HUMAN RESOURCE ADMINISTRATION IN THE RHC ARHA 2019

1. HUMAN RESOURCE ADMINISTRATION IN THE RHC ARHA 2019 April 25, 2019

2. Agenda 3. Training & Recordkeeping 2. RHC-Specific Requirements 1. General HR Requirements for Employers 4. Hot Topics

3. INDEPENDENT RHC: Responsible for all HR functions at the Clinic Administrator or Manager Level. Wears lots of hats. May lack resources or support. May need HR consultant or attorney for big questions. May work with accountants, payroll services or other 3rd parties. • PROVIDER-BASED: HR functions located at parent hospital. Clinic Manager needs basic understanding of HR administration. Must know corporate processes. Responsible for being source of information for RHC employees/staff.. Needs to collaborate with other departments.

4. Cell Phones, Texting, and Personal Devices • Younger employees and those who embrace technology will be more inclined to want to text or message as the preferred method of communication. • Make sure these texting and messaging is secure and that use of personal devises is compliant. • Encourage face-to-face communication for operational matters. • Discuss appropriate use of phones and personal devices. • Enable messaging with your PM/EHR.

5. The Hiring process

6. Do’s and Don'ts of Hiring • Have a standard hiring process for all positions. • Have applicants complete an application. • Make sure that the job description is accurate and not a cookie cutter one. • Get authorization to check background information.

7. Do’s and Don'ts of Hiring • To post opening internally or not? • Ask open-ended questions during the interview process. • Don’t ask questions which could be interpreted as discriminatory, biased or prejudiced in nature. • Aim for A+ players

8. Do’s and Don'ts of Hiring • Look at skills and accomplishments—not just education & experience. • Consider generational differences. • Communicate your clinic’s vision and mission clearly. • Encourage dialog and interaction to prevent a one-sided interview process.

9. The most important question: Are the right people on our bus?

10. Employing or Contracting Providers

11. Employee or Contractor? • J-0082 • (Rev. 177, Issued: 01-26-18, Effective: 01-26-18, Implementation: 01-26-18) • [§ 491.8(a) Staffing.] • (1) . . . Rural health clinic staffs must also include one or more physician’s assistants or nurse • practitioners. • (3) The physician assistant, nurse practitioner, . . . may be the owner or an employee of the • clinic . . ., or may furnish services under contract to the clinic . . . In the case of a clinic, • at least one physician assistant or nurse practitioner must be an employee of the • clinic. --SOM Appendix G

12. Employee or Contractor? • Professionals such as doctors, dentists, veterinarians, lawyers, accountants, contractors, subcontractors, public stenographers, or auctioneers who are in an independent trade, business, or profession in which they offer their services to the general public are generally independent contractors. However, whether these people are independent contractors or employees depends on the facts in each case. The general rule is that an individual is an independent contractor if the payer has the right to control or direct only the result of the work and not what will be done and how it will be done. The earnings of a person who is working as an independent contractor are subject to Self-Employment Tax. • https://www.irs.gov/businesses/small-businesses-self-employed/independent-contractor-defined • https://www.irs.gov/businesses/small-businesses-self-employed/independent-contractor-self-employed-or-employee

13. Laws and Regulations § 491.4 Compliance with Federal, State and local laws. The rural health clinic or FQHC and its staff are in compliance with applicable Federal, State and local laws and regulations.

14. Laws and Regulations • Equal Opportunity Employer • Office of Civil Rights • Non-discrimination • Fair Labor Act • OSHA • FMLA >50 employees • Worker’s Compensation • Benefits • State Regulations • Grant or Contract Regulations

15. Laws and Regulations • 42 CFR 491 Staffing Requirements • State Licensure Requirements • State RHC Regulations, if applicable • State Scope of Practice • State Labor Laws • Required Posters

16. Changes in Key Personnel Any change in ownership or physician(s) responsible for the clinic’s medical direction requires prompt notice to the RO. Neither of these changes requires resurvey or recertification if the change can otherwise be adequately verified. Notice of any change in the physician(s) responsible for providing the clinic’s medical direction should include evidence that the physician(s) is licensed to practice in the State. (SOM Appendix G) Determine if changes to the 855A Ownership/Managing Control sections are required. Determine if changes to the CMS-29 are required. Notify your SORH. . Update Rosters/Signage/ Job Descriptions/Contracts/Policies and Procedures/Agreements.

