<P> In the court decision, the court stated the Fair Labor Standards Amendments of 1974 exempted from the minimum wage and maximum hours rules of the FSLA persons "employed in domestic service employment to provide companionship services for individuals...unable to care for themselves ." 29 U.S.C. § 213 (a) (15). The court found that the power of the Department of Labor (DOL) to administer a congressionally created program necessarily requires the making of rules to fill any' gap' left, implicitly or explicitly, by Congress, and when that agency fills that gap reasonably, it is binding . In this case, one of the gaps was whether to include workers paid by third parties in the exemption and the DOL had done that . Since the DOL followed public notice procedure, and since there was a gap left in the legislation, the DOLs regulation stood and home health care workers were not covered by either minimum wage or overtime pay requirements (but see below). </P> <P> A rule issued from the DOL, entitled "Application of the Fair Labor Standards Act to Domestic Service," and meant to be effective from January 1, 2015, was written to revise "the definition of' companionship services' to clarify and narrow the duties that fall within the term; in addition third party employers, such as home care agencies, will not be able to claim either of the exemptions (from federal overtime or minimum wage rules .) The major effect of this Final Rule (would be) that more domestic service workers will be protected by the FLSA's minimum wage, overtime, and recordkeeping provisions ." However, Home Care Associates of America, the International Franchise Association (IFA), and the National Association for Home Care & Hospice sued the DOL in regards to the rule, and a federal district court threw out the rule . The Labor Department then appealed . In August 2015, the rule was upheld by the United States Court of Appeals for the District of Columbia Circuit . </P> <P> 710,000 paid by Medicare - Medicare often is the primary billing source, if this is the primary carrier between two types of insurance (like between Medicare and Medicaid). Also, if a patient has Medicare and that patient has a "skilled need" requiring nursing visits, the patient's case is typically billed under Medicare . </P> <P> 235,000 paid by private insurance, or self / family - Private insurance includes VA (Veterans Administration), some Railroad or Steelworkers health plans or other private insurance . "Self / family" indicates "private pay" status, when the patient or family pays 100% of all home care charges . Home care fees can be quite high; few patients & families can absorb these costs for a long period of time . </P>

Who supervises the use of home remedies in the home