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NY Wage Parity Compliance and Your Home Health Care Business. Crucial information for Home Care and Home Health Aid (HHA) Companies who want to be in compliance with the NY Wage Parity law.


  • NY Wage Parity and Your Home Health Care Business Yonina F. Shineweather, CPA yshineweather@bdbpayroll.com ! Zishe Glauber zisheg@bdbpayroll.com 5/22/2014
  • Part I: Wage Parity Compliance
  • Public Health Law of 3614-c Home Care Worker Wage Parity. ! ! ! Beginning March 1, 2012, established a minimum wage for home care aides who perform Medicaid reimbursed work for certified home health agencies (CHHAs), long term home health care programs (LTHHCPs) and managed care organizations (MCOs) within New York City and within the counties of Nassau, Suffolk and Westchester.
  • Licensed home care services agencies (LHCSAs), including limited licensed home care agencies (LLHCSAs) ! to the extent that they contract with a CHHA, LTHHCP or MCO ! to provide services to clients of those entities in the specified locations ! NOT LHCSAs who do not provide services thru the 3 above NOT Assisted Living Programs (ALPs) NOT Consumer Directed Personal Assistance Programs (CDPAP) Who Else is Covered?
  • A home care aide has primary responsibility for providing in-home assistance with: ! 1. activities of daily living (ADL) 2. instrumental activities of daily living (IADL) or 3. health-related tasks. ! including ! 1. home health aides 2. personal care aides 3. home attendants 4. home hospice care 5. any other licensed or unlicensed person whose primary responsibility is to provide in home assistance with activities of daily living or health related tasks. Which Employees are Covered?
  • Which Employees are NOT Covered? ! ! Anyone working on a casual basis = ! ! incidental irregular intermittent
  • What about Dually Eligible Cases? ! Home care aides who provide services for CHHAs, LTHHCPs or MCOs that are reimbursed in whole or in part by Medicaid must be reimbursed at no less than the minimum rate established according to the attached schedule. The living wage requirement applies to all dually eligible cases where Medicaid is the payer in part or in whole, including split bill cases.
  • A Brief Wage Parity History New York City Nassau, Suffolk , Westchester March 1, 2012 Base: $9.00 Additional: Supplemental: $1.35 90% OT: $10.88 Base: Additional: Supplemental: OT: $10.88 March 1, 2013 Base: $ 9.50 Additional: Supplemental: $ 1.43 95% OT (until 12/31/13): $10.88 Base: $9.00 Additional: Supplemental: $1.35 90% OT (until 12/31/13): $10.88 March 1, 2014 Base: $10.00 Additional: $1.69 Supplemental: $2.40 100% OT (from 12/31/13): $12.00 Base: $9.50 Additional: Supplemental: $1.43 95% OT (from 12/31/13): $12.00 January 1, 2015 Base: $10.00 Additional: $1.69 Supplemental: $2.40 100% OT: $15.00 Base: $9.50 Additional: Supplemental: $1.43 95% OT: $14.25 March 1, 2015 SAME AS ABOVE Base: $10.00 Additional: Supplemental: $2.40 100% OT: $14.25 March 1, 2016 SAME AS ABOVE Lesser of: 115% of the total compensation of NYC; OR the total compensation mandated by the living wage law of Nassau, Suffolk or Westchester counties depending on episode of care location.
  • What qualifies as Supplemental Wage? NOT ! Statutory Benefits such as ! 1. FICA 2. Statutory disability 3. Unemployment 4. Workers Comp
  • What qualifies as Supplemental Wage? Always look at EMPLOYER cost! Always beware of refunds or dividends!
  • Health insurance (including self-insured plans) Advantage: QIVAPP qualifications require Health benefits OR Comprehensive health coverage $70 million in the pool Self-insured plans quality if meet actuarial value requirements Additional reimbursement may be from $0.30 to $1.00 per hour over next couple of months Advantage: Higher wages sometimes cause employees to lose Medicaid Wage parity can keep employer and employee in ACA compliance What qualifies as Supplemental Wage?
  • Disadvantage: $2.40 per hour usually cant match employees current coverage ! $450-600 is minimum monthly premium for quality insurance What qualifies as Supplemental Wage?
