In The News

Run, Walk or Roll in 2022 Bob Doctor Fundraiser Virtual 5k!

When: Wednesday, September 28 - Sunday, October 9, 2022

The Bob Doctor Fundraiser is APTA CO's annual fundraiser done to honor the legacy of Bob Doctor and to raise support for the Colorado Chapter’s legislative advocacy activities. In addition to raising funds to support advocacy activities, proceeds of this event will also raise funds for scholarships given by the APTA CO Chapter. This year we will be holding a virtual 5K run/walk/roll fundraiser for all individuals throughout the state of CO to participate in! You will have from Wednesday September 28th through Sunday October 9th to complete the virtual 5K in your neighborhood, local park, gym, or wherever space you can think of!

You can either participate in a team or as an individual! The team who fundraises the most money will receive the Bob Doctor Trophy, and can display it in their clinic or school for the entire year.

Click here for more information & to register!


MedPAC Explores Standardized Plan Options in Medicare Advantage

Fierce Healthcare | By Robert King
Affordable Care Act (ACA) plans may not be the only ones to introduce standardized options, as a key advisory panel wants to apply a similar strategy to the popular Medicare Advantage (MA) program. 
The Medicare Payment Advisory Commission (MedPAC), which advises Congress on Medicare issues, is researching how standardized benefit options would work for MA. The goal is to include the findings in an annual report to Congress next year and explore how standardization could help simplify choice for seniors. 
“I think there’s some reasonable evidence about the challenges of choice,” said Michael Chernew, the commission chair, during the panel’s Thursday meeting.
MA plans are required to offer services under Medicare Parts A and B, but there are some differences based on cost-sharing and other supplemental benefit packages. The MA program has gained in popularity in recent years and with it an abundance of plan choices for seniors.
Commission staff gave an example of how standardized benefit packages work by breaking out three options based on how generous they were for cost-sharing. What types of plans would be subject to the standard package would have to be decided and could be vital.
“This requirement would aim to ensure a minimum level of access to standardized plans, but its impact could be limited if the plans that insurers are required to offer are unpopular,” said MedPAC staff member Eric Rollins.
Letting insurers offer both nonstandardized and the standard options could also help reduce any disruption for existing enrollees but could reduce any gains from standardization, he added. Only offering the standardized benefit plans, on the other hand, could cause too much disruption.
There could be a benefit to insurers, though, by avoiding paying a broker that guides seniors through different plan options. 
“There’s a huge financial incentive for them,” said commission member Lynn Barr.
However, some commission members were concerned about the impact standardization could have on plan innovation. 

Read Full Article 


House Passes Bill to Install Electronic Prior Authorization in Medicare Advantage Plans

Fierce Healthcare | By Robert King

 The House passed key legislation that creates an electronic prior authorization process for Medicare Advantage (MA) plans and other reforms aimed at a major headache for providers. 

The House unanimously passed the Improving Seniors’ Timely Access to Care Act on Wednesday via a voice vote. The legislation, which has new transparency requirements for MA plans, now heads to the Senate.

Lawmakers behind the legislation said in a joint statement the bill will “make it easier for seniors to get the care they need by cutting unnecessary red tape in the healthcare system,” said Reps. Suzan DelBene, D-Washington, Mike Kelly, R-Pennsylvania, Ami Bera, M.D., D-California, and Larry Bucshon, M.D., R-Indiana.

Prior authorization—where providers must first get insurer approval before performing certain services or making prescriptions—has increased in recent years much to the chagrin of providers who charge the process causes a massive administrative burden.

The House bill aims to require the establishment of an electronic prior authorization process for all MA plans to hasten the approval of requests. It would also require the Department of Health and Human Services (HHS) to create a process for faster, “real-time” decisions on the items or services that already get routinely approved.

Another new requirement is that MA plans must report to the federal government on how they use prior authorization, as well as the rate that such requests are approved and denied. The requirement comes as HHS’ watchdog found that MA plans have denied prior authorization claims for services that met Medicare’s coverage requirements.

The overwhelming House vote earned plaudits from several provider groups. 

“At a time when group practices face unprecedented workforce shortage challenges, 89% of [Medical Group Management Association] members report they do not have adequate staff to process the increasing number of prior authorizations from health insurers,” the Medical Group Management Association said in a statement. “By streamlining and standardizing the overly cumbersome and wildly inefficient MA prior authorization process, this legislation will return a focus to the physician-patient relationship.”

