HCAF has submitted formal comments to the U.S. Department of Labor (DOL) regarding its proposed rule to restore Fair Labor Standards Act (FLSA) exemptions for companionship services and live-in domestic service workers to their pre-2013 scope.

The 2013 regulatory changes — implemented in 2015 — barred licensed home health agencies from using these exemptions, while nurse registries and similar business models continued to operate outside of FLSA coverage. This created a two-tiered marketplace, leaving Florida’s highly regulated providers at a competitive disadvantage.

HCAF emphasized that restoring the exemptions would:

• Reestablish parity across provider types, ensuring licensed agencies aren’t penalized for complying with stricter oversight and accountability standards.
• Improve patient access and continuity of care by reducing unnecessary caregiver handoffs and allowing families to have consistent, trusted caregivers, especially critical for those with dementia or complex medical needs.
• Support workforce stability by enabling caregivers to work more hours for a single agency, fostering predictable income, reducing turnover, and cutting duplicative onboarding, Electronic Visit Verification (EVV), and training costs.
• Reduce unnecessary administrative burdens by eliminating the 20% duty-split test, which diverts resources from patient care to paperwork.

Workforce Realities

HCAF’s comments made clear that the home care workforce shortage is primarily a reimbursement problem, not an overtime policy issue. Caregiver wages in Florida are driven by Medicaid rates and managed care contracts. Restoring exemptions provides agencies flexibility to design staffing models around patient needs without undermining fair pay.

HCAF’s Recommendations

In its filing, HCAF urged DOL to:

1. Restore the companionship and live-in exemptions for third-party employers.
2. Issue clear, timely guidance on implementation and compliance.
3. Coordinate with the Centers for Medicare & Medicaid Services (CMS) and state Medicaid programs to ensure reimbursement policies align with the restored flexibility, especially for extended-hour and live-in care.

DOL is expected to finalize the rule later this year. HCAF will continue working with national partners to ensure Florida’s providers remain represented and that federal policies support — rather than hinder — patient access, workforce stability, and agency sustainability.

Click here to read HCAF’s full comments.