4/15 | End Annual Reviews: Stop Ignoring Your Staff 364 Days a Year

 

End Annual Reviews: Stop Ignoring Your Staff 364 Days a Year
Speaker: Scott Moore, Esq.
April 15, 2021 | 15:00 ET | Free to AAA members!

Have you ever received a performance review that truly drove you to work harder? It is time for employers to rethink the manner and method of providing employee performance feedback. In fact, the concept of performance feedback needs to evolve from a formal annual process to a more fluid ongoing dialogue about the nature and quality of the workplace relationship. EMS organizations continue to struggle with retaining employees, both field personnel and frontline supervisors. This program will discuss why traditional employee performance feedback models often hurt performance. We will cover the latest research on what truly drives employee performance and the innovative ways that high-performance teams are utilizing meaningful performance feedback tools in today’s workplace. Lastly, this session will discuss the important role that organizational culture plays in driving employee performance regardless of the performance feedback model your organization adopts. No matter the model, if your organizational culture does not support a transparent, trusting, and accountable relationship between leadership and your workforce, you will continue to struggle.

Register Now

4/15 | End Annual Reviews: Stop Ignoring Your Staff 364 Days a Year

 

End Annual Reviews: Stop Ignoring Your Staff 364 Days a Year
Speaker: Scott Moore, Esq.
April 15, 2021 | 15:00 ET | Free to AAA members!

Have you ever received a performance review that truly drove you to work harder? It is time for employers to rethink the manner and method of providing employee performance feedback. In fact, the concept of performance feedback needs to evolve from a formal annual process to a more fluid ongoing dialogue about the nature and quality of the workplace relationship. EMS organizations continue to struggle with retaining employees, both field personnel and frontline supervisors. This program will discuss why traditional employee performance feedback models often hurt performance. We will cover the latest research on what truly drives employee performance and the innovative ways that high-performance teams are utilizing meaningful performance feedback tools in today’s workplace. Lastly, this session will discuss the important role that organizational culture plays in driving employee performance regardless of the performance feedback model your organization adopts. No matter the model, if your organizational culture does not support a transparent, trusting, and accountable relationship between leadership and your workforce, you will continue to struggle.

Register Now

PA | $20,000 Signing Bonus, $25/Hour—Zero Applicants

From JEMS 

Cumberland Goodwill EMS (PA) hang up a help wanted sign, but no one answered.

Assistant Chief Nathan Harig tells ABC 27 they’re seeing a shortage of paramedics and are trying to hire a paramedic for an open position. One problem: not one person applied despite the agency offering a $20,000 signing bonus and $25 per hour pay.

“We’re doing everything we can to try to motivate people to come on in but it’s just not working,” Harig told the station.

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CBS | EMTs Are Quitting Their Jobs

From CBS News | “Emergency medical technicians are quitting their jobs — COVID-19 makes it too dangerous

Rather than expose himself to a stream of infected patients in Queens, Baer opted to retire last month, ending his career at least a full year earlier than he’d planned. That disqualified him from collecting his full pension, and Baer estimates he gave up between $2,000 and $4,000 a year in retirement benefits — a decision he doesn’t regret.

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Final Rule for ACA Section 1557

On June 12, 2020, the Office of Civil Rights (OCR) of the Department of Health and Human Services (HHS) published the long-awaited final rule which significantly changes several of the anti-discrimination provisions of Section 1557 of the Affordable Care Act.  The final rule, which is a departure from the agency’s previous interpretation of the rules which were enacted 2016 during the Obama administration.  Since, the enactment of the 2016 rules, there have been numerous legal challenges to these provisions in federal court.  HHS believes that these final rules will reduce or eliminate provisions that they state were ineffective, unnecessary, and confusing and will save roughly covered entities roughly $2.9 billion in costs.

2016 Section 1557 Requirements

Section 1557 of the ACA were the anti-discrimination provisions geared at ensuring all individuals had access to essential benefits.  When originally released in 2016, the Section 1557 rules prohibited discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs or activities, including discrimination on the basis of pregnancy, gender identity, and sex stereotyping.  The 2016 Rule also required that covered entities:

  • Establish a written Grievance Procedure.
  • Identify and maintain a Compliance Coordinator.
  • Publish non-discrimination notices in the top 15 languages spoken in the covered entity’s state.
  • Publish taglines informing individuals of the availability of aides and services in the top 15 languages spoken in the covered entity’s state.
  • Make available assistance for individuals with Limited English Proficiency (LEP) and those with disabilities, including communications related disabilities.
  • Include the mailing of non-discrimination notices and taglines in every “substantial communication” with individuals.
  • Included non-discrimination protections for individuals “on the basis sex” which was interpreted by OCR to include gender identity, sexual orientation, and termination of pregnancy.

2020 Section 1557 Final Rule

The Final Rule eliminated several key provisions of the 2016 Rule. The provisions that were eliminated included:

  • Discrimination protections for individuals “on the basis of sex”
  • Specific non-discrimination provisions “on the basis of sex”, including gender identity, sexual orientation, and termination of pregnancy.
  • Written Grievance Procedure.
  • Compliance Coordinator.
  • Publishing of non-discrimination notices in top 15 languages informing individuals of aides and services for individuals with Limited English Proficiency (LEP).
  • Publishing of taglines in top 15 languages informing individuals of aides and services for individuals with Limited English Proficiency (LEP).

