LeadingAge

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.

“Stay tuned.”

That’s probably the best advice I can give to those of you who are concerned about recent moves to raise the minimum wage in states across the country.

Wages are an important issue for LeadingAge members, especially members in California and New York, where the minimum wage will increase to $15 an hour over the next several years.

California will require all employers to pay the $15-an-hour minimum wage by 2022. New York will raise the minimum wage in New York City to $15 by the end of 2018. The minimum wage will increase to that level more gradually in other, more rural, parts of the Empire State.

Rising Wages Throughout the Country

While California and New York are grabbing headlines for their high minimum wages, they are not the only states raising that wage. In fact, 29 states and the District of Columbia now have minimum wages that are higher than the national hourly rate of $7.25.

Fourteen states raised the minimum wage this year alone, with the highest wage hikes taking effect in:

• Massachusetts ($11, effective in 2017).
• Vermont ($10.50, effective in 2018).
• Hawaii ($10.10, effective in 2018).

And there’s more to come.

Cities like Seattle and Los Angeles are on track to reach $15 an hour by 2020, while San Francisco will reach the $15 minimum wage by July 1, 2018.

By 2022, Oregon’s minimum wage will increase to $14.75 in Portland, $13.50 in midsize counties, and $12.50 in rural areas. Maryland’s minimum wage will reach $10.10 by July 2018.

Wage Increases: Here to Stay

The take-away from all of this state action seems clear to me:

If you’re not paying a higher minimum wage in your state this year, you’re likely to be paying one sometime in the near future.

Pundits on both sides of the debate have been quick to predict both economic disaster and “much ado about nothing” when it comes to raising the minimum wage. However, when pressed, most of these prognosticators admit that we simply don’t have enough information right now to make any kind of accurate predictions.

That’s why I suggest that we “stay tuned” to see how these wage increases roll out across the nation.

Don’t get me wrong. I’m not suggesting passivity. Rather, we need to stay alert to a number of issues:

Honoring regional differences: California’s legislation doesn’t differentiate among the state’s economically diverse regions. The minimum wage will eventually rise to $15 for every wage earner in the state, no matter where he or she lives.

That blanket requirement could create an unfair burden for rural providers. After all, an hourly wage of $15 will have a vastly different impact on providers and workers in urban Los Angeles than in rural Modesto.

I prefer the legislation in Oregon and New York, which took geographic variations into account when establishing minimum wage rates (Oregon) and implementation schedules (New York).

Reducing the burden on providers: Some larger providers, like LeadingAge Member ABHOW, tell McKnight's Long-Term Care News that they are already planning how they will adjust their operations to meet California’s new wage requirements.

Those adjustments won’t be easy for any provider. But I worry that smaller providers with slim operating margins may not be equipped to make any adjustments at all.

We can’t forget about these providers, or the older adults they serve. They may need some financial assistance to meet their obligations under the new law. They will certainly require some adjustments in Medicaid reimbursements to ensure that they can continue providing much-needed services and supports while paying higher wages.

Home care agencies, which depend so heavily on hourly workers to deliver services and supports, are particularly vulnerable. We need to do everything we can to ensure that higher wages in this sector don’t make services so expensive that low-income seniors can no longer afford to stay at home.

Staying Alert to Coming Trends

It’s not beyond the realm of possibility that a higher minimum wage could actually help providers, by reducing turnover and increasing employee productivity. But we won’t know that for quite some time.

That’s why I find it reassuring that many states have chosen to raise the minimum wage incrementally over a number of years. California’s legislation even allows the state to pause wage hikes if they result in negative economic or budgetary conditions.

This incremental approach gives employers the time they need to incorporate new labor expenses into their budgets. But, even more important, it gives states the opportunity to assess the real impact of minimum-wage increases and make adjustments to address any emerging problems.

Balancing Nonprofit Values and Business Viability

The Nonprofit Quarterly suggests that nonprofit organizations don’t really like talking about the minimum wage. I think that’s right.

On the one hand, our deep commitment to our local communities, and to people in need, stirs us to applaud efforts that level the economic playing field for America’s most vulnerable workers.

On the other hand, we worry about the impact of wage increases on our ability to sustain our missions.

