Earned Sick Time Final Regulation Summary and Analysis for Home Care Agencies

The final regulations on paid Earned Sick Time were released by the Attorney General’s Office (AGO) on Friday, June 19th with a number of substantial changes from the proposed regulations.   (The AG was charged with developing regulations to implement the new law – which was passed via a binding ballot question in 2014.)

The Home Care Alliance is pleased that most of the association’s comments were taken into consideration and the HCA thanks member home care agencies for their questions, concerns and suggestions. It is such involvement that allows the Alliance to better represent agencies and work for better results through our advocacy efforts.

Below is a basic summary of changes that home care agencies inquired about that were made between the proposed and final regulation.

Additionally, the Boston law firm Donahue, Barrett & Singal posted an analysis available to the public that is an excellent guide to the Earned Sick Time regulations. The Alliance has also partnered with Kurker Paget, LLC on a webinar for HCA members and further details and interpretation may become available.

Summary of Regulation Changes:

Section 33.01: Purpose, Scope and Other General Provisions

  • AGO added that “employees may choose to use, or employers may require employees to use, concurrent earned paid sick time…to receive pay when taking other statutorily-authorized leave that would otherwise be unpaid.”

Section 33.02: Definitions

  • AGO explained that “benefit year” is used interchangeably with “calendar year.”
  • The term “Calendar Year” was simplified to stand for any consecutive 12-month period as determined by the employer.
  • The term “Date of hire” was simplified to mean the employees “first date of actual work.”
  • Much more detail of employees and employers exempt from the law. Clarification that PCA’s are covered.
  • Regular hourly rate is newly defined as “the amount that an employee is regularly paid for each hour of work.”
  • “Same hourly rate” is clarified to mean employees regular hourly rate or, for employees earning varying rates from the same employer, either
    • The wages the employee would have been paid for the hours absent during the use of earned sick time if the employee had worked, or
    • A blended, weighted average of all regular rates over the previous pay period.
    • A clarification made in response to HCA’s comments for employees paid “fee-for-service,” the same hourly rate means a reasonable calculation of the wages or fees the employee would have received for the piece work, service or part thereof, if the employee had worked.
  • A clarification relative to “overtime, holiday pay, or other premium rates” that states “where an employee’s hourly regular hourly rate is a ‘differential rate,’ meaning  a different wage rate paid for the same work performed under differing conditions (e.g. a night shift), the ‘differential rate’ is not a premium.

 Section 33.03: Accrual and Use of Earned Sick Time

  • The AGO clarified that 40 hours per benefit year is the cap under the law. Employees  cannot accrue more unless the employer’s policy allows.
  • Employees accrue sick time only on hours worked, not while on PTO.
  • AGO added “Earned sick time may not be invoked as an excuse to be late for work without an authorized purpose under the regulations.”
  • AGO added “An employee may not accept a specific shift assignment with the intention of calling out sick for all or part of that shift.”
  • AGO added “Employers and their fee-for-service employees may arrange to make up hours during the same or next pay period.
  • AGO clarified “If an employee is exhibiting a clear pattern of taking leave on days just before or after a weekend, vacation, or holiday, an employer may discipline the employee for misuse of earned sick time, unless the employee provides verification of authorized use” under the regulation.

Break in Service

  • Regarding “Break in Service,” the AGO heard the Home Care Alliance’s concerns and shortened the timeline an employee has a right to use any unused sick time following “a break in service of up to four months.” However, following a break in service of between four months and one year, “an employee shall maintain the right to use earned sick time accrued before the break in service” if the unused time equals or exceeds 10 hours.

Transition Year/Safe Harbor

  • AGO clarified the “Transition Year/Safe Harbor” provision for employers with part time staff and per diem staff.
    • These employees must either accrue paid time off at the same rate as covered full time employees or receive prorated “lump sums” of paid time off.
    • If an employee is compensated other than on an hourly or salaried basis, the employee must accrue or receive lump sum allocations based on “a reasonable approximation of hours worked.”

