notice - kaweah delta medical center · kaweah delta medical center – acequia wing - executive...

400 West Mineral King Avenue · Visalia, CA · (559) 624 2000 · www.kaweahdelta.org

August 24, 2018

NOTICE The Kaweah Delta Health Care District Board of Directors will meet in a Human Resources Committee meeting at 9:00AM on Wednesday, August 29th in the Kaweah Delta Medical Center – Acequia Wing - Executive Office Conference Room {400 W. Mineral King, Visalia}.

All Kaweah Delta Health Care District regular board meeting and committee meeting notices and agendas are posted 72 hours prior to meetings in the Kaweah Delta Medical Center, Mineral King Wing entry corridor between the Mineral King lobby and the Emergency Department waiting room.

The disclosable public records related to agendas are available for public inspection at the Kaweah Delta Medical Center – Acequia Wing, Executive Offices (Administration Department) {1st floor}, 400 West Mineral King Avenue, Visalia, CA and on the Kaweah Delta Health Care District web page http://www.kaweahdelta.org. KAWEAH DELTA HEALTH CARE DISTRICT Nevin House, Secretary/Treasurer

Cindy Moccio Board Clerk & Executive Assistant to CEO DISTRIBUTION: Governing Board Legal Counsel Executive Team Chief of Staff http://www.kaweahdelta.org

http://www.kaweahdelta.org/

http://www.kaweahdelta.org/

KAWEAH DELTA HEALTH CARE DISTRICT BOARD OF DIRECTORS HUMAN RESOURCES COMMITTEE

Wednesday, August 29, 2018

Kaweah Delta Medical Center / 400 West Mineral King Executive Office Conference Room (1st floor Acequia Wing)

ATTENDING: Directors; Nevin House (Chair) & John Hipskind, MD; Gary Herbst, CEO; Dianne Cox, VP Human Resources; Brittany Taylor, Sr. Physician Recruiter; Blanca Bedolla, Recording

OPEN MEETING – 9:00AM

Call to order – Nevin House, Human Resources Committee Chair

Public / Medical Staff participation – Members of the public wishing to address the Committee concerning items not on the agenda and within the subject matter jurisdiction of the Committee may step forward and are requested to identify themselves at this time. Members of the public or the medical staff may comment on agenda items after the item has been discussed by the Committee but before a Committee recommendation is decided. In either case, each speaker will be allowed five minutes.

1) Community Needs Assessment Presentation – Review Results of Physician Needs Assessment Study- Brittany Taylor, Sr. Physician Recruiter

2) Physician Recruitment Update – Medical staff recruitment efforts update- Brittany Taylor, Sr. Physician Recruiter

3) Policies- Discuss changes to current policies - Dianne Cox, VP Human Resources a. AP.126 Physician Recruitment Policy {REVISED} b. HR.96 Personnel Files and Employee Health Records {REVISED} c. HR.95 Job Descriptions {REVISED} d. HR.213 Performance Management and Competency Assessment Program {REVISED} e. HR.218 Notification Requirements, Pre-Determination Process and Appeal Process

for Involuntary Termination, Suspension without Pay for More Than Five Days and Demotion {REVISED}

f. EHS.07 Tetanus, Diphtheria and Pertussis (Tdap) Policy for Health Care Workers {NEW}

g. EHS.08 Employee Health Standing Orders {NEW} h. HR.239 Extended Illness Bank (EIB) Donations {REVIEWED} i. HR.116 Temporary Transitional Work {DELETE} j. HR.97 Changes in Personal Status {DELETE} k. HR.187 Outside Employment and/or Volunteer Efforts {DELETE} l. HR.68 Garnishments, Wage Attachments, Levy’s {DELETE} m. HR.171 Alcohol and/or Drug Rehabilitation Leave {DELETE}

Wednesday, August 29, 2018 – Human Resources Committee Page 2 of 2 Herb Hawkins – Zone I ⃰⃰ Lynn Havard Mirviss – Zone II ⃰⃰ John Hipskind, MD – Zone III ⃰⃰ David Francis – Zone IV ⃰⃰ Nevin House – Zone V Board Member President Vice President Board Member Secretary/Treasurer

4) Kaweah Delta Health Care District Human Resources Direction, Evolution, and Future Programs- Discussion on potential improvements and advancements relating to Kaweah Delta employees a. Education Assistance Policy- College of the Sequoias b. Governance Institute Presentation- HR Committee Goals

Adjourn – Nevin House, Human Resources Committee Chair

In compliance with the Americans with Disabilities Act, if you need special assistance to participate at this meeting, please contact the Board Clerk (559) 624-2330. Notification 48 hours prior to the meeting will enable the District to make reasonable arrangements to ensure accessibility to the Kaweah Delta Health Care District Board of Directors meeting.

Community Need Physician Supply &

Demand Assessment(2017-2020)

Presented by: Brittany Taylor, Senior Physician Recruiter

Background

• Community Need Physician Supply/Demand Analysis: – Comprehensive, proactive, multi-year community need physician

supply/demand analysis and conclusions for physician recruitment, compliance, and strategic planning for ensuring access within our service areas and the communities we serve.

• Prior analysis completed in 2010 by AmeriMed• Data Collection Process began 7/1/17• Main opportunities identified

– Succession Planning– Primary Care Recruitment– Access to care barriers for Medicare and Medi-Cal patients

Purpose

• Ensure Compliance with OIG - Demonstrate a community need in the service area prior to allocating recruitment activities and resources.

– Lack of physicians in the community, overall by population demand ratios (affiliated/non-affiliated)

– Document current and forecasted need for a definedservice area

– Demonstrate inadequate access and a lack of physiciansserving indigent, Medicare and/or Medi-Cal patientswithin the service area.

– Demonstrate loss of essential community program, nothospital-specific (i.e., trauma)

– Demonstrate risk of loss of physicians next several yearsdue to departures or “risk of retirement”

• Starting point for strategic planning purposes. Requires frequent updates.

CNA PROCESS1. Definition of Kaweah Delta ’s Service Area: The Hospital should only provide recruitment incentives to physician specialties where a defined Community Need has been documented and physically locate the new physician’s office in a contiguous zip code from which the Hospital draws at least 75% of its inpatient admissions (Stark II, Phase III).

2. Quantitative: Statistical Analysis - Database: Compile a current comprehensive physician supply database by specialty. A roster of physicians and primary care Advanced Practice Providers practicing in the area was compiled including the Kaweah Delta and VMC medical staffs.

Practice calls - Validate various office locations, access to care, if they accept new patients, Medicare and Medi-Cal, office appointment days, and timeliness to care (number of weeks out for new patient appointments).

• Compare FTE to Physician-to-Population ratios using weighted average of the various national studies• Full time FTE: Physicians are calculated at 36 hours/week; APPs are calculated at 50% full time.

3. Qualitative: Market Factors Analysis/Access to Care AnalysisA comprehensive practice access analysis was conducted by calling all area practices as well as 1:1 interviews to define the following:

– Timeliness by payer including practices accepting new patients with Medicare or Medi-Cal. – Practices considered full to capacity or limited practices.

Additionally, the CNA proactively projects additional “at risk for retirement” FTEs defined as succession factors.

Service Area Maps

Service Areas - Population

Kaweah Delta’s service area growth rate from current to projected 2020:Service Area Growth RatePSA 3.53%75th 3.54%Tulare County 3.97%Kings County 1.06%

53 by 2020 Recommendations - PSA

7

8

53 by 2020 Recommendations - PSA

Primary Care - 2020 Needs Tulare/Kings Counties

Note: Data based on 100% market share

Medical/Surgical Specialties – 2020 NeedsTulare/Kings Counties

Thank you!

Mineral King Radiology Medical GroupCardiac & Thoracic Surgery 1 Interventional Radiology 1

Sequoia Cardiology Medical GroupIntensivist 2 Cardiology - Non-Invasive 2

Sequoia Radiation Oncology Medical AssociatesGI Hospitalist 3 Radiation Oncologist 1

South Valley VascularAdult Primary Care 3 Vascular Surgery 1Adult Primary Care - APP 1Dermatology 2 Valley Children's Health CareENT 1 Maternal Fetal Medicine 2Gastroenterology 2 Pediatric Hospitalist 1OB/GYN 3 Neonatology 1Podiatry 1 Pediatric Cardiologist 1Psychiatry 2Rheumatology 1 Valley Hospitalist Medical GroupUrology (1- physician; 1-APP) 2 Hospitalist - Nights 1

Adult Primary Care 3 Family Medicine Core Faculty 1OB/Gyn 1Pediatrics 1

Palliative Medicine 2

Kaweah Delta Physician Recruitment

Prepared by: Brittany Taylor, Physician/Leadership Recruiter [email protected] - (559)624-2899Date prepared: 8/13/2018

Kaweah Delta Medical Foundation

Kaweah Exeter Medical Group

Open Position Snapshot - August 2018

Other Recruitment

Golden State Cardiac & Thoracic Surgery

Vituity - Family Medicine Clinic

Horizon Critical Care

IQ Surgical Associates

1

Specialty Group Last Name First Name Availability Board Certification Miscellaneous Current Status

Cardiothoracic SurgeryGolden State Cardiac & Thoracic Surgery

Qandeel, M.D. Hisham TBD

American Board of Thoracic Surgery, Certified; American Board of Surgery, Certified

No CA license; Currently practicing as consultant in WA. Presented by Physician Empire

Site Visit: 7/20/18

Gastroenterology IQ Surgical Associates Servin-Abad, M.D. Luis TBD

American Board of Internal Medicine, Certified; American Board of Internal Medicine - Gastroenterology, Certified; American Board of Internal Medicine - Transplant Hepatology, Certified

No CA license; Currently practicing Advanced GI in Lakeland, FL. Met at specialty conference 6/4/18.

