Home health care agencies struggle with new federal rules.

The rules governing home health care are confusing, contradictory and expensive, say providers, and they're getting more so. But that doesn't mean the rules should be made lax, they argue. Some even look forward to quality enhancement as a by-product of new "outcome-oriented" Medicare surveys. Inevitably, home health care administrators agree, increased federal scrutiny has likely been spurred by the massive growth in the field in the past 15 years.