In The News

Noncompete Ban Could Make ‘No-Poach’ Agreements Harder to Enforce: Polsinelli

McKnights Home Care / By Adam Healy

The Federal Trade Commission’s ban on noncompete agreements threatens to undermine common tactics used by home care agencies to prevent client poaching, experts at law firm Polsinelli warned during a recent webinar.

The rule does not explicitly forbid documents such as nondisclosure agreements (NDAs) and no-poach agreements, which are often used by home care and hospice providers. However, FTC included a “functional equivalence” test to measure whether such provisions would in practice act as a noncompete, Polsinelli’s attorneys noted. As a result, these kinds of contractual provisions could be undone if they are applied too broadly.

“If you have an NDA that’s so broad that it would be seen as the functional equivalent of a non compete, you may have trouble,” Polsinelli attorney Scott Gilbert said during the webinar Tuesday. “If you have a super-broad NDA, it may not be enforceable.”

Furthermore, the FTC could throw out any contract provision that applies to workers after their employment has ended, explained Polsinelli shareholder Emma Scheuring. This includes no-poach clauses that prohibit caregivers from being hired directly by their patients after their employment by a home care agency ends.

“If you’re asking your caregivers not to go work for their clients — your clients — after they stop working for you, that’s a noncompete under the rule,” Scheuring said. “Anything that says, ‘Employee, once you leave working for me, you can’t go work for XYZ,’ that’s going to be problematic under the rule.” 

Other types of contractual obligations, including direct-hire clauses, were not addressed directly in the FTC’s rulemaking. But experts have previously stated that the use of these kinds of provisions may also be limited once the rule goes into effect.

Broad application

Against many providers’ wishes, FTC did not grant a blanket exemption for healthcare businesses. This means that for-profit home care, home health and hospice providers are subject to FTC’s ban, Polsinelli’s experts said.

And while the FTC generally does not have jurisdiction over nonprofit entities, the agency indicated in the rule’s comment section that it intends to look more closely at whether some businesses actually qualify as nonprofits. If “presented with an appropriate test case,” the agency may try to assert its jurisdiction on a nonprofit engaged in “relatively commercial activities,” according to law firm JD Supra.

Meanwhile, the Internal Revenue Service also recently suggested that it would be investigating whether some entities fit their nonprofit status, according to Gilbert.

“It wouldn’t surprise us at all to see collaboration between the FTC and the IRS in evaluating [whether a business is truly not-for-profit],” Gilbert said…

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Home Health: A Solution to Skyrocketing Healthcare Costs

MedCity News / By Andrew Molosky
 
A great deal of healthcare can take place in the home, leaving valuable bandwidth available for specialized facilities when they are needed.
 
A great deal of healthcare can take place in the home, leaving valuable bandwidth available for specialized facilities when they are needed.
 
As the 2024 presidential election draws nearer, nearly 75% of Americans report healthcare costs as a primary financial worry according to a new study from KFF. Americans have every reason to feel this way: over the last five decades per capita healthcare spending has increased from $353 in 1970 ($2,072 adjusted for inflation) to $13,493 today. But care quality has not increased by the same rate – rather, patients are simply paying more today for the same “one-size-fits-all” treatments. 
 
Rising costs and poor quality, however, are not the result of this administration or that one. They are a function of deeper problems endemic to the American healthcare industry itself. 
 
Added attention to the cost of care gives healthcare stakeholders the opportunity to step back and evaluate American healthcare as a whole. It is incumbent on us to think through system level changes and reshape the future of care delivery in this country.
 
Munck Wilson Mandala Partner Greg Howison shared his perspective on some of the legal ramifications around AI, IP, connected devices and the data they generate, in response to emailed questions.
 
Fortunately, home-based healthcare paradigms like hospice, that have long been recognized as the least institutionalized and profit-driven segments of the healthcare industry, offer a model for a return to healthcare sanity. 
 
American healthcare is beset by skyrocketing costs that force many patients to choose between their health and their financial stability. The statistics are staggering: Healthcare is the primary reason that Americans file for bankruptcy. Over half of Americans––57%––report having had some medical debt over the last five years.
 
