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:: NAHC Report
NAHC Report: Issue# 2275, 9/17/2013
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Department of Labor Issues Final Rule of Companionship Exemption
Vaccine Reimbursment Guidelines for Home Health Agencies
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Department of Labor Issues Final Rule of Companionship Exemption

The U.S. Department of Labor issued the Final Rule setting out changes to the longstanding regulations on the companionship services exemption from minimum wage and overtime compensation under the Fair labor Standards Act (FLSA). The Final Rule is available at:

NAHC continues to analyze the 358-page rule and will provide a more detailed review in the days to come. As a summary, the Final Rule:

  • Is effective on and after January 1, 2015. DoL delayed the effective date to provide for time for employers and funding sources to adjust.
  • Redefines “companionship services” to be limited to “fellowship”, “protection”, and limited direct care. Care related services are limited to no more than 20% of the hours worked.  This definition means that the vast majority of Medicaid personal care services will be subject to minimum wage and overtime requirements. Private pay home care impact will vary on a client-specific basis.
  • Excludes employees employed by home care agencies (“third-party employers”) from any remaining exemption.  The exemption will remain for workers directly employed by the client or a family member. However, that exemption will apply only if the services are within the new, limited definition of companionship.
  • Requires minimum wage and overtime for individuals with “joint employers”, e.g. individuals directly employed by the person receiving the services and a Medicaid public authority that has some control over pay, work schedule, work activities, or other indicia of an employer. This standard will likely mean that much of the Medicaid consumer directed care is subject to minimum wage and overtime even if it the services qualify as companionship under the new definition. Home care registries will need to do a operation-specific evaluation as some may be considered joint employers based on how they function.
  • Eliminates third-party and jointly employed live-ins from the live-in domestic services exemption.

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Hospice Sessions During this Year’s Annual Meeting

This year’s Annual Meeting – being held October 31 – November 3 in Washington, DC – has a wide range of educational sessions for professionals in every segment of the home care and hospice community.
Below is a sampling of the many educational offerings available for those pursing the hospice track:

Palliative Care and Hospice in an Accountable Care Model
This session will provide an overview of palliative care in relation to other services as an opportunity in new payment models
for the successful management of the seriously ill population. Considerations for successful implementation and sustainability will be reviewed. Opportunities and barriers for program integration across the care continuum will also be discussed.

Modeling Hospice Changes to Prepare For Medicare Reimbursement and Care Delivery Reform
This program will provide insight into current and anticipated reimbursement challenges that Medicare hospice providers
face in the coming years, with special emphasis on the status of hospice payment reform. Hospice experts will walk attendees through how their organizations are preparing to meet the current and upcoming challenges.

It has become ever more difficult to determine the last days of a person’s life. The causes of death have increasingly shifted to chronic diseases, leading to varying, complicated, and subtle trajectories of decline. Limited research into the final stages of many chronic diseases further complicates prognosis. This program will be a review of the latest concepts and tools for prognostication that can improve accuracy in determining the final stages of a disease trajectory.

Hospice Association of America Open Forum and Policy Roundup
The Medicare Hospice Program has entered an era of rapid change that is being driven by regulatory and legislative initiatives. This session will provide insight into the latest regulatory issues hospice providers must address, as well as changes that are anticipated in the not-too-distant future. The session will also serve as an opportunity for attendees to become acquainted with staff and leadership of NAHC’s Hospice Association of America.

"This year's Annual Meeting rises to the level of the challenges we face," said Theresa Forster, NAHC's Vice President from Hospice Policy & Programs. "We have educational programs that will help prepare hospice providers for the bumpy road ahead - be it navigating a new payment system, marketing your programs to a changing healthcare and payment landscape, or meeting the numerous new regulatory requirements being imposed by federal agencies. The Annual Meeting will help make sense of it all, and I hope to see you all there!"

To review all of the hospice sessions being offered at this year’s Annual Meeting, please click here.

To register for this year’s Annual Meeting, please click here.

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Vaccine Reimbursment Guidelines for Home Health Agencies

As agencies gear up for the 2013-2014 influenza season, questions often arise regarding the reimbursement rates for providing the flu vaccine to patients and the community.

There are two payment rates agencies must consider when providing vaccines: payment for the vaccine itself and payment to administer the vaccine.

Home health agencies (HHA) are reimbursed for the vaccine on a reasonable cost basis. Other than application of the lower costs or charges provision, Medicare recognizes the reasonable, allowable cost for the vaccine.

If, however, an HHA’s intermediary believes that the HHA has unreasonably incurred cost for the vaccines—or otherwise has not been a prudent buyer –it is up to the HHA to support that it was prudent and that the costs are reasonable. If it cannot, the intermediary will not recognize the unreasonable portion of the incurred cost.

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Administrative Director
Adventist Health/Home Care Services, Portland, Oregon

Adventist Health is seeking an experienced Home Care Administrator to oversee a growing and busy mission driven service provider in the greater Portland, Oregon area. Scope of job responsibilities include Home Health, Hospice, Home Medical Equipment, Home Infusion Therapy, and Private Duty business lines. The Administrative Director is responsible to direct, supervise, monitor and evaluate all functions and activities for the Adventist Health/Home Care Services department of Adventist Medical Center (AMC). We are looking to the right individual who can lead in business growth and development, financial management, HR management, and conformity to policies, procedures, quality improvement and regulatory requirements. In addition, we are looking for the right individual to support and promote the mission, philosophy and the vision of our Adventist Health/Home Care Services department, creating an environment in which all Homecare staff can work together harmoniously and with coordinated effort in compliance with AMC’s Service Standards. Candidates must have previous health care and leadership experience; home care experience preferred. Bachelors’ degree in a healthcare field required, Master’s in Business preferred. Compensation Commensurate with Experience.

Home Care Administrator, RN
Asbury Methodist Village at Home, Gaithersburg, Maryland

Why work for us?

Excellent Community Setting & Work Environment, Unparalleled & Exciting Growth Opportunity, Strong Corporate Resources Available, Autonomy to Run a Successful Program

Asbury Methodist Village, located in Gaithersburg Maryland, is currently searching for an experienced administrator to manage its Private Duty home care agency. Experience in home and community based services and a passion for working with the elderly are a must. The ideal candidate has five years home care experience in all areas of agency operation.  We provide home care to residents of our retirement community with a growth strategy to provide service off campus in the greater community.  The ideal candidate has a network of professionals to tap into for new referral sources to accomplish our growth goals. 

This position is responsible for the full range of operations including: clinical, financial, marketing, human resources, and public relations. Strong networking skills and the ability to develop relationships with referral sources, i.e. physicians, hospitals, healthcare agencies, etc.  Candidate must possess excellent communication and customer service skills. Must be proficient with MS Office, computerized scheduling software and medical records.

Excellent benefits and salary based upon professional experience.

To apply, please forward resume, cover letter, and complete salary history to Human Resources Representative via e-mail:  or fax to 301.250.2110. EOE.

For information about placing an ad, contact Scott Baum at

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