Site visit: 7/2/18

GastroenterologyKaweah Delta Medical Foundation

Greenberg, M.D. Adam 08/19American Board of Internal Medicine, Certified

CA Licensed; Candidate responded to eblast directly on 7/15/18.

Site visit: 9/10/18


Suchniak-Mussari, M.D.

Kristen 08/19American Board of Internal Medicine, Certified.

No CA License; Candidate responded to eblast directly on 7/6/18.

Site visit: 9/14/18


Hsueh, M.D. William 08/19American Board of Internal Medicine, Certified

No CA license; Presented by Fidelis Partners on 7/25/17.

Site visit: 11/10/17; Offer accepted.

GME Family Medicine Faculty (full-time)

Vituity Parungao, M.D. Jodi 09/18American Board of Family Medicine, Eligible

No CA license; Candidate information rec'd on 9/11/17.

Site visit: 9/19/17; Offer accepted; Tentative start date: 8/15/2018

HospitalistValley Hospitalist Group

Saadabadi, M.D. Zohreh 08/18American Board of Family Medicine, Eligible

No CA License; Currently completing Geriatric Medicine Fellowship; Candidate referred by Dr. Onsy Said on 3/5/18.

Site Visit 3/20/18; offer accepted; Tentative start date: August/September 2018

Candidate Activity

2


HospitalistValley Hospitalist Group

Tedaldi, M.D. Michael 07/19American Board of Internal Medicine, Eligible

CA Licensed; Spouse is currently PGY 1 with KDHCD General Surgery program; Candidate reached out directly on 11/10/17.

Site visit: 11/14/17; Offer accepted

Hospitalist - Critical CareCentral Valley Critical Care Medicine

Villaflor, M.D. Janjenali 08/19American Board of Internal Medicine, Eligible

No CA License; Presented by Medical Puzzle Piece Solutions on 7/9/18.

Site visit pending, October 2018

IntensivistCentral Valley Critical Care Medicine

Sagar, M.D. Ala Eddin 08/19

American Board of Internal Medicine, Certified; Pulmonary Medicine, Certified


Site visit pending, November 2018


Sharma, M.B.B.S. Arun TBDAmerican Board of Internal Medicine, Certified

No CA License; Completed fellowship in Neurocritical Care; Presented by Horizon Critical Care on 6/12/18.

Site Visit: 6/18/18


Sharma, M.D. Bikram TBD

American Board of Internal Medicine, Eligible; Critical Care Medicine, Eligible

CA License; Presented by Medical Puzzle Piece Solutions on 7/24/18

Site Visit: 8/2/18


Psihos, D.O. Peter John 08/18

American Osteopathic Board of Internal Medicine, Certified; Critical Care Medicine, Eligible (2018);


Site visit: 8/11/17; Offer accepted. Anticipated start date: 9/1/ 2018

Maternal Fetal MedicineValley Children's Hospital

Sperling, M.D. Jeffrey 08/19American Board of Obstetrics and Gynecology, Certified

CA Licensed; Presented by VCH on 7/18/18.

Site visit: 8/10/18

NeonatologyValley Children's Hospital

Sankaran, M.D. Deepika 08/19American Board of Pediatrics, Certified

No CA license; Presented by VCH on 7/25/18.

Site Visit: 10/12/18

Orthopedic Surgery - Adult Reconstruction

Orthopaedic Associates

Kim, D.O. Jun 08/19American Board of Orthopedic Surgery, Eligible

No CA license; Direct candidate referred by Dr. Bruce Le on 12/11/17.

Site visit: 3/1/18; offer accepted

OtolaryngologyKaweah Delta Medical Foundation

Giese, M.D. Rachel 01/19American Board of Otolaryngology, Certified

No CA license; Completing Head and Neck research fellowship; Presented by Fidelis Partners on 6/4/18.

Site visit: 7/19/18 Offer Extended

3


Pediatric - OutpatientKaweah Delta Medical Foundation

Khalid, M.D. Saba 05/18American Board of Pediatrics, Certified

CA licensed; Provided locum coverage at VMC.

Offer accepted; Tentative start date: August/September 2018

Pediatric HospitalistValley Children's Hospital

Ganesan, M.D. Thiyagu TBDAmerican Board of Pediatrics, Certified


Site Visit: 6/13/18


Kim, M.D. Kisung TBDAmerican Board of Pediatrics, Certified


Site Visit: 8/09/18


Jacob, M.D. Saul 09/18American Board of Pediatrics, Eligible

Spouse is Dr. Reetu Malhotra, Pediatric Hospitalist; Presented by VCH on 3/14/18.

Site visit: 3/26/18; Offer accepted (.25 FTE at KDH & .75 FTE at VCH). Start date: 9/4/18


Malhotra, M.D. Reetu 09/18American Board of Pediatrics, Eligible

Spouse is Dr. Saul Jacob, Pediatric Hospitalist; Presented by VCH on 3/14/18.

Site visit: 3/26/18; Offer accepted (.25 FTE at KDH & .75 FTE at VCH). Start date: 9/4/18

Radiation Oncology Sequoia Radiation Oncology Medical Associates

Lee, M.D. Jennifer 08/19American Board of Radiology - Radiology Oncology, Eligible

No CA License; Candidate applied directly.

Currently under review

Vascular SurgerySouth Valley Vascular

Nye, D.O. David 08/19

American Osteopathic Board of Surgery - General Surgery, Eligible

No CA License; Candidate applied directly with group.

Site Visit: 8/8/18

Administrative, Administrative Manual

Policy Number: AP126 Date Created: Not Set Document Owner: Kelsie Davis (Executive Assistant)

Date Approved: 04/28/2015

Approvers: Board of Directors (Administration)

Physician Recruitment Policy

Printed copies are for reference only. Please refer to the electronic copy for the latest version. PURPOSE: The purposes of this Policy are: (1) to assure that all members

(including Medicare and Medi-Cal beneficiaries) of the communities served by Kaweah Delta Health Care District (“DistrictKaweah Delta”) have adequate access to high quality primary care physicians, specialists and sub- specialists in the District Kaweah Delta service area; and (2) that assistance provided by the District Kaweah Delta to recruited physicians is based upon clearly identified and documented community need and is in compliance with all applicable laws and regulations (including Section 32121.3 of the Local Healthcare District Law and the “physician recruitment” exception to the Stark Law (42 CFR 411.357(e).

The DistrictKaweah Delta provides a wide array of health care services including critical care, rural health care clinics, and assisted living. The DistrictKaweah Delta is the primary provider of inpatient and other health care services in the Districtit’s primary market (Visalia and immediate surrounding communities). Further, the DistrictKaweah Delta is the regional healthcare center for many subspecialty services for those communities south of Fresno and north of Bakersfield.

Local Health Care District law permits District Kaweah Delta to financially assist in the process ofprovide financial assistance throughout the physician recruitment process when the use of such funds provides a public benefit. Income guarantees and other assistance to recruited physicians may be offered if 1) the DistrictKaweah Delta documents determines the community need, and 2) the DistrictKaweah Delta verifies that any financial assistance is “commercially reasonable” to induce a recruited physician to relocate his or her medical practice to the District service area.

DEFINITIONS:

Primary Care includes those physicians who have completed residencies in Family PracticeMedicine, Internal Medicine, and Pediatrics. Primary Care does not include obstetric/gynecology practices.

Specialty Care includes, but is not limited to, those physicians who have completed residency training in Anesthesia, Emergency

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Medicine, General Surgery, Hospitalists, Obstetrics/Gynecology, Pathology, Psychiatry, and Radiology.

Physician Recruitment Policy 2

POLICY:

Subspecialty Care includes, but is not limited to, those physicians who have completed fellowship training in medicine subspecialties (e.g. GI, Infectious Diseases, Pulmonary, Hematology, Oncology, Nephrology, and Cardiology), Pediatric subspecialties (e.g. neonatology), or Obstetrics/Gynecology subspecialties (e.g. perinatology), and those physicians who have completed residency or fellowship in surgical subspecialties (e.g. Orthopedics, Neurosurgery, and Hand).

