Home Health Care Policies: Court Blocks Home Care Overtime Protections

Posted by Nathan Hope on Jan 6, 2015

Over the Christmas holidays, the Federal Court struck down some of the proposed overtime rules and protections for home health employees and issued a 14-day stay on the ruling to analyze the plaintiffs’ arguments. The rules were highly opposed by many stakeholders and home health advocacy interest groups, while many care giving employees found the rules to be long overdue. The rules were set to take effect January 1^st, 2015.

In the case Home Care Association of America v. David Weil, the new overtime rules championed by the U.S. Department of Labor were overturned. The rules would have gone into effect beginning January 1^st. Many trade associations in the home care industry were opposed to the proposed overtime rules by stating that they (the rules) would directly hurt the home care industry and drive up spending for an already financial strained Medicare system. This is all despite the fact that Medicare spending has shown to currently sit below the expected spending levels that were projected several years ago.

The plaintiffs, including Home Care Association of America, National Association for Home Care and Hospice, and the International Franchise Association for Home Care and Hospice challenged a rule that would prohibit the exemption of companionship services and live-in domestic services. With the rules being overturned, “Fellowship and protection” services provided by care workers will continued being denied overtime protections. Additionally, live-in service providers will also continue to be denied overtime protections with the court now blocking rule’s implementation.

A representative of the National Association for Home Care and Hospice stated that the rule would have affected 90% of care in regards to the court ruling.

“This is a victory for elderly and disabled persons who rely on home care,” said NAHC President Val Halamandaris. “This victory proves the value of industry unity. United, fighting on behalf of the elderly and disabled we cannot fail, divided, we cannot succeed.”

However, many health care employees do not share the same sentiments. Many advocacy groups claim that this ruling provides a clear example of the exploitation of home caregivers throughout the country. The Paraprofessional Healthcare Institute (PHI) is one such group that highly opposes the court’s actions in allowing the ruling to be delayed past its January 1^st implementation date. A quote from the PHI blog states:

“As we previously stated after the December 22nd ruling, the Final Rule’s extension of minimum wage and overtime protections to most home care workers is the right policy—both for those employees, whose demanding work merits these fundamental wage guarantees, and for recipients of services who deserve a stable and professional workforce allowing them to remain in their homes and communities.” (phinational.org)

The temporary stay on the ruling will be in effect until January 15^th to hear the remainder of the plaintiffs’ argument regarding “companionship services” and why they do not qualify for overtime pay. The Court will hold a hearing regarding a preliminary injunction on Friday, January 9^th.

New Benefits, Rights and Protections in the Affordable Care Act

ObamaCare offers many new benefits, rights and protections. Some of the Benefits of ObamaCare are all ready here, more ObamaCare benefits are coming 2014 and beyond. Let’s take a look at some of the advantages of our new health care reform law and how its new benefits, rights and protections affect you, your family and your business.

Benefits of ObamaCare: A Quick Summary of ObamaCare’s Benefits, Rights and Protections

ObamaCare offers you and your family many new benefits rights and protections on all new plans. Health plans that started after 2010 will have to switch you over to a plan that offers these benefits in 2014.

Plans signed before 2010 may have grandfathered status. Learn more aboutGrandfathered Health Plans. Here is a quick overview of the different benefits, rights and protections which are all covered in detail below and discussed in-depth on the site.

• New Health Insurance Marketplaces (AKA Exchanges) allow shoppers to compare Health Plans that include all new benefits, rights and protections.

• Cost assistance to individuals, families and small businesses through the marketplace.

• Medicaid eligibility is expanded in 26 states to 138% of the federal poverty level giving millions of Americans access to healthcare.

• No annual or lifetime limits on healthcare.

• All major medical insurance is guaranteed issue, meaning you can’t be denied coverage for any reason.

• Insurance companies can’t drop you when you are sick or for making a mistake on your application.

• You can’t be denied coverage for pre-existing conditions.

• You have the right to quickly appeal any health insurance company decision.

• You have the right to get an easy-to-understand summary about a health plan’s benefits and coverage.

• Young Adults can stay on their parent’s plan until 26.

• A large improvement to women’s health services.

• Reforms to the healthcare industry to cut wasteful spending.

• Better care and protections for seniors.

• New preventative services at no-out-of pocket costs.

• Essential health benefits like emergency care, hospitalization, prescription drugs, and maternity and newborn care must be included on all non-grandfathered plans at no out-of-pocket limit.

• You can’t be charged more based on health status or gender.

• Plus many more benefits, rights and protections.

Know the Law. The Affordable Care Act contains 10 titles, each title addresses a different aspect of health care reform. Title I Quality, affordable health care for all Americans addresses most of the new benefits, rights, and protections. Check out our Summary of Provisions of the Patient Protection and Affordable Care Act for a plain English summary of each provision pertaining to the “benefits of ObamaCare”.

