Home Health & Hospice Week

Hourly versus salary is key. Under the new FairPay rules, workers earning less than $23,660 per year -- or $455 per week -- are guaranteed overtime protection.

The Department of Labor outlines the basics of its new overtime regulations, which will take effect Aug. 23, on its Web site at www.dol.gov/esa/regs/compliance/whd/fairpay/main.htm.

"Registered nurses who are paid on an hourly basis should receive overtime pay," the DOL says in a new fact sheet on nurses' wages. But if RNs receive a salary, make at least $455 per week and meet the qualifications for the learned professional exemption, they are exempt from the overtime rules.

"Licensed practical nurses and other similar health care employees, however, generally do not qualify as exempt learned professionals ... and are entitled to overtime pay," the DOL explains. Just like home health agencies, skilled nursing facilities don't have to pay for items bundled into the SNF prospective payment system rate unless they have a valid arrangement with an outside supplier, the Centers for Medicare & Medicaid Services notes in a new transmittal. And that means durable medical equipment suppliers should secure a written agreement to steer clear of bundling errors.

"Whenever a supplier furnishes services that are subject to consolidated billing in the absence of a written agreement with the SNF, the supplier risks not being paid for the services," CMS warns in May 21 Transmittal No. 183.

CMS puts pressure on the SNF to secure written agreements with outside suppliers to avoid bundling confusion. Many inappropriate claims for DME can be avoided if the SNF gives the supplier accurate and correct information on the resident's bundling status, the memo stresses.

"Medicare does not prescribe the actual terms of the SNF's written agreement with its supplier (such as the specific amount or timing of the supplier's payment by the SNF)," CMS points out. The SNF and supplier should arrive at specifics "through direct negotiation between the parties." The contract should include dispute resolution procedures, though, the memo says. Nursing homes may be the biggest hurdle in the path to expanded home care benefits. A nursing home trade association wrote a letter to the editor of the Pittsburgh Business Times, protesting a story that had praised home care as a cost-saving long-term care setting.

"Moving an individual out of a facility-based setting like a nursing home to a home setting may indeed save costs -- but only in the short term, when less care is required," wrote Alan Rosenbloom, president and CEO of the Pennsylvania Health Care Association. "However, longer-term costs are likely to be higher for home care."

Rosenbloom urged lawmakers to recognize that under the "'woodwork effect' ... higher demand for in-home services is resulting in progressively higher government health care costs." Another [...]