Introduction

Recently, I have spoken with several business owners who are in the process of establishing home care services in Florida. Many of whom, were seeking to start a Home Health Agency (HHA), but they were unaware of the alternatives available, such as Nurse Registries (NR) and Homemaker Companion(HC) services. Through these conversations, I realized that many new entrepreneurs assume that an HHA license is the only option for delivering home care services. There are alternatives.

However, there are distinct differences between these types of home care providers, each with its own set of services, regulatory requirements, and licensing implications. Additionally, some payers and insurance companies have specific preferences, sometimes requiring a Home Health Agency license over a Nurse Registry license or a Nurse Registry license over a Homemaker Companion license, depending on the type of services being reimbursed.

Furthermore, many business owners are unaware that according to the instructions for Schedule 1: Estimated Provider Costs and Source of Funds, for health care clinics, home health agencies, and home medical equipment agencies included in the Proof of Financial Ability to Operate. In this connection, the total proof of funding cannot be less than three times the amount on line 17, as required by section 408.8065(1)(c) of the Florida statutes. This means that if your working capital requirements are minimal, the contingency funding must be three times more than that of a nurse registry. For example, if your contingency funding, which is defined as one month's average operating expenses, is $100,000, then an HHA must show a source of funds amounting to $300,000. In contrast, a nurse registry only needs to show $100,000. There is no such requirement for homemaker companion services.

In this blog post, I will break down the differences between Home Health Agencies, Nurse Registries, and Homemaker Companion services in Florida. Understanding these distinctions can help business owners choose the right path for their home care venture.

Understanding the Three Types of Home Care Providers

1. Home Health Agencies (HHAs)

What They Do

Home Health Agencies (HHAs) in Florida provide a wide range of medical and healthcare services to patients in their homes. These services can include skilled nursing care, physical therapy, occupational therapy, speech therapy, medical social services, and assistance with daily living activities such as bathing, dressing, and medication management.

Licensing Requirements

HHAs are highly regulated and must obtain a license from the Florida Agency for Health Care Administration (AHCA). To be licensed, agencies must meet specific state regulations regarding patient care, safety, staffing, and operational protocols. Key requirements include:

• Submission of a comprehensive application.

• Proof of financial stability to cover start-up costs, working capital, and contingency funds, which, as noted above, must be at least three times the amount of one month's average operating expenses. The payor sources can include reimbursement from third parties and include Private Pay, Medicare, Medicaid, Insurance   and   HMO/PPO. For more information about the working capital requirement, refer to my YouTube video entitled #1 Question asked of the Proof of Financial Ability to Operate for a Florida Healthcare License

• Detailed business and operational plans, including staffing models and service offerings.

• Employment of licensed healthcare professionals such as registered nurses (RNs), licensed practical nurses (LPNs), and therapists.

• Regular inspections to ensure compliance with state health and safety standards.

Application Process

The application process for starting a Home Health Agency is rigorous and requires substantial documentation. detailed operational plans, evidence of compliance with health and safety regulations and include a proof of financial ability to operate. AHCA reviews the application and conducts inspections to ensure the HHA is prepared to deliver quality healthcare services.

2. Nurse Registries

What They Do

Nurse Registries operate differently from Home Health Agencies. Instead of directly employing caregivers,( as employees requiring a Form W-2), Nurse Registries act as referral services that connect patients with independent caregivers such as registered nurses, licensed practical nurses, certified nursing assistants (CNAs), and home health aides (HHA's). These caregivers are not employees of the registry but are instead self-employed contractors.

The services provided by caregivers referred through a Nurse Registry can include nursing care, personal care, and companionship services. While the caregivers may offer medical and non-medical services, the registry itself does not manage or supervise the care directly.

Licensing Requirements

Like HHAs, Nurse Registries must be licensed by AHCA. The licensing process for Nurse Registries focuses on ensuring that the registry properly vets and refers qualified caregivers. Key requirements include:

• Background checks

• Contracts that define the relationship between the nurse registry and the independent caregivers.

