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  • Regulatory Mandatory Reporting > Home Care Worker Wage Parity Law

    This law establishes a minimum wage requirement for home care aides who perform Medicaid-reimbursed work (including partial payment for dual-eligible Medicaid and Medicare plans) for certified home health agencies (CHHAs), long-term home health care programs (LTHHCPs), licensed home care service agencies (LHCSAs), limited licensed home care service agencies (LLHCSAs) and other organizations that employ home care aides in New York City or in Nassau, Suffolk or Westchester County. This law is in effect in New York City for services provided on or after March 1, 2012, and in Nassau, Suffolk and Westchester counties for services provided on or after March 1, 2013.

    If your organization, hospital or hospital system is a contracted entity providing home care services for EmblemHealth Medicaid or Managed Long Term Care (MLTC) members in New York City or Nassau, Suffolk or Westchester County, you are required to provide EmblemHealth with quarterly written certification of your organization’s or hospital’s compliance with the minimum wage requirements of the Home Care Worker Wage Parity — Public Health Law of §3614-c. This certification must also be sent to the New York State Department of Health (NYSDOH) annually.

    Certified Home Health Agencies (CHHAs)
    Contracted CHHAs providing home care services to EmblemHealth Medicaid, Partial Capitated MLTC and/or MAP MLTC members in New York City or in Nassau, Suffolk and/or Westchester counties are required to provide EmblemHealth with annual written certification of their organization’s or hospital’s compliance with the minimum wage requirements of the Home Care Worker Parity law. Certifications must be made using the approved NYSDOH certification form.

    Licensed Home Care Services Agencies (LHCSAs)
    Contracted LHCSAs providing home care services to EmblemHealth Medicaid, Partial Capitated MLTC and/or MAP MLTC members in New York City or in Nassau, Suffolk and/or Westchester counties are required to provide EmblemHealth with quarterly written certification of their organization’s compliance with the minimum wage requirements of the Home Care Worker Wage Parity law. Certifications must be made using the approved NYSDOH certification form

    Note: Entities that are or have a CHHA or LTHHCP that contracts with LHCSAs or other third parties are required to submit an annual certification to the NYSDOH and obtain quarterly written certification from the contracted entities, attesting those contracted entities are also in compliance with this provision.

    Submitting Your Certifications to EmblemHealth

    Quarterly certifications are due to EmblemHealth on March 1, June 1, September 1 and December 1 of each year. Annual certifications are due to the NYSDOH by March 1 of each year.

    Please fax the certification (and subcontractor list, if applicable) to EmblemHealth’s Provider Network Operations department at 1-212-510-5330.

    Consequences of Noncompliance

    EmblemHealth is required to annually certify that all of its contracted CHHAs, LTHHCPs and LHCSAs are in compliance with the Home Care Worker Wage Parity law. Therefore, any CHHA, LTHHCP or LHCSA that fails to certify will inhibit EmblemHealth’s ability to accurately comply with its certification requirement. As such, noncompliance with the certification requirements detailed herein may result in termination of our agreement with your organization.

    Required Record Keeping

    All providers must maintain records of compliance for at least 10 years. These records must be made available to the NYSDOH upon request. If you have any questions about complying with this request, please contact your EmblemHealth provider representative.

    More Information

    For more information about the Home Care Worker Wage Parity provision and its implementation, please send an email to homecare@health.state.ny.us with “Home Care Worker Parity” in the subject line.

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    Glossary terms found on this page:

    A process in which an individual, an institution or educational program is evaluated and recognized as meeting certain predetermined standards. Certification usually applies to individuals; accreditation usually applies to institutions.

    A legal agreement between an individual member or an employer group and a health plan that describes the benefits and limitations of the coverage.

    A business entity that performs delegated functions on behalf of the insurer or managed care organization.

    Health care services rendered to a member in their home in lieu of confinement in a hospital or skilled nursing facility. Care must be under the supervision of a registered professional nurse. This type of care may include physical, occupational or speech therapy, medical supplies and medication prescribed by a doctor.

    An institution which provides inpatient services under the supervision of a physician, and meets the following requirements:

    • Provides diagnostic and therapeutic services for medical diagnosis, treatment and care of injured and sick persons and has, as a minimum, laboratory and radiology services and organized departments of medicine and surgery
    • Has an organized medical staff which may include, in addition to doctors of medicine, doctors of osteopathy and dentistry
    • Has bylaws, rules and regulations pertaining to standards of medical care and service rendered by its medical staff
    • Maintains medical records for all patients
    • Has a requirement that every patient be under the care of a member of the medical staff
    • Provides 24-hour patient services
    • Has in effect agreements with a home health agency for referral and transfer of patients to home health agency care when such service is appropriate to meet the patient's requirements

    A permit (or equivalent) to practice medicine or a health profession that is: 1) issued by any state or jurisdiction in the United States and 2) required for the performance of job functions.

    Acronym for Medicare Advantage. An alternative to the traditional Medicare program in which private plans run by health insurance companies provide health care benefits that eligible beneficiaries would otherwise receive directly from the Medicare program.

    A jointly funded federal and state program that provides hospital and medical coverage to the low-income population and certain aged and disabled individuals.

    A nationwide insurance program for the disabled and people age 65 and over, created by the 1965 amendments to the Social Security Act and operated under the provisions of the Act. It consists of two separate but coordinated programs, Part A and Part B.

    An individual and each of his or her eligible dependents, including Medicare beneficiaries who are enrolled or participate in a benefit program and who are entitled to receive covered services from the practitioner pursuant to such benefit program and the terms of the practitioner's agreement.

    The group of physicians, hospital, and other medical care providers that a specific plan has contracted with to deliver medical services to its members.

    The state regulatory agency that certifies reimbursement methods and rates to hospitals and reviews HMO activities in the state of New York. Also called NYSDOH.

    The state regulatory agency that certifies reimbursement methods and rates to hospitals and reviews HMO activities in the state of New York. Also called the New York State Department of Health.

    A medical practitioner or covered facility recognized by EmblemHealth for reimbursement purposes. A provider may be any of the following, subject to the conditions listed in this paragraph:

    • Doctor of medicine
    • Doctor of osteopathy
    • Dentist
    • Chiropractor
    • Doctor of podiatric medicine
    • Physical therapist
    • Nurse midwife
    • Certified and registered psychologist
    • Certified and qualified social worker
    • Optometrist
    • Nurse anesthetist
    • Speech-language pathologist
    • Audiologist
    • Clinical laboratory
    • Screening center
    • General hospital
    • Any other type of practitioner or facility specifically listed in the member's Certificate of Insurance as a practitioner or facility recognized by EmblemHealth for reimbursement purposes

    A provider must be licensed or certified to render the covered service. The covered service must be within the scope of the Provider's license or certification.

    A set of providers contracted with a health plan to provide services to the enrollees.

    New York State Department of Health. This agency provides information for consumers, doctors, researchers and health care providers.

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