The Centers for Medicare and Medicaid Services (CMS) is moving forward with its Patients over Paperwork initiative, which was created in accordance with President Trump’s Executive Order directing federal agencies to reduce burdensome regulations in order to improve the patient and provider experience, and the health care system as a whole. On September 26, 2019, CMS passed the Omnibus Burden Reduction (Conditions of Participation) Final Rule (Final Rule), with the goal of removing CMS regulations that have become extraneous or burdensome on health care providers, allowing providers to increase and improve focus on patients. CMS estimates savings resulting from the Final Rule will be 4.4 million hours of time, and $800 million annually. The Final Rule was published on September 30, 2019, and goes into effect 60 days thereafter. Hospitals and Critical Access Hospitals (CAHs), however, have six months to implement antibiotic stewardship programs and CAHs have eighteen months to implement Quality Assessment and Performance Improvement (QAPI) programs.
Continue Reading CMS Passes Final Rule Reducing Regulations Burdensome on Health Care Providers

The New York Senate and Assembly recently passed Senate Bill S2844B to strengthen current laws for employees who are victims of wage theft to secure and collect unpaid wages from their employers for work already performed. This bill would amend five sections of the law (Lien Law; Labor Law; Attachment under the Civil Practice Law and Rules; the Business Corporations Law; and the Limited Liability Law). If signed by the Governor, this bill would create a broad right for any employee to obtain a lien on an employer’s property based on the allegation of a wage claim and would significantly increase employee power in such disputes.
Continue Reading New York Legislature Passes Bill Allowing Employees to Place a Lien on Employer’s Property for Wage Claims

On June 13, 2019, Connecticut Governor Ned Lamont signed into law Public Act No. 19-19 “An Act Concerning Epinephrine Auto Injectors” (PA 19-19), which went into effect on the same date.

This legislation expands access to epinephrine, which can be lifesaving when treating anaphylactic allergic reactions. PA 19-19 permits “authorized entities” to acquire and maintain a supply of epinephrine cartridge injectors, subject to certain conditions. With a few exceptions, authorized entities are for-profit or nonprofit entities or organizations that employ at least one “person with training.”
Continue Reading Connecticut Enacts Law to Increase Access to Epinephrine Auto Injectors

On March 26, 2019, the New York Court of Appeals upheld the state Department of Labor’s (the DOL) so-called “13-hour rule” governing payment of home health care aides who work 24-hour shifts. In a closely-watched decision with significant ramifications for the state’s home health industry,  New York’s highest court reversed two 2017 appellate decisions that had overturned the DOL’s  rule and caused substantial uncertainty for home health providers throughout the state.  In short, the New York Court of Appeals confirmed that New York home health care aides may be paid for 13 hours of a 24-hour shift, as long as the aides are given eight hours of sleep time (with five of those being uninterrupted hours) and three hours of meal breaks.

As background, in New York home health aides who work 24-hour shifts have been treated as “live-in employees” for purposes of New York’s Minimum Wage Order regulation (the Wage Order). Under the DOL’s interpretation of the Wage Order, employers were not required to pay an aide for each hour of a 24-hour shift as long as the aide was given up to eight hours of sleep time (with at least five of those hours uninterrupted) and three hours for meal breaks. The DOL most recently affirmed its interpretation via an opinion letter issued in March 2010, which states in pertinent part that “it is the opinion and policy of this Department that live-in employees must be paid not less than for 13 hours per 24-hour period provided that they are afforded at least eight hours for sleep and actually receive five hours of uninterrupted sleep, and that they are afforded three hours for meals.” This recognition of the 13-hour rule for live-in employees was consistent with positions taken by the DOL in previous decades.
Continue Reading New York Court of Appeals Upholds Thirteen-Hour Rule for Home Health Aide Pay