17. Links and Resources: US Department of Labor https://www.dol.gov/ Office of Civil Rights https://www.hhs.gov/ocr/ OSHA For Healthcare https://www.osha.gov/SLTC/healthcarefacilities/standards.html

18. RHC Federal Regulations 42 CFR § 491 https://www.gpo.gov/fdsys/pkg/CFR-2011-title42-vol5/pdf/CFR-2011-title42-vol5-part491.pdf CMS Policy Benefit Manual, Chapter 13https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c13.pdf CMS Claims Processing Manual, Chapter 9 https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c09.pdf State Operations Manual, Appendix G https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_g_rhc.pdf

19. The Role of Written Policies and Employee Handbooks

20. Policies Written Policies are intended to communicate broad statements of compliance and intention. Use written policies for information that will largely remain static and demonstrates overall compliance measures. Do not create trivial policies. Have required RHC policies that pertain to certification standards. Handbook/Training Modules Use the employee handbook and supplemental training modules to communicate information which may change or need to be updated or redesigned. You can reference supplemental documents in your policy.

21. Time-Keeping and record-keeping

22. Exempt or Non-exempt Positions are classified as either exempt or non-exempt depending on the nature of the job tasks to be performed and if the employer is required to pay overtime. You may know these jobs as “blue collar” or “white collar” jobs or salaried versus hourly wage jobs. To be considered a bona fide executive, administrative, or professional employee under the Fair Labor Standards Act, workers must be compensated on a salary or fee basis at a rate of not less than $455 (week), $1,971.66 (monthly), or $23,660 (annually), excluding board, lodging, or other facilities. Some states have higher limits. Job status determines how or if overtime is paid as well as other benefits.

23. Overtime, On-Call and Other Tricky Details Overtime is defined as time worked over 40 hours a week. In healthcare workplaces, overtime may also be calculated using the 8:80 rule for employees working fixed schedules over a 14 day period. An employee must agree to be paid under the 8:80 rule. All employees should be made aware of pay rate and period methodologies. Employers are not required to pay increased wages for weekends, after hours, or holidays although it is customary. Fact Sheet #54 – The Health Care Industry and Calculating Overtime Pay https://www.dol.gov/whd/regs/compliance/whdfs54.pdf On-Call: You must compensate for on-call hours if the employee is precluded from other activities or is restricted while on-call.

24. Payroll Record • Employee Legal Name, Address, DOB, SSN, Sex • Base Salary/Rate of Pay/How Pay is calculated • Job Title/Description • Regular Work Week (Start/Stop) • Straight Hours Worked • Overtime Hours Worked • Deductions/Withholdings • Pay Period and Pay Date • Fact Sheet #21: Recordkeeping Requirements under the Fair Labor Standards Act (FLSA) • https://www.dol.gov/whd/regs/compliance/whdfs21.pdf

25. Record-Keeping: Employees • For each employee: • Completed Application • Signed Job Description • I-9 (securely stored) • Payroll tax forms (W-4, state forms). Updated every year. • HIPAA, Security & Privacy Acknowledgments • Signed Standard of Conduct • Signed Employee Handbook page • Employee Health Information (securely stored) • OIG Sanction Check (Annually or more frequently) • Other required background checks • Health screenings (TB/Hep B)

26. Record-Keeping: Providers and Licensed Staff • Completed Application/Contract • Signed Job Description, if applicable • Resume or CV • Payroll forms, as applicable (W-9, W-4, state forms) • HIPAA, Security & Privacy Acknowledgments • Signed Standard of Conduct • Signed Employee Handbook page • Employee Health Information (securely stored) • OIG Sanction Check • Other required background checks • Diplomas • Certifications • Licenses/DEA/State Pharmacy Licenses • Complete Work History

