Differences & Similarities between Home Health Agencies and Nurse Registries – Part 3

Welcome to the third part of our series about the differences between home health agencies and nurse registries. In this installment, we’ll review the last criterion from our list:  one qualifying service by direct employee.

Medicare requires that a home health agency provide skilled nursing services and at least one other therapeutic service (physical, speech or occupational therapy; medical social services; or home health aide services) by direct employee. For example, if the agency selects physical therapy services as the “direct employee service”, all physical therapy care delivered by the agency must be by an employee and not by an independent contractor or anyone outside organization. Conversely, that would require that the agency has no physical therapists who are independent contractors with the agency. After satisfying that Medicare Condition of Participation, (MCOP), a home health agency may engage independent contractors to provide all other services.

Regarding independent contractors, one should be aware of the very fine line between the factors which determine whether an individual is, in fact, an independent contractor.   The Department of Labor and IRS have regulations regarding the classification of individuals, and a quick internet search will provide the Medicare Certified home health agency with an often used “20 Factor Checklist” of issues to help determine whether one would be classified as an independent contractor or an employee.

The MCOP has strict requirements of home health agencies regarding supervision and responsibility for care provided by persons under contract. Accrediting organizations require even more in-depth involvement with supervision of contractors. The State of Florida does not require the extent of supervision of contractors as the MCOP and accrediting organizations do.

Nurse registries, on the other hand, must provide all direct patient care services through independent contractors and are prohibited from providing direct patient care services by employee in accordance with Florida law.  They may provide only skilled nursing, home health aide services, (by home health aides or certified nursing assistants), or homemaker and companion services. Nurse registries are not licensed to provide therapy services.

This concludes our three-part series on the differences between home health agencies and nurse registries. As you may know, there are many other distinctions, but we’ve presented our “top three.”

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