I. Documentation of Community Need: A. Given the DistrictKaweah Delta is the only provider of inpatient services

in Visalia and nearby surrounding communities and is a regional provider of numerous subspecialty services, . the DistrictKaweah Delta will focus the resources that are available for physician recruitment as deemed necessary for meeting our community’s most compelling needs. Objective measures of community need include: population to physician ratios, outside consultant recommendations, and the need for 24/7/365 emergency on-call services.

B. Where the communities served by the DistrictKaweah Delta have need

for physicians other than inpatient primary care, specialty and subspecialty services, the DistrictKaweah Delta may collaborate in recruiting with other healthcare providers in the region.

II. Conditions for Assistance:

A. Contemporaneous documentation shows tThe DistrictKaweah Delta identifiesrecognizes that there is a n e e d t o legitimate and objective basis for utilizing utilize the District’s its public resources to attract the physician(s) needed (e.g., the community’s need for these particular services is documented determined and demonstratesbased on (i) a lack of service availability or long waiting periods for the service; (ii) the lack of physicians serving the indigent or Medi-Cal population within the District’sKaweah Delta’s service area; or (iii) the need for ensuring on-call emergency coverage for the Emergency Department and other services). The recruited physician must commit to serving indigent and Medi-Cal patients.

B. A recruited physician must agree to establish (if new in practice) or relocate his or her existing practice to the DistrictKaweah Delta’s service area, and maintain a full-time practice, as defined in the recruitment agreement, to ensure the community obtains the necessary benefit from the physician’s presence in the community.

C. A recruited physician must obtain and maintain active appropriate staff privileges on the Medical Staff(s) of the DistrictKaweah Delta’s facilities throughout the term of the recruitment agreement.

D. A recruited physician must be willing to provide full disclosure of necessary information and allow reasonable review of patient and financial records that may be necessary to audit compliance with the terms of the recruitment agreement.


E. A recruited physician must maintain a current California state medical


license, current DEA license, and professional liability insurance and eligibility or certification in his/her respective specialty.

F. A recruited physician must may be required to participate in Medicare, Medi-Cal and other third party payor programs, and make good faith efforts to apply in a timely manner for credentialing with health plans that serve the communities of the DistrictKaweah Delta. Except as otherwise approved by the DistrictKaweah Delta, the recruited physician must contract with the DistrictKaweah Delta to assist in the payor credentialing process and to provide assistance in setting up the processes for the timely billing and collection of professional services.

G. A recruited physician must participate in the hospital’s specialty on-call panel if applicable.

III. Assistance: A. Requirements for physician recruitment assistance agreements must be

reviewed by District Kaweah Delta for compliance with applicable laws and regulations. In consideration of the foregoing, it is the policy of the Kaweah Delta Board of Directors of District that the DistrictKaweah Delta may provide the following types of physician recruitment assistance, each of which are outlined in this Paragraph III: • use of and payment for recruitment firms; • loans for transition assistance, including practice start-up expenses

and reimbursement of moving expenses and relocation costs paragraph III.B);

• loans for payment of net income guarantees, (including a benefit expense allowance (paragraph III.E);

• loans for payment of allowable practice expenses (paragraph III.E); • loans for payment of a signing bonus (paragraph III.F.1); • loans for payment for continuing medical education (paragraph III.C); • loans for reimbursement of repayments of medical student loans

(paragraph III.M); • loans for payment of a stipend for a fellowship program (paragraph

III.F.2); •

B. A recruited physician will may be provided with transition assistance for relocation and start-up expenses and costs. Expenditures for relocation and start-up expenses and costs must be reviewed and determined to be allowable in accordance with Exhibit A, Allowable Relocation Expenses Guidelines and Exhibit B, Allowable Start-Up Expenses Guidelines, except as otherwise agreed upon in writing and set forth in the recruitment agreement. The allowance for start-up and relocation costs and expenses, in the aggregate, shall not exceed $40,000.

C. Allowance for continuing medical education (CME) shall may be paid during the initial year of practice by the recruited physician, and shall be paid for the actual costs incurred in obtaining CME. The allowance for CME may not exceed $5,000.

D. The allowances for transition assistance and CME under paragraph B and

C will be structured as repayable loans subject to forgiveness if the

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recruited physician maintains his or her practice in the community for a predetermined period of time, provides on-call coverage for the


Emergency Department and renders health care services to all segments of the community, including Medi-Cal and indigent patients (all of which have been agreed upon in order to ensure the economic benefit to the recruited physician relative to the value of community benefit).

E. The DistrictKaweah Delta may recruit a physician(s) and guarantee his

or her income and practice expenses, and provide for a benefit allowance:

1. The maximum assistance for an income guarantee is two years.

2. A determination of an appropriate compensation range for the applicable specialty or subspecialty will be completed and approved by the DistrictCompliance Department and provided to the DistrictKaweah Delta’s Physician Compensation Committee (VP of HR, KDHCD CMO & KDMF CEO). The Physician Compensation Committee will review and approve the compensation amounts w i t h i n t h e r a n g e p r o v i d e d b y t h e C o m p l i a n c e D e p a r t m e n t . A ny amounts exceeding the provided range will require Executive Fair Market Value Committee approval prior to any discussions with physician candidates or recruitment firms. Fair Market Value Committee prior to communication of compensation amounts to any physician recruiter and prior to any discussions with physician candidates. The guaranteed income amount shall be set in advance and be commensurate with similarly situated physicians in the community.

3. Support staff, administrative services and practice expenses must be reviewed and determined to be allowable expenses and costs as established and administered under Exhibit C, Allowable Practice Expenses Guidelines, except as otherwise agreed upon in writing and set forth in the recruitment agreement. If a physician is recruited through another physician or group practice, the support staff, administrative services and practice expenses must be reviewed and determined to be allowable expenses and costs as established and administered under Exhibit D, Allowable Incremental Practice Expenses Guidelinesfor Joint Recruitment with an Existing Medical Practice, except as otherwise agreed upon in writing and set forth in the recruitment agreement.

4. The income guarantee advances, including practice expenses, must be structured as repayable loans subject to forgiveness if the physician maintains his or her practice in the community for a predetermined period of time, provides on-call coverage for the Emergency Department and renders health care services to all segments of the community, including Medi-Cal and indigent patients and (all of which have been agreed upon in order to ensure the economic benefit to the recruited physician relative to the value of community benefit).

F. The DistrictKaweah Delta may consider other types of permitted assistance to a physician and surgeon in exchange for consideration and upon terms and conditions the District Kaweah Delta Board of Directors deems reasonable and appropriate. See policy CP.03, Medical Director


and Physician Provider Contracts, for additional information regarding the Fair Market Value process.

F.G. These Types of assistance may include:

1. Payment of a signing bonus in exchange for the execution of the recruitment agreement. The signing bonus may be in full at the time of signing the recruitment agreement, or in one or more payments, including a payment concurrent with the recruited physician's commencement of practice in the District Kaweah Delta’s service area. The amount and schedule of a signing bonus will be approved by the Fair MarketPhysician Compensation


Value CCommittee and may not exceed $25,000 without the prior approval of the DistrictKaweah Delta’s Chief Executive Officer.

2. Payment of a stipend to a recruited physician who will participate in a specialty fellowship program prior to commencing his/her practice in the DistrictKaweah Delta’s service area. The stipend may be paid in one or more payments during the term of the fellowship program. The amount and schedule of a fellowship program stipend will be approved by Fair Market Value Physician Compensation Committee and may not exceed $25,000 without the prior approval of the DistrictKaweah Delta’s Chief Executive Officer.

G.H. If a recruited physician fails to meet the terms of the recruitment agreement, the DistrictKaweah Delta may suspend assistance for non-compliance until the default is corrected. However, if the default is not cured in a timely manner, the amounts paid out or loan balances remaining due shall be due and payable generally within a period not exceeding one hundred twenty (120) days. However, balances may be due and payable within a period greater than one hundred twenty (120) days provided requisite approval is obtained by the Chief Executive Officer or Senior Vice President.

H.I. In the event of death or permanent disability of the physician, the

agreement may include provisions to forgive all or a portion of any remaining amounts due when appropriate insurance policies are in force.

I.J. Each agreement will have a designated maximum amount of assistance

authorized for a particular physician-recruit.

J.K. A recruited physician shall agree to the right of the DistrictKaweah Delta to inspect and audit his or her practice in order to verify compliance with the recruitment agreement.

K.L. A recruited physician agrees to retain his/her records of

billings, collections, and expenses for at least five (5) years.

L.M. Recruitment loans shall be evidenced by a promissory note with a market- rate of interest approved by the Chief Financial Officer, and secured by the account receivables of the recruited physician.