In addition to eliminating certain provisions, the final rule also relaxed the requirements relative to providing meaningful access to interpreter services for individuals with Limited English Proficiency (LEP).  Under the 2016 rule, the agency assessed compliance with the meaningful access requirement by whether a covered entity established and implemented a Language Access Plan.  This included providing access to interpreter services to individuals with LEP.  The 2020 final rule requires covered entities only make “reasonable efforts” to ensure meaningful access to aides and services for individuals with LEP.  However, the final rule does not change the requirements for meaningful access for individuals with disabilities or communication related disabilities.

The Bottom Line for EMS Providers

When the 2016 Section 1557 rule was enacted, the AAA sought guidance from OCR due to what we perceived to be compliance challenges for mobile-based healthcare providers.  Our concerns were related to how mobile-based healthcare providers can ensure that the public and the patients we serve receive adequate notice of the protections afforded under Section 1557.  As is often the case, when new regulations are enacted, they are enacted for standard “brick and mortar” healthcare providers, not ambulance services.  At the time, our guidance was to post the required notices and taglines on your organization’s website and in the patient signature areas of your patient care report.

From a practical perspective, the enactment of this final rule will have limited impact for ambulance providers.  Presuming an ambulance service’s compliance with the provisions of the 2016 rule, member companies can decide if they wish to eliminate their existing Compliance Coordinator position and Grievance Procedure.  However, OCR still requires a covered entity to have written process for handling discrimination complaints.  Therefore, it may be beneficial to simply maintain the 2016 requirements to ensure you can demonstrate compliance.

One welcome change is the elimination of the need to include the Section 1557 non-discrimination notices and taglines in every “substantial communication” with individuals.  Many members voiced that they incurred a significant expense mailing the nondiscrimination notice and tagline requirements in every invoice or patient communication.  This often added several additional pages to all patient communications which increased printing and postage costs substantially.  Our recommendation is for ambulance providers to continue to make the non-discrimination notices and taglines available on your organizational website and in any electronic communications as these mediums do not significantly increase costs.

Compliance Assistance

OCR has numerous compliance assistance documents on their website.  Additionally, members can contact the AAA for assistance with these regulatory changes.

EEOC Guidance on COVID-19 Antibody Testing

The Equal Employment Opportunity Commission (EEOC) issued updated guidance yesterday titled, What You Should Know About COVID-19 and the ADA, the Rehabilitation Act, and Other EEO Laws yesterday.  The updated guidance addresses employers who wish to require employees to have a COVID-19 antibody tests prior to re-entering the workplace.  The guidance consists of seventeen pages of Frequently Asked Questions (FAQ) to assist employers as they navigate this truly unprecedented time for employers and employees during a pandemic.

The updated guidance alerts employers that they may not require employees to undergo COVID-19 antibody testing as this would constitute an unlawful “medical examination” under the Americans with Disabilities Act (ADA).  Under the ADA, employers are limited in the medical related inquiries that they can make of employees.  Medical related inquiries can be considered a Medical Examination and are strictly regulated under the ADA and the Rehabilitation Act.  Under the ADA, an employer “shall not require a medical examination and shall not make inquiries of an employee as to whether such employee is an individual with a disability or as to the nature and severity of the disability, unless such examination or inquiry is shown to be job-related and consistent with business necessity.” 29 CFR § 1630.14.  The reason certain medical examinations are prohibited is due to the likelihood that the examination may identify medical conditions that constitute a protected disability under the ADA.

The EEOC has issued previous guidance that permits COVID-19 viral testing in the employment setting.  The distinction between the antibody test and the viral test is the presence of active virus and the obligation of employers to provide a workplace that is free from known hazards.  The viral tests are generally administered prior to the employee entering the workplace and are considered “job related and consistent with business necessity.”  Additionally, employers may take the body temperatures of employees as they enter the workplace and at intervals during their shift.  However, employers must be aware that some individuals with COVID-19 are asymptomatic and may not have an elevated body temperature.  Additionally, the records related to taking employee temperatures are confidential and should be maintained with other employee medical records.

The best practice for employers, have a documented plan.  Ensure that all employees understand their role in controlling the spread of the virus.

Be sure employees:

  1. Monitor their own temperature and COVID-19 symptoms.
  2. Wear a face covering and practice social distancing, even in the workplace to the extent it is possible.
  3. Frequently wash their hands
  4. Stay home if they are sick or display symptoms;
  5. Let their employer know if they have a family member or significant other who has COVID-19 or is displaying symptoms.
  6. Regularly clean and disinfect any equipment they utilize, before, during, and at the conclusion of their workday.

Employers should:

  1. Be sure to provide employees with COVID-19 education.
  2. Place signage in the workplace to remind employees and visitors to wear facial coverings and maintain social distancing.
  3. Provide disposable face coverings for anyone entering the building who does not have a mask.
  4. Maintain a log of all individuals, employees or visitors, who enter the building. The log should include their name, organization, and a method of contact.
  5. Provide all visitors with contact information should they become ill or exhibit symptoms in the 14 days following a visit to your workplace.
  6. Limit meetings or gatherings of employees.
  7. If administering employee temperatures
    1. Communicate the process to employees
    2. Establish what temperature will be considered too high for working (CDC considers a fever to be at least 100.4 F)
    3. Ensure all individuals are wearing face masks and social distancing, to the extent possible
    4. If employer requires temperature taking, be sure that the time employees spend associated with this procedure is tracked and compensated.
    5. As stated previously, maintain records confidentially

If you have questions or your organization needs assistance in determining if you have the appropriate safeguards in place, be sure to reach out to the AAA for help.