Each new benefit, right and protection is part of one of ObamaCare’s provisions. As you can see by the image below some of the most popular Provisions in the Affordable Care Act are the ones that the least amount of people are aware of.

Study: American Seniors Face Health Care Gaps, Despite Medicare

A new study by the Commonwealth Fund published recently in Health Affairs finds that Americans older than 65 are more likely to have chronic illnesses and to struggle to afford health care – despite qualifying for the federal Medicare program – t

November 25, 2014 09:17 AM

A new study by the Commonwealth Fund that appears in the most recent edition of Health Affairs found that American seniors are more likely to have chronic illnesses and to have difficulty affording their healthcare despite receiving Medicare benefits.

On average, beneficiaries with traditional Medicare will end up spending more than $4,000 per year on out-of-pocket health costs, according to the study’s authors. That constitutes a level of cost-sharing much higher than that seen in comparable nations.

According to a Kaiser Health News reporton the study, the research found that:

• 87 percent of U.S. respondents 65 or older indicated having one chronic condition and 68 percent had two or more. Canada was the next highest, with 83 percent having one disease and 56 percent having two or more.
• 19 percent of United States respondents reported cost as an obstacle in getting care last year. The next highest rate was in New Zealand, with 10 percent.
• 55 percent said it “somewhat or very easy” to get care after hours, a figure that was higher in all countries but Sweden, Canada and Australia.
• American respondents were among the most likely to have discussed with a physician healthy lifestyles and end-of-life planning.
• While each nation’s health system had strengths, the survey highlighted room for improvement across the board. The study, which comes in the midst of Medicare’s open enrollment season, may provide beneficiaries with key factors to consider as they review their coverage choices.

The findings, which are based on phone surveys conducted in 11 industrialized countries, highlight gaps in Medicare coverage that should be addressed, said Donald Moulds, one of the study’s authors and executive vice president for programs at the Commonwealth Fund.http://www.nahc.org/NAHCReport/nr141124_12/

A third of family caregivers spend over $10K a year

Surprising amount of time and money spent by family caregivers each year

Posted on September 17, 2014

This week an article was published in USA Today “A third of family caregivers spend over $10K a year” by Nancy Hellmich and discusses a new survey conducted on Caring.com that has some interesting results from 1,345 respondents that you should probably take note of as a private duty or home care company.  The survey revealed that about a third of family caregivers are spending 30 hours a week on caregiving tasks and about $10,000 per year on other caregiving expenses.  The most significant findings in terms of marketing your home care company are:

“About half of the caregivers in the survey are retired; 39% are working full time, part time or are self-employed. Of those who are working, 60% say their duties have had a negative impact on their jobs; 17% say they have had to miss a significant amount of work because of those caregiving duties.”

This is significant because the 39% that are working and saying that the caregiving duties at home are having a negative impact on their job are the exact people you need to be marketing your services to in order to help solve their problems and alleviate that element of stress.  At Leading Home Care we always stress how important it is for you to focus on the family decision maker (usually the oldest daughter) and how you can help them by asking about Mom and/or Dad, listening to her concerns, and showing her how you can help her relieve those caregiving stresses.

There are some other interesting findings from this survey.  They are outlined in the full article, so take a look and think about ways to implement those findings into your marketing strategy.

New Legislation Would Increase Funding Toward Home & Community Based Services

Fifteen years after a landmark Supreme Court ruling and one year following a report showing that many states have not made adequate progress in ensuring the availability of home- and community-based services (HCBS), a U.S. Senator is now taking action with a new piece of legislation.

This week, Senator Tom Harkin (D-IA) introduced The Community Integration Act to ensure that the choice and opportunity to live HCBS settings are available to all Americans living with disabilities, as an alternative to nursing homes and other institutional settings. 

“Studies clearly show that home and community-based care is not only what most people want, but it is also more cost-effective,” Harkin stated. “The choice to live in the community is one of the most important civil rights issues we face today.”

Harkin’s legislation arrives almost 15 years ago to the data that the Supreme Court ruled in Olmstead v. L.C. that the unnecessary segregation of individuals with disabilities in institutions is a violation of the Americans with Disabilities Act (ADA).

Despite the ruling, a July 2013 report released by the Senate Health, Education, Labor, and Pensions (HELP) Committee—of which Harkin is Chairman—found that more than 200,000 working-age Americans remain unfairly segregated in nursing homes. 

A critical finding in the report reveled that by 2010, only 12 states had spent more than 50% of Medicaid funds on HCBS care rather than institutional care. 

