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Update - At the request of the judge presiding over a legal challenge, OSHA has agreed to extend the effective date of the anti-retaliation provisions of the final injury and illness electronic reporting rule to December 1, 2016. The agency previously had agreed to extend the deadline from August 10 to November 1, 2016. The provisions require employers to inform their employees of their right to report work-related injuries and illnesses without fear of retaliation; to implement reasonable procedures for reporting injuries and illnesses that do not discourage workers from making such reports; and prohibit employers from retaliating or discriminating against workers for reporting injuries and illnesses.


The Occupational Safety and Health Administration (OSHA) published a final rule on May 12, 2016 which it says will improve tracking of workplace injuries and illnesses.  Portions of the rule go into effect on August 10, 2016; while other portions of the rule will be phased in over time. 


Key Provisions of the Rule: 


  • Electronic Submission – The final rule calls for electronic submission of injury and illness reports; however, what needs to be filed generally is dependent on the number of employees employed at an establishment.  Part-time, seasonal and temporary workers at any time during the calendar year are to be included in the number of employees for purposes of the electronic submission requirement.

     
    • 250 or more employees – The employer must submit electronically OSHA Forms 300, 300A and 301 annually.

       

    • 20 or more but less than 250 in certain identified industries – The employer must submit electronically OSHA Form 300A annually.  Included in the list of identified industries are nursing care facilities (NAICS 6231), community care facilities for the elderly (NAICS 6233) and other residential care facilities (NAICS 6239).

       

    • Other employers who receive notification from OSHA to electronically submit their OSHA Forms 300, 300A and 301. 


     

  • Public Posting of Data – Data from the public submissions will be posted in a publicly accessible website.  Information that could be used to identify individual employees will be scrubbed from the website. 

  • Employee Injury and Illness Reporting Requirements – Employers must develop reasonable procedures for employees to report work-related injuries and illnesses promptly and accurately.  A procedure is not reasonable if it would deter or discourage a reasonable employee from accurately reporting a workplace injury or illness.   Additionally, employers must inform employees of the procedures it develops and that:  

     
    • Employees have a right to report work-related injuries and illnesses.

       

    • Employers are prohibited from discharging or in any way discriminating against employees for reporting work-related injuries and illnesses.

       
      • OSHA will now be able to enforce this provision through citation issued as a result of any OSHA inspection.  Previously, retaliation claims would have to be initiated in Federal court. 


       


     

Incentive Programs – Because of OSHA’s concerns that many commonly used incentive programs may deter reporting illnesses or injuries, or incentivize underreporting thereof, OSHA is warning employers that they must be careful in designing and implementing their incentive programs.  Employers should avoid incentive programs designed around lagging indicators, such as those that rewards employees for going a certain period of time without an injury or illness.  Rather, incentive programs should be designed very carefully around leading indicators, such as those that reward employees for identifying and reporting hazards or for participating in the employer’s safety committee.  Going forward, OSHA will assess the acceptability of incentive programs on a case-by-case and has no plans, at the present time, to provide specific guidance to employers. 


Post-Accident Drug and Alcohol Testing – The final rule promises to affect employers’ ability to perform post-accident and post-injury drug and alcohol testing, again because OSHA believes that broad testing policies deter employees from reporting workplace injuries.  As a result, the agency maintains that any deterrence to reporting ultimately results in misleading injury and illness statistics.  Under the final rule, employers may not use drug/alcohol testing (or the threat thereof) as a form of adverse action against employees who report injuries illnesses.  The rule, however, does not apply to post-accident testing required by Federal regulations or permitted by state workers’ compensation laws.  Some guidelines moving forward: 


  • Blanket testing policies are prohibited – Employers should limit post-accident testing to those situations in which drug or alcohol use is likely to have contributed to the accident.

     
    • If the injury or illness is such that there is no plausible connection to drug or alcohol use, testing should not be performed.  Examples of injuries/illnesses with no such connection include back or muscle strains caused by overexertion, carpal tunnel syndrome, animal bites, bee stings and the like.