USSC Upholds Equal Protection for Victims of Sex-Based Discrimination

Yesterday, the U.S. Supreme Court issued a decision that settles the greatly contested issue of whether Title VII of the Civil Rights Act’s protection against discrimination on the basis of sex, includes sexual orientation and gender identity.  The ruling stems from three cases, Altitude Express Inc. v. Zarda, Barstock v. Clayton County, Georgia, in which the plaintiffs were terminated following their employer learning that each were gay, and R.G. & G.R. Harris Funeral Homes Inc. v. Equal Employment Opportunity Commission, where the plaintiff was terminated after she informed her employer that she was going to undergo gender reassignment surgery.

The decision, which was written by Judge Gorsuch essentially states that one cannot discriminate against an individual on the basis of their being gay or transgender and not offend Title VII’s prohibition on sex-based discrimination.  This ruling settles years of contradictory administrative interpretations and enforcement of sex-based discrimination under Title VII.  While most states have settled this issue by enacting state-level prohibitions on discrimination on the basis of sexual orientation or gender identity, this definitively ensures the protections of entire classes of individuals who were previously unprotected by the law.

Employer are encouraged to revisit all policies, procedures, and practices to ensure that they are compliant with the U.S. Supreme Court ruling.  As always, members are encouraged to contact the American Ambulance Association to obtain compliance assistance.

Nominate Your Rising Leaders! 40 Under 40 Due Jan 31

The American Ambulance Association is seeking nominations for its inaugural Mobile Healthcare 40 Under 40! This is your opportunity to recognize exceptional rising leaders as the future of EMS.

Nomination Instructions

To submit a nomination, please complete the form below. Nominations are due January 31, 2020. Incomplete nominations cannot be considered.

Timeline

Nominations are due January 31, 2020. Incomplete nominations cannot be considered. Honorees will be selected by the AAA Membership Committee and announced in February 2020.

Selection Process & Criteria

Honorees will be selected based ONLY on the information provided in their nomination form. Nominees should have contributed to their organization, state ambulance association, AAA, other professional associations, and/or the EMS profession in an extraordinary way beyond faithful completion of job duties. Please be sure to include detail about the nominee’s impact to date and future promise.

Please note that nominees must be under 41 on December 31, 2020 (meaning that they cannot turn 41 in 2020). No specific job role or title is required for consideration.

Recognition

Honorees will be recognized on the American Ambulance Association’s website and social media platforms. Winners will also receive complimentary registration to the 2020 AAA Annual Conference & Trade Show in Las Vegas, Nevada November 2–4.

Thank you for helping AAA recognize the young leaders of EMS!

July Brings Legal Changes for Employers in Many States

Oregon Statewide Transit Tax

Important notice to ambulance service employers based in the state of Oregon: there is a new statewide transit tax taking effect on July 1, 2018. Beginning July 1st, employers must start withholding a tax of 1/10th of 1% from the wages of Oregon residents or from non-residents who perform services in Oregon. The Department of Revenue has published detailed information on the statewide tax with a list of available resources to assist employers with compliance.

Iowa Lowers Standard for Positive Alcohol Tests

Effective July 1, 2018, Iowa employers may lower their standard for taking employment action for positive alcohol tests from the old state standard of .04 to .02. Iowa has one of the strictest employment drug and alcohol testing requirements in the country. Employers are required to have a written policy that is distributed to all employees and job candidates for their review. Employers must establish a drug and alcohol awareness program alerting employees of the dangers of drug and alcohol use in the workplace, and most employees must be provided an option to enter a rehabilitation program instead of being disciplined. In addition, all supervisory staff must attend a two-hour initial drug and alcohol training and a one-hour annual refresher.

Rhode Island Paid Sick Leave

Rhode Island has followed a growing list of states and municipalities that have enacted paid sick leave for employers with 18 or more employees. In October, the Health and Safe Families and Workplaces Act was signed by Governor Gina Raimondo. The new paid sick leave law takes effect July 1, 2018. Under the new law, employees will accrue one hour of paid sick time for every 35 hours worked, up to a maximum of 24 hours in a calendar year in 2018. That rate will increase to 32 hours in 2019 and 40 hours in 2020.

Under the new law, employers must allow employees to use paid sick time for the employee’s or employee’s family members illness, injury, or health condition; when the employee’s workplace or child’s school is closed due to a public health emergency; or for reasons related to domestic violence, sexual assault, or stalking. Employers cannot take adverse employment action against employees utilizing leave under this Act.

Employers need to prepare by amending any relevant paid time off policies, ensuring that there is an adequate mechanism for tracking the accrual and use of paid sick leave, and educating all management staff on the provisions of the new paid sick time law to ensure compliance. The new Sick Time Regulations provide additional compliance guidance.

Pay History Inquiries

Effective July 1, 2018, a new law in Vermont prohibits employers from making salary history inquiries from job candidates. Vermont joins several other states and municipalities that have enacted pay equity measures.