M.N. In extraordinary circumstances, the District’sKaweah Delta’s Chief

Executive Officer may authorize, as an additional incentive (within the meaning of §32121.3(a)(4) of the District Law) assistance to a recruited physician to assist in the repayment of his/her medical school student loans. See policy CP.03, Medical Director and Physician Provider Contracts, for additional information regarding the Fair Market Value process.

1. Student loan assistance will be provided based on the determination

by the D i s t r i c t ’ s Kaweah Delta’s Chief Executive Officer that the assistance is necessary to recruit a physician who will fill a critical medical need at the Hospital or in the community, including such factors as a clinical specialty that the DistrictKaweah Delta has

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been unable to fill a need for a considerable period of time or the recruited physician, by virtue of his/her training, will expand the range of clinical modalities or other professional services not currently available in the Districtcommunity.


2. The assistance is subject to verification of the outstanding indebtedness.

3. Depending on the aggregate amount of the assistance, student loan assistance will be paid over a period of two or more years, with each annual payment subject to a one to two year forgiveness and interest at a market-rate of interest approved by the Chief Financial Officer. Payments of student loan assistance may be paid in one lump annual amount or in period payments as determined by the Chief Financial Officer.

4. All payments will be made to the recruited physician.

5. The recruitment agreement will stipulate that the DistrictKaweah Delta is not responsible, in any manner, for making payments to any lender(s) holding the student loans.

6. The recruited physician will certify at the end of each year that he/she has used the payments towards repayment of his/her student loans, and provide supporting documentation of the payments.

7. The student loan assistance will be subject to repayment under a promissory note in the event of a default by the recruited physician during the student loan assistance period and secured by a security agreement granting the DistrictKaweah Delta an interest in the accounts receivable of the recruited physician and such other collateral as may be available and necessary to secure the obligation.

N. The District may provide recruited physician an additional loan ("EHR Loan") in the amount up to twenty-five thousand dollars ($25,000.00) subject to the physician's commitment to achieve "meaningful use" within the meaning of the Health Information Technology for Clinical Health Act of 2009, Pub. L. 111-5 and the regulations thereunder ("HITECH Act") and apply for and maintain Medicare Incentive Payments as an eligible professional under 42 C.F.R. § 495.102 of the HITECH Act. EHR Loan payments will be subject to the conditions to be set forth in the recruitment agreement.

IV. Other Conditions:

A. The DistrictKaweah Delta may share risk for recruitment costs and income guarantee payments with a physician or physician group who wish to jointly recruit with District Kaweah Delta, a new physician to the service area.

B. The DistrictKaweah Delta shall establish an annual or multi-year plan and budget for this program based on identified needs.

C. Agreements will be standardized, but terms may vary according to the specific request and situation.

D. Kaweah DeltaThe District, at its discretion, may obtain a life or disability insurance policy on a physician under a physician recruitment contract.

E. In accordance with the District law, no recruitment agreement shall do any


of the following:

1. Impose as a condition any requirement that the recruited physician’s patients or a quota of the physician’s patients, be admitted or referred to a specified hospital;

2. Restrict the recruited physician from establishing staff privileges at, referring patients to, or generating business for another entity; or

3. Provide payment or other consideration to the recruited physician for the physician’s referral of patients to any District Kaweah Delta facility or affiliated organizations.

F. Agreements will be subject to ongoing compliance with this policy which is intended to comply with all applicable laws and regulations and which may be amended from time to time as the applicable laws and regulations change, and /or as the interpretations of the laws and regulations change.

PROCEDURE:

A. Physician Recruitment Strategic Planning Committee serves as an advisory committee and makes recruitment recommendations to the CEO.

B. CEO makes recommendations, as determined appropriate, to the Medical Executive Committee (MEC).

C. MEC forwards final physician recruitment recommendations to the Board of Directors for approval. The District Board shall reserve the right to make the final decision, considering, among other things, the District’s budget and the needs of the communities served by the District.

D. The Fair Market Value Committee shall be responsible to review and establish the range of recruitment assistance for each medical specialty.

KDMF Recruitment:

A. KDMF Board of Directors establishes the Physician Staffing Plan (PSP) for physician recruitment and provides it to the Joint Operating Committee (JOC).

B. JOC utilizes the PSP for recruitment. C. DistrictKaweah Delta Compliance Department is responsible to provide

compensation ranges for each specialty and provides the information to the Physician Compensation Committee. See policy CP.03, Medical Director and Physician Provider Contracts, for additional information regarding the Fair Market Value process.

D. The Physician Compensation Committee will review and approve the compensation amounts w i t h i n t h e r a n g e p r o v i d e d b y t h e C o m p l i a n c e D e p a r t m e n t . A ny amounts exceeding the provided range will require Executive Fair Market Value Committee approval prior to any discussions with physician candidates or recruitment firms.

E. All recruitment agreements shall be prepared and approved by legal counsel as to form and compliance with applicable laws.

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F. The DistrictKaweah Delta Board of Directors shall reserve the right to make the final decision, considering, among other things, the DistrictKaweah Delta’s budget and the needs of the communities served by the District.

Other Recruitment:

A. Executive Team reviews requests for recruitment assistance based on community needs which includes, a lack of service availability or long waiting periods, lack of physicians serving the indigent or Medi-Cal population within the DistrictKaweah Delta’s service area and the need for ensuring on-call emergency coverage for the Emergency Department and other services.

B. Kaweah Delta District Compliance Department is responsible to provide compensation ranges for each specialty and provides the information to the Physician Compensation Committee. See policy CP.03, Medical Director and Physician Provider Contracts, for additional information regarding the Fair Market Value process.

C. The Physician Compensation Committee will review and approve the compensation amounts w i t h i n t h e r a n g e p r o v i d e d b y t h e C o m p l i a n c e D e p a r t m e n t . A ny amounts exceeding the provided range will require Executive Fair Market Value Committee approval prior to any discussions with physician candidates or recruitment firms.

E.D. All recruitment agreements shall be prepared and approved by legal counsel as to form and compliance with applicable laws pursuit to CP.03, Medical Director and Physician Contracts.

F.E. The DistrictKaweah Delta Board of Directors shall reserve the right to make the final decision, considering, among other things, the DistrictKaweah Delta’s budget and the needs of the communities served by the District.

RELATED EXHIBITS: Exhibit A: Transition Assistance -- Allowable Relocation Expenses Exhibit B: Transition Assistance -- Allowable Start-Up Expenses Exhibit C: Allowable Practice Expenses Exhibit D: Allowable Incremental Practice Expenses for Joint Recruitment with an Existing Medical Practice

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"These guidelines, procedures, or policies herein do not represent the only medically or legally acceptable approach, but rather are presented with the recognition that acceptable approaches exist. Deviations under appropriate circumstances do not represent a breach of a medical standard of care. New knowledge, new techniques, clinical or research data, clinical experience, or clinical or bio-ethical circumstances may provide sound reasons for alternative approaches, even though they are not described in the document.

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Exhibit A Page 1 of 3

AP126 Exhibit A

Allowable Relocation Expenses Relocation Expense Loan:

In general, relocation loans are paid on a reimbursement basis, up to the negotiated cap identified in the recruitment agreement. Original itemized receipts that support the reimbursable amount requested must be provided in order for payment to be released. All reimbursement receipts must be submitted within sixty (60) days from the date service was provided or item purchased.

All relocation expenses and costs submitted for reimbursement must be incurred following the effective date of the recruitment agreement. Reimbursement must be made directly to the physician and not to the vendor. In the event that the physician requests and the DistrictKaweah Delta gives consents to for direct payment to a vendor, such payment will be added to the balance of the physician’s loan for relocation. Any direct payment to vendors will be subject to the negotiated cap identified in the recruitment agreement for relocation expenses.

Allowable Relocation Expenses for Reimbursement:

• House Hunting - One (1) house hunting trip per recruited physician may be

authorized and reimbursed not to exceed two (2) nights and three (3) days in length. Reimbursement is available for approved airfare, hotel, car rental and meal expenses for the recruited physician, spouse, significant other or domestic partner and children. Reimbursed meal expenses will be limited to forty dollars ($40.00) per person, per day (excluding alcohol).

• Travel from current residence to contracted Service Area for the following:

• Physician and spouse, significant other or domestic partner and

children who are moving to reside in the same residence. • Costs incurred during the travel period for moving include air fares, gas cost,

hotel cost, and meals at forty dollars ($40.00) per person per day (excluding alcohol).

• Reimbursement for such costs are limited to District’s Kaweah Delta’s

calculated expected cost from the address identified as the previous primary residence to the new residence. For instance, if a physician travels to an area other than their previous primary residence and then travels to the new residence, DistrictKaweah Delta will only reimburse the expected costs of the physician’s travel from the previous primary residence to the new residence.


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• Cost of moving all household goods and personal effects including: packing

labor and materials, temporary storage costs up to thirty (30) days, shipping via truck, air or mail service, unloading labor, etc.