• Record-keeping and compliance

• Proof of financial ability to operate, although the financial requirements are less stringent compared to HHAs. For example, if the contingency funding required is $100,000, the Nurse Registry would need to show $100,000 in available funds, unlike an HHA, which would need to show $300,000, assume minimal working capital requirements. The payor sources can include reimbursement from third parties , that included Private Pay, Medicaid Waiver, Insurance   and   HMO/PPO. It should be noted Medicare is not an allowable payer for a Nurse Registry. For more information about the working capital requirement, refer to my YouTube video entitled #1 Question asked of the Proof of Financial Ability to Operate for a Florida Healthcare License

Application Process

The application process for a Nurse Registry is less complex than that of a Home Health Agency, but it still requires substantial documentation and includes a proof of financial ability to operate.

3. Homemaker Companion Services

What They Do

Homemaker Companion services provide non-medical assistance to individuals who need help with daily living activities but do not require medical care. Services offered by Homemaker Companion providers can include housekeeping, meal preparation, companionship, and assistance with errands or transportation. These services are often used by elderly individuals or those with disabilities who want to remain in their homes but need support with daily tasks.

Licensing Requirements

Homemaker Companion services are subject to less stringent regulations compared to HHAs and Nurse Registries. They must still obtain a license from AHCA, but the focus of the licensing process is on ensuring that providers comply with basic standards for non-medical care. Key requirements include:

• Background checks

• Compliance

• Maintenance of records related to the services provided.

Also, Homemaker Companion services do not need to provide the proof of financial ability to operate. This makes them a simpler and less costly option to establish as compared to HHAs and Nurse Registries.

Application Process

The application process for Homemaker Companion services is the simplest of the three categories. Providers must submit an application to AHCA, undergo background checks. A homemaker and companion business licensed by the Agency for Health Care Administration (AHCA) in Florida can accept private pay from patients. Since these businesses typically provide non-medical services that are not covered by Medicare or most traditional health insurance plans, accepting direct payments from patients (or their families) is a common practice. I generally see private pay or cash pay only. There may be instances, that they can bill third parties, but it depends on the specific type of third party and the terms of the payment arrangement.

Comparing the Application Processes

When comparing the application processes for Home Health Agencies, Nurse Registries, and Homemaker Companion services, it's clear that the complexity and regulatory burden vary significantly.

1. Home Health Agencies (HHAs): The application process for HHAs is the most demanding. Applicants must provide proof of financial to operate, develop comprehensive business and operational plans, and comply with stringent health and safety regulations. The licensing process includes inspections and ongoing oversight to ensure that the HHA meets state standards for healthcare delivery. Additionally, as required by Florida law, HHAs must show proof of funding that is three times the amount of one month's average operating expenses, assuming minimal working capital requirements.

2. Nurse Registries: The application process for Nurse Registries is less complex than for HHAs but still requires careful planning and documentation. Nurse Registries must demonstrate their ability to connect patients with qualified caregivers and maintain compliance with state regulations. They must show proof of financial to operate, but this requirement is typically less than that of HHAs, as the contingency funding requirement is not multiplied by three.

3. Homemaker Companion Services: The application process for Homemaker Companion services is the simplest. Undergo background checks, and maintain records. Since no medical care is involved, there are fewer regulatory requirements and inspections compared to HHAs and Nurse Registries. Importantly, Homemaker Companion services are not required to show proof of financial ability to operate, making them a more accessible option for new businesses who may have difficulty in accessing funding.

Summary

Choosing the right type of home care service in Florida depends on the specific needs of the patient and the level of care required. Home Health Agencies offer comprehensive medical and healthcare services, making them the best option for individuals who need skilled nursing or therapy at home. However, the regulatory requirements for starting a Home Health Agency are the most demanding, requiring extensive documentation and compliance with health and safety standards, as well as significant financial proof of funding.

Nurse Registries provide a middle ground, offering access to skilled and unskilled caregivers. They are ideal for patients who need personal care or companionship services but prefer the flexibility of working with independent caregivers. The financial requirements are less stringent compared to HHAs, making it easier to meet the funding requirements.

Homemaker Companion services are the least regulated and provide non-medical assistance. They are a good choice for individuals who need help around the house but do not require medical care. With fewer regulatory hurdles and no financial proof of funding requirements, they are often the simplest option for entrepreneurs looking to enter the home care industry in Florida.

By understanding the differences between these three types of home care providers and business owners can make informed decisions about the best care options for their needs or the type of home care business they wish to establish in Florida. As always, if you are unsure and need help in choosing a Home Health Agency, Nurse Registry, and Homemaker Companion services, it's always a good idea to consult with a Florida healthcare attorney or a healthcare consultant.