Joining the State of Vermont, the City of San Francisco has enacted a ban on asking job applicants about their salary or pay histories. The Parity in Pay Ordinance, signed by May Ed Lee, takes effect on July 1, 2018. The Ordinance bans employers, including City contractors and subcontractors, from considering current or past salaries in hiring candidates for employment. In addition, the Ordinance prohibits employers from asking job applicants about pay history or disclosing a current or former employee’s salary history without their authorization. A statewide ban on asking applicants about their pay histories took effect this past January.

It is recommended that employers in all states, whether legally prohibited or not, remove any reference on their job applications to an employee’s current or past wage/salary. In addition, employers should amend their pre-hire process to eliminate any pay history inquiries. This will provide employers with the best protections against allegations of pay discrimination claims.

Massachusetts Pay Equity

Back in August, 2016, Governor Baker signed An Act to Establish Pay Equity (MEPA) which takes effect on July 1, 2018. The new law is aimed at ending discrimination in the workplace by ensuring that individuals who perform “comparable” work earn competitive salaries. Additionally, the bill prohibits employers from making salary or wage history inquiries with job candidates and provides protections for employees to freely discuss their salaries with other employees.

The new law is aimed at preventing the perpetuation of past employer discriminatory pay practices by prohibiting the employer from basing a salary decision on the candidate’s current or past salary. Employers need to ensure that there are no inquiries on their employment applications or requested during the pre-hire process. Additionally, employers should amend any policies and procedures that might discourage employee discussions about wages.

Lastly, employers should perform a pay equity audit to identify potential wage disparities that may exist in their workplace. Employers who perform a good-faith, reasonable self-evaluation to identify pay disparities will be able to assert an affirmative defense to claims of violations of the Act. The Massachusetts Attorney General has issued guidance and a pay equity toolkit to assist employers with compliance.

California Expands National Origin Discrimination Protections

Effective July 1, 2018, amendments to the California Fair Employment and Housing Act (FEHA) will expand the national origins protections for employer discriminatory practices for applicants and employees to include:

  1. physical, cultural, or linguistics characteristics associated with a national origin group;
  2. marriage to or association with persons of a national origin group;
  3. tribal affiliation;
  4. membership in, or in association with, an organization identified with or seeking to promote the interests of a national origin group;
  5. attendance or participation in schools, churches, temples, mosques, or other religious institutions generally used by persons of a national origin group; and
  6. name that is associated with a national origin group

The Regulations provide protections that include prohibitions on employees adopting “English only” language rules in the workplace, unless the restriction is justified by business necessity, narrowly tailored, and was meaningfully communicated to employees. Discrimination based on an employee’s accent, height and weight (unless job-related and consistent with business necessity), and immigration status.

2018 OSHA Electronic Injury Reporting Deadline

Last year we notified AAA members that they must begin electronically reporting their workplace injury data to OSHA starting December 1, 2017 for 2016. This is just a reminder to all employers that they must electronically report their 2017 workplace injury data through the OSHA Injury Tracking Application (ITA) no later than July 1, 2018. Previously, for employers who had state-level work injury provisions, OSHA did not require injury reporting until the state enacted the appropriate tools to collect the injury data. This has changed, as OSHA announced on April 30, 2018 that employers in states that have not completed the adoption of a state rule yet must also report their 2017 injury data through the OSHA ITA. If any member has not set up their account with OSHA on the ITA, we strongly suggest that you do so immediately. The AAA can assist members in ensuring that they are compliant with this reporting requirement.

Georgia Hands Free Law

Georgia has enacted the Hands-Free Georgia Act (House Bill 673) which becomes effective July 1, 2018. The law makes it illegal for all motor vehicle drivers to “physically hold or support, with any part of his/her body” a wireless device. In addition, drivers are prohibited from writing, sending, or reading any text-based communications, including instant messages, email, or internet data usage. The law requires that a driver utilize an earpiece or hands-free device for all purposes while driving and may not touch their device. This includes utilizing any device for navigational purposes, even while stopped at a traffic signal.

There are exceptions to the new law for reporting traffic accidents: medical emergencies, fires, criminal activity, or hazardous road conditions. The exceptions do include first responders, including EMS agencies during the performance of their official duties. I believe that it is important for agencies to provide very clear communications regarding mobile device usage. I strongly suggest that any employee guidance states that the use of hand-held devices be limited to what is required to facilitate or affect patient care. It is recommended that when the use of a device is necessary, the technician or dispatcher make the notification, provided it does not interfere with monitoring or providing direct care to the patient. For more information or guidance visit the Heads Up Georgia website.

South Dakota Data Breach Law

South Dakota has enacted a new Data Breach Notification Law (SB62) for any entity conducting business in South Dakota that has or retains computerized personal or protected information of South Dakota residents. The law has a very broad definition of personal information and includes “social security numbers, driver’s license numbers, credit card or financial information, health information, identification numbers assigned by an employer for authentication purposes, username or email addresses with passwords, security questions, etc.”

The breach notification obligation attaches when the information holder reasonably believes that personal or protected information has been acquired by an unauthorized person. The law states that they must notify the affected individual within 60 days. Breaches affecting 250 or more individuals must also be reported to the South Dakota Attorney General. If the information holder reasonably believes that the breach will not likely result in harm to the affected individual, no disclosure is necessary provided they investigate and maintain documentation of the investigation for at least three years. Employers should review their data privacy policies and practices to ensure they comply with the new law.

