In the News

Employee Retention Credit

If you are a business owner or in agency management, hopefully you have at least looked into the Employee Retention Credit (ERC), a refundable tax credit that businesses can claim on qualified wages paid to employees, including certain health insurance costs. If you haven’t, you should!

The ERC can be a complex credit, especially if you want to get all that you can out of it, but there are a number of businesses structured to help. APTA Home Health does not endorse any particular tax consulting or service group, but we have been approached by several re: the ERC.

Many of these businesses will charge 15% - 25% to assist you with the credit, but several state home care and hospice associations have recommended a company that only charges 6% of monies that are actually recovered. They offer a free analysis of your situation, and do not charge their fee until you obtain the credit.

Contact Kris Sanford of Round Peg, an affiliate of Box Financial, for more information at [email protected] or m: 801-678-3635 (Text me, I respond quicker!). Be sure to ask Kris and his team for an overview of the credit and for the educational material that they have available from the IRS and other resources.


Third Try’s the Charm? National Labor Relations Board (Again) Narrows Definition of “Independent Contractor” Under the National Labor Relations Act

By Jim Paretti, Fred Miner, and David Ostern

On June 13, 2023, the National Labor Relations Board (“NLRB” or “the Board”) issued its long-awaited decision in The Atlanta Opera,1 in which it overturned prior law (SuperShuttle DFW, Inc.) and reinstated a narrower test for “independent contractor” (as opposed to “employee”) under the National Labor Relations Act (“NLRA” or “the Act”). As a practical matter, this means that more workers are likely to be classified as employees—who, unlike independent contractors, are permitted to form and join a union, and otherwise enjoy the workplace protections of the Act—than under prior law. The decision is not wholly surprising, insofar as NLRB General Counsel Jennifer Abruzzo announced early in her tenure that convincing the Board to overturn SuperShuttle was among her top priorities. The Atlanta Opera was approved three to one, with the Board’s single Republican member concurring in the result of the case but dissenting from the Board’s analysis and overruling of prior precedent.

In The Atlanta Opera, the Board reinstated the common-law agency test for determining worker status found in the Restatement (Second) of Agency §220.  Under that test, the Board looks at the following factors, assessing and weighing them, with no one factor being decisive:

  • The extent of control, which by agreement, the employer may exercise over the details of the work.
  • Whether or not the one employed is engaged in a distinct occupation or business.
  • The kind of occupation, with reference to whether, in the locality, the work is usually done under the direction of the employer or by a specialist without supervision.
  • The skill required in the particular occupation.
  • Whether the employer or the workman supplies the instrumentalities, tools and the place of work for the person doing the work.
  • The length of time for which the person is employed.
  • The method of payment, whether by the time or by the job.
  • Whether or not the work is part of the regular business of the employer.
  • Whether or not the parties believe they are creating the relation of master and servant.
  • Whether the principal is or is not in business.

Applying this test, the Board concluded that subject makeup artists and hairstylists working for the Atlanta Opera were employees, not independent contractors. The Atlanta Opera marks another chapter in a 16+ year saga concerning the definition of independent contractor under the Act, which has already twice gone to the U.S. Court of Appeals for the District of Columbia Circuit, and seems destined to make a third visit.

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CMS Releases New Consumer-Friendly Resources for the No Surprises Act

[On June 14], the Centers for Medicare & Medicaid Services (CMS) made available new consumer-friendly web pages for people with easy-to-read information regarding the consumer protections in the No Surprises Act.

The No Surprises Act protects people covered under group and individual health plans from receiving surprise medical bills when they receive most emergency services, non-emergency services from out-of-network providers at in-network facilities, and services from out-of-network air ambulance service providers. It also establishes an independent dispute resolution process for payment disputes between plans and providers, and provides new dispute resolution opportunities for uninsured and self-pay individuals when they receive a medical bill that is substantially greater than the good faith estimate they get from the provider.

Unexpected medical bills are a significant source of stress, frustration, and confusion for people in the United States. The No Surprises Act gives them new rights to prevent, navigate, and find resolutions to many of these “surprise” bills. 

To help consumers understand their rights, consumer-friendly web pages are now available for people with easy-to-read information and actionable guidance. The webpages’ design and content were informed by human-centered design research and user testing with patients, caregivers, patient advocates, and others.   

