In The News

DOL Withdraws Trump Administration Independent Contractor Test

From SESCO Management Consultants

The U.S. Department of Labor (DOL) has eliminated a Trump administration end-of-term rule for determining whether workers should be classified as independent contractors or employees under the Fair Labor Standards Act (FLSA). The former administration rolled out the rule in January 2021, and though it went through the full rulemaking process, it never took effect.

Current Economic Realities Test

As it stands, the DOL’s current guidance on the factors considered under the economic realities test, last updated in July 2008, remains in place. These factors include:

  • The extent to which the services rendered are an integral part of the principal’s business;
  • The permanency of the relationship;
  • The amount of the alleged contractor’s investment in facilities and equipment;
  • The nature and degree of control by the principal;
  • The alleged contractor’s opportunities for profit and loss;
  • The amount of initiative, judgment or foresight in open market competition with others required for the success of the claimed independent contractor; and
  • The degree of independent business organization and operation.

Withdrawal and Dispute

On March 12, 2021, DOL proposed to withdraw the rule prior to its effect, an action that met opposition from business groups. On March 26, 2021, business groups challenged the proposed withdrawal in court, arguing that the DOL failed to provide a meaningful notice and comment period in violation of the Administrative Procedure Act. This case, however, remains in its early stages.

Possible Alternatives and Consequences for Employers

Since his inauguration and in his campaign, President Biden has signaled that he intends to make worker-friendly policies a priority in his administration. Biden has stated that he supports an “ABC Test” for independent contractors, similar to the oneCalifornia adopted in 2018,imposing a fairly restrictive standard for a person to qualify as an independent contractor.

Regardless of the test used, the Biden-era DOL, under Secretary Marty Walsh, likely will favor classification of workers as employees, rather than as independent contractors. For example, as recently as April 30, 2021, Walsh stated that, in many cases,gig workers should be classified as employees. Employers that utilize independent contractors should consider evaluating whether these individuals are appropriately classified, recognizing that this is a point of focus for the Biden-era DOL.



CDC: Fully Vaccinated People Can Forego Masks, Social Distancing

Inside Health Policy
By Beth Wang / May 13, 2021 at 3:20 PM
The Centers for Disease Control and Prevention on Thursday (May 13) announced that anyone who is fully vaccinated can participate in indoor and outdoor activities, large or small, without wearing a mask or physical distancing. However, people who are traveling on buses, trains, airplanes and other forms of public transportation must still wear masks.
CDC Director Rochelle Walensky said the agency updated its guidance in response to data that have emerged over the last two weeks showing that COVID-19 cases in the United States have dropped by a third. Vaccines have also become increasingly available over the past two weeks.
Real-world data also have shown that the vaccines are highly effective against COVID-19, Walensky said. She cited a study from Israel that showed the vaccines were 97% effective against symptomatic infection and 86% effective against asymptomatic infection in over 5,000 health care workers. Another study of more than 4,000 health care workers in the United States showed that the vaccines were 90% effective against any infection. A third study of 24 hospitals showed that the vaccines are 94% effective against hospitalizations from COVID-19.
Data also show the vaccines are effective against the variants circulating in the United States, according to Walensky. A study published last week in the New England Journal of Medicine showed the Pfizer vaccine is about 90% and 75% effective against infection from the B.1.1.7 and B.1.351 variants, respectively, circulating in the United States. Additional studies confirm that the Moderna and Johnson & Johnson vaccines are also effective against circulating variants, Walensky added.
Additionally, Walensky said, data have shown that those who get infected after being vaccinated are more likely to have a lower viral load and a shorter duration of infection. They’re also less likely to transmit the virus to others.
We have all longed for this moment where we can get back to some sense of normalcy,” Walensky said. “Based on the continuing downward trajectory of cases, the scientific data on the performance of our vaccines and our understanding of how the virus spreads, that moment has come for those who are fully vaccinated.”
Masks will still be required on public transportation and in public transportation stations, including airports. And health care facilities will continue to follow their specific infection control guidelines, Walensky said.
The CDC director cautioned that if things get worse, CDC will change its recommendations.
“This past year has shown us that this virus can be unpredictable. So if things get worse, there is always a chance we may need to make changes to these recommendations. But we know that the more people are vaccinated, the less cases we will have and the less chance of a new spike or additional variants emerging,” Walensky said.
She added that anyone who does develop symptoms should still wear a mask and get tested right away. Unvaccinated people should also continue to wear masks. -- Beth Wang ([email protected])

