89% of US Department of Labor Investigations Revealed Violations

As the nation recognizes Home Care and Hospice Month, the United States Department of Labor (DOL) presented a public webinar aimed primarily at the Southeast care industry so that employers and employees alike understand their rights and responsibilities under the Fair Labor Standards Act (FLSA). An alarming 89 percent of investigations completed between 2020 and…

Dept of Labor Webinar to Address ‘Alarming Violations’ in Southeast Care Industries

Thursday, Nov 17, 2022 11:00 AM to 12:30 PM Eastern Register now! Violations in 89 percent of investigations between 2020-2022, $16M in recoveries for workers As the nation marks Home Care and Hospice Month, the U.S. Department of Labor will hold a public webinar on federal wage and hour regulations for home care, residential care…

New Independent Contractor Test Increases Risk of Independent Contractor Misclassification in the Home-Based Care Industry

By Angelo Spinola & Matthew Kapsak of Polsinelli The U.S. Department of Labor (“DOL”) is about to issue a Proposed Rule that will have a significant impact on the test used to determine whether someone is an independent contractor or an employee under the Fair Labor Standards Act (“FLSA”). The Proposed Rule, if adopted, will…

Hospice Notes for July 13, 2022

Congress is facing a packed few weeks in the lead-up to the monthslong August recess. The potential revival of a slimmed-down reconciliation package sought by Senate Democrats remains top-of-mind for many DC watchers. While nothing is concrete at this point, it unfortunately appears likely that any smaller party-line reconciliation bill will omit major funding investments in Medicaid home-and-community-based services (HCBS). Last year’s House-passed Build Back Better Act included $150 billion for HCBS, seen as a transformative injection of resources that would increase access and better support the frontline home care workforce.

NAHC continues to work with other diverse coalitions to push for the inclusion of HCBS funding in any emerging deal.

Elsewhere on Capitol Hill, the House Appropriations committee recently approved a number of FY2023 government funding bills, including the Labor, Health and Human Services, Education, and Related Agencies (LHHS) package that contains discretionary spending for federal health programs. While it is certain that future Senate-side bipartisan negotiations will ensure any final government funding package that will ultimately become law will differ from what the House Appropriations committee has cleared, it is still instructive to keep track of the Democrat-led House deal, as it provides insight into that group’s policy priorities. A few provisions relevant to home-based care providers, detailed in the bill’s accompany report, include the following (note -many of these are merely signaling in nature, as opposed to explicitly directive):

  • Medicare Coverage of Home-based Extended Care Services.—The Committee encourages CMS to consider options to improve extended care services for Medicare beneficiaries, such as through home-based extended care by home health agencies (bottom of pg 184)
  • Patient Access to Home Health Care.—The Committee supports the intent of the network adequacy rules of CMS for Medicare Advantage organizations and for Medicaid managed care organizations under 42 C.F.R. 438 and 457 to maintain a network of qualified providers sufficient to provide adequate access for covered services to meet the health care needs of the patient population served. The Committee requests a report within 180 days of the date of enactment of this Act on regulatory actions related to network adequacy (bottom of pg. 186)
  • Home Health Aides.—The Committee recognizes that home health aides (HHAs) are the foundation of professional home-based caregiving, and that the growing population of disabled, chronically ill, and elderly Americans receiving home-based care requires a skilled and highly trained HHA workforce prepared to manage complex care needs. The Committee encourages HHS to explore how HHAs are meeting clinical competencies necessary to provide high-quality home-based care (pg. 221)
  • Direct Care Workforce Demonstration.—The Committee provides $3,000,000 for a Direct Care Workforce Demonstration project, to reduce barriers to entry for a diverse and high-quality direct care workforce, including providing wages, benefits, and advancement opportunities needed to attract or retain direct care workers. (pg. 211)
  • Dementia Care Management Model.—The Committee urges the Center for Medicare & Medicaid Innovation (CMMI) consider how best to test a Medicare dementia care management model. The Committee encourages CMMI to continue working with stakeholders to find a way to test a value-based dementia care management model that could reach dementia patients across the stages and include coordinated care management and caregivers. The Committee requests an update not later than one year after the date of enactment of this Act on the progress for this model. (pg. 180)

The bill also includes several provisions that would help to increase the health care workforce. Among other things, the bill includes: nearly $2 billion in new money for the Department of Labor, including for apprenticeship programs, Workforce Innovation and Opportunity state grants, and Senior Community Service Employment; $15,6 billion in new money for HHS to enhance nursing workforce development and other health care programs; and enhanced funding for targeted programs of the Administration on Community Living.

The Committee also adopted a manager’s amendment from House Appropriations Committee Chairwoman Rosa DeLauro (D-CT), that added language to the committee report that urges the Health Resources and Services Administration  (HRSA) to “address the skilled care workforce needs of seniors through existing workforce education and training programs.”

