U.S.-based home health, personal care, and hospice services provider Pluto Acquisition I Inc.'s (d/b/a AccentCare Inc.) reported materially weaker-than-expected cash flow metrics as a result of the ongoing COVID-19 pandemic, Centers for Medicare&Medicaid Services' (CMS') claims review, and the new reimbursement scheme for home health providers. S&P Global Ratings is affirming its 'B-' issuer credit rating and revising its outlook to stable from positive. At the same time, we are affirming our 'B-' rating and '3' recovery rating on the company's first-lien facility. The stable outlook reflects our expectations that, although the company has achieved improved margins and maintains adequate liquidity, we expect limited free cash flow generation for at least the next 12 months. Social; health and