What’s more, the United States spends much more on healthcare per person than peer nations; some studies suggest we spend twice as much. As the most prosperous, innovative country on Earth, our healthcare system should be the best. Instead, it’s one of the worst amongst wealthy countries…

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Elara Caring Agrees to Pay $4.2 Million to Settle False Claims Act Allegations That It Billed Medicare for Ineligible Hospice Patients

U.S. Department of Justice

Elara Caring, and its wholly owned subsidiaries JHH/CIMA Holdings Inc., CIMA Healthcare Management Inc., CIMA Hospice of Texarkana L.L.C., CIMA Hospice of East Texas L.L.C. and CIMA Hospice of El Paso L.P., have agreed to pay $4.2 million to resolve allegations that they violated the False Claims Act by knowingly submitting false claims and knowingly retaining overpayments for the care of hospice patients in Texas who were ineligible for the Medicare hospice benefit because they were not terminally ill. 

“The hospice benefit under Medicare provides critical services to vulnerable patients,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “The department will continue to ensure that this benefit is used to assist those who need it, and not to line the pockets of those who seek to abuse it.”

The settlement resolves allegations that Elara Caring’s Texarkana, Texas, location, which previously operated as CIMA Hospice, knowingly submitted false claims for hospice services provided to patients who were ineligible for the hospice benefit because they were not terminally ill.  The patients at issue in the settlement were at the Texarkana location between 2014 and 2019 and in 2020. The settlement also resolves allegations regarding two patients at other Texas locations between 2015 and 2021. The settlement further resolves allegations that Elara Caring knowingly and improperly concealed or avoided obligations to repay overpayments for these patients…

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CMS’ Daniel Tsai Stands Behind ‘80-20’ Provision, Medicaid Access Rule In Congressional Hearing

Home Health Care News / By Joyce Famakinwa
 
A senior Centers for Medicare & Medicaid Services (CMS) official stood behind the “80-20 rule” — which has drawn major pushback from the home-based care industry — during a congressional hearing Tuesday.
 
Last week, the “Ensuring Access to Medicaid Services” rule was finalized. The impetus behind the rule is to strengthen access to home- and community-based services (HCBS) for Medicaid beneficiaries.
 
The provision that has grabbed the most attention is the one that would require 80% of Medicaid payments for HCBS to be reserved for direct care workers’ wages.
 
During the hearing, House Energy and Commerce Committee Chair Cathy McMorris Rodgers (R-Wash.) was critical of the 80-20 rule.
 
“The Medicaid access rule’s so-called 80-20 policy will lead to home care agencies reducing the amount of care that they can provide,” she said. 
 
Daniel Tsai – the deputy administrator and director of Center for Medicaid and CHIP services at CMS – defended the 80-20 provision, pointing to low wages in HCBS and the correlation to care quality, as he also did last week
 
“Data shows that direct care workers typically earn low wages and receive limited benefits, contributing to a shortage of direct care workers and high rates of turnover in this workforce, which can limit access to and impact the quality of HCBS,” he wrote in his witness testimony. “By supporting and stabilizing the direct care workforce, this provision will result in better qualified employees, lower turnover, and a higher quality of care, improving access to quality care for Medicaid beneficiaries.”
 
CMS wants to ensure that this percentage of Medicaid payments are going to direct care workers instead of things like administrative overhead or profit…

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2024 Pediatric Palliative and Hospice Needs Assessment

NHPCO

The National Hospice and Palliative Care Organization (NHPCO) has released the 2024 Pediatric Palliative and Hospice Care Needs Assessment. If your organization has cared for at least one pediatric patient during the last four years, please complete the survey. The Needs Assessment is a product of the NHPCO’s Pediatric Advisory Council with the goal to gain a better understanding of the organizations and providers caring for pediatric patients with serious illnesses throughout the United States. The needs assessment helps create resources and support advocacy. You do not need to be an NHPCO member to complete the survey. Any questions can be directed to the Pediatric Advisory Council at [email protected].

Over the next month, NHPCO will be sharing the Needs Assessment on social media, feel free to share the posts or create your own.

Facebook           Twitter                 LinkedIn              Instagram

Any questions can be directed to Alix Ware at [email protected]

 
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