 Section 33.06: Documentation of Use of Earned Sick Time

  • AGO clarified that an employer may require written documentation for an employee’s use of earned sick time that:
    • Exceeds 24 consecutive scheduled work hours;
    • Exceeds 3 consecutive days on which the employee was scheduled to work;
    • Occurs within 2 weeks prior to an employee’s final scheduled day of work before termination of employment, except in the case of temporary employees;
    • Occurs after 4 unforeseeable and undocumented absences within a three-month period.
  • AGO clarified that “health care providers may require employees making any use of earned sick time during local, state or federally declared emergencies to provide written documentation from a medical provider substantiating its use and to follow additional notification procedures set forth by the employer.” The employer may discipline the worker if they fail in this regard.

Fitness for Duty

  • AGO clarified that “an employer may require an employee to provide a ‘fitness-for-duty’ certification, a work release, or other documentation from a medical provider before an employee returns to work after an absence during which earned sick time was used if such certification is customarily required and consistent with industry practice or state and federal safety requirements and reasonable safety concerns exist regarding the employee’s ability to perform duties.”
    • “Reasonable safety concerns” means a reasonable belief of significant risk of harm to the employee or others.

Section 33.07: Allowable Substitution of Employers’ Paid Time Off

  • AGO clarified that “an employer’s own paid time off, vacation, sick leave, or other policy may be substituted for earned sick time so long as 40 hours of time off is provided under the policy, or such lesser amount as each employee might earn if the employer were not using the substitute policy” and the employees can use PTO for the same purposes under the same conditions as outlined in the regulation.

Return to www.thinkhomecare.org.

Input On MassHealth LTSS Sought

One of the featured speakers at the HCA of MA Annual Meeting last week was Scott Taberner, newly named MassHealth’s Chief of Behavioral Health and Supportive Care.  LTSS is the new umbrella term under which all medical and personal care assistance that MassHealth clients may need – for several weeks, months, or years – when they experience difficulty completing self-care tasks as a result of aging, chronic illness, or disability.  This includes, but is not limited to, nursing facility care, adult daycare programs, home health services, personal care services, transportation, and assistance assistance provided by a family caregiver.

In his remarks,  Taberner indicated that the Baker administration is launching a major initiative to improve health outcomes for Masshealth clients and make the MassHealth program more sustainable over the long term.  As part of that initiative, considerable attention will be paid to what, how, to whom and by whom, LTSS services are provided.  On his agenda Are: rethinking  how to modify fee for service payment to pay for value and outcomes;  what provider contracting and management arrangements might look like in a Medicaid Accountable Care Organization;  and how, in general, MassHealth can improve the LTSS “experience” of clients and providers.

MassHealth is holding the last of its open public hearings on these topics in the coming weeks.  They are open to any entity to submit comments and suggestions to the team looking at this programmatic area.  Rate increases for all community based services are, of course, at the top of the Alliance’s request list.  We are looking for suggestions from our member agencies –  with a strong history of provding MassHealth LTSS  – for suggestions as to how both rates and programmatic reforms could enhance our capacity to serve MassHealth clients with both medical and behavioral health needs.

We believe this is a unique opportunity to bring forward creative approaches to restructuring the MassHealth home health and home care programs.  Alliance members are invited to submit any and all concerns and suggestions to Pat Kelleher by July 2 for inclusion in our comments.

Fallon Total Care Dropping Out of ‘One Care’ Program

The state’s Executive Office of Health and Human Services (EOHHS) announced that one of the three health plans managing health care for dually eligible ages 21 to 64 through the One Care Demonstration Program will be dropping out.

As of September 30, 2015, Fallon Total Care will be parting ways with the capitated financial alignment program, which will leave Commonwealth Care Alliance and Network Health as the remaining plans. Fallon Total Care provides One Care coverage in Hampden, Hampshire, and Worcester counties to approximately 5,475 individuals and represented the second largest enrollment of the three plans. Commonwealth Care Alliance, as of the May 2015 enrollment report, was handling 10,305 dually eligible individuals.

“MassHealth assures members who are currently enrolled with Fallon Total Care (FTC) that we will work hard to ensure as smooth a transition as possible, working with current members, FTC, the other One Care plans, our partners at CMS, advocates, and the One Care Implementation Council,” stated MassHealth in a brief statement. “One Care members will not lose their MassHealth or Medicare, and all members will have continuous access to health care services, supportive services, and medications.”