       

    • OSHA states in the rule that “[e]mployers need not specifically suspect drug use before testing, but there should be a reasonable possibility that drug use by the reporting employee was a contributing factor . . . . In addition, drug testing that is designed in a way that may be perceived as punitive or embarrassing to the employee is likely to deter injury reporting.”  (emphasis added).  This statement is very troubling in that it is impossible for an employer to know beforehand what an employee perceives, and this seemingly gives employees who do not want to be tested wide latitude for objection on the basis that they perceive it to be punitive or merely embarrassing. 


     

  • At least a cursory investigation into the facts surrounding the accident should precede any decision to conduct a drug/alcohol test – The focus of such an investigation would be to rule out any condition attributable to the employer, especially if that condition would be an OSHA violation, and to determine if there are any facts indicating that drug or alcohol use could be a contributing factor. 

     
    • Employers should be mindful of Centers for Disease Control (CDC) parameters of 8 hours for alcohol testing and 32 hours for drug testing.

       


     

  • Employers must not tie drug and alcohol testing to whether (a) an OSHA recordable injury or illness is involved, or (b) an employee files a state workers’ compensation claim.  The accident and the circumstances surrounding it should be the trigger; not the injury. 

  • It is critical for supervisors to be trained to consult with HR personnel before ordering a post-accident drug or alcohol test so that the appropriate investigation can be undertaken. 

Effective Dates/Dates for Submitting Required Forms Electronically – As noted above, the rule has varying effective dates. 


  • August 10, 2016 – Employers must be in compliance with those provisions of the rule dealing with (a) employee injury and illness reporting policies, (b) informing employees of their right to report a work-related injury or illness, and (c) the prohibition against discharging or otherwise discriminating against employees for reporting an injury or illness. 

  • January 1, 2017 

     
    • Requirements relating to electronic submission of Part 1904 recordkeeping forms. 


     

  • July 1, 2017

     
    • Deadline for all employers with 250 or more employees in their establishment to submit their 2016 Form 300A electronically.

       

    • Deadline for all employers with at least 20 but less than 250 employees in their establishment within the NAICS categories listed above to submit their Form 300A electronically. 


     

  • July 1, 2018

     
    • Deadline for all employers with 250 or more employees in their establishment to submit their 2017 Forms 300A, 300 and 301 electronically.

       

    • Deadline for all employers with at least 20 but less than 250 employees in their establishment within the NAICS categories listed above to submit their Form 300A electronically. 


     

  • Beginning in 2019 and going forward, all forms must be submitted by March 2 of every year. 

Conclusion – The final rule presents significant compliance challenges to LeadingAge members as it does to all employers, particularly in the area of incentive program design and implementation and post-accident drug and alcohol testing.  Moreover, the ability of the public to access all electronic injury and illness reports will subject LeadingAge members to increased scrutiny, not just from OSHA inspectors but from employee advocates and interest groups as well.  Given the historically high rates of injuries and illnesses within the aging services field, LeadingAge members should be working with their workplace safety committees, consultants and legal counsel to meet these challenges now. 

The staffing processes of skilled nursing facilities are on the brink of a major upheaval. With a focus on transparency and accuracy of staffing information, The Centers for Medicare and Medicaid Services (CMS) will soon be requiring all nursing facilities to submit staffing information electronically.

Read this whitepaper and use the 5-step action plan contained within to ensure your organization is PBJ ready:

  1. Identify & Classify All Direct Care Staff
  2. Assign CMS Job Codes
  3. Know What Counts, What Doesn't
  4. Institute Proper Checks & Balances
  5. Get Proactive

 

This article was reprinted with permission from OnShift. 

On March 18, the Centers of Medicare & Medicaid Services (CMS) issued an S&C memo entitled "Payroll-Based Journal (PBJ) – Implementation of required electronic submission of Staffing Data for Long Term Care (LTC) Facilities," to reiterate that the mandatory collection period of Payroll-Based Journal staffing information begins on July 1, 2016. 


