NAHC Presents Private Duty Home Care Legislative Priorities at March on Washington
April 13, 2016 11:22 AM
A panel of policy experts at the National Association for Home Care & Hospice’s (NAHC) 2016 March on Washington detailed the top legislative issues related to private duty home care for advocates to discuss with Congress during their time in Washington. Patricia Drea, Chairman of the Private Duty Home Care Association, a NAHC affiliate, said that private duty agencies are facing a variety of new challenges. “There have been so many changes in the last couple years,” she said, noting the companionship exemption going away in 2015 as well as changes to the “white collar” exemption.
“I would suggest that you need—all of us, know matter how small your agency—you need an attorney that is an expert in wage and hour, because there are things that will come along that you will not know the answer to,” she said. “You must have access to expert guidance.”
Drea noted additional challenges including the employer mandate; more licensed states (now a total of 31, with the most recent being California); paid sick leave; and recruitment issues. “You have to become a recruitment and retention expert in private duty/private pay in order to serve the clients and not turn away clients.” Drea added, “She who has the caregivers wins.”
William A. Dombi, Vice President for Law at NAHC, provided an update on NAHC’s efforts with regards to the companionship exemption. In addition to NAHC’s case before the Supreme Court, Dombi said, there is pending legislation before Congress that would restore the companionship and live-in domestic services exemptions. He emphasized the importance of ensuring Congress understands that “you are not businesses just looking out for your own profit.”
“Our position has long been that we support good wages, overtime compensation, and appropriate benefits to all home care workers,” he said. “On the private pay side, the party who pays the price is usually somebody with limited income, somebody with disabilities, or somebody of senior status. So we have to make care affordable.”
Following are summaries of the top legislative priorities related to private duty home care presented at the March on Washington:
Restore the Companionship Exemption to the Fair Labor Standards Act. A companionship services exemption under wage and hour laws should be restored/maintained at the state and federal level until a comprehensive plan can be implemented that addresses service funding, worker health insurance, and career development. Congress should reverse the Department of Labor rule change that effectively eliminated the application of the companionship services exemption to home care. Alternatively, Congress should ensure that government-funded home care programs adequately reimburse employers for the added costs of overtime compensation and provide financial protection to consumers of private pay services through tax credits or other subsidies. Finally, Congress should enact reforms to the FLSA that establish a reasonable compensation structure for home care that respects the uniqueness of that employment setting where the patient/client is the primary focus of responsibility. That reformed structure should also properly address the unique aspects of “live-in” care where employees reside in the home of the client, receive room and board, and take on caregiving responsibilities throughout a 24 hour day.
Improve Home Care Services for Veterans.Congress should require the coverage of home care services by qualified home health agencies for all veterans who would prefer to stay in the home as opposed to a VA hospital or nursing home. Moreover, use of existing home care providers should be encouraged by the government to avoid increasing taxpayer costs by creating new VA provider entities. Further, Congress should ensure that the VA has the resources necessary to implement the long term care demonstrations of P.L. 108-422. Congress should also monitor the implementation of the CHOICE program to ensure that care access is improved, prohibit unreasonable waits for home care, and institute transparency and efficiency into the CHOICE program operations.
Require Coverage of Home Care and Hospice in Private Health and Long Term Care Insurance. Congress should require that private health and long term care insurance companies provide a standardized benefit package that includes coverage for home care and hospice. Any listing of “Essential Benefits” in private insurance offered through health insurance exchanges under the ACA should include home health care and hospice. Private long term care insurance policies should include coverage of the full range of home and community based care.
Encourage States to Adopt Home Care Quality of Care Standards Through Voluntary Accreditation or Licensure Laws.Congressshouldmandatedevelopmentofauniformmodel accreditation or licensure standards forhomecareagenciesandencouragestatestoadopt andimplementthemodellaws. ANAHCtaskforcepreviouslydevelopedaproposed modellicensurelawtoassiststatesinadoptingalicensurelaw or strengthening their currentlaw thatCongresscoulduseasastartingpoint. Thesemodellawsshould encompassalltypesof homecareprovidersincludingskilled,intermittentcare,personal care, infusion therapy, private dutynursing, staff registries and hospices. However, private, voluntary accreditation can be a viable alternative to licensure laws.
Modify Employer Responsibilities in Health Reform to Address Home Care-Specific Needs.Congress should amend the Patient Protection and Affordable Care Act (PPACA) to fund the cost of health insurance for full-time workers. Alternatively, PPACA should be amended to exempt home care providers from the employer responsibilities. Congress should also consider amending the definition of full-time to 40 hours a week or repealing the mandate altogether. Funding of worker health insurance can occur through a subsidy to all home care providers to supply health insurance, and/or provide a subsidy or tax credits to home care clients to cover the increased cost of care triggered by the employer responsibility provisions. Congress should help the states ensure that low wage home care workers have health insurance through Medicaid or otherwise. Congress should amend also PPACA to allow for a definition of a full time employee that evaluates the individual’s working hours over a 180 day period rather than the current monthly calculation. Finally, Congress should amend PPACA to require that all government health programs adjust provider rates to meet the additional costs that will be incurred by health care providers to make health insurance available to all their employees.