MassHealth also promised further updates on the transition and did not share any reasoning for Fallon Total Care departing the One Care Program.

Return to www.thinkhomecare.org.

2015 Annual Report

The Alliance is pleased to publish its 2015 Annual Report, documenting its achievements, activities, and finances of the Home Care Alliance of Massachusetts and the Foundation for Home Health over the most recent year.

In addition to reading it below, you may download the PDF, or order a free copy via snailmail (supplies are limited).

Return to www.thinkhomecare.org.

 

Advocacy Alert: Urge FY16 Budget Conference Committee to Support Home Care

The House and Senate have formed a six-member “conference committee” that will merge the two budget proposals into a final fiscal plan for the state. Agencies and advocates can help get home care included in the reconciled budget by sending a message to the committee.
Work is ongoing, but must be completed by the beginning of the new state fiscal year on July 1st so time is limited to send an email. The House Conference Committee members are Representatives Brian Dempsey (D-Haverhill), Stephen Kulik (D-Worthington), and Todd Smola (R-Warren) while the Senate  members include Senators Karen Spilka (D-Ashland), Sal DiDomenico (D-Everett), and Vinny deMacedo (R-Plymouth).
Specifically, the Home Care Alliance is pushing the inclusion of a special commission to study state oversight options and minimum standards for private pay home care agencies. The Alliance is also supporting other amendments to expand access to home care services for seniors and also to create a comprehensive and collaborative state plan for Mobile Integrated Health.
The message itself can be viewed before sending and outlines the items that the Alliance is supporting. They include the following:
  • Senate Outside Section 90 as amended: Private Home Care Agency Study
    • Private-pay home care agencies across the state that provide mostly non-medical support services in the home have no state oversight and a study commission is needed to determine the best solution.
    • This commission will make recommendations on licensure standards and potential quality measures that will protect consumers and create a level playing field in the industry.
  • House Amendment #336: Mobile Integrated Healthcare
    • Recognizing the success and utility of existing “community paramedicine” programs on a smaller scale, this language ensures that the Department of Public Health and stakeholders in the public safety and healthcare communities convene to determine the best possible model of “mobile integrated health” for Massachusetts.
  • Senate Amendment #747: Expanding Eligibility for Home Care Services
    • This language raises the Elder Affairs home care program income eligibility limit to 300% of the federal poverty level ($35,010 in CY 2014), and requires all home care enrollees who are not on MassHealth to make a copayment towards the cost of their services on a sliding fee basis.
    • The program currently has a top income limit set at 224% of the FY 15 federal poverty level ($26,561). Raising home care to 300% of FPL allows the program to serve the “near poor” who are currently excluded.

Return to www.thinkhomecare.org.

MA Attorney General Announces Earned Sick Time ‘Transition Year’

At the first of a string of public hearings to provide input on proposed regulations on the forthcoming earned sick time law, Attorney General Maura Healey announced a “transition year” for employers already offering paid time-off.

The Attorney General explained that for the period of July 1 when the law goes into effect until December 31, 2015, “any employer with a paid time off policy in existence as of May 1, 2015, providing to employees the right to use at least 30 hours of paid time off during the calendar year 2015 shall be in compliance with the law with respect to those employees and to any other employees to whom the use of at least 30 hours of paid time off under the same conditions are extended.”

Further details are available on a bulletin released on the AG’s earned sick time webpage.

The AG also revealed the intent of her office to avoid a six-month delay in implementing the law, as has been requested by some business advocacy groups. With Healey holding firm on not delaying the law’s implementation, and with some major business groups endorsing the “transition year” move, it was very likely a compromise to grant some leniency to employers.

For more information on the earned sick time law as well as how you can submit comments and help the HCA comment, see this previous blog post.

Return to www.thinkhomecare.org.

Advocacy Alert: Email your Senator to Support Home Care in the Senate Budget

The Alliance has worked with home care champions in the Senate to file amendments to the Ways & Means budget to improve home health care services. The HCA now needs home care agencies and advocates to send a message to gain support these proposals TODAY by clicking here!