27. OIG Excluded Party Search 7.3.1 Providers Must Screen for Excluded Individuals To further protect against payments for items and services furnished or ordered by excluded parties, all current providers and providers applying to participate in the Medicaid program must take the following steps to determine whether their employees and contractors are excluded individuals or entities: • Screen all employees and contractors to determine whether any of them have been excluded by searching the exclusion list located on the Alabama Medicaid Agency’s website. All providers must check the list prior to hiring staff to ensure potential staff has not been excluded from participation in the program. All providers must check the list again monthly to ensure existing staff have not been excluded from participation in the program since the last search. https://www.medicaid.alabama.gov/content/Gated/7.6.1G_Provider_Manuals/7.6.1.2G_Apr2019/Apr19_07.pdf

28. OIG Search Tips • Check all known names including maiden, former married names. • If name results, then check by Social Security Number • Screen shot the results • Self-report hiring violations • If you are using a background or screening service, make sure they understand your specific screening requirements. • Check contractors using the SAM system • Links: • https://exclusions.oig.hhs.gov/Default.aspx • https://www.sam.gov/SAM/pages/public/searchRecords/search.jsf

29. Record-Keeping: Confidentiality • Safeguard employee files. • Protect confidentiality. • Store payroll information separately. • Store employee health information separately. • Store negative information separately. • Peer review investigations, professional licensure concerns, patient safety or care issues should be included in quality files.

30. Record-Keeping: Training • Document Employee Orientation • Document Initial Training on: • HIPAA/Privacy & Security, general and specifically for role • Compliance/Standard of Conduct • RHC Policies and Procedures • Emergency Procedures (Fire, External, Medical Emergency) • Use of PPE/Standard Precautions/Protocols • Clinical Competency Check-off • Lab testing/controls • Procedures • Specific Tasks

31. Record-Keeping: Training • Annual Training on: • HIPAA/Privacy & Security, general and specifically for role • Compliance/Standard of Conduct • RHC/Hospital Policies and Procedures • Emergency Preparedness Training • Emergency Preparedness Testing • Clinical Competency Check-off • Lab testing/controls • Procedures • Specific Tasks

32. What Surveyors Want • Surveyors and Evaluators will want evidence of employee files and training records. If these records are maintained by your parent entity, make sure that you either have access to the needed documents via a shared drive or that you have duplicate records on-site at your RHC. Surveyors may differ on how and where records are maintained.

33. Periodic Performance Management & Communication

34. Performance Management • Formal annual review = OLD SCHOOL • Gen X and Millennials require more frequent, real time feedback. • Use open-ended questions to evaluate employee satisfaction and to identify potential areas of concern or improvement. Two-sided process or 360° • If job responsibilities have changed, revise job description. • If performance is unsatisfactory, have a defined method of putting employee on a PIP. • Be clear on how salaries or wages will be effected by performance.

35. Terminations • Know your state laws. Know compensation rules. • Clearly define terms for immediate dismissal. • Clearly define terms for PIPS or probation. • Document all actions. • Follow corporate or hospital protocols, if applicable. • Act succinctly and objectively. • Have paperwork ready. • Secure IT and system access. • Minimize disruption to clinic operations. • Have a plan for reassigning tasks or work load. • Notify hospital HR or attorney, if applicable. • Be able to communicate any post-employment benefits to employee. • Communicate changes to employees and staff.

36. Employee Grievances • Have an employee grievance process. • Inform employees of the processes. • Document employee complaints and resulting actions. • Take employee complaints seriously. • Apply the investigative process uniformly. • Use the process to identify opportunities for improved employee communication, training and the revision of processes. • Take appropriate actions for complaints which when investigated indicate a breach in regulatory compliance.

37. Creating Co-Worker Harmony • Get the right people on your bus. • Create a team mentality. • Educate on how each role is dependent on the other for success. All roles are valuable and critical to your RHC mission. • Encourage collaboration, brainstorming, and team-building.. • Discourage texting battles between employees. • Incentivize the team for optimal success. • Zero tolerance for gossip, negative talk.or schisms • Serve as a mediator for minor employee conflict.

38. In the Mind of a Miserable Employee Does my employer KNOW me? Does my job make a DIFFERENCE? How can I MEASURE my Success? • Anonymity • Irrelevance • Immeasurement

39. Questions?More Information? • Patty Harper • pharper@inquiseek.com • 318-243-2687 • www.inquiseek.com