The webpage aims to be inclusive and accessible by: 

  • Meeting Web Content Accessibility Guidelines (WCAG 2.1 AA)
  • Providing all information in both English and Spanish
  • Using plain language and clean design
  • Centering the human experience with diverse and colorful illustrations
  • Building the site to be responsive to different devices, including mobile phones and tablets
  • Offering clear and multiple pathways for people to learn about their rights

When people visit the consumer website, they’ll be guided through: 

  • Understanding their rights under the No Surprises Act, including out-of-network billing protections and good faith estimates for future care
  • Identifying actions they can take to exercise their rights and find a resolution if they receive an unexpected medical bill, using a Q&A tool that asks about their situation
  • Submitting a complaint if they think their provider, facility, or insurance company didn’t follow the rules of the No Surprises Act through an optimized process and redesigned form
  • Disputing a bill if they are uninsured or didn’t use insurance and they were charged more than their good faith estimate
  • Finding guides that will help them navigate medical billing questions, as well as learning how to connect with the No Surprises Help Desk



Many Older Adults with Dementia Experience Recurrent ED Visits, Study Finds

McKnight’s Home Care
A “significant portion” of community-dwelling older adults with dementia display a pattern of repeated emergency department (ED) visits, according to a study published Wednesday by the American Geriatrics Society (AGS).
The “population-based retrospective cohort study,” which analyzed ED visits among community-dwelling adults 66 years and older in Ontario, Canada, over a nearly 10-year period, also found that frequent users of anticonvulsants, antipsychotics and benzodiazepines had the highest risk of recurrent ED visits. 
Of the over 175,000 older adults studied, two groups — Group J (10,365 individuals) and Group L (7,353 individuals) — were deemed to be at a “higher-risk” of recurrent ED visits. Both groups included more individuals residing in rural and low-income areas and also having higher usage rates of anticonvulsants, antipsychotics, and benzodiazepines.
Dementia prevalence is expected to increase globally, from 57 million in 2020 to 153 million by 2050, but higher healthcare costs and barriers to diagnosis and care access are creating health disparities, the study said. 
The study also found that a history of an ED visit or visits during the prior year was the strongest predictor of recurrent visits and perhaps the most useful for identifying older adults in need of interventions.

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Trouble Falling Asleep, Staying Asleep Linked to Increased Risk of Stroke

People who have insomnia symptoms such as trouble falling asleep, staying asleep and waking up too early, may be more likely to have a stroke, according to a study published in Neurology. In addition, researchers found the risk was much higher in people under 50 years old. The study does not prove that insomnia symptoms cause stroke; it only shows an association.

"There are many therapies that can help people improve the quality of their sleep, so determining which sleep problems lead to an increased risk of stroke may allow for earlier treatments or behavioral therapies for people who are having trouble sleeping and possibly reducing their risk of stroke later in life," said study author Wendemi Sawadogo, MD, MPH, Ph.D., of Virginia Commonwealth University in Richmond and member of the American Academy of Neurology.

The study involved 31,126 people with an average age of 61. Participants had no history of stroke at the beginning of the study.

Participants were asked four questions about how often they had trouble falling asleep, trouble with waking up during the night, trouble with waking up too early and not being able to return to sleep, and how often they felt rested in the morning. Response options included "most of the time", "sometimes" or "rarely or never." Scores ranged from zero to eight, with a higher number meaning more severe symptoms.

The people were then followed for an average of nine years. During that time, there were 2,101 cases of stroke.

After adjusting for other factors that could affect the risk of stroke including alcohol use, smoking and level of physical activity, researchers found that people with one to four symptoms had a 16% increased risk of stroke compared to people with no symptoms. Of the 19,149 people with one to four symptoms, 1,300 had a stroke. Of the 6,282 people with no symptoms, 365 had a stroke. People with five to eight symptoms of insomnia had a 51% increased risk. Of the 5,695 people with five to eight symptoms, 436 had a stroke.

The link between insomnia symptoms and stroke was stronger in participants under age 50 with those who experienced five to eight symptoms having nearly four times the risk of stroke compared to people with no symptoms. Of the 458 people under age 50 with five to eight symptoms, 27 had a stroke. People age 50 or older with the same number of symptoms had a 38% increased risk of stroke compared to people with 33 had a stroke.

"This difference in risk between these two age groups may be explained by the higher occurrence of stroke at an older age, " Sawadogo added. "The list of stroke risk factors such as high blood pressure and diabetes can grow as people age, making insomnia symptoms one of many possible factors. This striking difference suggests that managing insomnia symptoms at a younger age may be an effective strategy for stroke prevention. Future research should explore the reduction of stroke risk through management of sleeping problems."

This association increased further for people with diabetes, hypertension, heart disease and depression.

A limitation of the study was that people reported their own symptoms of insomnia, so the information may not have been accurate.

More information: Neurology (2023).

Journal information: Neurology 

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