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DOL Issues Final Rule on Independent Contractors, Effective March 11

SESCO Management Consultants

The U.S. Department of Labor (DOL) has issued a final rule to clarify who is an independent contractor under the Fair Labor Standards Act (FLSA).

The final rule also rescinds a 2021 rule in which two core factors—control over the work and opportunity for profit or loss—carried greater weight in determining the status of independent contractors. The 2021 rule, which is still in effect, made it easier for employers to classify workers as independent contractors, rather than as employees.

The final rule will take effect on March 11, 2024.

The final rule returns to a more employee-friendly standard. Under the final rule, employers would use a totality-of-the-circumstances analysis, in which all of the factors do not have a predetermined weight. The six factors the DOL would look at are:

Opportunity for profit or loss. If a worker can set or negotiate his pay, accept or decline jobs, choose the order or time of performance, engage in marketing to expand the business, and hire others, purchase materials or otherwise invest in the business, the worker is more likely to be an independent contractor. However, deciding to do more work or accept more jobs is not indicative of contractor status. It is unclear how the ability to "accept or decline jobs" indicates contractor status, while the decision to "take more jobs" does not.

Investments by the worker and the employer. Investments that are "capital or entrepreneurial" in nature, such as those increasing the worker's ability to do different types or more work, reducing costs or extending market reach are indicative of contractor status. However, investing in tools to do the job indicates employee status. It is not clear how this factor would be applied in jobs that do not require any significant investment beyond a computer and internet connection. This factor also embraces the idea that the worker's level of investment should be compared to the business' investments. The utility of the relative-comparison factor is at best unclear and at worst illogical, as nearly every business will have invested more overall than any individual worker, and it would change the nature of the employment relationship based not on the worker's activities or the work done, but simply on the size of the business engaging the worker.

Degree of permanence of the work relationship. When the working relationship is indefinite or continuous, it indicates employee status. When the work is definite in duration, nonexclusive, project-based, or sporadic "based on" the worker providing services to other businesses, it is indicative of contractor status. When the work is project-based or sporadic for some other reason (such as the nature of the business), then it does not indicate contractor status.

Nature and degree of control. This factor looks at various indicia of control over the work and the economic aspects of the relationship. Importantly, control that is merely reserved, but not exercised, still counts as "control." Also notable is the DOL's statement that control exercised to ensure compliance with "legal obligations, safety standards, or contractual or customer service standards may be indicative of control." Prohibiting a subcontractor from engaging in unlawful discrimination, requiring it to follow safety rules or flowing down compliance clauses, would therefore appear to undermine contractor status.

Extent to which the work performed is an integral part of the employer's business. This factor weighs in favor of employee status when the work is "critical, necessary, or central to the employer's principal business." It is unclear what role a contractor could play that would not be "critical, necessary, or central to the employer's business." For instance, external accounting and marketing functions, both historically areas for independent contractors, would seem to be both "critical" and "necessary."

Skill and initiative. This factor looks at whether the worker uses "specialized skills" in performing the work, and whether those skills "contribute to business-like initiative." Being highly skilled in the substance of a particular field (such as engineering, journalism, or hospitality) does not seem to be the kind of "skill" contemplated. Rather, skill in running an independent business is what matters.

The DOL then includes a catch-all provision stating that additional factors may be relevant "if the factors in some way indicate whether the worker is in business for themself, as opposed to being economically dependent on the employer for work."

[Department of Labor’s updated Independent Contractor test As the March 11 effective date approaches, the DOL has issued FAQs offering guidance]

If employers have any questions or concerns, we recommend they contact SESCO Management Services to ensure compliance. For assistance, contact them at 423-764-4127 or by email at [email protected]

 

Speaker Johnson in Pressure Cooker as Partial Shutdown Deadline Nears

The Hill | By Emily Brooks and Al Waver
 
Pressure is ratcheting up on Speaker Mike Johnson (R-La.) as he returns to work this week aiming to push through a government funding deal to avoid a shutdown that could hurt the GOP in an election year. 
 
Johnson faces major risks as he seeks to solidify the first major legislative deal of his tenure, including those from conservatives who say Republicans should be willing to shut down the government to secure the southern border.
 
“There’s incredible pressure on Speaker Johnson to step up as the highest-ranking Republican in Congress and get a deal that can pass. The last guy lost his job trying to do it,” one Senate GOP aide told The Hill, referring to former Speaker Kevin McCarthy’s (R-Calif.) ouster in October after he cut a deal to temporarily fund the government. 
 
Johnson and Democratic leaders announced a deal on topline spending numbers on Sunday, largely modeled after a debt limit deal that McCarthy struck with the White House last year that prompted months of rebellion from hardline conservatives — but that Johnson said secured included new offsets.
 
The new Speaker, like McCarthy, has a tiny majority that seems only to be shrinking. With House Majority Leader Steve Scalise (R-La.) out for cancer treatment until next month, it means losing just three GOP lawmakers on any vote forces Johnson to rely on Democratic lawmakers to pass major legislation.
 
There are some differences in play when it comes to Johnson and McCarthy.
 
While McCarthy had trust issues and damaged relations with a host of conservatives in his conference, Johnson is in more of a grace period with his members that gives him more leeway.
And unlike McCarthy, he is also working in an election year where Republicans want to avoid mistakes that would make it harder for them to hold on to and build their House majority in the fall. Republicans are eyeing full control of Washington as their odds for picking up the Senate grow and as polls show former President Trump with an edge on President Biden.  
 
Rep. Dave Joyce (R-Ohio), a House GOP appropriations cardinal, stressed that appropriators think a shutdown is “a bad idea.”
 
