State Updates Health Care Worker Bonus Guidance
With the third claims submission period of the Health Care Worker Bonus (HWB) program underway, the Department of Health (DOH) has updated the Frequently Asked Questions (FAQ) document that serves as the primary guidance on the program and its requirements. The most recent version of the FAQs, dated April 7, 2023, includes about a dozen updates. Updated and newly added questions are highlighted in yellow.
The bulk of the new questions focus on correcting missed, underpaid, and overpaid claims. While DOH had announced the process for returning overpayments previously, the update adds clarifications and announces a new process for correcting underpayments. It also reiterates the April 3rd FAQ update that informed employers that missed claims from prior vesting periods could be submitted during any subsequent submission period.
DOH has added a feature that allows employers to correct awarded bonuses that were determined by the employer to have been lower than they should have been. The process assumes that the error was caused by an issue with either the recorded salary or average weekly hours worked and allows for the modification of those values for any underpaid employee. Instructions on how to make this modification are provided in the HWB Portal End User Guide. The guide is available once you have logged into the HWB Portal.
Please note that bonus claims for workers made eligible for the program by the November 2022 expansion should be submitted during the regular claiming periods going forward. When the program was expanded, DOH implemented a dedicated exception submission period for vesting periods 1 and 2 for those made eligible by the expansion. Payments for claims that were submitted during the exceptions submission period that closed on March 3rd are still pending. Consistent with recent guidance, claims that should have been submitted in prior claiming periods but were not can be submitted as late claims in subsequent submission periods. DOH recommends that providers maintain documentation for the reason of any late claim.
The FAQ update also adds a new section of questions titled “Employee Help.” While urging employees who believe their bonus payment is incorrect to work with the employer to resolve concerns, the new information indicates that the Office of the Medicaid Inspector General (OMIG) is developing a process for employees to submit allegations that their employer has not complied with the requirements of the program. Employees who are the subject of any attempt to take back a portion of a bonus payment are advised to contact the Department of Labor (DOL).
Those FAQs that have been recently added or updated are copied below.
Claim Submission and Payment Issuance
Q. I am a qualified employer who was unable to complete my submission of qualified employees during a prior vesting period. Can I submit employees eligible for a bonus for Vesting Period 1 and/or 2 at a later date?
A. Providers/Employers who were not able to or did not complete submission of qualified employees within 30 days of the end of the Vesting Period when the employee was eligible are able to file a late submission. Employers will be able to submit claims for any prior vesting period during any submission period. For example, during Submission Period 5, employers will be permitted to submit claims for any of the five Vesting Periods.
- Employers should make every attempt to submit claims as soon as the employee is eligible.
- Employers must validate that employee(s) met all other qualifying criteria during the respective vesting period.
- This flexibility does not change the criteria that a qualified employee is eligible for only two vesting periods per employer in an amount equal but not greater than $3,000 across all employers.
- An extension to submit for Vesting Period 1 will be limited to only the submission close date for Vesting Period 2 (October 31st) [NOTE: This bullet seems erroneous and is not in the PDF version of this FAQ.]
Please be advised that, in accordance with SOS § 367-w(4)(f), claims submitted more than 30 days after the respective Vesting Period are technically late for filing purposes. All Employers should document and retain information regarding the reason for any late submission for audits and investigation purposes relating to the submission of claims for the HWB Program.
Q. What happens if I recognize an error during the submission period?
A. While the applicable claiming period is open, the HWB Portal includes a delete function to remove submissions made in error. Once an erroneous submission is deleted, a corrected submission can be loaded into the HWB portal.
Q. If an employer identifies an error in a bonus claim where they claimed a lower bonus amount for an eligible employee that they should have, how can the employer amend a submission to ensure the employee receives the correct amount?
A. Effective April 1st, a correction process is available. Instructions on how to submit corrections to modify either an employee’s salary or hours worked from a previous submission can be found within the HWB Portal End User Guide available within the HWB Portal. The correction process is for employers to correct awarded bonuses ranging from $0.00 to $1000.00 which were determined by the Employer to have been lower than they should have been. Correction payments will be paid as a lump sum and included in qualified employer’s weekly Medicaid cycle payment from eMedNY. Cycle information published once available.
Q. What happens if I identify an overpayment after a submission period is closed.
A. Please note this process is for EMPLOYERS only. Employers are required to report, return, and explain any overpaid HWB funds received. Additional information, including directions on reporting and returning your overpayment can be found here: Office of the Medicaid Inspector General.
Please Note: Employers are prohibited from recovering bonuses paid to Employees under the HWB program even if the payment is later identified as an overpayment. See “Q. Can an Employer take back the HWB bonus from and Employee?."
Q. In the event that I am unable to issue payment to a former employee, or later determine a submitted employee to be ineligible, how do I return an overpayment of HWB bonus to the State?