What this means to skilled nursing providers is that the new PBJ reporting requirements are not going away or even being postponed, despite the relatively low number of organizations currently participating in the PBJ voluntary submission program.


CMS also reiterated that the electronic PBJ staffing information is a condition of participation, and as such, failure to submit or reporting inaccurate data can be costly, potentially leading to citation and civil money penalties. 


The good news is CMS also understands that supplying this data is a big undertaking for providers and made the following statement on initial enforcement, “As providers are adjusting to this new requirement, we may refrain from imposing enforcement remedies (e.g., for good faith efforts). Additionally, we will provide feedback mechanisms to providers, such as warnings, that will help facilitate compliance with this requirement." 


However, the state of Washington recently committed to using submitted Payroll-Based Journal staffing information to measure their minimum 3.4 hours per day of resident care beginning July 1, 2016.


The recently published outline of Washington’s new SNF Medicaid reimbursement methodology states, “Using payroll and census data for the CMS Payroll Based Journal, the Department will extract data and conduct a quarterly review. This compliance analysis would be done on a quarterly basis and would look at a staffing per day average for that quarter. The Department will be checking the numbers reported to ensure that they are averaging out to actual daily staffing and that the staffing is not varying wildly throughout the quarter.”


And if history has taught us anything, when one domino falls others will soon follow, making it likely that other states will use the required PBJ information to measure staffing compliance. This amplifies the importance for providers to get PBJ reporting right.


I’ve recently had the opportunity to educate and share PBJ best practices for numerous state and national industry associations. At the beginning of each presentation I ask the audience to rank how prepared they feel they are for the upcoming PBJ deadline. Time and time again, over 90% of the audience doesn't feel like they are fully prepared and more often than not they feel very unprepared to meet the reporting requirements. With a quickly approaching start date, providers need to prepare now.


As an industry partner, we are here to help. PBJ success goes beyond which hours should be counted or the format of the data to be submitted. Download this free whitepaper to learn 5 steps you should take now to ensure you are prepared for the new regulations.


 


 


This article was reprinted with permission from OnShift. 

"The key purpose of this [LeadingAge article] update," says Colleen Bloom, "is to highlight some advantageous opportunities outside of electing Option 4, a suggestion which flies in the face of old recommendations and long-standing beliefs dependent on Section 8 policies which go back original renewal policies (which go back to the mid-1990s), when long-term project-based Section 8 contracts first began expiring.  

The Terraces of Boise first opened last summer, and it’s already making an impression on new residents and the community at large. Each year, the city of Boise partners with the Idaho chapter of the Building Owners and Managers Association (BOMA) for the Building Excellence Awards. As part of the 2016 honors, The Terraces was selected as the Mayor’s Choice Award winner.

 

Sponsored by American Baptist Homes of the West, The Terraces is a continuing care retirement community that includes 161 independent living units, 40 assisted living units, 24 memory care suites and 48 skilled nursing beds. It welcomed its first residents in late July 2015.

 

Greystone’s Bud Green, who served as part of the development team for this project, recently shared his thoughts on the community:

 

“Many years ago, planning began on The Terraces of Boise on behalf of ABHOW. To now see the initial vision refined into a completed senior community is a joy and very satisfying for all the people involved in making this community a reality. The Terraces of Boise can now serve the seniors of Boise with quality care in an environment that provides many social opportunities for residents and their families. ABHOW will now be able to perpetuate their long history of service to seniors, but now from the significant community asset called The Terraces of Boise.”

 

The Mayor’s Choice Award will be officially given at the Building Excellence Awards luncheon on May 19.

 

See video and photos of the community.

 

Learn more about The Terraces of Boise.

 

This article was reprinted with permission from Greystone.

