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  NAHC Report: Issue #3012, 10/13/2016
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CMS Data on Illinois Pre-Claim Review is Misleading
Illinois Proposal Would Cap Hours of Home Care Workers
For Your Information: DOL Webinar: Preparing for the Overtime Final Rule
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CMS Data on Illinois Pre-Claim Review is Misleading

The Centers for Medicare and Medicaid Services released “Early Data from Illinois,” regarding the pre-claim review (PCR) demonstration program begun in that state on August 3, 2016.

The CMS attempts to project a relatively benign image of the PCR demonstration, the truth is that the data presented and the data that is missing both indicate that the problems PCR has created for home health agencies (HHA) and their patients are significant and, if anything, growing worse.

CMS indicates that 91 percent of review requests were submitted through the contractor’s online portal, with the time to complete the submission dropping from a 12-minute average to nine minutes by week eight. However, this data is highly misleading and does not include the extensive time needed to collect the documentation for submission or the time it takes to review all the documentation for compliance. Assembling, reviewing and submitting this documentation is a new requirement under the PCR experiment and an HHA study shows that the new functions take nearly one hour of nurse time per pre-claim review submission, not merely the 9-12 minutes spent online at the contractor’s portal.

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Illinois Proposal Would Cap Hours of Home Care Workers

A Department of Labor regulation ordering that all home care workers must earn time-and-a-half overtime pay has predictably led to efforts to cap the hours caregivers can be paid per week.

In Illinois, the state Department of Human Services implemented a policy in May 2016 that capped the hours home care workers could be paid per week at 40, in response to the federal ruling. However, the policy was put on hold in August after a union representing 25,000 home care workers prepared to file suit to block the new rule. Now, the administration of Illinois Governor Bruce Rauner (R) wants to impose the rule through the state legislature’s Joint Committee on Administrative Rules.

The policy would require clients in the home care program to hire as many personal assistants as necessary to cover the hours of care they need each week without requiring any of them to work overtime. Anyone working over 40 hours per week would have to submit written justification to the department for approval and anyone working unapproved overtime three times would be barred from payment through the program. The state claims this policy is necessary to save money.

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DOL Webinar: Preparing for the Overtime Final Rule
Monday, October 17, 2016 11:00:00 AM EDT – 12:00:00 PM EDT

Presented by DOL’s Wage & Hour Division in partnership with the Small Business Administration’s Office of Advocacy

Monday, October 17, 2016 11:00:00 AM EDT - 12:00:00 PM EDT

Representatives from the Wage and Hour Division will cover the basics of the U.S. Department of Labor’s final rule updating the overtime regulations of the Fair Labor Standards Act (FLSA), highlight resources and guidance available for employers, and answer compliance assistance questions.
The final rule is effective on December 1, 2016.

While the session will include the opportunity to submit questions during the presentation’s Q&A segment, we also encourage you to submit questions in advance to

Register today at:

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