Tag Archives: workers’ compensation

Why CNAs and Home Health Aides Should Care about the Fight over a Federal Regulation

Today’s post comes from guest author Jon Rehm, from Rehm, Bennett & Moore.

A U.S. District Court in Washington, D.C., recently struck down a federal regulation that would mandate that home health aides are paid the minimum wage and paid overtime under the federal Fair Labor Standards Act (FLSA). Though the decision will likely be appealed, this decision is still a bad decision for the men and women who do the hardest jobs in health care – home health aides and certified nursing assistants.

Why home health aides aren’t covered by federal wage laws

Home health aides were exempted from the FLSA 40 years ago in order to make caring for the elderly less expensive. However, companion care has become a big and very profitable business. An index of publically traded home-health-care stocks has consistently outperformed the stock market as a whole for the last 13 years. This profitably is due in part to the minimum wage and overtime exemptions for home health aides.

How the home health exception affects other jobs in the medical field

The federal government estimates that nearly 1 million are employed as home health aides, while private sources estimate that number as 2 million. Home health is also a fast-growing field of employment. Home health aides essentially have the same job duties as certified nursing assistants (CNAs). CNAs are generally covered by minimum wage and overtime laws, but workers with the same skills and same duties are exempt from those laws if they are working as home health aides. CNA wages are pushed down by home health aide wages, which are exempt from federal wage laws.

Why pay is about more than wages

A recent study of CNAs showed that nearly 60 percent of CNAs report injuries during a 12-month period. The injury rate is similar for home health aides. The study also showed that higher-paid CNAs were injured less frequently than lower-paid CNAs. The study indicated that organizational factors really drove injury rates among CNAs. In other words, in settings where CNAs are truly valued, paid fairly and trained, the injury rates are lower. But if CNAs are treated as low-wage, high-turnover cogs in a machine, then injury rates are higher. Low pay for CNAs and home health aides isn’t just an issue for employees. Low pay for home health aides and CNAs has been linked to poor patient care.

While the Obama administration has been criticized for being too aggressive in enforcing the FLSA, the U.S. Department of Labor announced that they will delay enforcement of the home health aide regulation until July 2015. This assumes courts will let the Department of Labor actually enforce the regulation. Anyone concerned about this issue should contact their members of Congress to support legislation that ends the home health aide exception. People should also contact their state legislators to support legislation that would ensure that home health aides are covered by state wage and hour laws.

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The SMART Act and Workers’ Compensation

Today’s post comes from guest author Leila A. Early from The Jernigan Law Firm.

            Medicare should not pay medical bills that are the primary responsibility of a third party.  When they do, they want to be reimbursed, and all parties understand that concept, but the problem is the lengthy delays and lack of due process. The SMART Act, which was signed into law by President Obama on January 10, 2013, amends and reforms the Medicare Secondary Payer Act to improve the reimbursement process. It is located in Title II of H.R. 1845 and entitled “Strengthening Medicare Secondary Payer Rules.”

            Section 201 requires CMS to maintain a secure web portal with access to claims and reimbursement information. Payments for care made by CMS must be loaded onto the portal within 15 days of the payment being made. The portal must also provide supplier or provider names, diagnosis codes, dates or service, and conditional payment amounts. Moreover, the portal must accurately identify that a claim or payment is related to a potential settlement, judgment or award. After several steps, the parties may download a final conditional payment amount from the website. If there is a dispute over the conditional payment amount, CMS must respond/resolve the dispute within 11 days or the proposed resolution by the claimant/applicable plan will be deemed accepted. In terms of appeals, CMS must draft regulations that give applicable insurance plans limited appeal rights to challenge final conditional payment amounts. This process will go into effect around April of 2013. 

            Section 202 states that by November 15th of each year (beginning in 2014), CMS is required to calculate and publish a threshold for liability claims. If an amount owed is under that threshold amount, CMS is barred from seeking repayment.  Section 205 states the statute of limitations for conditional payment recovery by CMS is three years after the receipt of notice of a settlement, judgment, award, or other payment made.

            The SMART Act applies to workers’ compensation cases, so it is important to understand the law and how it will be applied in the future. Read it and follow its implementation closely.

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What Does That Stand For? Commonly Used Acronyms in Workers’ Compensation Cases

Today’s post comes from guest author Brianne Rohner from Rehm, Bennett & Moore.

Every profession has certain turns of phrase or acronyms they use on a daily basis that, to the layperson, mean very little and may only serve to add confusion to an already difficult issue. The legal profession and the representation of injured workers is no different. Injured workers often find themselves traveling down a confusing road armed only with directions written in an unfamiliar or foreign-sounding language. The experienced attorneys at our firm navigate clients down this road on a daily basis.  

Below is a list of commonly used acronyms to assist in understanding what is happening with your workers’ compensation case when everyone around you is suddenly speaking another language. Please keep in mind that the accompanying definitions are very general, and you should seek the advice of an experienced workers’ compensation attorney for more information or assistance with your case. Please also see the links for other blog posts for more information on some of these issues.    

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Well-documented Expense Records Increase Value of Your M&T Reimbursement

Expense ReportWhile receiving medical treatment related to a workers’ compensation case, claimants often have additional expenses such as mileage, fuel costs, transportation fares, and out-of-pocket prescriptions. Yet many claimants don’t realize they are entitled to reimbursement for expenses they incur in obtaining treatment.

Submitting information related to these expenses is an important part of the workers’ compensation process. Problems can arise, however, when incomplete or disorganized information is provided to an insurance carrier. This can result in delays and errors in receiving the proper amount to which they are entitled.

Claimants can avoid these sorts of problems with small acts of diligence and record keeping. Here are a few suggestions:

Save your receipts and keep a record of your doctor visits. Keeping a log and saving receipts incurred from specific doctor visits provides a “narrative” that makes it easier to tie together dates and expenses.

Make sure to use the correct form. The New York State WCB requires Continue reading

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