during the period 1.5 5.1 121.1
Unrecognized compensation expense $ 2.0    
Unrecognized compensation expense weighted-average period for recognitions (years) 1 year 9 months 18 days    
Stock Option [Member] | Maximum [Member]      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Contractual term of share-based award ten years    
Non-Vested Stock Units [Member] | Maximum [Member]      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Vesting period of equity-based awards 4 years    
Non-Vested Stock Units [Member] | Minimum [Member]      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Vesting period of equity-based awards 1 year    
Non-Vested Stock Units - Service-Based [Member]      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Stock compensation expense $ 12.1 $ 9.4 $ 7.5
Unrecognized compensation expense $ 22.6    
Unrecognized compensation expense weighted-average period for recognitions (years) 2 years 2 months 12 days    
Non-vested stock granted, weighted average grant date fair value (usd per share) $ 115.07 $ 234.42 $ 206.10
Non-Vested Stock Units - Service-Based and Performance-Based [Member]      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Stock compensation expense $ 2.2 $ 10.2 $ 13.5
Unrecognized compensation expense $ 1.1    
Unrecognized compensation expense weighted-average period for recognitions (years) 1 year 1 month 6 days    
Non-vested stock granted, weighted average grant date fair value (usd per share) $ 133.70 $ 262.67 $ 201.90
Performance-based award, target number of units to be received (shares) 71,349    
v3.22.4
CAPITAL STOCK AND SHARE-BASED COMPENSATION - Employee Stock Purchase Plan Purchases (Details) - $ / shares
 3 Months Ended 103 Months Ended 127 Months Ended
Dec. 31, 2022
Sep. 30, 2022
Jun. 30, 2022
Mar. 31, 2022
Dec. 31, 2021
Sep. 30, 2021
Jun. 30, 2021
Mar. 31, 2021
Dec. 31, 2020
Dec. 31, 2022
Share-Based Payment Arrangement [Abstract]                    
Employee Stock Purchase Plan shares issued (shares) 11,498 12,047 10,814 6,184 7,161 7,466 5,095 4,060 3,171,373 3,235,698
Price per Employee Stock Purchase Plan share issued (usd per share) $ 71.01 $ 82.27 $ 89.35 $ 146.45 $ 137.60 $ 126.74 $ 208.19 $ 225.07 $ 17.89 $ 71.01
v3.22.4
CAPITAL STOCK AND SHARE-BASED COMPENSATION - Stock Option Valuation Assumptions (Details) - Stock Option [Member] - $ / shares
 12 Months Ended
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2020
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Risk Free Rate, minimum   0.80% 0.38%
Risk Free Rate, maximum   1.35% 1.51%
Risk Free Interest Rate 1.91%    
Expected Volatility, minimum   39.84% 40.15%
Expected Volatility, maximum   41.40% 42.80%
Expected Volatility Rate 40.97%    
Expected Term 6 years 3 months 6 years 3 months 6 years 3 months
Weighted Average Fair Value $ 61.31 $ 107.45 $ 86.72
Share-based Compensation Arrangement by Share-based Payment Award, Fair Value Assumptions, Expected Dividend Rate 0.00% 0.00% 0.00%
v3.22.4
CAPITAL STOCK AND SHARE-BASED COMPENSATION - Stock Option Activity (Details) - USD ($)
$ / shares in Units, $ in Thousands
 12 Months Ended
Aug. 10, 2020
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2020
Number of Shares        
Outstanding, beginning balance (shares)   273,973    
Granted (shares)   33,656    
Exercise of stock options (in shares)   37,635    
Canceled, forfeited or expired (shares)   (51,382)    
Outstanding, ending balance (shares)   218,612 273,973  
Exercisable (shares)   163,286    
Weighted Average Exercise Price        
Outstanding, beginning balance (usd per share)   $ 137.54    
Granted (usd per share)   143.25    
Exercised (usd per share)   61.23    
Canceled, forfeited or expired (usd per share)   174.57    
Outstanding, ending balance (usd per share)   142.86 $ 137.54  
Exercisable (usd per share)   $ 122.54    
Weighted Average Contractual Life (Years)        
Outstanding, weighted average contractual life (years)   6 years 6 months 21 days 7 years 2 months 15 days  
Exercisable, weighted average contractual life (years)   6 years 14 days    
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]        
Exercise of stock options (in shares)   37,635    
Payments Related to Tax Withholding for Share-based Compensation   $ 7,981 $ 16,898 $ 54,493
Executive Stock Option Exercise [Member]        
Number of Shares        
Exercise of stock options (in shares) 500,000      
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      
Exercise of stock options (in shares) 500,000      
Tax benefit from stock option exercise       24,000
Payments Related to Tax Withholding for Share-based Compensation       $ 40,400
v3.22.4