Vermont Recreational Marijuana

Starting July 1, 2018, the State of Vermont has legalized recreational marijuana under a measure passed by the Vermont legislature (H.B. 511). The new law permits residents to grow and possesses up to one ounce of marijuana without facing criminal penalties. This law does not prohibit employers from having policies that prohibit marijuana use. The law also provides that employers do not have to accommodate the use or transportation of marijuana in the workplace. However, employers are advised to review their current workplace drug policies and practices to ensure that their practices are consistent with the new state law.

Vermont has a long-standing prohibition of random drug testing of employees, except when required or permitted under Federal law. Under Federal law, Federal contractors and grantees must maintain a drug-free workplace under the Drug Free Workplace Act. It is important that employers seek legal consultation if an employee notifies the employer that they are using marijuana for a condition that might qualify as a “disability” under the Americans with Disabilities Act (ADA). The Vermont Attorney General has published a Guide to Vermont’s Laws on Marijuana in the Workplace to assist employers with compliance.

Build Your Future with a Career in EMS

The U.S. Bureau of Labor Statistics expects career opportunities for EMTs and Paramedics to grow another 15 percent by 2026, far outpacing most other professions… With EMS agencies hungry for skilled providers, there has never been a better time to chart your career path in mobile healthcare.

This week, an editorial from AAA President Mark Postma was featured in a special Media Planet section on healthcare careers. Read the full article►

SHRM: 65% of EEOC Cases Resolved Without Cause

If you ask most healthcare attorneys the best way for healthcare providers to avoid being sued is to listen to their patient, communicate clearly, and most importantly, be nice. The same can be said for employment related legal actions.  In a great article released by the Society of Human Resource Management (SHRM), suggests that over 65% of the cases filed with the Equal Employment Opportunity Commission (EEOC) were found to be resolved without “reasonable cause”. Just like with the provision of healthcare, employers can often avoid time consuming and costly employment litigation by making sure that the leadership and management team communicates clearly to employees about performance expectations, listens to employee concerns or feedback, and possibly most importantly, treats their employees nicely regardless of the message they are delivering. The employment relationship is just like any other human relationship. Those where there is mutual respect and appreciation yield the richest experience.

How to Stand Out Using Low-Cost Recruitment, Retention Strategies

Scrolling through Facebook, I regularly notice EMS providers seeking feedback from friends and colleagues. Someone will post, “Hey, I’m moving to this city. Does anybody know some good ambulance services that are hiring?” Plenty of people will respond, “This is a pretty good place.” Others share warnings such as, “Don’t work for Provider X.” Word of mouth can be valuable for any EMS. What current and former employees say about their positive work experience is a major benefit to recruitment and retention. In order to ensure a top-notch service to customers and to attract top-tier employees, recruitment and retention must be at the top of the to-do list. This is important for both public and private EMS departments. With negative word of mouth, unless somebody is desperate to get a job, “Provider X” in the example above won’t receive a second look from applicants. While some services use salary as a major recruitment and retention tool, it’s not the only way to stand out. There are various low-cost strategies to employ when it comes to recruiting and retaining employees.

Moving on up

Opportunities for advancement are one attractive benefit. In a fire service, providers often begin their tenure as a fire service paramedic. They can take a test to become a paramedic lieutenant. If a space opens up, a person can test to be a paramedic captain or eventually paramedic chief. In private ambulance services, the organizational structure is often different. Provide an infrastructure for improvement is of the utmost importance. For many professionals, that upward mobility is gained through education. Offering more knowledge benefits both parties and has an impact across the continuum of care. The advanced education benefit allows providers to offer better care and to communicate better with colleagues in other healthcare disciplines about a patient’s care. This builds loyalty among employees toward a service that continues to invest in their skills.

Some organizations may avoid providing education while on the clock. Advanced planning ensures coverage while expanding the team’s skills. Work with your team to determine the most convenient time and day for the provider and the EMS to obtain educational opportunities.

Learning curve

An EMS department can offer a number of educational opportunities — starting with all the necessary courses to maintain certification — to expand a provider’s knowledge.
Some of the options include the following:

  • Tuition reimbursement for college
  • Flight paramedic, critical care or tactical paramedic certifications
  • Critical care continuing education

These certifications make providers, and the service they work for, stand out above the crowd. Think of the added benefit of saying, “All of my paramedics are critical care paramedics.”

To recruit or to retain

So what comes first – recruitment or retention? That depends on the needs of an individual service. If a service, for example, is 10 people short, filling those spots is paramount. If there aren’t any open spots, concentration turns to keeping the providers you have satisfied and offering the best service possible. These providers are valuable because they are most familiar with your area, contracts and how your service does business. Whether recruitment or retention is the goal, the following perks may help candidates choose your organization over competitors:

  • Free uniforms
  • Recognition awards, dinners, picnics and other company events
  • Colleague referral programs
  • Discounts for services and products, such as gym memberships, travel, etc.
  • Tax breaks for EMS volunteer hours (in some states)

While some services rely on a quick increase in salary as their only tactic, recruitment and retention is impacted by much more. Finding and incorporating multiple ways to value your providers and their contributions is the most beneficial path to follow.

HR Wrap-Up: A Look Back at 2016

As we wind up 2016 I thought it would be a good idea to review the year’s human resource and legal developments to ensure that our members are compliant and prepared for what faces them in 2017.  We knew that this was going to be an interesting year as we experienced the most unusual Presidential Election in our history.  It overshadowed everything else that occurred in 2016.  As the Obama administration comes to its final days, employers and ambulance providers saw some of the most sweeping regulatory changes.