 

In May 2014, the Financial Accounting Standards Board (FASB) completely rewrote the rules for revenue recognition. Accounting Standards Update (ASU) 2014-09 –Revenue from Contracts with Customers created a new principle-based framework to determine when and how an entity recognizes revenue from its customer contracts. The effective date for the changes under ASU 2014-09 has been pushed back one year from the original date due to implementation issues. Effective dates are set to begin after December 15, 2017, for public entities, including entities with conduit debt, and after December 15, 2018, for all others, according to CliftonLarsonAllen.

 

New framework based on core principle 

FASB established a core principle for recognizing revenue within the new rules: revenue should be recorded only when services are provided or goods are transferred to customers at the agreed price. 

FASB provides five steps for organizations to determine how to recognize revenue from customers: 

  1. Identify the contract(s) with a customer. 
  2. Identify the performance obligations in the contract. 
  3. Determine the transaction price. 
  4. Allocate the transaction price to the performance obligations in the contract. 
  5. Recognize revenue when (or as) the entity satisfies a performance obligation. 

 

Implementation challenges for health care industry 

The American Institute of CPAs (AICPA) Health Care Entities Revenue Recognition Task Force is one of 16 industry task forces created to identify potential implementation issues and provide guidance. Although no formal guidance has been issued yet, the task force has begun to identify significant issues that may affect the health care industry. These issues will be submitted to various AICPA and FASB committees for consideration. 

The intent of the new rules is to establish a core principle for revenue recognition across all industries. While this concept may not appear to be overly complex at first glance, the different sub-industries within health care have a variety of contractual arrangements with customers to provide services and goods (performance obligations). The numerous ways that entities are paid may make implementation challenging. 

The greatest impact of the new rules will be on transactions that overlap at the end of the reporting period (typically year-end); therefore, organizations should focus their efforts on the revenue recognition issues related to those transactions. 

 

Variations by health care sub-industry 

The new revenue recognition model will have an impact across the health care industry, from hospitals to continuing care retirement communities (CCRCs). Each health care sub-industry will have challenges unique to their field. 

 

Continuing care retirement communities 

Under current standards, nonrefundable entrance fees are amortized over the expected lives of residents, while monthly service fees are recognized immediately. Under the new standard, a CCRC will likely need to estimate the transaction price that includes both amortization of the nonrefundable entrance fee and the expected monthly service fees the organization receives under the resident contract. The implementation issues will include identifying the performance obligation or obligations and transaction price, then recognizing revenue as the performance obligation(s) are satisfied. 

CCRCs will need to assess whether there is a financing component (an interest free loan) in the advance entrance fee the organization receives, which would increase the transaction price with the imputed interest. Given the various plan options that are available, the answer may differ from one organization to the next. One key area that implementation committees should focus on is understanding the impact of the new revenue framework on each type of contract, which ranges from life-care to fee-for-service. 

 

Hospital and health systems 

Hospitals face many challenges as well. For example, when providing emergency services to uninsured or self-pay patients, they must determine when a contract is created, and when and how the transaction price is determined. Hospitals will also need to apply the standard’s concept of “implicit price concessions,” such as adjustments to gross charges for third-party payers, or the amount the hospital expects to be entitled to for their services in estimating the transaction price. After the transaction price is determined, the probability of collection will need to be determined for revenue recognition. These considerations will impact both the timing of revenue recognition and the amount that is recognized. 

 

Third-party payor settlements 

Health care providers will need to address the process for estimating third-party payor settlements as “variable consideration” under the new standard. The current estimate is broadly based on knowledge and experience. Under the new standard, the estimate will need to be based either on the expected value (probability weighted amounts in a range) or the most likely outcome, if the outcomes are limited. 

 

Other considerations for health care providers 

Organizations can apply the new standard to a portfolio of contracts with similar characteristics “if the impact would not materially differ from applying to individual contracts.” This can create consistency and efficiencies during implementation and future revenue recognition. Health care providers will be able to determine what detail of disaggregation of portfolios is needed, such as life-care or fee-for-service contracts, uninsured and self- pay patients, co-payments and deductibles, charity care, Medicaid and Medicare, or other third-party payers. Organizations can immediately begin developing portfolios of revenue contracts in preparation for implementation of the standard. 