CAPITAL STOCK AND SHARE-BASED COMPENSATION - Non-Vested Stock Option Activity (Details)
 12 Months Ended
Dec. 31, 2022
$ / shares
shares
Number of Shares  
Non-vested stock options beginning balance (shares) | shares 129,439
Granted (shares) | shares 33,656
Vested (shares) | shares (64,496)
Forfeited (shares) | shares (43,273)
Non-vested stock options ending balance (shares) | shares 55,326
Weighted Average Grant Date Fair Value  
Non-vested stock options beginning balance (usd per share) | $ / shares $ 182.45
Granted (usd per share) | $ / shares 143.25
Vested (usd per share) | $ / shares 150.79
Forfeited (usd per share) | $ / shares 173.11
Non-vested stock options ending balance (usd per share) | $ / shares $ 202.81
v3.22.4
CAPITAL STOCK AND SHARE-BASED COMPENSATION - Non-Vested Stock Units Activity (Details) - $ / shares
 12 Months Ended
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2020
Non-Vested Stock Units - Service-Based [Member]      
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Number of Shares [Roll Forward]      
Non-vested, beginning balance (shares) 180,823    
Granted (shares) 211,361    
Vested (shares) (59,006)    
Canceled, forfeited or expired (shares) (70,025)    
Non-vested, ending balance (shares) 263,153 180,823  
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Weighted Average Grant Date Fair Value [Abstract]      
Non-vested, beginning balance (usd per share) $ 195.25    
Granted (usd per share) 115.07 $ 234.42 $ 206.10
Vested (usd per share) 146.76    
Canceled, forfeited or expired (usd per share) 194.68    
Non-vested, ending balance (usd per share) $ 141.62 $ 195.25  
Non-Vested Stock Units - Service-Based and Performance-Based [Member]      
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Number of Shares [Roll Forward]      
Non-vested, beginning balance (shares) 186,951    
Granted (shares) 71,349    
Vested (shares) (85,767)    
Canceled, forfeited or expired (shares) (104,486)    
Non-vested, ending balance (shares) 68,047 186,951  
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Weighted Average Grant Date Fair Value [Abstract]      
Non-vested, beginning balance (usd per share) $ 206.36    
Granted (usd per share) 133.70 $ 262.67 $ 201.90
Vested (usd per share) 156.18    
Canceled, forfeited or expired (usd per share) 237.30    
Non-vested, ending balance (usd per share) $ 144.55 $ 206.36  
Additional Performance Based Award Target share Max Amount 32,048    
v3.22.4
COMMITMENTS AND CONTINGENCIES - Narrative (Details)
$ in Thousands
 1 Months Ended 3 Months Ended 12 Months Ended 27 Months Ended
Jun. 27, 2016
patient
Jan. 18, 2016
USD ($)
claim
Nov. 03, 2015
patient
May 21, 2015
patient
Jun. 06, 2011
beneficiary
Aug. 31, 2017
USD ($)
claim
Dec. 31, 2022
USD ($)
Sep. 30, 2022
USD ($)
Jun. 30, 2022
USD ($)
Dec. 31, 2022
USD ($)
Mar. 31, 2010
beneficiary
Mar. 31, 2022
USD ($)
Dec. 31, 2021
USD ($)
Jun. 30, 2021
USD ($)
Mar. 31, 2021
USD ($)
Jan. 10, 2019
USD ($)
Loss Contingencies [Line Items]                                
Indemnity receivable             $ 13,600     $ 13,600     $ 13,600      
Patient accounts receivable             296,785     296,785     $ 274,961      
Health insurance retention limit                   1,300            
Workers' compensation insurance retention limit                   2,000            
Professional liability insurance retention limit                   300            
South Carolina [Member] | Hospice [Member]                                
Loss Contingencies [Line Items]                                
Number of beneficiaries | beneficiary                     30          
Indemnity receivable             2,800     2,800            
Indemnification amount                               $ 2,800
South Carolina [Member] | Hospice [Member] | Extrapolated [Member]                                
Loss Contingencies [Line Items]                                
Number of beneficiaries | beneficiary         16                      
South Carolina [Member] | Hospice [Member] | Unfavorable [Member]                                
Loss Contingencies [Line Items]                                
Recovery amount of the overpayment made to the subsidiary   $ 3,700                            
Recovery amount of overpayment made to subsidiary including interest   $ 5,600                            
Number of claims submitted by subsidiary | claim   9                            
Recovery amount of over payment made to subsidiary including interest withheld             5,700     5,700            
US Department of Justice [Member] | Hospice [Member]                                
Loss Contingencies [Line Items]                                