Fair Labor Standards Act (FLSA)

The biggest change facing employers in 2016 was the Fair Labor Standards Act (FLSA) overtime changes.  The Department of Labor (DOL) issued updated regulations which were to become effective December 1, 2016, raising the minimum salary thresholds for the so called “white collar” exemptions.  Under the new regulations, the minimum salary would increase from $455 to $970 per week.  For those employees earning under the new amount, employers would need to decide if they are going to raise the salary level or pay the employee overtime for hours worked over 40 in one week.  The changes have not gone into effect yet as a 5th Circuit Judge issued an injunction on the implementation of the new Regulations until the question of their legality is determined.

Most employees in the ambulance industry are hourly paid employees and the Regulatory changes are will not affect their overtime eligibility.  However, ambulance providers should take these changes as an opportunity to evaluate each position within their organization and ensure that any exempt position is appropriately classified.

Civil Penalty Changes

This past August the Department Of Labor published two interim final rules that adjusted the penalties for enforcement actions by several of its agencies.  The penalties increased because Congress passed the Federal Civil Penalties Inflation Adjustment Act in 2015 last November with the intent of improving the effectiveness of civil monetary penalties and hopes of maintaining their deterring effect.  Many agency penalties had not been adjusted since 1990.

The new penalties will only be applicable to penalties assessed after August 1, 2016 for violation that occurred after November 2, 2015.  The DOL posted a chart detailing all of the penalty increases.

Posting Changes

Many of the mandated employer postings also experienced a change this year as a result of the FLSA Regulation updates and because of the Civil Penalty increases.  Employers need to be sure to update the required Federal employment postings in their workplaces.  The new postings are available on the Department of Labor’s website free of charge.  Alternatively, many employers purchase the all-in-one combination Federal and State posters from third party vendors.  Whether obtained from the DOL or from a vendor, the postings need to be updated to reflect these new changes.

Fair Labor Standards Act (FLSA)

The required FLSA posting will reflect the change to the classification of employees, requirements for nursing mothers, and updated enforcement section.  The new posting also removes the prior reference to a specific penalty amount as the penalties will adjust at regular intervals under the penalty adjustment changes.

Occupational Health & Safety Act (OSHA)

In May, the AAA published an advisory notifying members about upcoming changes to the reporting requirements under OSHA, including provisions regarding the notification to employees of non-retaliation for those who file work injury or illness claims.  The non-retaliation notice provisions became effective November 1, 2016.  The new OSHA posting reflects the notice to employees regarding the non-retaliation provisions.

Employee Polygraph Protection Act (APPA)

Like the FLSA posting, the Employee Polygraph Protection Act (EPPA) posting has changed to reflect the removal of a specific penalty amount.  The new EPPA posting can be found on the DOL’s website.

Transgender

One of the more active debates during the end of 2015 and for most of 2016 was an issue not directly related to employers but that had significant impacts on employers was the North Carolina House Bill 2.  HB 2 was sweeping legislation that required restroom and locker room facilities be utilized by individuals based upon the gender listed on their birth certificate.

In May, the Department of Justice filed a Civil Rights suit against the State of North Carolina and its Governor stating that the legislation was “state sanctioned discrimination” and was illegal.  After several legal challenges it appears that the legislation will be repealed by the new North Carolina administration.  Even without the repeal of the legislation employers were on notice that all Federal regulatory agencies included transgender rights as protected under Title VII and subject to the law.

This is notice to employers that they need to allow all employees to utilize the restrooms and changing facilities that are consistent with their gender identity.  The best practice for employers is to provide privacy for all individuals, whether or not they are in a gender specific facility.  This means that restroom and shower facilities should provide as much privacy as possible.  This could include installing privacy strips to restroom stalls, large partitions between urinals, and privacy curtains for showers.  Employers should not assume that individuals born the same gender are comfortable with or do not seek the same privacy in these setting as do individuals of different genders.  The message should be to respect the privacy of all individuals regardless of their gender or gender identity.

Affordable Care Act (ACA) Section 1557 Rules

This past July new Regulations, which implement Section 1557 of the Affordable Care Act (ACA), became effective.  The provisions of Section 1557 build off of existing Title VII and other discrimination laws that extend protections to previously underserved or under-represented groups of people with regard to healthcare.  The new Regulations prohibit discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs or activities.  In addition, the Regulations provide discrimination protections on the basis of pregnancy, gender identity, and sex stereotyping.  The Final Rule also requires that “covered entities” make available assistance for individuals with Limited English Proficiency (LEP) and those with disabilities, including communications related disabilities.

The new Regulations require that covered entities have a Compliance Coordinator and a Grievance Procedure.  The Compliance Coordinator is to monitor and coordinate compliance with the provisions of the Final Rule.  The Grievance Procedure has to provide the appropriate due process standards that would allow for the prompt and equitable resolution of complaints concerning actions prohibited by Section 1557.  HHS has included a sample Grievance Procedure in Appendix C to Part 92—Sample Section 1557 of the Affordable Care Act Grievance Procedure  to assist covered entities in meeting this requirement.