The most hospice and palliative care-specific bills in Congress right now include the Palliative Care and Hospice Education and Training Act (PCHETA) (S.4260) and the Expanding Access to Palliative Care Act (S. 2565). PCHETA would bolster the serious illness professional workforce and boost palliative and hospice research funding, while S.2565 would require CMMI to test a dedicated community-based palliative care demonstration informed by the recently-ended, hospice-only Medicare Care Choices Model (MCCM). Both bills are currently Senate-only at this point, and we need your continued advocacy and outreach to continue to garner co-sponsors for these important policies. Use NAHC’s grassroots outreach campaigns to ask your Senators to support these bills.

Elsewhere in DC, much of the policy conversation on palliative care in particular is occurring within CMMI. In light of the Innovation Center’s strategic refresh late last year, it has become apparent that leadership there is focused on streamlining their demonstration portfolio and developing ways to better integrate specialty care (which is how they conceptualize palliative care) into broader, population health-style models, primarily the ACO programs.

Recently, CMMI posted a blog that broadly spells out their early vision for this kind of integration. In the piece, they specifically write: “Until more ACOs can assume full risk, collaborative care codes, as currently used in behavioral health, could support integration and co-location of some specialty care, such as palliative care.”

NAHC, in tandem with other members of the National Association of Hospice & Palliative Care, continues to work with CMMI to explore how best to support and scale home and community-based palliative care.

Federal Grant Will Create New Center to Support the Direct Care Workforce

The federal Administration for Community Living (ACL) plans to create a new initiative that will serve as a technical assistance and capacity-building center for direct care workers providing home and community-based services for older adults and individuals with disabilities. ACL intends to award a five-year grant to a lead entity to create and maintain the National Technical Assistance Center. Estimated total funding will be $1.2 million to $1.3 million, per year for the five-year project period.

Home-based care providers are currently experiencing one of the most difficult workforce environments in decades. Many organizations are unable to meet current demand as a result of inadequate staffing, primarily among the frontline direct care workers and aides that provide a large portion of the hands-on services for vulnerable patients and families.

  • Grant applications are due June 28, 2022
  • An overview informational teleconference will be held on May 17 at 3:00pm ET (Dial-in number: 888-942-9712; Participant passcode: 5313288).
  • Find out more about the details of the grant opportunity HERE

ACL envisions that this new initiative will serve as a central hub for state, private, and federal entities involved in the hiring, recruitment, training, and workforce development associated with the delivery of HCBS. The effort will deepen the collaboration between ACL, the Department of Labor, and other HHS agencies, including the Centers for Medicare and Medicaid Services (CMS) and the Assistant Secretary for Planning and Evaluation (ASPE).

The center will focus on strategies and practices at the systems and provider levels, and will disseminate information and direct technical assistance (TA) to support stakeholders’ efforts to bolster and improve the direct care workforce. The TA Center will offer access to a curated array of model policies, best practices, training materials, technical assistance, and learning collaboratives.

Eligible applicants include public and private non-profit entities, community-based organizations, faith-based organizations as well as institutions of higher education. Given that current DCW workforce challenges are complex and informed by a number of factors, ACL expects that no single organization will be able to single-handedly meet the center’s objectives on its own. Accordingly, grant applicants will need to describe how they plan to partner with other organizations, including those representing the needs of traditionally unserved and underserved, to fully carry out the center’s mission and deliver on its priorities.

Detailed grant information is available HERE. If you have any questions about this grant opportunity, please contact Caroline Ryan at ACL at caroline.ryan@acl.hhs.gov

Federal Grant Will Create New Center to Support the Direct Care Workforce

Information on grants is here The federal Administration for Community Living (ACL) plans to create a new initiative that will serve as a technical assistance and capacity-building center for direct care workers providing home and community-based services for older adults and individuals with disabilities. ACL intends to award a five-year grant to a lead entity…

Federal Grant Will Create New Center to Support the Direct Care Workforce

The federal Administration for Community Living (ACL) plans to create a new initiative that will serve as a technical assistance and capacity-building center for direct care workers providing home and community-based services for older adults and individuals with disabilities. ACL intends to award a five-year grant to a lead entity to create and maintain the National Technical Assistance Center. Estimated total funding will be $1.2 million to $1.3 million, per year for the five-year project period.

Home-based care providers are currently experiencing one of the most difficult workforce environments in decades. Many organizations are unable to meet current demand as a result of inadequate staffing, primarily among the frontline direct care workers and aides that provide a large portion of the hands-on services for vulnerable patients and families.

  • Grant applications are due June 28, 2022
  • An overview informational teleconference will be held on May 17 at 3:00pm ET (Dial-in number: 888-942-9712; Participant passcode: 5313288).
  • Find out more about the details of the grant opportunity HERE.