“When we shut down, it costs us $60 million a day,” Joyce said.
 
Under a two-tiered funding extension that Johnson spearheaded in order to avoid a single massive omnibus spending bill, part of government funding runs out on Jan. 19, and the rest runs out two weeks later on Feb. 2. 
 
That leaves little time for Johnson to get the deal into legislative bill text form and usher it through the House in face of the GOP opposition…

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Take Action: Congress Should Use Hospice Funds for Hospice Needs!

As negotiations to fund the government continue, Congress must reject cuts to the Medicare hospice benefit. If Congress chooses to extend a faulty hospice aggregate payment cap formula, nearly $1 billion in funds will be taken from hospice care and spent elsewhere. 

As the population rapidly ages, Congress should be focusing funds on improving access to hospice care, not using hospice as a piggybank for other priorities!

The National Hospice and Palliative Care Organization (NHPCO), LeadingAge, the National Association for Home Care & Hospice (NAHC), and the National Partnership for Healthcare and Hospice Innovation (NPHI) are united in their opposition to the use of hospice dollars to exclusively fund non-hospice priorities. 

Share this action with your networks with the hashtag #HospiceAction!

Take action today! Click Act Now!

 

Top Home Care Trends For 2024

Home Health Care News | By Andrew Donlan
 
The rising costs of home care were a trend in 2022 and 2023. They will remain one in 2024, and could finally come to a head. 
 
That’s only one trend, of many, that will impact home care providers in the new year. 
But it alone will also lead to other trends, such as increased M&A, adoption of future-facing technologies like AI, and further investment in tangential service lines and alternative payer sources outside of private pay. 
 
Below are all of the home care trends HHCN believes should be on providers’ radar in 2024.
Curious what we predicted for last year? Revisit our 2023 trends here.
 
Client retention, length of stay will become a major issue 
 
Home care providers are regularly seeing the costs of providing home care services rise. With that, billing rates are also rising for Americans in need of care. 
 
Over the past few years, those rates have risen anywhere from 20% to 40% – and sometimes more – based on the market. The most wealthy Americans will still pay for the hours they need, or their family members need. 
 
But less well-off families will begin to look elsewhere for care, or at least cut down the hours of home care they’re willing to pay for. 
 
Only 14% of American seniors can afford to pay for home care out of pocket, according to a recent analysis conducted by the Joint Center for Housing Studies of Harvard University. Again, based on the market, that number can dip far lower. 
 
For home care providers primarily dealing in private pay, this will create burdensome volatility and unpredictability for their businesses. Those long-term clients that make the whole ship sail may be no longer, or at least few and far between. 
 
“If anything goes wrong in the home, they’re canceling services,” Daniel Gottschalk, the co-CEO of Family Tree Private Care, told HHCN in December. “They’re going to find alternative options.”
That could affect retention, too. Caregivers that don’t have steady schedules or steady clients may jump ship, looking for more sustainable work elsewhere. 
 
Home care providers will continue to diversify, whether that be in Medicaid or Medicare Advantage
 
Providers will react in a few ways to shortened client length of stays and rising costs. 
First, they will do what they can to keep rates down. 
 
“[Cost of care] has really increased,” The LTM Group CEO David Kerns told HHCN, referring to his company’s private-pay business in October. “But we’ve tried not to increase prices too much, just because you have to be hyper-aware of that access to care.”
 
Eventually, that will no longer be a viable option, however. Home care providers – in addition to making the aforementioned investments into operational efficiency – will either become companies tailored to the uber wealthy or, alternatively, look to diversify their businesses…

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Home Health Agencies Grapple With ‘Acuity Creep’ As Patient Needs Become More Complex

Home Health Care News | By Patrick Filbin 

In recent years, due to factors like the pandemic and the reinvention of hospitals, home health agencies are having to take care of much more complicated patients.

As the demand for home-based care continues to rise, so does the need for more intensive care plans as patients continue to be sicker and more complex.

Home health agencies are feeling this “acuity creep,” and they’re adjusting. But at times, it’s hard to keep up.
“When I’m talking about acuity creep, I’m thinking about how much need do the patients in our care models require?” Michael Johnson, president of home health and hospice at Bayada Home Health Care, said. “It’s not just medical needs, either — there’s a social need as well. We’ve seen a definite increase in the needs of our patients.”

The Moorestown, New Jersey-based Bayada is one of the largest home health providers in the country. It has over 360 locations across 23 states and six other countries.
In order to find out if the acuity creep had affected Bayada, Johnson recently dug through the last four years of PDGM data for patient diagnoses and found a noticeable decrease in categories like musculoskeletal rehab and an increase of patients who needed neuro rehab, cardiac and complex behavioral health.

The last three categories can be filed under “more need,” Johnson said. With the need for intense care comes the need for more nurses, home health aides and other caregivers.
“When they’re sicker — as we’ve seen it — we need nursing care for the same person,” Johnson said. “In the case where there’s a nursing shortage, that becomes a bit of a crunch, so from a staffing perspective, that’s been a challenge. When I think about need, I think about workforce.”

Eric Gommel — chief strategy officer at Virginia Health Services — is also focused on workforce development due to this acuity creep.

Virginia Health Services is a provider of home health, palliative and hospice care, and also offers senior housing and other nursing services.

The company has invested heavily in apprentice programs and career ladder initiatives as a way to combat the acuity creep.
“They’re the primary people taking care of our seniors,” Gommel said. “It’s the sad reality of our society that we expect the most out of our children and these caregivers – and we pay them the least.”

Many of the issues that arise when trying to take care of more complex patients, Gommel has found, are in the preparation and education of staff members…

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