 

How we can help 

FASB, AICPA, and several trade associations have begun studying these issues, but formal guidance is not expected soon. In addition, because the effective date of these new rules has been deferred, many have taken a “wait and see” attitude. Unfortunately, the date for implementation will eventually arrive. 

Both public and nonpublic companies should prepare to adopt the new requirements by inventorying their revenue streams and evaluating how revenue will be affected by the new rules. CliftonLarsonAllen professionals have deep insight into issues in the health care industry and understand how these rules are likely to impact the industry in general, as well as individual clients. We can help you understand and adapt to these standards so that you can embrace the changes with confidence. 

 

This article was reprinted with permission from CliftonLarsonAllen.

The Centers for Medicare & Medicaid Services (CMS) has introduced the Payroll-Based Journal (PBJ) system allowing providers to electronically submit staffing information. CMS already has started collecting this data from providers on a voluntary basis and mandated that all skilled nursing facilities start electronically inputting staffing information effective July 1, 2016.

Reporting Requirements

Facility census data and total direct care hours worked, including hours for agency and contract staff, must be included in the submission. CMS defines direct care staff as individuals who—through interpersonal contact with residents or resident care management—provide care and services allowing residents to attain or maintain the highest practicable physical, mental and psychosocial well-being. Direct care staff doesn’t include individuals whose primary duty is maintaining the physical environment of the long-term care facility, i.e., performing housekeeping tasks. Each direct care employee must have an employee record within the PBJ system that contains a unique employee ID, hire and termination dates and pay type code, e.g., nonexempt, exempt or contract classification.

Providers will be required to submit their staffing and census data quarterly and will have 45 days after the last day in each fiscal quarter to do so. Therefore, the due date for the first PBJ submission for staffing data from July 1, 2016, to September 30, 2016, is November 14, 2016. 

Step 1:  Enroll in the program as soon as possible to begin keying all required information and practicing quarterly submissions. 

Coding

CMS has defined 37 job codes to be properly identified and assigned to employees for each shift when reporting direct care hours worked. A job code must be attached for every hour submitted, which can be difficult as job responsibilities fluctuate throughout a shift. To streamline the collection and reporting of hours, facilities should report hours worked based on an employee’s primary role for each shift. To facilitate this, direct care hours should be scheduled and reported by an employee’s shift job code. Facilities should start by assigning each position and shift a job code to be paired with direct care staff. This process is complicated and should be discussed with staff scheduling personnel, time and attendance personnel and software vendors to allow for appropriate setup and automation where possible.

Step 2:  Begin working with software providers early to determine how to automate data collection and coding processes so accurate information can be uploaded versus manually submitted.

Reporting

Knowing what hours should and shouldn’t be reported in the PBJ will help compile a complete and accurate file for submission. 

Don’t Report  

  • Hours paid for any type of leave or nonwork-related absence from the facility
  • Unpaid overtime
  • Hours for services billed to fee-for-service Medicare or other payor
  • Hours providing services to residents in noncertified beds, i.e., if nursing home staff is shared with an assisted living facility, only report hours dedicated to the nursing home

 Report

  • Contract and agency work
  • Corporate staff at a facility performing activities fitting into a CMS job category
  • Salaried staff who don’t clock in or out

It’s each provider’s responsibility to develop a process to document, track and verify staffing information so all care hours are accounted for within PBJ requirements. CMS has stated the hours reported should be based on payments made for services and verified through payroll, invoices or contracts. 

It’s important providers start working now to accumulate the information for all direct care workers as well as contracted employee data from contract labor providers. This data needs to be collected from multiple sources and systems and will take time to assemble. Once assembled, it should be stored in a centralized location that can be easily accessed and updated for PBJ submission.

 

Step 3:  Begin identifying hours not tracked by the time and attendance system and implement a process to accurately capture those hours and verify all direct care hours to payroll or expense records.