Below is a list of the items the Alliance will be leading on and supporting in the FY16 Senate budget process.

Restoring Home Nursing Rates: Senator Jennifer Flanagan

•    Purpose: This budget language seeks to restore the MassHealth rate for home health nursing visits past 60 calendar days of care to the payment level prior to the rate cut of December 1, 2008. This amendment creates a consistent rate for as long as an individual on MassHealth requires home health care.

Improved MassHealth Rates for Home Health Aide Services: Senator Barbara L’Italien

•    Purpose: Since 2007, home health aide rates to agencies from MassHealth have remained at $24.40 per hour, which is meant to cover aide salary, benefits, travel, supervision and administrative costs for the employing home health agency. This amendment seeks to raise the rate MassHealth reimburses home health agencies for home health aide services by 12% at a cost to MassHealth of $1.75 million.

Study of MassHealth Third Party Liability: Senator Anne Gobi

•    Purpose: A study is necessary because correct reimbursement coverage determinations for Medicare/Medicaid dual eligibles are far more complex in home health care than in other medical services as the services and program coverage rules are very similar. The process of submitting all or most MassHealth home health claims for review and re-review to Medicare is highly costly to both agencies and the state. The rate of Medicare coverage has also been steadily declining.

Homemaker Salary Reserve: Senator Michael Barrett

•    Purpose: Appropriate $3 million from the Community First Trust Fund for a FY16 Homemaker Salary Reserve.  This request will continue a campaign to support essential workers by providing an annualized wage and benefit increase of approximately 32 cents an hour to over 26,000 homemakers and personal care homemakers.

Community-Based Safety Net Adjustment: Senator Kathleen O’Connor Ives

•    Purpose: Treat non-profit home health agencies that provide a significant number of home health visits to MassHealth patients as safety-net providers eligible for upward rate adjustments.

FMAP Trust Fund: Senator Michael Rodrigues

•    Purpose: On January 1, 2014, Massachusetts began receiving an enhanced Federal Medical Assistance Percentage (FMAP) for certain Medicaid expansion populations through the ACA.  This amendment creates a trust fund to house this funding and dedicate it to Medicaid and low-income health programs.

Expand Elder Service Home Care Income Eligibility: Senator Barbara L’Italien

•    Purpose: Raise the income eligibility standard for State Home Care Program services funded by Elder Affairs to those below 300% of the Federal Poverty Level.

For more information on what was included in the Senate Ways & Means budget, visit this previous blog post.

Return to www.thinkhomecare.org.

2015 Innovation Showcase & Star Awards Photos are Here!

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HCA held its annual recognition event to honor the best and brightest individuals and programs in the home care industry. We acknowledged the work of certain individuals and agencies, but in doing so we celebrate all of home care, what it is and how we make a difference in so many lives.

Home care in Masachusetts has a long and proud history dating back over a century. The four programs and seven individuals that we recognized are both part of that great lineage and helping to shape a future for home centered care that is even more vibrant and impactful. They are working across the continuum to improve the post hospital transitions for patients and their families to promote rehabilitation and recovery. They are managing complex chronic illnesses
in ways that support independence, and they are expanding what it means to be a community-based provider. Most remarkably, as Pamela Mann, will reminded us at the ceremony, they do it all while holding on to the compassion, and high touch approach that has been the hallmark of the home health experience for more than a century.
Congratulations to all our Stars. You make us proud to be associated with you.

The pictures from this great event are available on our Facebook page. Click HERE to view them!

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Photos courtesy of HCA Staff and Brendan Fournier

Senate Ways & Means Budget Includes Wins for Home Care

The Home Care Alliance is proud to announce that the Senate Committee on Ways & Means included language for one of the organization’s priority issues that will help strengthen private-pay home care.

An “outside section” in the Senate Ways & Means Committee budget establishes a Commission to study and make recommendations for state oversight options for private-pay home care agencies. The language closely mirrors what the Alliance proposed. Also, it represents a huge step towards attaining not just minimum standards and consumer protection, but greater recognition that private pay home care is an option for families and individuals who need assistance.

