PROTECT AND EXPAND ACCESS TO HOME CARE AND HOSPICE
SERVICES, INCLUDING CARE PAID FOR BY COMMERCIAL
INSURERS, PUBLIC PAYERS, AND INDIVIDUALS
1. MODIFY EMPLOYER RESPONSIBILITIES IN HEALTH REFORM TO ADDRESS
HOME CARE-SPECIFIC NEEDS. Congress should a) amend the Patient Protection and
Affordable Care Act (ACA) (H.R.3590; P.L.111-148) to exempt home care providers from the
employer responsibilities, provide a subsidy to 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; b) amend the ACA 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; c)
help the states ensure that low wage home care workers have health insurance; d) change the
definition of full time in the ACA from 30 hours to 40 hours; and e) amend the ACA to allow for
a definition of full time employee that evaluates the individual’s working hours over a 180 day
period.
2. OPPOSE CHANGES TO THE COMPANIONSHIP SERVICES AND LIVE-IN
EXEMPTIONS TO THE FAIR LABOR STANDARDS ACT. A companionship services
exemption under wage and hour laws should be restored 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 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.
3. 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.
4. ENCOURAGE STATES TO ADOPT HOME CARE QUALITY OF CARE
STANDARDS THROUGH VOLUNTARY ACCREDITATION OR LICENSURE LAWS.
Congress should mandate development of uniform model accreditation or licensure standards
for home care agencies and encourage states to adopt and implement the model laws. A
NAHC task force previously developed a proposed model licensure law to assist states in
adopting a licensure law or strengthening their current law that Congress could use as a starting
point. These model laws should encompass all types of home care providers including skilled,
intermittent care, personal care, infusion therapy, private duty nursing, staff registries and
hospices. However, private, voluntary accreditation can be a viable alternative to licensure laws.