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Special Report — Complying with Wage and Hour Regulations (Part 3 of 3)

The SESCO Report July/August, 2022 (Part 3 of 3)

Common Misconceptions and Compliance Issues

SESCO is available through a Professional Service Agreement or through a per diem fee to conduct a thorough Wage and Hour as well as HR and employment law audit. Contact SESCO to learn more about our Professional Service Agreement and services provided to clients in all industries across the country — [email protected] or 423-764-4127.

Calculating Overtime

Misconception 8: We have multiple locations and at times require our employees to travel to other sites during their work day. We require them to clock out when they leave and clock back in when they arrive at the new location. As such, we do not have to pay for this drive/non-working time. Travel to and from work or travel outside the normal work day is generally not considered compensable time. However, travel time must be counted as hours worked to include:

- It is time spent traveling from one work site to another

- It is driving even after hours to fulfill an employer's requirements or requests such as going by the bank on the way home

- If the employee has gone home from work for the day but is called out again to travel, this would be compensatory.

Misconception 9: Sometimes we offer training to our employees. Since we are paying for the training and they are not doing any work, we do not have to pay our employees. Anytime an employer requires an employee to attend training during working hours, that time will be considered working time. Training is not considered hours worked if all of the following conditions are satisfied:

- Meetings are held outside of hours worked

- Employee attendance is completely voluntary

- If an employee does not show they are not disciplined in any way

- The training is not directly related to the employee's job

- The employee does no work during the training time

- The course or training is held after work hours and is not a requirement of the job even if the subject matter pertains to the job.

Misconception 10: We have to use a time clock or electronic timekeeping system to keep track of the hours of our nonexempt employees.

The DOL states that employers may use any timekeeping method that they choose. This would include allowing employees to record their hours of work by hand. Regardless of the method, SESCO always recommends that the employee and manager/HR Director sign off agreeing that true and accurate hours of work have been recorded.

Misconception 11: Our company supports our community in a number of different ways to include supporting charities. We recommend to our employees that they should volunteer. As it is not working time, we do not have to pay them.

Charitable work performed at the employer's request as part of the job or during working hours is considered work time. Charitable work/volunteering will not be considered hours worked if:

- It is completely voluntary (even if the program is sponsored by the employer)

- It is performed outside of scheduled working hours

If employees get the impression that their jobs would be in jeopardy in any way or that they would receive fewer perks for failing to contribute to charity work, a court could say that the hours were not voluntary but were coerced. In addition, employees cannot perform volunteer work for an organization that employs them if the work is similar to that for which they are paid.

Misconception 12: We pay our employees bonuses and incentives for things such as meeting production goals, good attendance, good safety goals, etc. We are not required to pay overtime on these additional earnings.

There are technically two (2) different types of bonuses which include discretionary and non-discretionary. Discretionary bonus payments are completely that, discretionary. These bonuses are not communicated to employees, employees are not working towards accomplishing goals to receive the bonus and these bonuses are not regular and recurring. Typically defined discretionary bonuses which would not be required in overtime calculations are such as Christmas bonuses. Non-discretionary bonuses are required to be included in overtime payments. Non-discretionary bonuses are bonuses that incentivize an employee's behavior or production. These monies must be included in the regular rate for the purposes of overtime. Even if these non-discretionary bonuses are paid on a monthly, quarterly or even an annual basis. An employer is required to go back and roll these non-discretionary bonuses into each workweek and calculate overtime on these bonuses. If your organization pays these non-discretionary bonuses to employees, you should contact SESCO to learn more about the calculation of overtime as well as request SESCO's staff recommendation which will provide an "easy" method to calculate the overtime due.


Colorado Issues Final Rules on Benefits and Employer Participation Requirements for Paid Family and Medical Leave Insurance Program, Clarifies Private Plan Option

Colorado’s rule making process regarding its new paid family and medical leave insurance program (“FAMLI”) continues. On August 26, 2022, the state published final regulations on benefits and employer participation requirements (“Benefits Rules”), which provide the most concrete guidance to date regarding the benefits to which employees will be entitled under the FAMLI program as of January 1, 2024. 

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