Correction: Deane Beebe is the media relations director for the Paraprofessional Healthcare Institute, a national advocacy group for home healthcare workers that is opposing a rule change from the Arkansas Division of Medical Services to limit home health care aides to 40 hours per week. This article incorrectly reported the name of the organization.
A new rule proposed by the Arkansas Division of Medical Services would limit home health care aides to working 40 hours per week if any portion of their pay comes from Medicaid dollars.
The new rule would also bar workers from seeing more than one client per day to eliminate mileage or travel reimbursements.
Several patient and worker advocates said such a change would have an adverse effect on patient care and worker incomes.
State officials said the move is necessary to deal with a federal Department of Labor rule change that newly requires minimum wage and overtime pay for those workers. They said state Medicaid rules prohibit paying overtime out of those funds.
Arkansas residents have until Saturday to comment on the changes.
Home health care workers had previously been exempt from federal minimum wage and overtime requirements because of a "companionship exemption" in the federal Fair Labor Act that has existed for decades.
The exemption lumped home health care aides into the same category as baby sitters, who are not awarded those protections under the Fair Labor Act. Those health care workers were either paid a per day rate for their services or claimed their hours worked at a regular pay rate -- whether those hours reached 40 or more -- without being eligible for overtime.
"People are coming home from hospitals with chronic conditions they're managing in the home with the help of home care workers," said Deane Beebe, the marketing director for the Professional Healthcare Institute, an advocacy group for home health care workers.
"These workers are by no means simply companions. They're not somebody who plays cards, maybe goes for a walk or plays chess. They are doing backbreaking work, often solitary work, to help manage the needs of clients."
The federal exemption was eliminated earlier this year by a rule change scheduled to go into effect in January across the country.
Several states protested the change, asking for waivers because of the large number of home health care aides employed in their states and budgets that run along the fiscal year -- between July 1 and June 30 -- that would have been severely affected by the increased pay requirements starting in January.
Letters came in from state Medicaid directors and from state directors of developmental disabilities services, seeking time to adjust budgets to account for the additional pay needed to meet the federal rule requirements.
The federal government agreed to wait six months to enforce the rule change and to take into consideration honest efforts to accommodate the changes for the first six months of enforcement.
Once the federal rule goes into effect, 29 states will have wage and overtime requirements for home health care aides for the the first time, according to state-by-state research collected by the Professional Healthcare Institute. Another six states currently have minimum wage requirements for those workers but will have overtime requirements for the first time.
Fifteen states currently have labor laws that require both a minimum wage and overtime pay for home health care aides.
States are taking different approaches to implementing the new rule.
Both Kansas and Oregon submitted waiver requests. California Gov. Jerry Brown included a 40-hour per week cap for home health care workers in his state budget proposal, drawing protests and an outcry from advocates of in-home patient care. Brown eventually agreed to remove the cap from his budget plan.
Kate Luck, a spokesman for the Arkansas Department of Human Services, said the proposed rule at the Division of Medical Services is needed because of restrictions in the state's Medicaid program.
"Medicaid does not pay for overtime," Luck said. "The proposed rule really comes back to whether the [home care worker] is being paid for through Medicaid funds."
The proposed rule also limits home care workers to seeing one patient or client per day to eliminate travel reimbursement requests.
"Travel time would be self-reported, and we don't have any way to validate those travel times. ... We don't have any way to track that," Luck said.
"If someone isn't reporting their miles correctly, it could open the state up for a lawsuit. That could also be considered Medicaid fraud. We don't want to open the door to Medicaid fraud if we have no way to independently monitor the travel [claims]."
Home health care aides for disabled people are usually arranged through the state's Division of Developmental Disabilities Services or through the Department of Aging. The disabled person or a guardian can choose a self-directed care plan or use a service provider that employs home care workers.
Under self-directed care plans, the person receiving the care can choose the home health aide, which can be a parent, relative, neighbor or friend in those scenarios.
Opponents of the rule say those self-directed patients will likely be most affected by the rule if it passes. For example, a parent who takes full-time care of a disabled adult child can currently claim reimbursement for more than 40 hours of care per week at a standard hourly reimbursement rate without overtime.
Hundreds of caretakers in Arkansas now claim more than 40 hours a week of care reimbursement. Under the rule change, they will be capped at 40 hours, and they can either provide the additional care without compensation or hire a second home care aide to take care of any additional needs throughout the week.
If someone is disabled and living independently, the state currently pays a home health aide a daily rate regardless of how many hours that aide works during a 24-hour period. The new rule will mean those disabled people will have the same option of having a second home health aide during the week.
Last year, 4,139 people paid for home health aides through Developmental Disabilities Services waivers in Arkansas. An additional 1,150 self-directed waivers were issued through Department of Aging for home health aides.
Larger states, like California, estimate about 360,000 people receiving home health aide help annually.
The proposed rules will likely be reviewed by the Legislature's Public Health Committee before being presented to the Arkansas Legislative Council for review. Once rules are approved by the council, they usually go into effect within 30 to 60 days with some exceptions.
Those wishing to submit a comment on the proposed rule can visit www.medicaid.state.ar.us. Rule changes are listed under the "General" tab on the website.
Metro on 11/28/2014