ACL envisions that this new initiative will serve as a central hub for state, private, and federal entities involved in the hiring, recruitment, training, and workforce development associated with the delivery of HCBS. The effort will deepen the collaboration between ACL, the Department of Labor, and other HHS agencies, including the Centers for Medicare and Medicaid Services (CMS) and the Assistant Secretary for Planning and Evaluation (ASPE).

The center will focus on strategies and practices at the systems and provider levels, and will disseminate information and direct technical assistance (TA) to support stakeholders’ efforts to bolster and improve the direct care workforce. The TA Center will offer access to a curated array of model policies, best practices, training materials, technical assistance, and learning collaboratives.

Eligible applicants include public and private non-profit entities, community-based organizations, faith-based organizations as well as institutions of higher education. Given that current DCW workforce challenges are complex and informed by a number of factors, ACL expects that no single organization will be able to single-handedly meet the center’s objectives on its own. Accordingly, grant applicants will need to describe how they plan to partner with other organizations, including those representing the needs of traditionally unserved and underserved, to fully carry out the center’s mission and deliver on its priorities.

Detailed grant information is available HERE. If you have any questions about this grant opportunity, please contact Caroline Ryan at ACL at caroline.ryan@acl.hhs.gov

Dept of Labor Announces Listening Sessions on Revisions to Overtime Regs

  • Seeking input on executive, administrative, professional exemptions

The U.S. Department of Labor announced a series of listening sessions with workers, employers and workplace stakeholders on potential revisions to regulations used to enforce the Fair Labor Standards Act’s minimum wage and overtime exemptions for executive, administrative and professional employees.

The FLSA requires employers to pay most U.S. employees at least the federal minimum wage for all hours worked, and overtime pay at not less than time and one-half the regular rate of pay for hours worked over 40 in a workweek.

The law, however, provides an exemption from minimum wage and overtime pay for workers employed as “bona fide” executive, administrative or professional employees. To be exempt, employees must generally meet certain tests regarding their job duties and be paid on a salary basis at not less than $684 per week.

“Our goal is to use these sessions to listen, engage workers and hear their perspectives on the possible impact of changes to the regulations,” explained Acting Wage and Hour Division Administrator Jessica Looman. “As we consider the needs of today’s workforce and industry demands, we need public input to ensure that revisions to the overtime regulations fulfill the original intent and promise of the law.”

In fiscal year 2021, the department’s Wage and Hour Division recovered more than $138 million in overtime back wages for more than 145,000 workers. In its FLSA investigations, the division found overtime back wages represented 80 percent of all back wages found due.

The division announced that it will hold a listening session for workers, employee stakeholders and union representatives as follows:

WHO:                         Employees, Employee advocates and union representatives

WHEN:                      Thursday, May 5, 2022 at 6-7 p.m. EDT

WHERE:                    Register for the Southeast Worker Overtime Listening Session Registration

Dept of Labor Announces Listening Sessions on Revisions to Overtime Regs

  • Seeking input on executive, administrative, professional exemptions

The U.S. Department of Labor announced a series of listening sessions with workers, employers and workplace stakeholders on potential revisions to regulations used to enforce the Fair Labor Standards Act’s minimum wage and overtime exemptions for executive, administrative and professional employees.

The FLSA requires employers to pay most U.S. employees at least the federal minimum wage for all hours worked, and overtime pay at not less than time and one-half the regular rate of pay for hours worked over 40 in a workweek.

The law, however, provides an exemption from minimum wage and overtime pay for workers employed as “bona fide” executive, administrative or professional employees. To be exempt, employees must generally meet certain tests regarding their job duties and be paid on a salary basis at not less than $684 per week.

“Our goal is to use these sessions to listen, engage workers and hear their perspectives on the possible impact of changes to the regulations,” explained Acting Wage and Hour Division Administrator Jessica Looman. “As we consider the needs of today’s workforce and industry demands, we need public input to ensure that revisions to the overtime regulations fulfill the original intent and promise of the law.”

In fiscal year 2021, the department’s Wage and Hour Division recovered more than $138 million in overtime back wages for more than 145,000 workers. In its FLSA investigations, the division found overtime back wages represented 80 percent of all back wages found due.

The division announced that it will hold a listening session for workers, employee stakeholders and union representatives as follows:

WHO:                         Employees, Employee advocates and union representatives

WHEN:                      Thursday, May 5, 2022 at 6-7 p.m. EDT

WHERE:                    Register for the Southeast Worker Overtime Listening Session Registration

Dept of Labor Announces Listening Sessions on Revisions to Overtime Regs

Seeking input on executive, administrative, professional exemptions The U.S. Department of Labor announced a series of listening sessions with workers, employers and workplace stakeholders on potential revisions to regulations used to enforce the Fair Labor Standards Act’s minimum wage and overtime exemptions for executive, administrative and professional employees. The FLSA requires employers to pay most U.S. employees at least the federal…