 

Providers should start working now to set up a process allowing staff information to be easily accessed and summarized in a dashboard format. This will help establish staffing requirements based on census and analysis against budgeted hours so providers can identify any gaps and make adjustments to ensure ongoing compliance and quality of care.

To facilitate completion of the three steps, click here to enroll two registered users in the program and view the online training available at qtso.com.

If you have any questions, contact your BKD advisor.

 

This article was reprinted with permission from BKD.

 

 

How do you feel about change? Bill Murray’s character in the movie “Groundhog Day,” stuck as he was in an endlessly repeating day, eventually comes to appreciate that “Anything different is good.” At the other end of the spectrum, as Robert Kennedy once observed, “Change has its enemies.” Change is always happening, everywhere, all the time. We may not like it, but it’s there, always percolating. That’s not a bad thing. After all, were it not for change we might still be living in caves and chasing dinner down with pointy sticks.

But while change is good, dealing with change on an organizational level can be challenging. The people in your senior care community get used to doing things a certain way, and have grown accustomed to a particular flow. When things happen to change that flow, people notice. When adopting new technology, this is more apparent than ever.

The introduction of new technology changes the way people work. New technology replaces the “old” ways of doing things. Technology replaces paper, manual processes and cumbersome touch points with a new streamlined and automated way of doing things. The change that comes along with technology is for the better – whether it’s for greater productivity or to drive revenue or to improve the way care is delivered to patients and residents in senior living communities. Nonetheless, it’s still change.

When adopting new technology, consider the following tips so employees on all levels can more effectively manage the change that comes along with it.

  1. Communicate – Effective communication requires a plan, something a bit more thought out than a memo tacked to a bulletin board in the staff lounge. But don’t worry, the components of that plan aren’t complicated. First, what’s your message? You need to distill the information about the technology and associated processes into a clear, concise, coherent message. Who will be affected? How will they be affected? Be straightforward, communicate in advance, and be sure to highlight why the technology is being introduced. No one likes surprises. The clearer you are upfront, the fewer headaches you will have as the changes unfold.
  1. Appoint a Champion – The most successful implementations I have seen are driven by an internal champion who has management support. The champion is accountable for the success of the initiative. The champion should have appropriate authority to oversee the program and, yes, make changes when needed. This person is the face of the initiative and coordinates among stakeholders and all levels within the organization. An effective champion has their finger on the pulse of the roll-out and how the transition to the technology is affecting users and employees, so the organization can stay on top of the impact of change and ensure success.
  1. Measure Success – Be sure to establish key measures from the outset of your initiative. Benchmark your current state prior to rolling out new technology so you can effectively track progress. Set goals at different stages of implementation so you can clearly see progress. In addition, be sure to account for anecdotal and qualitative measures, especially in the beginning. These are additional inputs that can help round out your measures of success.
  1. Cross-Train – With sky-high employee turnover rates in long-term care and senior living, you must be prepared for change. Cross-training multiple employees is a good idea in order to minimize the risk that can happen when a key employee leaves. Virtual and on-demand training can help get new users up to speed quickly. Be sure to take advantage of the services, training, and guidelines from your technology partners to minimize the impact when an employee leaves.

 

Change can be your friend. When adopting new technology, careful upfront planning and follow-through can make all the difference.

 

This article was reprinted with permission from OnShift.

An Active Shooter is an individual actively engaged in killing or attempting to kill people in a confined and populated area; in most cases, active shooters use firearms(s) and there is no pattern or method to their selection of victims. Active shooter situations are unpredictable and evolve quickly.

Typically, the immediate deployment of law enforcement is required to stop the shooting and mitigate harm to victims. Because active shooter situations are often over within 10 to 15 minutes, before law enforcement arrives on the scene, individuals must be prepared both mentally and physically to deal with an active shooter situation.

Download the full report written by the Department of Homeland Security to learn how to prepare your organization.

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