[Please note that, local, State, and private business mask and social distancing guidelines still prevail]



Democrats’ Push to Lower Medicare Age Raises Hopes, Concerns

Bloomberg By Tony Pugh | April 28, 2021 5:32AM ET

Congressional Democrats appear to have found common ground in a proposal that has animated both their progressive and moderate factions: lowering the Medicare eligibility age from 65 to 60—or even lower.
Supporters want to help fund the benefits expansion with $456 billion that Medicare could save over 10 years through President Joe Biden’s plan to let the program negotiate its own drug prices.
After the massive loss of jobs and employer-based health coverage due to Covid-19, Democrats say public support for their plan is strong. A recent Gallup poll found roughly 46 million Americans couldn’t pay for quality health care if they needed it. And even before the pandemic struck, 77% of Americans, including 69% of Republicans, favored letting adults ages 50 to 64 buy into the Medicare program, according to a January 2019 poll by the Kaiser Family Foundation.
Getting their policy goals accomplished, however, will still prove to be a heavy political lift.
Congressional Republicans have railed against expanding federal health-care programs and have shown no signs of budging. The powerful pharmaceutical lobby opposes Medicare negotiating its own drug prices. And “simply lowering Medicare’s eligibility age does not solve the core problem of affordability and would put at risk the existing coverage so many Americans rely upon,” David Allen, a spokesman for America’s Health Insurance Plans, said in a statement.

Read Full Article

CMS extends joint replacement model for three years

Modern Healthcare 
Michael Brady
CMS' Center for Medicare and Medicaid Innovation on Thursday signed off on a three-year extension of the Comprehensive Care for Joint Replacement model.
It will now last through the end of 2024. The final rule changes the definition of an episode to include outpatient hip and knee replacements, modifies how the agency calculates target prices and reduces the number of reconciliation periods from two to one. It also makes changes to beneficiary notice requirements, gainsharing caps and the appeals process. Regulators expect the extension to save the Medicare program about $217 million over three years.
In addition to extending the CJR model, the final rule makes permanent a three-month extension of the model's fifth performance year, which will now end March 31. It was initially slated to end at the end of 2020. The rule solidified COVID-19 related flexibilities for the model's fifth performance year and new diagnostic related groupings for hip and knee procedures.
CMMI originally planned to continue the model through 2023. But it scuttled those plans in light of the COVID-19 pandemic, which wreaked havoc on the healthcare system. Policymakers waived or delayed several reporting and value-based payment requirements in response, but those exceptions will begin to draw to close alongside the public health emergency.
The CJR model is supposed to test if bundled payments and quality measurements for hip and knee replacements cause providers to boost quality and coordinate care from the first hospitalization and throughout the recovery period.

What you Need to Know About Vaccines and Vaccine Safety

At least 20% of adults have consistently said that they would not get vaccinated or would do so only if required, and a lack of accurate information continues to be a concern among those who are not ready to get a COVID-19 vaccination. To address these fears, it's important to emphasize the facts, including how the accelerated timeline for the COVID-19 vaccine does not translate to compromises on safety.
In a new Healthcare Triage YouTube series, funded by NIHCM Foundation, Dr. Aaron Carroll explains the history of vaccines and vaccine development–one of the greatest public health achievements of all time–in six short, consumer-friendly videos covering:

  • · the timeline of COVID-19 vaccine development and the mRNA vaccine approach
  • · the history of anti-vaccine sentiments, vaccine legislation, and societal backlash (Part 1, Part 2) 
  • · how vaccines work with the immune system
  • · the history of vaccine development (Part 1, Part 2)

Dr. Carroll is a Professor of Pediatrics at Indiana University School of Medicine and the host of the award-winning Healthcare Triage series on YouTube.


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