• Cost of day care during travel or upon arrival to Service Area up to thirty

(30) days. • Cost of pet care including medical or kennel provisions during travel or upon

arrival to Service Area up to thirty (30) days; quarantine requirements will be reviewed on a case by case basis.

Examples of Excluded Relocation Expenses Not Allowed for Reimbursement:

• Any travel, medical or maintenance cost incurred during travel not in direct route

to the ending destination of the new residence (such as site seeing detours). • Cost related to the travel of extended family for purposes of visiting or

accompanying immediate family during travel. • Cost paid to family members to assist in the move (e.g., babysitting and

unloading or unpacking household goods and personal effects). • Vehicle service determined to have an extended life (new tires, new equipment,

detailing, etc). However, an oil change in preparation for the drive is reimbursable.

• Luxury travel - such as upgrades to first class air travel or limousine

service. • Entertainment expenses.

• ATM withdraws.

• Real estate commissions.

• Down payment for new home or office.

• Return trips to your former residence, not including the reimbursed house

hunting trip. • Security deposits forfeited due to physician’s relocation. For example, a

forfeited country club membership deposit not refunded due to physician’s cancellation of membership is not an allowable expense for reimbursement.




• Costs associated with the relocation of the following items: o 4th automobile o Classic automobiles, unless primary transportation for the physician

o Recreational vehicles,

transportation including motorcycles, unless primary

o Aircraft o Boats o Campers o Supplemental Insurance o Live plants o Livestock o Exotic animals o Greenhouses


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Exhibit B Page 1 of 2

Exhibit B

Allowable Start-Up Expenses

Start-up Expense Loan: In general, a start-up loan is paid on a reimbursement basis, up to the negotiated cap identified in the recruitment agreement. Original itemized receipts that support the reimbursable amount requested must be provided in order for payment to be released. All reimbursement receipts must be submitted within sixty (60) days the service was provided or items purchased.

Start-up expenses are differentiated from practice expenses in that start-up expenses represent costs incurred for the sole purpose of establishing the practice and would not routinely be incurred on an on-going basis for the operation of a practice.

All start-up expenses and costs submitted for reimbursement must be incurred following the effective date of the recruitment agreement and prior to the end of the first (1st) three (3) months following the Effective Practice Date.

Allowable Start-up Expenses for Reimbursement:

• Legal fees or application and licensing fees related to the incorporation of the

relocated medical practice; • Legal fees related to the negotiation of lease agreements for the relocated

practice and miscellaneous legal costs associated with the initial establishment of the relocated practice;

• Legal fees related to the negotiation and execution of the recruitment

agreement; • Purchase of minor medical equipment;

• Purchase of furniture and fixtures;

• Purchase and installation of a phone system;

• Purchase and installation of a computer system (software and hardware);

• Purchase and installation of a medical records software system;


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Exhibit B Page 2 of 2

• Painting and remodeling of the office (such as new carpet, new window treatments, new cabinets, etc.);

• Salaries and related payroll and benefits costs for office and medical staff hired

within one month prior to the practice effective date; • Rent payments prior to the start of the practice effective date;

• Signage for practice;

• Credentialing application fees for medical staff privileges in the Service Area;

• Application fee for the Tulare Kings County Medical Society.

Examples of Excluded Start-up Expenses Not Allowed for Reimbursement:

• Refundable deposits, unless Physician assigns the refundable deposit to

DistrictKaweah Delta; • Cost of continuing or closing previous practice, e.g., licenses, leases, tail

coverage, billing and collection activities, loans, prior debt, legal fees, etc.; • Licenses or application fees paid prior to the effective date of the

recruitment agreement.


Exhibit C 11/14/11 Page 1 of 10

Exhibit C

Allowable Practice Expenses

Practice Expense Loan:

In general, practice expenses represent routine and recurring expenses that are expected and budgeted for the operation of the practice. Such costs are expected to be solely for the operation and benefit of the business and office - not personal in nature.

Practice expenses must relate to the Incentive Period and must be incurred following the effective date of the agreement.

Supporting documentation, including, but not limited to, receipts and invoices must be submitted for review by DistrictKaweah Delta for practice expense audit and review.

Practice Expense Categories:

Office Space Lease/Rent:

• Rent will only be allowed for the number of months in the incentive

period. If the incentive period does not begin on the first of a month, rent can either be pro-rated for the first month of the incentive period or it must be pro-rated at the end of the incentive period.

• Copies of all lease arrangements (leases, sub-leases, etc.) must be

provided to the DistrictKaweah Delta to substantiate the rental payment prior to the disbursement of the first payment.

• Legal fees to negotiate the initial lease agreement are excluded from

Practice Expenses since such costs are considered start-up expenses pursuant to Exhibit B.

• Refundable deposits are not an allowable Practice Expense, unless the

physician assigns the refundable deposit to DistrictKaweah Delta.

















Phone:

• Purchase and monthly service of cell phone and or/ pager for the physician only are allowable Practice Expenses. The purchase of the phone and contract plan must be a fair market agreement.

• Monthly service of office phone system is an allowable Practice

Expense. Initial purchase and installation of a phone system is excluded from Practice Expenses since such costs are considered start-up expenses pursuant to Exhibit B.

• In the event that the practice needs to purchase a phone system but

does not have available start-up expense reimbursement available, the standard depreciation for the equipment will be an allowable Practice Expense.

• Monthly service for cell phone and/or pager following the effective date

of the recruitment agreement is an allowable Practice Expense. Monthly service fees for the previous cell phone or pager may be included as an allowable Practice Expense, as needed, during the first (1st) thirty (30) days of the Incentive Period.

• Monthly cost for an answering service for the relocated practice is an

allowable Practice Expense. Costs associated with maintaining an answering service for the previous practice are not allowable Practice Expenses.

Utilities:

• Cost of water, electricity, trash, gas and other routine utility costs will

be permitted as an allowable Practice Expense for the number of months of the Incentive Period. If the Incentive Period does not begin on the first of a month, such utilities can either be pro-rated for the first month of the Incentive Period or it must be pro-rated at the end of the Incentive Period.

• Refundable deposits for Utilities are not considered allowable Practice

Expenses unless the deposit is assigned to DistrictKaweah Delta.



Insurance:

• If Professional Liability Insurance (“PLI”) is paid quarterly or annually, such costs will be an allowable Practice Expense and will be reported in the month the PLI is paid or the first month of the Incentive Period if the expense is paid prior to the Effective Practice Date in the recruitment agreement.

• DistrictKaweah Delta will only permit as an allowable Practice Expense

PLI costs for coverage months within the Incentive Period. Any pro-rated costs for covered months outside of the Incentive Period will not be permitted by the DistrictKaweah Delta as an allowable Practice Expense or Start- Up Expense.

• Supporting documentation, such as invoices or policies identifying

coverage periods and type of coverage, must be provided to the DistrictKaweah Delta for administration of the agreement. Allowed Practice Expenses for any insurance costs will not be permitted unless the supporting documentation is provided.

• Insurance premiums or deductibles relating to a physician and the

physician’s immediate family’s benefit expenses such as health, life, auto, home, flood, personal, umbrella, etc are not considered allowable Practice Expenses because such expenses are paid under the benefits expense provision of the recruitment agreement.

• If a physician employs a family member, that family member’s benefit

expenses for health insurance and retirement benefits will not be considered allowable Practice Expenses because such expenses are reimbursed under the benefits expense provision of the recruitment agreement.

• Property and general insurance for the relocated practice is an

allowable Practice Expense. Salaries, Fringe Benefits and Payroll Taxes:

• Following the Effective Practice Date identified in the recruitment

agreement, the monthly cost of clinic and office staff (e.g., medical assistant, midlevel, biller, receptionist, accountant, office manager and medical records clerk) directly working for the recruited physician and providing service to the relocated practice will be allowable Practice Expenses.



• Staffing costs for employees or contractors prior to the Effective Practice Date identified in the recruitment agreement are excluded as Practice Expenses because such costs are allowable start-up expenses for reimbursement pursuant to Exhibit B.

• Staff wages and salaries must be reasonable, appropriate and consistent

with the local market for such services.

• Staff cost may not include any portion paid to the physician or for the physician’s benefit. For example, payroll taxes and related benefits paid for the physician may not be included as Practice Expenses because such expenses are reimbursed pursuant to the benefit expense provision of the recruitment agreement.

• A staff list will be provided identifying the employee or contractor, job

title, job description, employment status, salary, fringe benefits, and payroll taxes. This information will also include hire date and, as appropriate, termination date of staff.

• Allowed staff appreciation costs and meals will be capped annually at

one thousand dollars ($1,000.00). Medical Supplies:

• Costs of supplies or minor medical equipment relating to the clinical

practice are allowable Practice Expenses. Examples of acceptable medical supplies include, but are not limited to, stethoscopes, blood pressure cuffs, thermometers, scales, otoscopes, tongue depressors, bandages, cotton balls and linens.