  • Pension Dental Vision Medical FSA Life insurance Extended disability Critical injury PTO Transit checks (DOH silence) Child care benefits Education subject to What qualifies as Supplemental Wage?
  • Restrictions on Education Benefits Must primarily benefit the employee Not specific to the operations of the employer Attendance is voluntary Attendance is outside of regular hours Not directly related to job No productive work performed
  • Structuring a Supplemental Wage Plan I. Define your goals 1. wage parity compliance 2. ACA compliance 3. continuing coverage 4. employee satisfaction 5. reduce premium losses from terminates II. Know your broker 1. infrastructure 2. experience 3. service 4. ACA upgrades/monitoring? III. Reduce plan volatility 1. more worker satisfaction 2. less drain on payroll/HR staff
  • A Quick ACA Review Employers must provide all employees who work at least 30 hours a week or 130 hours a month with minimum essential health coverage that provides minimum value and is affordable to the employee. Affordable means for lowest cost of single plan employee would pay < 9.5% of his/her income. ! Effective 1/1/15 for employers of 100 or more full time and full time equivalents.
  • Warning! Plans may provide ACA MEC (minimum essential coverage) ! But not offer ACA MV (minimum value) ! = Employer at risk for penalties
  • How Wage Parity Could Create ACA Problems? ACA penalties only apply if employees seek insurance on the Exchange and receive a credit/subsidy. ! Employees with Medicaid (80%) may not turn to the Exchange BUT ! If employees lose Medicaid primary coverage due to coordination issues with wage parity bare bones plans which dont meet ACA requirements, you may be at risk for ACA penalties in 2016.
  • What Do Your Employees Want? 1. Usually, cash supplements 2. Not to lose Medicaid (80% currently) *** 3. Plan stability ! An Offer They Cant Refuse! ! *** If employee refuses benefits, you can ignore the refusal and still pay the premium instead of a cash supplement. Its not necessary to report employees refusal.
  • Issues with Varying Plans Generates employee confusion HR/Payroll staff fields questions, dissatisfaction ACA MV plans must stay constant for employees stability period (usually at least 6 months) Early hour-banking strategies: less common now Weekly plans: less common now For self-insured plans, once employee is out sick, loses benefits! Trend: base coverage on last months hours
  • Volatility Reduction 1. Health plan coverage remains fixed 2. Use transit or child care, etc. to grant additional benefits as needed 3. Also good for 5 week months ! Example: Monthly premium costs employer $300 Employee works 130 hours. Supplemental due = 130 x $2.40 = $312 Solution: Load $12 on transit card.
  • What qualifies as Additional Wage? Not overtime Vacation Sick Holiday Personal Shift or assignment differential/premium Accruals to meet NYC Sick Pay Law No tax relief as for supplemental wage 1199 Union: state approved including some portion as supplemental wage
  • Safe-harbor Additional Wage Package Annual leave: accrued at one hour for every 26 worked (up to 2.3 hours per week and 10 days or 120 hours per year) Sick leave: accrued at one hour for every 26 worked (up to 2.3 hours per week and 10 days or 120 hours per year) Personal day: accrued at one hour for every 250 worked (up to 8 hours per year) Holidays: New Years Day, Martin Luther King Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day, Christmas Day Paid time off: when they fall on days that the employees are scheduled to work Premium pay: 1.5 times the base, when employees work on any of five holidays designated by the employer for premium pay Live-in work: an extra $16.95 per day, or $1.4125 per hour Weekend work: an extra $1.10 per hour Multiple clients: an extra $0.50 per hour
  • Weighted Average of Differentials Allowed ! total wage differentials paid to covered workers divided by total hours worked by covered workers >= $1.69 ! If < $1.69, use PTO accruals to supplement
  • What about Overtime? 1. No DOH guidance, even to NYSAHCP 2. PHI position: no wage parity for OT: $12.00 3. Some: Pay regular time wage parity: $14.09 4. Some: Pay OT + sup. + addit: $16.09
  • Required Certifications Annual reporting to DOH by ! a) CHHAs www.health.ny.gov/health_care/medicaid/redesign/docs/wage_parity_att_a_2.pdf


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