In addition, the Regulations require that all covered entities post notices assuring patients that the covered entity does not discriminate on the basis of race, color, national origin, sex, age, or disability and that auxiliary aides and services for individuals with Limited English Proficiency (LEP) and Communication related disabilities.  To alert these individuals, ambulance providers must post a notice regarding the availability of these aids and services in the top 15 languages spoken in the state of operation.

A Look Ahead to 2017

OSHA

Starting in 2017, employers will be required to electronically report work related injuries to OSHA.  The AAA posted information about this new requirement last week.  Employers should anticipate increased OSHA investigatory activity following this first year of injury reporting.  Currently, OSHA obtains the majority of their injury data from employee complaints or on site visits.  These new reporting requirements are intended to persuade employers to be more proactive with regard to workplace safety.  As we learn more about the tools OSHA will utilize to collect this information, we will notify members.

EEO-1 Pay Reporting

The Equal Employment Opportunity Commission (EEOC) and the Office of Federal Contract and Compliance Programs (OFCCP) have approved a new EEO-1 Form that will be used starting with the 2017 report, which will be due on March 31, 2018.  The new report requires private employers, including federal contractors and subcontractors, with 100 or more employees to submit summary pay data on the EEO-1 Form.  Federal contractors and subcontractors with 50-99 employees will not submit summary pay data but will continue to report demographic data (sex and race or ethnicity) on the EEO-1 as they did before.  Also, Federal contractors and subcontractors with 49 or fewer employees, and companies without federal contracts with 99 or fewer employees, will not be required to complete the EEO-1 report.  The goal is to remove the pay inequities amongst different protected classes.

Employers will have some time to make the necessary changes to their systems to ensure that their systems can collect and report this data.

Minimum Wage Increases

There are 21 states that are going to have a minimum wage increase in 2017.  While most of our industry pay rates are above the minimum wage amounts.  Services should check their state minimum wage to ensure that their mandated minimum wage pay and postings are up to date.

New Form I9

Just a reminder that employers will be required to use the new Form I9 for all employees hired on or after January 22, 2017.  The USCIS announced last month that it has updated the Form I9 and for employers to begin utilizing these forms no later than January 22, 2017.  For more information on the new Form I9, view the IRS Press Release announcement posted last month.

New W2 Reporting Requirements

Employers need to be aware that the Internal Revenue Service (IRS) has moved up the date that employers have to file their Form W2 with the IRS.  Previously, employers had until the end of February to file their Form W2s with the IRS.  Under the new deadline, employers must file all Form W2 by January 31, 2017.  The January 31st deadline has long applied to furnishing of the Form W2s to their employees.  For more details on the new filing deadline, read the IRS Announcement.

Signing Off for 2016

This has proven to be an incredibly busy year for all employers, including ambulance providers.  AAA Members should remember that there are numerous resources available through the AAA in the Member Area on the website, through AAA Staff and Consultants, and also with the hundreds of members who are all working together to care for the patients and communities we serve.  Do not face the challenges in your organization alone.  Your membership brings with it a great deal of tools and resources so that you can focus on providing your patient with outstanding service.  Happy New Year.

 

Older USCIS E-Verify Records to Be Deleted

The U.S. Citizenship and Immigration Services (USCIS) will be deleting records from the E-Verify system that are ten years old or older.  For employers who have been using the E-Verify system since 2006, you may wish to download and archive any records before the end of this year.  These records could be useful for an employer in the event an employer is audited.  The USCIS will delete those records in March, 2017.  For more details on why it is important to archive this data, see the Society for Human Resources Management article.

Video: Employee Feedback Tears & Fears

American Ambulance Association’s human resources expert, Scott Moore, delves into strategies for managing unprofessional responses to the feedback you provide your employees. A must-watch for supervisory and management staff of all levels!

Have a question for Scott? AAA members, submit your requests today via our HR & Operations Consultation form!

New I9 Form Must Be Used By January 22

On November 14, the United States Citizenship and Immigration Services (USCIS) published a revised I9 Employment Eligibility Verification form. Ambulance services (and all other employers) must implement the new version of the form by January 22, 2017.

The updated form is easier to complete on a computer, and includes clarified instructions and extra space for additional information.

Get full details on the USCIS site.

ACA Section 1557: Final Rule Published that Affect Healthcare Providers

This past July, the AAA advised our members about new Section 1557 Non-Discrimination provisions of the Affordable Care Act (ACA) impacting ambulance providers that became effective on July 18, 2016.  On May 13, 2016, the Department of Health & Human Services (HHS) published the Final Rule aimed at improving access to care and eliminating discrimination and inequities in the provision of healthcare services.  At that time we identified several provisions in the new rules that we felt ambulance providers might have difficulty complying with.  The AAA requested some guidance from the Office of Civil Rights (OCR) regarding these challenges and had some dialogue with representatives from that office this past week.

Please be sure to review the July Advisory on the AAA Website for a detailed explanation of the rule requirements.   As a brief review, the new ACA Section 1557 rules build off of existing Title VII and other discrimination laws that extend protections to previously underserved or under-represented groups of people with regard to healthcare.  The new Regulations prohibit discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs or activities.  In addition, the Regulations provide discrimination protections on the basis of pregnancy, gender identity, and sex stereotyping.  The Final Rule also requires that “covered entities” make available assistance for individuals with Limited English Proficiency (LEP) and those with disabilities, including communications related disabilities.