• Cost of prescriptions will be allowed up to a specified cap as determined

at the time of the agreement and as appropriate for the physician specialty.

• Cost of injectables/tablets will be allowed up to a specified cap as

determined at the time of the agreement as appropriate for the physician specialty.

• Medical supplies allowed as Practice Expenses may not include the

purchase of medical equipment identified in DistrictKaweah Delta’s Capitalization Policy, AP 135. Equipment and supplies subject to the Capitalization Policy will be evaluated based upon individual and aggregate purchases. A copy of AP 135 will be attached to the recruitment agreement.



• If an item is not allowable as a medical supply because it is identified in the Capitalization Policy, the physician may elect to use available Start-up Expense reimbursement pursuant to Exhibit B provided the purchase is before the Effective Practice Date of the recruitment agreement or within the first (1st) three (3) months of the Incentive Period. If Start-Up Expense reimbursement is unavailable because the physician has exhausted the negotiated cap for such expenses, the medical supply cost will be administered pursuant to the DistrictKaweah Delta’s fair market lease rate factor.

Office Supplies and Postage:

• Costs of office supplies or minor office equipment relating to the

business side of the practice are allowable Practice Expenses. Examples of acceptable office supplies include, but are not limited to, paper products, forms, staples, pens and small business machines (e.g. shredder, calculator).

• Personal postage is not an allowable Practice Expense.

• Office supplies allowed as Practice Expenses may not include the

purchase of office or business equipment identified in DistrictKaweah Delta’s Capitalization Policy, AP 135. Equipment and supplies subject to the Capitalization Policy will be evaluated based upon individual and aggregate purchases.

• If an item is not allowable as an office supply because it is identified in the

Capitalization Policy, the physician may elect to use available Start-up Expense reimbursement pursuant to Exhibit B provided the purchase is before the Effective Practice Date of the recruitment agreement or within the first (1st) three (3) months of the Incentive Period. If start-up expense reimbursement is unavailable because the physician has exhausted the negotiated cap for such expenses, the office supply cost will be administered pursuant to the DistrictKaweah Delta’s fair market lease rate factor.

• Computer equipment such as tablets or laptops under the capital purchase threshold must be pre-approved for purchase by the DistrictKaweah Delta.

Leased Equipment:

• The lease cost of reasonable medical and office equipment and

office furniture is an allowable Practice Expense.

• “Fair Value Lease” will be defined by Generally Accepted Accounting Principles (“GAAP”). For Fair Value Leases, the lease


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cost, for any lease term within the Incentive Period, will be an allowable Practice Expense.

• “Bargain Purchase Option” will be defined by GAAP. For a Bargain

Purchase Option with a one dollar ($1.00) buyout, if the term of the lease agreement is consistent with the equipment’s useful life, such lease cost during the Incentive Period will be an allowable Practice Expense.

• For Bargain Purchase Option, with a term less than the useful life of the

equipment, the DistrictKaweah Delta will recalculate the lease cost for the equipment as if the lease were a Fair Value Lease. In recalculating the lease cost the DistrictKaweah Delta will use an estimated useful life for the equipment as established by the American Hospital Association’s then current publication “Estimated Useful Lives of Depreciable Hospital Assets” in determining the fair value buyout, if any, at the end of the lease period. The resulting lease payment identified by the recalculation methodology described in this paragraph will be referred to as a “Recalculated Lease” payment for purpose of this Exhibit C.

• If a physician elects to purchase the equipment or enter into a loan

agreement to purchase the equipment, the allowable Practice Expense for that equipment will be the Recalculated Lease payment as defined above.

• Automobile leases are not allowable Practice Expenses.

Licenses:

• The pro-rated cost of obtaining and maintaining the California license to

practice medicine and DEA license during the Incentive Period are allowable Practice Expenses. Physician must provide copies of renewal applications and receipts to support the cost of each license for the DistrictKaweah Delta to pro-rate the cost. Providing copies of money orders alone are not acceptable documentation for allowing the Practice Expense.

• Costs of obtaining and maintaining medical licenses in other states or

unrelated to the relocated practice are not allowable Practice Expenses.

• Continuing medical education costs are separately discussed below and

not considered a License expense.



CME Training:

• Physician will be entitled to an annual reimbursement up to five

thousand dollars ($5,000.00) during the Incentive Period for costs expended in connection with attending medical conventions and/or seminars related to physician’s recruited specialty. DistrictKaweah Delta will reimburse physician for physician’s personal expenses related to tuition or registration, travel, lodging and meals (excluding alcohol).

Non-CME Training:

• Training of physician or staff for business software or other training

necessary utilized in the relocated practice that is unrelated to the physician or staff’s continuing education hours will be an allowable Practice Expense subject to an annual cap of two thousand four hundred dollars ($2,400.00).

Professional Services: Legal /Accounting/Consulting Fees:

• Legal fees unrelated to the legal fees permitted in Exhibit B but

related to the administration of the relocated practice are considered an allowable Practice Expense as long as such fees directly relate to the relocated practice during the Incentive Period. Legal fees are subject to an annual allowance cap of five thousand dollars ($5,000.00). Any legal fees unrelated to the relocated practice or related to the physician’s personal affairs are not allowable Practice Expenses.

• Legal fees incurred during the term of the recruitment agreement to alter

the administration of the recruitment agreement, amend, or terminate the recruitment agreement will not be considered a Practice Expense.

• Accounting and consulting fees unrelated to the fees permitted in

Exhibit B but related to the administration of the recruited physician’s relocated practice are considered an allowable Practice Expense as long as such fees directly relate to the recruited physician’s relocated practice during the Incentive Period. Accounting and consulting fees are subject to an annual allowance cap of three thousand dollars ($3,000.00). Any accounting or consulting fees unrelated to the recruited physician’s relocated



practice or related to the recruited physician’s personal affairs are not allowable Practice Expenses.

Maintenance:

• Costs of routine and recurring maintenance related to the office

building, medical or office equipment are allowable Practice Expenses.

• Remodeling or replacement of permanent office fixture costs (e.g.

carpet, light fixtures, air conditioners, etc.) are not allowable Practice Expenses.

Doctor’s Exchange:

• Costs of answering service for the relocated practice during the

Incentive Period are allowable Practice Expenses. Dues and Subscriptions:

• Pro-rated costs of professional dues directly related to the recruited

specialty during the Incentive Period are allowable Practice Expenses.

• Allowable pro-rated subscription costs during the Incentive Period will include professional material directly related to the recruited specialty and patient reading material.

• Country club, fitness club or social organization membership fees are

not allowable Practice Expenses. Advertising and Marketing:

• Physician is required in the recruitment agreement to order during the

Incentive Period an advertisement in the Yellow Pages and hold a minimum of one (1) open house within the first (1st) six (6) months of the Effective Practice Date of in the recruitment agreement.

• Pro-rated costs of reasonable advertising and marketing the relocated

practice during the Incentive Period are allowable Practice Expenses. Examples of such costs include advertising in the, white pages, newspapers, magazines and hosting open houses at the recruited physician’s office.



• DistrictKaweah Delta will allow a one time cost for Yellow Pages

advertisement, capped at two thousand dollars ($2,000.00).

• DistrictKaweah Delta will allow costs associated with a maximum of two (2) open houses held during the Incentive Period. Open house allowable Practice Expenses are capped at four thousand dollars ($4,000.00).

• DistrictKaweah Delta must pre-approve any positions or hiring by the

Medical Group of new personnel with the intent of managing social media and/or advertising.

Billing and Collections:

• Monthly service fees paid to billing and collection companies related to

the relocated practice during the Incentive Period are allowable Practice Expenses.

Automobile Expenses:

• Automobile expenses, including mileage, are not considered allowable

Practice Expenses. Debt Service:

• During the Incentive Period, the allowed amount for student loans will

be the amount identified as the minimum payment in the account statement for the student loans from an accredited education lending organization. DistrictKaweah Delta will not allow as a Practice Expense student loan payment obligations that are not identified as held by an accredited education lending organization.

• All other debt service unless identified as allowable in Leased Equipment

or Maintenance will not be an allowable Practice Expense. Late Fees:

• Late fees are not an allowable Practice Expense.

Donations/Charitable Contributions:

• Costs of participation in fundraisers or charitable contributions from the

physician, relocated practice or corporation will not be an allowable Practice Expense.


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Business Credit Cards:

• Business credit cards with annual membership fees will be an allowable Practice Expense up to an annual cap of one hundred dollars ($100.00).

Tail Coverage:

• Professional liability tail coverage for the previous medical practice is not

an allowable Practice Expense unless specifically identified in the recruitment agreement and approved by the Chief Executive Officer prior to the execution of the recruitment agreement.

Business Meals:

• Business meals are not an allowable Practice Expense.


