NYSDOH Rules No Private Practices Qualify for HWB Program

In response to questions from NYSDA, the New York State Department of Health (NYSDOH) has issued updated Frequently Asked Questions (FAQs) that make it clear that no private dental or medical practices, no matter how many Medicaid patients they serve, are eligible for the Health Care Worker Bonus (HWB) Program.  NYSDOH is taking the position that the statute requires the employer to be a facility like a dental clinic and that the facility must also serve at least 20% Medicaid patients, unless it is a facility that requires a Certificate of Need to get licensed.  Although the law could be interpreted otherwise, the NYSDOH interpretation of cumulating all the separately stated qualifications is plausible and it definitely saves the program money.  You can read the updated NYSDOH FAQs on the HWB Program below.

Q.  Please clarify the criteria necessary for an employer to be subject to the Healthcare Workforce Bonus (HWB) Program?

A.  The HWB statute provides two separate definitions of qualified employers, both of which are subject to the requirements of the HWB program.

Under paragraph (2)(b), an employer is subject to the HWB program if they meet all of the five following criteria:

  1. They are a Medicaid enrolled provider;
  2. They bill for Medicaid services (either through FFS, managed care, or a 1915(c) waiver);
  3. Employ at least one eligible employee;
  4. Are included in the list of provider and facility types in the statute; AND
  5. They serve at least 20% Medicaid enrollees OR are subject to a certificate of need (CON) process.

The Department of Health is not prescribing a specific methodology to determine the 20% Medicaid threshold criteria.  Employers must determine whether their organization complies with this requirement as part of the employer attestation required for HWB claim submission.


Q.  Please clarify the types of employers eligible for the HWB Program?

A.  Paragraph (2)(b) identifies employers eligible for the program, and are limited to:

  • Providers and facilities licensed, certified, or otherwise authorized under:
    • articles 28, 30, 36 or 40 of the public health law
    • articles 16, 31, 32 or 36 of the mental hygiene law
    • article 7 of the social services law
  • Pharmacies registered under §6808 the education law
  • School-based health centers
  • Programs funded by the OMH, OASAS, Office of the Aging, or OPWDD, AND
  • Other provider types determined by the commissioner and approved by the director of the budget (at this time no other provider types have been determined).

Q.  What employer types are subject to the Certificate of Need (CON) process, and thus not required to meet the 20% threshold, but still required to be actively enrolled Medicaid providers?

A.  Below is a list of employer types subject to the CON process:

Employer Types Subject to the CON Process
Hospitals
Nursing Homes
Diagnostic and Treatment Centers
Midwifery Birth Centers
Ambulatory Surgery Centers
Dialysis Providers
Certified Home Health Agencies
Licensed Home Care Service Agencies
Long Term Home Health Care Programs
Hospices
Adult Care Facilities

Q.  I am not an not enrolled to receive payments from eMedNY.  Am I subject to the HWB program?

A.  Paragraph (2)(c) of the statute identifies employers subject to the HWB program even if they are not eligible to receive payments from eMedNY.  Entities with at least one eligible employee with programs identified in statute such as OMH, OPWDD, OASAS, OCFS, or Municipalities.


Q.  I am an employer who is not enrolled to receive payments from eMedNY and am not funded through OMH, OASAS, OCFS or OPWDD, am I subject to the HWB program?

A.  With the exception of education and state-operated facilities, who will be eligible in the fall for the bonus program, employers who are not enrolled to receive payments from eMedNY and are not funded by OMH, OASAS, OCFS, or OPWDD are not likely eligible for the program.

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