“Fifteen years ago in Olmstead v. L.C., the Supreme Court held that under the ADA, individuals with disabilities have the right to choose to receive their services and support in home- and community-based settings, rather than only in a nursing home or other institutional setting,” Harkin stated. “But we have yet to fully realize this promise, and many individuals with disabilities—our family members and friends—continue to reside in institutional settings against their wishes.”

Harkin’s Community Integration Act aims to eliminate the “nursing home bias” in Medicaid by alloying the provision of similar care or services in HCBS settings, as well as prohibit states from making anyone ineligible for HCBS based on a particular disability.

The legislation would also require states that have found an individual to be eligible for nursing home care to also be eligible for care in HCBS settings; set clear requirements for states regarding the provision of services in HCBS services.

States would also be required to report the number of individuals with disabilities in institutional settings and the number that have been transitioned to HCBS settings.

“The Community Integration Act honors the Olmstead decision and ensures that states take the steps needed to ensure that all individuals with disabilities are given the opportunity to receive their services and supports in a community based setting, where they can work, participate in community life, and be an integral part of their communities,” Harkin stated. 

Written by Jason Oliva

Amedisys’ $150 million settlement finalized

The U.S. Department of Justice has finalized a $150 million settlement with Amedisys Inc. involving allegations that the Baton Rouge company submitted false home health care billings to the Medicare program.
The total includes more than $26 million to settle six whistleblower lawsuits in Pennsylvania and one in Georgia.
The whistleblowers were primarily former Amedisys employees, whose lawsuits are sealed.
Amedisys had set aside $150 million in 2013 in anticipation of a settlement. The company did not admit to any wrongdoing.
“This settlement demonstrates the department’s commitment to ensuring that home health providers, like other providers, comply with the rules and don’t misuse taxpayer dollars,” said Stuart F. Delery, assistant attorney general for the Justice Department’s civil division. “It is critical that scarce Medicare home health dollars flow only to those who provide qualified services.”
The settlement resolves a number of allegations.
The Justice Department alleged Amedisys billed Medicare between 2008 and 2010 for nursing and therapy services that were medically unnecessary or provided to patients who were not homebound, and misrepresented patients’ conditions to increase its Medicare payments.
The billing violations were alleged to be the result of management pressure on nurses and therapists to provide care based on financial benefits to Amedisys, rather than the needs of patients.
The Justice Department also alleged that Amedisys had improper financial relationships with referring physicians.
It said Amedisys employees coordinated patient care services at below-market prices for a Georgia oncology practice, a violation of federal laws that restrict the financial relationships home health care providers may have with doctors who refer patients to them.
Amedisys provides home health and hospice care to more than 360,000 patients each year, with operations in 37 states, Washington, D.C., and Puerto Rico, according to its website.
Amedisys reiterated its previous stance Wednesday on the settlement, saying it disagreed with the Justice Department allegations and settled to avoid the cost of a protracted legal battle. Amedisys said it operated according to “stringent policies” that require services be medically necessary.
In its settlement, Amedisys also is bound by an agreement that requires the company to implement compliance measures to avoid or promptly detect conduct similar to what prompted the settlement.
The company said Wednesday that it has made significant investments in its compliance program, which was designed to meet the guidelines of the Department of Health and Human Services’ Office of Inspector General.
CRT Capital Group LLC Managing Director Sheryl Skolnick, who tracks the company, said she expects things will get worse at Amedisys — operationally and financially.
“This fine, whether old news or new, is a crushing blow to AMED’s turnaround hopes in our view, especially as it comes in a low-volume, embattled home health and hospice reimbursement environment,” Skolnick said.

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The $150 million settlement is a big number given Amedisys’ financial condition. The amount is five times what CRT estimates Amedisys will earn in 2014 before income taxes, depreciation and amortization.