Provisions of the Rule

The Rule requires that covered entities, including ambulance providers, with 15 or more employees to name a Compliance Coordinator and establish a Grievance Procedure.  The Compliance Coordinator is to monitor and coordinate compliance efforts with regard to the provisions of Section 1557.  The Grievance Procedure has to provide the appropriate due process standards that would allow for the prompt and equitable resolution of complaints concerning actions prohibited by Section 1557.  HHS has included a sample Grievance Procedure in Appendix C to Part 92—Sample Section 1557 of the Affordable Care Act Grievance Procedure  to assist covered entities in meeting this requirement.

In addition, the Rule requires that all covered entities make available (post) notices to patients and members of the public assuring them that the covered entity does not discriminate on the basis of race, color, national origin, sex, age, or disability.  Required in the notice is that the covered entity has a Grievance Procedure and a Compliance Coordinator for those who feel that they may have been discriminated against.  In addition, the notice must include the accessibility of auxiliary aides and services for individuals with LEP and those with communication related disabilities.  HHS has included a sample notice that covered entities can utilize to meet these notice requirements.  Also, providers are required to post tag-lines regarding non-discrimination and the availability of auxiliary aides in the top 15 languages spoken in the state that they provide services.

During our discussion with representatives from OCR, we explained that ambulance providers would have little difficulty complying with the Compliance Coordinator and Grievance Procedure requirements of the new rule but that the notice requirements would be a bit more challenging.  We explained that, as mobile healthcare providers, patients do not generally come to our ambulance stations to access care but that we usually encounter patients on the scene of an accident or in a patient’s home.  We expressed our concern that merely posting notices at our ambulance stations locations would not likely meet compliance with the new rules.  OCR agreed with our concern and acknowledged that the Section 1557 provisions had been drafted with conventional “brick and mortar” healthcare providers in mind.

During the dialogue, we notified OCR that we have advised members to post the required notices at their physical locations, on their company websites, and in any other way that is feasible given our unique healthcare delivery model.  We discussed the difficulties with placing the notice in the vehicle and the many reasons why this was not a viable option, which OCR acknowledged as presenting a unique challenge.

Bottom Line

While OCR did not provide us with a reprieve from the notice requirements of the new rule, staff did state that our members needed to use “reasonable” efforts to provide a meaningful notice to our patients.  While not the specific guidance we had hoped for, it is an acknowledgement that our healthcare delivery model presented practical challenges with these specific requirements.  It is also possible that OCR issues more definitive written guidance in the future, but that is not likely to come until after the new Administration takes shape.

Takeaways

It goes without saying that member companies should already comply with Compliance Coordinator and the Grievance Procedure provisions of the rule.  With regard to the notice provisions, member companies need to post the required notices at any station location and on their company websites in a conspicuous place.  Also, that member companies post the required notices and taglines in a on any “significant publications or communications” that the company provides or distributes to patients or the public that they serve.  The guidance did not define a “significant publication” but states that postcards and small pamphlets would not be considered “significant.”

More practically, given the nature of our industry, services should add language to any written correspondence that they have with the patient.  For example, services can add the required notices and taglines to the patient signature process.  Not that the patient has to sign off on the Sect 1557 notices but have the required notices and taglines precede the patient authorization signature language on your trip record.  In addition, services should include the notice requirement to any correspondence or invoices sent to the patient.

Member companies may consider that the “reasonableness” of their efforts to provide notice may differ for emergency and non-emergency patients.  Not all of the patients our members encounter are in emergency situations on a busy roadway.  Typically, non-emergency patients have lower sense of urgency and the field providers may be able to more meaningfully provide notice to the patient of the non-discrimination provisions, grievance procedure, and the availability of auxiliary aides and services for patients with LEP and communication related disabilities.  This can be done in a number of ways.

It is important that an ambulance provider be able to demonstrate that they made “reasonable efforts” to ensure the patient has access to care free from discrimination, understands that the company has a grievance procedure in the event that they feel like they have been discriminated against, and that the company will make available to them the auxiliary aides and services if they have LEP or communications related disabilities.  OCR appears to be focusing their efforts on helping providers become compliant rather than any draconian enforcement approach.

Non-Compliance & Penalties

OCR has generally adopted a position of assisting covered entities with compliance with the rules.  Their office is a resource for our all covered entities whose intent is to comply with these new rules.  However, providers who fail to make reasonable efforts or who continue to be non-compliant after identifying issues, should be aware that guidance available on the OCR website states that it will utilize enforcement mechanisms which include:

“The existing enforcement mechanisms under Title VI, Title IX, Section 504 and the Age Act apply for redress of violations of Section 1557. These mechanisms include: requiring covered entities to keep records and submit compliance reports to OCR, conducting compliance reviews and complaint investigations, and providing technical assistance and guidance.”

“Where noncompliance or threatened noncompliance cannot be corrected by informal means, available enforcement mechanisms include suspension of, termination of, or refusal to grant or continue Federal financial assistance; referral to the Department of Justice with a recommendation to bring proceedings to enforce any rights of the United States; and any other means authorized by law. The final rule also recognizes that an individual may bring a civil action to challenge a Section 1557 violation”

Conclusion

If you still have questions regarding what your organization’s obligations are under the ACA Section 1557 rules are, please do not hesitate to reach out to the AAA or to the Office of Civil Rights with the U.S. Department of Health & Human Services.

Coming soon for AAA members: Employee Background Screening

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