Exhibit D Page 1 of 14

Exhibit D

Allowable Practice Expenses for Joint Recruitment with an Existing Medical Practice

Joint Recruitment Practice Expense Loan: Additional conditions must be met for DistrictKaweah Delta to assist in recruiting a physician to join an existing practice. These include requirements that: (1) remuneration must be passed directly through to and remain with the recruited physician, except for actual costs incurred by the existing practice; (2) in the case of an income guarantee, the cost allocated by the existing practice to the recruited physician may not exceed the additional incremental costs attributable to the recruited physician, unless the recruited physician is replacing a deceased or retired physician or the specialty is underserved in the community (In those instances, the cost allocated by the practice may be per capita but may not exceed twenty percent (20%) of the practice’s aggregate costs); (3) records of actual costs and pass through amounts must be maintained for at least five (5) years; and, (4) the existing practice may not impose additional practice restrictions on the recruited physician making it difficult for a recruited physician to remain in the community and fulfill his or her commitments under the recruitment agreement with the DistrictKaweah Delta.

In the limited situation in which the recruited physician to the existing medical practice is replacing a deceased or retiring physician, or the community is underserved in the identified specialty, a practice may, for purposes of an income guarantee, allocate to the recruited physician a per capita allocation of the practice’s aggregate overhead and other expenses, not to exceed twenty percent (20%) of the practice’s aggregate costs.

Alternatively, the practice may allocate the actual incremental expenses attributable to the recruited physician as discussed in this Exhibit. If the practice elects to use and qualifies for a limited per capita allocation, the practice expenses and administration discussed in Exhibit C control the administration of the joint recruitment with an existing medical practice.

In all other cases, the existing practice may allocate to the recruited physician only the actual additional incremental expenses attributable to the recruited physician as discussed in this Exhibit.

In general, incremental practice expenses represent routine and recurring additional expenses that are expected and budgeted for the operation of the practice directly attributable to the recruited physician. Such costs are
















expected to be solely for the operation and benefit of the recruited physician in the practice - not personal in nature.

Incremental practice expenses must relate to the Incentive Period and must be incurred following the effective date of the agreement.

Supporting documentation, including, but not limited to, receipts and invoices must be submitted for review by DistrictKaweah Delta for practice expense audit and review.

Incremental Expense Categories:

Office Space Lease/Rent:

• Rent is not an allowable Incremental Practice Expense unless the

existing physician or group practice leases additional space for the recruited physician. The existing lease amount may not be apportioned or submitted as an incremental practice expense.

• If additional space is leased for the recruited physician, rent will only

be allowed for the number of months in the incentive period. If the Incentive Period does not begin on the first of a month, rent can either be pro-rated for the first month of the incentive period or it must be pro-rated at the end of the incentive period.

• If additional space is leased for the recruited physician, copies of all lease

arrangements (leases, sub-leases, etc.) must be provided to the DistrictKaweah Delta to substantiate the rental payment prior to the distribution of any payment including the additional space expense.

• If additional space is leased for the recruited physician, legal fees to

negotiate the initial lease agreement for additional space for the recruited physician are excluded from Practice Expenses since such costs are considered start-up expenses pursuant to Exhibit B.

• If additional space is leased for the recruited physician, refundable

deposits are not an allowable Incremental Practice Expense for reimbursement, unless the physician or group practice assigns the refundable deposit to the DistrictKaweah Delta.














Phone:

• Purchase and monthly service of cell phone and or/ pager for the recruited physician only are allowable Incremental Practice Expenses. The purchase of the phone and contract plan must be a fair market agreement.

• Monthly service of office phone system is not an allowable

Incremental Practice Expense unless there is an additional expense or cost directly attributable to the recruited physician. Initial purchase and installation of phone system are excluded from Incremental Practice Expenses unless required because of additional leased space for the recruited physician. In the event of additional leased space requiring initial purchase and installation of phone service, such costs would be considered start-up expenses pursuant to Exhibit B.

• In the event that the practice needs to purchase a phone system for the

recruited physician’s additional space but does not have available start-up expense reimbursement available, the standard depreciation for the equipment will be an allowable Incremental Practice Expense.

• Monthly service for recruited physician’s cell phone and/or pager

following the effective date of the recruitment agreement is an allowable Incremental Practice Expense. Monthly service fees for the recruited physician’s previous cell phone or pager may be included as an Incremental Practice Expense, as needed, during the first (1st) thirty (30) days of the Incentive Period.

• Monthly cost for an answering service is not an allowable

Incremental Practice Expense unless there is an additional expense or cost directly attributable to the recruited physician. Costs associated with maintaining an answering service for the recruited physician’s prior practice are not allowable Incremental Practice Expenses.

Utilities:

• Utilities are not an allowable Incremental Practice Expense for

reimbursement unless the existing physician or group practice incurs additional costs attributable to the recruited physician. Generally, utilities will not be an allowable Incremental Practice Expense unless the existing physician or group practice leases additional space for the recruited physician. Utilities expense for



the existing space may not be apportioned or submitted as an Incremental Practice Expense.

• If additional utilities are necessary for the recruited physician, cost of

water, electricity, trash, gas and other routine utility costs will be allowed as Incremental Practice Expenses for the number of months of the Incentive Period. If the Incentive Period does not begin on the first of a month, such utilities can either be pro-rated for the first month of the Incentive Period or it must be pro-rated at the end of the Incentive Period.

• If additional utilities are necessary for the recruited physician,

refundable deposits for utilities are not considered Incremental Practice Expense unless the physician or group practice assigns the deposit to the DistrictKaweah Delta.

Insurance:

• If Professional Liability Insurance (“PLI”) for the recruited physician is

paid quarterly or annually, such costs will be an allowable Incremental Practice Expense and will be reported in the month the PLI is paid or the first month of the Incentive Period if the expense is paid prior to the Effective Practice Date in the recruitment agreement.

• DistrictKaweah Delta will only permit as an allowable Incremental

Practice Expense the recruited physician’s PLI costs for the coverage months within the Incentive Period. Any pro-rated costs for covered months outside of the Incentive Period will not be permitted by the DistrictKaweah Delta as an allowable Incremental Practice Expense or Start-Up Expense.

• Supporting documentation, such as invoices or policies identifying

coverage periods and type of coverage, must be provided to the DistrictKaweah Delta for administration of the agreement. Allowance for any insurance costs will not be issued unless the supporting documentation is provided.

• Insurance premiums or deductibles relating to a recruited physician and

the recruited physician’s immediate family’s benefit expenses such as health, life, auto, home, flood, personal, umbrella, etc are not considered Incremental Practice Expenses because such expenses are reimbursed under the benefits expense provision of the recruitment agreement.



• If a physician or group practice employs a recruited physician’s family member, that family member’s benefit expenses for health insurance and retirement benefits will not be considered allowable Incremental Practice Expenses because such expenses are reimbursed under the benefit expenses provision of the recruitment agreement.

• Property and general business insurance are not an allowable

Incremental Practice Expense unless the existing physician or group practice incurs additional costs attributable to the recruited physician. Generally, property and general business insurance will not be an allowable Incremental Practice Expense unless the existing physician or group practice leases additional space for the recruited physician. Property and general business insurance expense for the existing space may not be apportioned or submitted as an Incremental Practice Expense.

• If additional property and general business insurance is necessary for

the recruited physician, cost of such insurance will be allowed for the number of months of the Incentive Period. If the Incentive Period does not begin on the first of a month, such expenses may either be pro-rated for the first month of the Incentive Period or it must be pro-rated at the end of the Incentive Period.

Salaries, Fringe Benefits and Payroll Taxes:

• Salaries, fringe benefits and payroll taxes for staff are not allowable

Incremental Practice Expenses unless the existing physician or group practice hires additional staff to directly work for the recruited physician’s relocated practice. The existing staffing costs of salaries, fringe benefits and payroll taxes may not be apportioned or submitted as an Incremental Practice Expense.

• If additional staffing costs are incurred following the Effective Practice

Date of the recruitment agreement, the monthly cost of additional clinic and office staff (e.g., medical assistant, midlevel, biller, receptionist, accountant, office manager and medical records clerk) directly working for the recruited physician only will be an allowable Incremental Practice Expenses.

• If additional staffing costs for employees or contractors for the recruited

physician are incurred prior to the Effective Practice Date of the recruitment agreement, such costs are excluded as



Incremental Practice Expenses but will be allowable start-up expenses for reimbursement pursuant to Exhibit B.

• Staff wages and salaries must be reasonable, appropriate and consistent

with the local market for such services

• Staff cost may not include any portion paid to the recruited physician or for the recruited physician’s benefit. However, payroll taxes and related benefits paid for by the employing physician or group practice are allowable Incremental Practice Expenses. The recruited physician’s portion of payroll taxes and benefits is not an allowable Incremental Practice Expense because such expenses are reimbursed to the recruited physician pursuant to the benefit expense provision of the recruitment agreement.

• A staff list will be provided identifying the employee or contractor, job

title, job description, employment status, salary, fringe benefits, and payroll taxes. This information will also include hire date and, as appropriate, termination date of staff.