Investors apparently shrugged off the settlement announcement. The company’s shares closed at $13.82, down 32 cents, in light trading.
Skolnick said most investors will view Wednesday’s settlement as confirmation of the previous announcement, already discounted into the stock price.
Brian Tanquilut, an analyst with Jefferies Group, said Wednesday’s announcement, most of which was already known, doesn’t change anything for Amedisys.
Amedisys operated under a corporate integrity agreement some time ago and has the knowledge and systems in place to abide by the agreement, he said.
The finalized settlement does put some stress on Amedisys’ balance sheet, which will prevent the company from making acquisitions at a time when there are buying opportunities, he said.
The home health industry is struggling with rate cuts, and it makes sense that the larger, more capable companies would take advantage of those opportunities.
Amedisys is having to do the reverse, he said. The company has been shedding underperforming locations.
Earlier this month, Amedisys said it is closing 29 home health and hospice centers and consolidating another 25 in places where its care centers are servicing the same markets.
Under the settlement, Amedisys will pay the $150 million, plus interest, in two installments.
The first, $115 million plus interest, must be paid by May 2. The second installment must be paid by Oct. 23.
The company also will pay $3.9 million for attorneys’ fees and expenses in whistelblowers lawsuits. Amedisys will record that charge in the first quarter of 2014.
Wednesday’s announcement comes on top of a whirlwind of activity in recent weeks and months in which an activist investment firm, which accumulated a 14.9 percent stake in Amedisys, got a member appointed to the board, while the company’s chief executive officer/founder and a senior financial officer resigned.
Amedisys also posted a fourth-quarter and annual loss earlier this month.
The investigation was conducted by the Justice Department’s Commercial Litigation Branch of the Civil Division. Federal prosecutors in Alabama, Kentucky, South Carolina and New York state worked on the case.
Others involved were the Department of Health and Human Services’ Office of Inspector General, Federal Bureau of Investigation, Office of Personnel Management’s Office of Inspector General, Defense Criminal Investigative Service of the Department of Defense and the Railroad Retirement Board’s Office of Inspector General.

BY TED GRIGGS

tgriggs@theadvocate.com

Tablets Help Home Health Agency Boost Care Coordination, Cut Costs

CHIME is chiming in on the value of mHealth.

The College of Health Information Management Executives unveiled a case study this week that examines how a California-based home care and hospice agency is seeing benefits by using tablets.

The process wasn't easy, though. The 11-page case study points out that the organization spent a decade working with laptops and smartphones – and experiencing problems with each – before moving on to tablets. It's indicative of an mHealth movement that is moving by fits and starts toward acceptance.

Sutter Care at Home, an affiliate of Sacramento-based Sutter Health with more than 1,300 caregivers in 23 counties throughout northern California, transitioned to tablets running on the Android system in 2012. According to Jennifer Brecher, Sutter Care at Home's project manager, the tablets offer caregivers instant access to important information from the system's Epic electronic medical record, as well as real-time communication with fellow caregivers for care coordination.

“Tablets have sped up the flow of the process,” she said in the case study. “In the past, if one of the clinicians went to see the patient on Monday and the physical therapist would go on Tuesday, the therapist would not have the electronic information about the Monday visit available. This is better from a productivity standpoint and better for the patient.”

Phil Chuang, Sutter's chief strategy officer and former director of information services, said the group had tried for about a decade to bring mobile computing into the home care process. They started with laptops, then tried smartphones, but each had limitations that affected how the caregivers did their jobs in sometimes-remote parts of the state.

They then switched to 7-inch tablets equipped with 4G mobile broadband access, and have seen noticeable results.

With the tablets, Brecher said, caregivers can now finish documentation on a visit in 24 hours, rather than the three days it took before tablets were introduced. They can also enter photos into the medical record, consult with specialists and order medical supplies (the agency reports a 20 percent per-visit decrease in supply costs in the first year that tablets were used).

“If we want to achieve better outcomes for care, we need to be sure that we are staying on top of best clinical care practices,” he said in the case study. “It’s unfair to expect a field nurse to keep up on what is best practice in all areas. This system helps drive best practice; a wound care nurse manager determines what supplies should be on the formulary and keeps it updated as improved supplies become available on the market.”

Chuang said the agency spends 18 hours training a new nurse to use the tablet, a process that includes classroom time and encouragement to take the tablet home and practice with it. The program also requires a lot of work from the IT department, which has to keep track of a thousand devices spread out all over northern California. Sutter officials said they purchase tablets commonly available to consumers, the only requirement being that they run on Android.

Among the advantages, Chuang said in the case study: IT can manage the devices from afar.

“Mobile device management is a way to bring consistency to the devices out there,” he said. “The system allows us to know where a device is, to wipe a device, to push out new policies. Our level of control is far more powerful than anything we had with laptops. We know the status of every device, without any user intervention.

“There are always issues with security compliance with any device,” he added in the case study. “If someone loses a laptop, how do you know if it was encrypted? The last time it was on the network is the last time we can tell. When our security office wants to know whether a device was encrypted, we can tell them exactly when, and we can issue a wipe command and erase the device immediately. We have a level of security that we never had with laptops.”

Sutter officials say the tablets will improve care coordination and documentation for homecare nurses, who face unique challenges in their mobile environments. They can improve their documentation, communicate and consult with other caregivers and share data and resources with their patients. Chuang expects the project will be even more meaningful as accountable care measures take root, putting more emphasis on care coordination, prevention of hospital readmissions and data transparency.

“That’s the power from a patient care perspective, that we can communicate with you and the patient wherever you are,” he said. “That’s what the mobile technology gets us.”

Written By:Eric Wicklund - Editor, mHealthNews

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