On October 11, 2018, the Occupational Health and Safety Administration (OSHA) issued a memorandum to clarify its position regarding whether drug testing policies and safety incentive programs would be considered violations of OSHA’s regulations. Employers may recall that, in May 2016, OSHA published a final rule that, among other requirements, prohibited employers from retaliating against employees for reporting work-related injuries or illnesses. That portion of the final rule became known as the Anti-Retaliation Rule. Almost immediately, there was confusion over which workplace safety incentive programs and post-incident drug testing policies, if any, were permissible under the final rule. OSHA originally took the position that certain programs and policies could deter employees form reporting work-related injuries and illnesses, thus violating the Anti-Retaliation Rule. OSHA has now clarified that the Anti-Retaliation Rule does not prohibit workplace safety incentive programs and post-incident drug testing.
Continue Reading OSHA Clarifies Position On Anti-Retaliation Rule

Workplace violence is a risk at any health care workplace. Whether from patients, residents, clients, or employees. The Occupational Safety and Health Administration (“OSHA”) estimates that three quarters of all workplace assaults reported annually – approximately 19,000 – occurred in health care and social service settings.

While OSHA does not have any specific regulations addressing violence in the workplace, OSHA’s General Duty Clause applies to covered employers and requires they provide their employees with a place of employment that is “free from recognized hazards that are causing or are likely to cause death or serious harm.” It is OSHA’s position that the General Duty Clause imposes a legal obligation upon an employer to provide a workplace free of conditions or activities “that either the employer or industry recognizes as hazardous and that cause, or are likely to cause, death or serious physical harm to employees when there is a feasible method to abate the hazard.”

In recent years, OSHA has published guidelines to the health care community – Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers – with specific recommendations to prevent violence in health care workplaces. OSHA also has a webpage dedicated to workplace violence, which provides helpful guidance and training materials.

In an effort to further assist health care organizations better prevent and address violence in their workplaces, in April the Joint Commission released a Sentinel Event Alert addressing physical and verbal violence against health care workers. The Joint Commission accredits and certifies health care organizations and programs in the United States.


Continue Reading Recent Joint Commission Guidance Recommends Steps for Health Care Organizations to Reduce Workplace Violence

On September 11, 2017, the Ninth Circuit in US and State of Nevada ex rel. Welch v. My Left Foot Children’s Therapy, LLC, upheld the denial of the defendant’s motion to compel arbitration in a False Claims Act (FCA) relator case, holding that an employee-relator’s FCA claims did not fall within the scope of the arbitration agreement with her former employer.  The FCA claims were based on allegations that the employer had filed fraudulent Medicaid claims.

The Court first looked to the Federal Arbitration Act (FAA) in determining that interpretation of the arbitration agreement would generally be a matter of state law.  Nevertheless, the Court also applied certain guiding principles of the FAA, including the rule as interpreted by the U.S. Supreme Court  that “’questions of arbitrability must be addressed with a healthy regard for the federal policy favoring arbitration’” (quoting Moses H. Cone Mem’l Hosp. v. Mercury Constr. Corp., 460 U.S. 1, 24 (1983)).

In issuing its ruling, however, the Court did not foreclose the potential for arbitration agreements to include FCA claims within their scope.


Continue Reading Ninth Circuit Denies Arbitration in a False Claims Act Case

In Stevens v. Rite Aid Corp., No. 15-277 (March 21, 2017), the U.S. Court of Appeals for the Second Circuit reversed a jury award of almost $2 million that had been awarded in favor of a pharmacist who had a fear of needles and could not comply with Rite Aid’s new policy that required pharmacists to administer immunization injections to customers.

In 2011, in an effort to fill a vaccination void in the healthcare market, Rite Aid imposed a new requirement that all pharmacists must administer immunizations.  Rite Aid revised its job description, requiring pharmacists to obtain valid immunization certificates and establishing immunizations as a part of the pharmacist’s essential job functions.

The plaintiff had worked for Rite Aid for 34 years.  After receiving notice of the new requirement, he presented Rite Aid with a note from his treating physician stating that he suffered from trypanophobia, a fear of needles.  His condition caused him to become lightheaded, pale, and feeling that he might faint.  The physician stated that the plaintiff could not safely administer an injection since the likelihood that he would faint would be unsafe for both the patient and the plaintiff.  Due to his trypanophobia, the plaintiff requested that Rite Aid provide him with a reasonable accommodation under the Americans with Disabilities Act.  A short time later, Rite Aid terminated his employment.
Continue Reading Appeals Court Reverses ADA Jury Verdict for Pharmacist with Fear of Needles