Loss contingency accrual                             $ 6,500  
Reversal of Loss Contingency Accrual                           $ 6,500    
US Department of Justice [Member] | Massachusetts [Member] | Hospice [Member]                                
Loss Contingencies [Line Items]                                
Number of patients | patient       53                        
US Department of Justice [Member] | Morgantown, West Virginia [Member] | Hospice [Member]                                
Loss Contingencies [Line Items]                                
Number of patients | patient     66                          
US Department of Justice [Member] | Parkersburg, West Virginia [Member] | Hospice [Member]                                
Loss Contingencies [Line Items]                                
Number of patients | patient 68                              
Safeguard Zone Program Integrity Contractor [Member] | Florida [Member]                                
Loss Contingencies [Line Items]                                
Loss contingency accrual               $ 25,200 $ 25,800     $ 17,400        
Indemnity receivable             10,900     10,900            
Accounts Receivable, Allowance for Credit Loss, Writeoff               1,500                
Reduction To Net Service Revenue                 $ 8,400              
Safeguard Zone Program Integrity Contractor [Member] | Lakeland, Florida [Member] | Home Health [Member]                                
Loss Contingencies [Line Items]                                
Recovery amount of the overpayment made to the subsidiary           $ 34,000 26,000     26,000            
Number of claims submitted by subsidiary | claim           72                    
Actual claims payment           $ 200                    
Error rate (percent)           100.00%                    
Litigation Settlement Interest               11,500                
Total Legal Settlement Payment               34,300                
Legal Settlement Payment Less Interest               $ 22,800                
Safeguard Zone Program Integrity Contractor [Member] | Clearwater, Florida [Member] | Home Health [Member]                                
Loss Contingencies [Line Items]                                
Recovery amount of the overpayment made to the subsidiary           $ 4,800 3,300     $ 3,300            
Number of claims submitted by subsidiary | claim           70                    
Actual claims payment           $ 200                    
Error rate (percent)           100.00%                    
Litigation Settlement Interest             1,200                  
Total Legal Settlement Payment             3,700                  
Legal Settlement Payment Less Interest             $ 2,400                  
v3.22.4
COMMITMENTS AND CONTINGENCIES - Insurance Programs (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2022
Dec. 31, 2021
Commitments and Contingencies Disclosure [Abstract]    
Health insurance $ 16.2 $ 16.2
Workers’ compensation 40.8 40.5
Professional liability 5.0 5.2
Estimated Insurance Total 62.0 61.9
Estimated Insurance Long Term Portion (0.2) (0.2)
Estimated Insurance Excluding Long Term Portion $ 61.8 $ 61.7
v3.22.4
EMPLOYEE BENEFIT PLANS - Narrative (Details) - USD ($)
 12 Months Ended
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2020
Retirement Benefits [Abstract]      
Employer match amount $ 0.44    
Employee contribution amount $ 1.00    
Maximum percentage of employee salary eligible for employer match (percent) 6.00%    
401(k) expense recognized $ 18,600,000 $ 17,000,000 $ 12,900,000
v3.22.4
SHARE REPURCHASE - Narrative (Details) - USD ($)
$ / shares in Units, $ in Thousands
 11 Months Ended 12 Months Ended 17 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2022
Feb. 02, 2023
Aug. 02, 2021
Dec. 23, 2020
Share Repurchase [Line Items]                  
Purchase of company stock   $ 17,351   $ 99,878 $ 0        
2021 Share Repurchase Program [Member]                  
Share Repurchase [Line Items]                  
Purchase of company stock       $ 100,000          
Stock repurchase program, authorized amount                 $ 100,000
Stock repurchase program, expiration date     Dec. 31, 2021            
Shares repurchased (shares)       446,832          
Shares repurchased, weighted average price per share (usd per share)       $ 223.49          
New Share Repurchase Program [Member]                  
Share Repurchase [Line Items]                  
Purchase of company stock   $ 17,000              
Stock repurchase program, authorized amount               $ 100,000  