Both perspectives are very real and very important. And they are not mutually exclusive.

We need to keep both perspectives in mind in the coming years.

We need to stay alert and proactive as new minimum wage requirements roll out around the country.

And we need to get creative so we can remain true to our nonprofit roots by continuing to honor workers while working to preserve our noble missions.

CliftonLarsonAllen completed the 2015 LeadingAge-Chief Executives of Multi-Site Organizations (CEMO) Leadership Compensation Survey that tracks trends in multi-site aging services organizations.

Over 129 multi-site organizations were surveyed representing a broad geography and size. The purpose of the survey was to provide multi-site aging services organizations with data on executive compensation levels, trends, and practices.

Succession planning and incentive compensation emerged as 2 areas of immediate interest to the boards of health care organizations. 

Recommendations on incentive pay and succession planning can be found in the report, or you can order the survey for the full findings.

The 2016 survey report will outline compensation and other employment practices of multisite aging services organizations throughout the country. The data covers more than 15 key executive positions and will include:

• Salary, total cash compensation, and total salary including benefits.
• Incentive plan utilization and targets.
• Benefit plan incidence.
• Regression analysis for compensation based on the organization’s revenue.
• Governance-related survey data regarding compensation practices.

Tiered pricing for the survey report is based on the buyer’s status as:

• Survey participants
• LeadingAge CEMO members
• LeadingAge non-CEMO members
• Others

The recruitment period for participating organizations has begun and lasts until May 31, 2016. The survey findings will be published and available for purchase in late Fall 2016, with a significant discount for participants. 

To participate in the survey, contact Mario McKenzie at mario.mckenzie@claconnect.com. 

Click Here for more information on the 2015 Survey Report from CliftonLarsonAllen.

On January 20, 2016, the U.S. Department of Labor's (DOL) Wage and Hour Division (WHD) issued an Administrator's Interpretation broadening the circumstances under which employers could be found to be joint employers. 

For LeadingAge members, the issue of joint employment arises primarily in the use of nurse staffing agencies.

In these situations, the nurse is hired and paid by the staffing agency but is working on the member’s premises. As such, the member is likely to set the nurse’s schedule and have oversight of the nurse’s work. In this way then, the nurse could be considered a joint employee of both the staffing agency and the member.

Why is the joint employment doctrine important? Quite simply, if a LeadingAge member is considered the joint employer of a given individual, the member can be held liable under the Fair Labor Standards Act (FLSA) for any wage violations with respect to that employee by the staffing agency.

Determination of a joint employment relationship depends largely on the extent to which the potential joint employer has control over the employee in such matters as hiring and firing, supervision and determination of pay. 

Historically, courts have differed in their interpretations of the doctrine. The new interpretation by the DOL, however, seeks to unify those interpretations by applying expansive principles for joint employment relationships found in the Migrant and Seasonal Agricultural Worker Protection Act (MSPA).  

Specifically, while the MSPA still considers control a part of the joint employer analysis, it is but one part of a seven-part test:

• Whether the employer has the power, either alone or through a contractor, to direct, control, or supervise the worker(s) or the work performed;
• Whether the employer has the power, directly or indirectly, to hire or fire, modify the employment conditions of, or determine the pay rates or the methods of wage payment for, the worker(s);
• The degree of permanency and duration of the relationship of the parties;
• The extent to which the services rendered by the worker(s) are repetitive, rote tasks requiring skills that are acquired with relatively little training;
• Whether the activities performed by the worker(s) are an integral part of the overall business operation of the employer;
• Whether the work is performed on the employer's premises, rather than on premises owned or controlled by another business entity; and
• Whether the employer undertakes responsibilities in relation to the worker(s) that are commonly performed by employers, such as preparing and/or making payroll records, preparing and/or issuing paychecks, paying FICA taxes, providing workers' compensation insurance, or providing equipment or materials required for the job. 

Experts warn that the DOL interpretation is likely to be very problematic for providers that outsource work, utilize staffing or temp agencies, embed consultants in their workforce, or share employees with subsidiaries or affiliates. 

LeadingAge recommends that members consult with their employment counsel to review their practices, determine their potential exposure to liability and develop means of limiting that exposure.