Other positive notes came from the Senate’s proposed budget as well. The line item funding the Pediatric Palliative Care Program was increased by $250,000 over what the House approved. The Mass. Department of Higher Education’s “Nursing and Allied Health Workforce” line item was allotted $200,000 after being zeroed out by the Governor and matches the House’s appropriation.

ma budget pie chart picThe Senate also included $150,000 in funding for the “Home and Community-Based Services Policy Lab,” which aims, in part, to study the effectiveness and value of state-funded community-based services.

In the elder services category, the Senate’s proposed budget ups the House in the Home Care Purchased Services account by $3 million along with an additional $866,677 in the Home Care Case Management and Administration account. The other notable increase from the Senate Ways & Means budget is in the elder nutrition program (meals on wheels), which came in $121,889 above the House.

In MassHealth, both the Managed Care and the Senior Care accounts were level-funded. The Senate increased the MassHealth Fee-for-Service line item, which has traditionally governed home health nursing rates, by $481.5 million over the House. However, without specific language for home health included, it would appear an amendment needs to be proposed to raise those MassHealth payment rates.

Outside sections that are mentionable include language to create a “MassHealth savings report” that aims to find savings and cash management strategies in the Executive Office of Health and Human Services budget by October 1, 2015. There is also a commission established to oversee the Center for Health Information and Analysis, whose mission it is to be the clearinghouse for quality, affordability, utilization, access, and outcomes information of the state’s health care system.

The Alliance will look to propose amendments to increase MassHealth rates for home health aides along with restoring skilled nursing rates from the 2008 payment cut. The Alliance also plans to play a supporting role in raising wages for homemakers and creating transparency on federal healthcare reform funding.

Stay tuned for advocacy alerts with details on sending emails urging your state senator to support home care in the state budget.

Return to www.thinkhomecare.org.

Companion Services Lawsuit Update

The following Update was published in the National Association for Home Care, NAHC Report on May 7, 2015.  

A three-judge panel heard oral argument on Thursday at the US Court of Appeals in  DC  on NAHC’s challenge to the validity of new Department of Labor rules governing overtime compensation for “companionship services” and “live-in domestic services.” The case involves the government’s appeal of the federal District Court ruling that sided with NAHC and invalidated both rules that were scheduled to take effect on January 1, 2015. NAHC is joined in the lawsuit by the International Franchise Association and the Home Care association of America.

In the appeal, the Department of Labor (DoL) is represented by the US Justice Department. NAHC and its co-plaintiffs are represented by Maurice Baskin of Littler Mendelson and Bill Dombi, Director of NAHC’s Center for Health Care Law.

The judges expressed a great deal of interest in the DoL rule change affecting live-in services. It appeared the reason for their interest was two-fold. First, that rule had not been previously addressed by the US Supreme Court, in contrast to the Supreme Court ruling in a 2007 case brought by NAHC  challenging  union efforts to stop application of the “companionship services” overtime exemption with workers employed by home care companies. Second, the language in the law on live-in domestic services is different than the law on the companionship services exemption as to the power of DoL to “define and delimit” terms.

Both sides presented strong arguments on the case indicating that the matter presents complex and difficult issues of law. NAHC’s arguments focused on the impact of the rule change on consumers of home care and the rules’ complete eradication of the overtime exemptions in the face of congressional actions to retain it for nearly 40 years.  The DoL counsel argued that DoL has the power to fill definitional gaps in the law with respect to such terms as “companionship services” and which employees the overtime exemption applied to. That focus was intended to take advantage of standards of law that give deference to federal agency interpretations where the plain language of the law passed by Congress does not full provide the needed interpretation.

It is expected that the Court of Appeals will issue a ruling in the next two months as the Court goes on recess in July. In the event that NAHC is successful in defeating the government’s appeal, it can be anticipated that DoL will make an effort to gain review before the Supreme Court. NAHC and its partners are also committed to take all steps available to prevent the challenged rules from taking effect, including an appeal to the Supreme Court if needed. Stay tuned to NAHC Report for any developments in this important litigation.