Stock repurchase program, expiration date           Dec. 31, 2022      
Shares repurchased (shares)   150,000              
Shares repurchased, weighted average price per share (usd per share)   $ 115.64              
Subsequent Event [Member] | 2023 Share Repurchase Program                  
Share Repurchase [Line Items]                  
Stock repurchase program, authorized amount             $ 100,000    
Stock repurchase program, expiration date Dec. 31, 2023                
v3.22.4
SEGMENT INFORMATION - Narrative (Details)
 12 Months Ended
Dec. 31, 2022
segment
Segment Reporting [Abstract]  
Number of reportable business segments 4
v3.22.4
SEGMENT INFORMATION - Operating Income of Reportable Segments (Details) - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2020
Segment Reporting Information [Line Items]      
Net service revenue $ 2,223,199 $ 2,214,112 $ 2,071,519
Other operating income 0 13,300 34,372
Cost of service, excluding depreciation and amortization 1,260,425 1,233,356 1,185,369
General and administrative expenses, excluding depreciation and amortization and impairment charge 754,100 711,200 668,200
Depreciation and amortization 24,935 30,901 28,802
Impairment charge 3,009 0 4,152
Operating expenses 2,042,427 1,975,497 1,886,623
Operating income (loss) 180,772 251,915 219,268
Home Health [Member] | Reportable Business Segments [Member]      
Segment Reporting Information [Line Items]      
Net service revenue 1,355,500 1,353,800 1,249,200
Other operating income   7,300 20,200
Cost of service, excluding depreciation and amortization 769,000 756,600 729,900
General and administrative expenses, excluding depreciation and amortization and impairment charge 348,500 328,500 307,200
Depreciation and amortization 4,000 4,300 3,900
Impairment charge 0   3,400
Operating expenses 1,121,500 1,089,400 1,044,400
Operating income (loss) 234,000 271,700 225,000
Hospice [Member] | Reportable Business Segments [Member]      
Segment Reporting Information [Line Items]      
Net service revenue 787,800 791,800 750,100
Other operating income   6,000 13,100
Cost of service, excluding depreciation and amortization 426,500 425,200 400,600
General and administrative expenses, excluding depreciation and amortization and impairment charge 203,300 198,400 175,400
Depreciation and amortization 2,300 2,700 2,200
Impairment charge 0   800
Operating expenses 632,100 626,300 579,000
Operating income (loss) 155,700 171,500 184,200
Personal Care [Member]      
Segment Reporting Information [Line Items]      
Other operating income     1,000
Personal Care [Member] | Reportable Business Segments [Member]      
Segment Reporting Information [Line Items]      
Net service revenue 61,400 65,000 72,200
Other operating income   0 1,100
Cost of service, excluding depreciation and amortization 46,700 49,100 54,900
General and administrative expenses, excluding depreciation and amortization and impairment charge 9,200 11,200 12,400
Depreciation and amortization 100 200 200
Impairment charge 0   0
Operating expenses 56,000 60,500 67,500
Operating income (loss) 5,400 4,500 5,800
High Acuity Care [Member] | Reportable Business Segments [Member]      
Segment Reporting Information [Line Items]      
Net service revenue 18,500 3,500 0
Other operating income   0 0
Cost of service, excluding depreciation and amortization 18,200 2,500 0
General and administrative expenses, excluding depreciation and amortization and impairment charge 33,100 10,000 0
Depreciation and amortization 3,300 1,300 0
Impairment charge 3,000   0
Operating expenses 57,600 13,800 0
Operating income (loss) (39,100) (10,300) 0
Other [Member] | Other Segment [Member]      
Segment Reporting Information [Line Items]      
Net service revenue 0 0 0
Other operating income   0 0
Cost of service, excluding depreciation and amortization 0 0 0
General and administrative expenses, excluding depreciation and amortization and impairment charge 160,000 163,100 173,200
Depreciation and amortization 15,200 22,400 22,500
Impairment charge 0   0
Operating expenses 175,200 185,500 195,700
Operating income (loss) $ (175,200) $ (185,500) $ (195,700)
v3.22.4
RELATED PARTY TRANSACTIONS - Narrative (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2020
Medalogix [Member]      
Related Party Transaction [Line Items]      
Related party transaction, amount of transaction $ 9.4 $ 5.7 $ 3.9
v3.22.4
SUBSEQUENT EVENTS Narrative (Details) - Subsequent Event [Member] - 2023 Share Repurchase Program - USD ($)
$ in Millions
 11 Months Ended
Dec. 31, 2023
Feb. 02, 2023
Subsequent Event [Line Items]    
Stock repurchase program, authorized amount   $ 100.0
Stock repurchase program, expiration date Dec. 31, 2023