A. Employers who have received a bonus payment for an ineligible employee, regardless of the reason, must return the HWB to the State. Employers’ participation is subject to audit, investigation and review of paid claims by the Office of Medicaid Inspector General. Overpayments must be returned to OMIG. For more information on how employers should return HWB overpayments please see: Self-Disclosure of Health Care Worker Bonus Payments | Office of the Medicaid Inspector General.
Q. What happens when a submission period has closed and an employer mistakenly applied for an employee who is not qualified for the bonus or applied for a larger value bonus than the employee should have received?
A. Employers who have received a bonus payment for an ineligible employee, regardless of the reason, must return the HWB to the State. Employers’ participation is subject to audit, investigation, and review by the Office of Medicaid Inspector General. Overpayments must be returned to OMIG. For more information on how employers should return HWB overpayments please see: Self-Disclosure of Health Care Worker Bonus Payments | Office of the Medicaid Inspector General. If the submission period is still open See “Q: What happens if I recognize an error during the submission period?”
Q. Should bonus payments be reduced for any wage garnishment liabilities (e.g., for child support)?
A. HWB program bonus payments must be offset by a qualified employer in compliance with any legally enforceable order against an eligible employee’s wages, which includes the HWB bonus payment.
A previous version of this Q&A indicated that the HWB program should not be reduced for any wage garnishment liabilities. This was incorrect.
An employer who failed to withhold as required by a legally enforceable order against an employee’s wages, which includes the HWB payment should review the legally enforceable order for the remedies required if such withholding was not made.
Employee Separation
Q. If an employee passes away, is the employee or the employee’s estate entitled to a bonus payment?
A. When an employee passes away, the employment relationship ends similar to when the employee quits or leaves their employer. See the above table for guidance on whether the employee or the employee’s estate is entitled to the bonus payment depending upon when the employment relationship ends.
Q. Is an employer required to provide a bonus to an otherwise eligible employee who has been terminated for cause, whether prior to or after the deadline for the employer’s payment of the bonus?
A. Employers may be obligated to pay former employees who are eligible and vested while in their employment provided that their employment was not terminated within thirty (30) days of the Employer receipt of bonus funds. As such, if the employee was terminated after the employer’s payment of the bonus, the employer is still required to pay the bonus to the employee.
Q. I am an Employer who is enrolled in eMedNY but in a non-payable status, am I subject to the HWB program.
A. Enrolled Medicaid providers who meet the eligibility criteria for the HWB but are enrolled with a non-payable status in eMedNY, this includes Managed Care Only and OPRA (Ordering, Prescribing, Referring, Attending) enrollment status, may be subject to the HWB program. Additional information on submitting for bonus will be provided.
Employee Help
Q. I am an employee and did not receive my health worker bonus, but believe I am eligible. What should I do?
A. First, please review these Q&A and the HWB webpage to see if you may be an eligible Employee. If you think you meet the criteria AND you worked for an entire vesting period, you may be entitled to a HWB bonus payment. Employers are responsible for determining which employees are eligible for the bonus. Therefore, you are encouraged to work with your employer to see if a resolution can be reached. Please note that your Employer has about 90 days after the end of your vesting period to pay you the bonus.
As such, you should first contact your employer and ask why you were not submitted for the bonus. If you believe your employer made a mistake in their determination of your eligibility, and the period for submitting claims is still open, please attempt to resolve the matter with your employer.
The Office of the Medicaid Inspector General (OMIG) is developing a process for employees to submit allegations that their employer has not complied with the requirements of the Healthcare Worker Bonus program. If you cannot reach a resolution with your employer, and wish to file an allegation, you will be required to complete a form that includes (1) your title, (2) your period of employment and average hours worked during the applicable vesting period, (3) your earnings excluding bonuses and overtime, and other pertinent information. This process will be launched soon, please check back for updates.
Q. Can an Employer take back a HWB bonus payment from an Employee?
A. No. Once an Employer pays a bonus to an Employee under the HWB program, the Employer may not take back any portion of that bonus payment from the Employee, even if the claim is determined inappropriately paid and recovered by the Office of Medicaid Inspector General (OMIG). See SOS § 367-w(5)(d). If an Employer pays a bonus under the HWB program, and then attempts to take back any portion of the bonus payment from the Employee, the Employee should contact the New York State Department of Labor at (888) 469-7365.
The email address for bonus-related questions is NYSWorkersBonus@health.ny.gov. Questions pertaining to the portal and on how to submit claims are fielded by the HWB Call Center, which can be reached at 1-866-682-0077. Employers should also refer to the HWB Portal End User Guide, which can be accessed when signed into the portal. The DOH HWB site and FAQs provide what guidance is available on the program. Submissions for the third vesting period that covered the six months ending March 31, 2023 should be submitted by May 1st. The next vesting period will cover April 1, 2023 through Sept. 30, 2023.
LeadingAge NY Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841