• If additional staff costs are incurred for the recruited physician,

allowed staff appreciation costs and meals attributable to the additional staff will be capped annually at one thousand dollars ($1,000.00).

Medical Supplies:

• Costs of supplies or minor medical equipment attributable to the

recruited physician relating only to the recruited physician’s clinical practice are allowable Incremental Practice Expenses. Examples of acceptable medical supplies include, but are not limited to, stethoscopes, blood pressure cuffs, thermometers, scales, otoscopes, tongue depressors, bandages, cotton balls and linens. The allocation of such costs will be assigned to the recruited physician based upon reasonable accounting principles and consistently applied through outthroughout the Incentive Period.

• Cost of prescriptions attributable to and relating only to the recruited

physician’s practice will be allowed up to a specified cap as determined at the time of the agreement and as appropriate for the physician specialty.

• Cost of injectables/tablets attributable to and relating only the recruited

physician’s practice will be allowed up to a specified cap



as determined at the time of the agreement and as appropriate for the physician specialty.

• Medical supplies allowed as Incremental Practice Expenses may not

include the purchase of medical equipment identified in DistrictKaweah Delta’s Capitalization Policy, AP 135. Equipment and supplies for the recruited physician may be subject to the Capitalization Policy and will be evaluated based upon individual and aggregate purchases. A copy of AP 135 will be attached to the recruitment agreement.

• If an item is not allowable as a medical supply for the recruited

physician because it is identified in the Capitalization Policy, the recruited physician may elect to use available Start-up Expense reimbursement pursuant to Exhibit B provided the purchase is before the Effective Practice Date of the recruitment agreement or within the first (1st) three (3) months of the Incentive Period. If start- up expense reimbursement is unavailable because the recruited physician has exhausted the negotiated cap for such expenses, the medical supply cost will be administered pursuant to the DistrictKaweah Delta’s fair market lease rate factor.

Office Supplies and Postage:

• Costs of office supplies or minor office equipment attributable to the

recruited physician relating only to the business side of the recruited physician’s practice are allowable Incremental Practice Expenses. Examples of acceptable office supplies include, but are not limited to, paper products, forms, staples, pens and small business machines (e.g. shredder, calculator). The allocation of such costs will be assigned to the recruited physician based upon reasonable accounting principles and consistently applied through out the Incentive Period.

• Personal postage is not an allowable Incremental Practice Expense.

• Office supplies allowed as Incremental Practice Expenses may not

include the purchase of office or business equipment identified in DistrictKaweah Delta’s Capitalization Policy, AP 135. Equipment and supplies for the recruited physician may be subject to the Capitalization Policy and will be evaluated based upon individual and aggregate purchases.



• If an item is not allowable as a office supply for the recruited physician because it is identified in the Capitalization Policy, the recruited physician may elect to use available Start-up Expense reimbursement pursuant to Exhibit B provided the purchase is before the Effective Practice Date of the recruitment agreement or within the first (1st) three (3) months of the Incentive Period. If start- up expense reimbursement is unavailable because the recruited physician has exhausted the negotiated cap for such expenses, the office supply cost will be administered pursuant to the DistrictKaweah Delta’s fair market lease rate factor.

Leased Equipment:

• Medical and office equipment and office furniture are not allowable

Incremental Practice Expenses unless the existing physician or group practice must lease the items for the recruited physician’s practice. The existing medical and office equipment and office furniture costs may not be apportioned or submitted as an incremental practice expense.

• For medical and office equipment and office furniture that are for the

exclusive use of additional support staff to provide support for recruited physician or the recruited physician, the costs and expenses for those items will be allowable Incremental Practice Expenses subject to recalculation as identified in this Section, Leased Equipment.

• For office equipment and furniture that are for general use by staff or

physicians, the costs and expenses for those items will not be allowable Incremental Practice Expenses.

• For medical equipment that is for the exclusive use of the recruited

physician, the costs and expenses for such equipment will be allowable Incremental Practice Expenses subject to recalculation as identified in this Section, Leased Equipment.

• For medical equipment that is for use by the recruited physician and

other physicians in the group practice, the allocated costs and expenses assigned to the recruited physician based upon reasonable accounting principles and consistently applied through out the Incentive Period for such equipment will be allowable Incremental Practice Expenses subject to recalculation as identified in this Section, Leased Equipment.



• “Fair Value Lease” will be defined by Generally Accepted Accounting Principles (“GAAP”). For Fair Value Leases, the lease cost, for any lease term within the Incentive Period, will be an allowable Incremental Practice Expense provided such cost is acceptable pursuant to this Section, Leased Equipment.

• “Bargain Purchase Option” will be defined by GAAP. For a Bargain

Purchase Option with a one dollar ($1.00) buyout, if the term of the lease agreement is consistent with the equipment’s useful life, such lease cost during the Incentive Period will be an allowable Incremental Practice Expense provided such cost is acceptable pursuant to this Section, Leased Equipment.

• For Bargain Purchase Option, with a term less than the useful life of the

equipment, the DistrictKaweah Delta will recalculate the lease cost for the equipment as if the lease were a Fair Value Lease. In recalculating the lease cost the DistrictKaweah Delta will use an estimated useful life for the equipment as established by the American Hospital Association’s then current publication “Estimated Useful Lives of Depreciable Hospital Assets” in determining the fair value buyout, if any, at the end of the lease period. The resulting lease payment identified by the recalculation methodology described in this paragraph will be referred to as a “Recalculated Lease” payment for purpose of this Exhibit.

• If a recruited physician, existing physician or group practice elects to

purchase the equipment or enter into a loan agreement to purchase the equipment, the allowable Incremental Practice Expense for that equipment will be based on the Recalculated Lease payment as defined above subject to allocation to the recruited physician as discussed in this Section, Leased Equipment.

• Automobile leases are not allowable Incremental Practice Expenses.

Licenses:

• The pro-rated cost of obtaining and maintaining the California license to

practice medicine and DEA license for the recruited physician during the Incentive Period are allowable Incremental Practice Expenses. The recruited physician must provide copies of renewal applications and receipts to support the cost of each license for the DistrictKaweah Delta to pro-rate the cost. Providing copies of



money orders alone are not acceptable documentation to support an allowed expense.

• Costs of obtaining and maintaining medical licenses in other states or

unrelated to the relocated practice are not allowable Incremental Practice Expenses.

• Continuing medical education costs for the recruited physician are

separately discussed below and not considered a License expense. CME Training:

• The recruited physician, existing physician or group practice will be

entitled to an annual reimbursement up to five thousand dollars ($5,000.00) during the Incentive Period for costs expended in connection with the recruited physician’s attendance at medical conventions and/or seminars related to physician’s recruited specialty. DistrictKaweah Delta will reimburse the recruited physician, existing physician or group practice for recruited physician’s personal expenses related to tuition or registration, travel, lodging and meals.

Non-CME Training:

• Training of the recruited physician or additional staff for the recruited

physician in business software or other training necessary utilized in the relocated practice that is unrelated to continuing education hours for the recruited physician or additional staff for the recruited physician will be an allowable Incremental Practice Expense subject to an annual cap of two thousand four hundred dollars ($2,400.00).

Professional Services: Legal/Accounting/Consulting Fees:

• Legal fees unrelated to the legal fees permitted in Exhibit B but

related to the administration of the recruited physician’s relocated practice are considered an allowable Incremental Practice Expense as long as such fees directly relate to the recruited physician’s relocated practice during the Incentive Period. Legal fees are subject to an annual allowance cap of five thousand dollars ($5,000.00). Legal fees unrelated to the recruited physician’s relocated practice or related to the recruited physician’s personal affairs are not allowable Incremental Practice Expenses.



• Legal fees incurred during the term of the recruitment agreement to

alter the administration of the recruitment agreement, amend, or terminate the recruitment agreement will not be considered an Incremental Practice Expense.

• Accounting and consulting fees unrelated to the fees permitted in

Exhibit B but related to the administration of the recruited physician’s relocated practice are considered an allowable Incremental Practice Expense as long as such fees directly relate to the recruited physician’s relocated practice during the Incentive Period. Accounting and consulting fees are subject to an annual allowance cap of three thousand dollars ($3,000.00). Any accounting or consulting fees unrelated to the recruited physician’s relocated practice or related to the recruited physician’s personal affairs are not allowable Incremental Practice Expenses.

Maintenance:

• Costs of routine and recurring maintenance related to the office

building, medical or office equipment are not allowable Incremental Practice Expenses unless such costs are a result of additional space leased for the recruited physician.

• Remodeling or replacement of permanent office fixture costs (e.g.

carpet, light fixtures, air conditioners, etc.) are not allowable Incremental Practice Expenses.

Doctor’s Exchange:

• Additional incremental costs of answering service directly attributable

to the recruited physician for the relocated practice during the Incentive Period are allowable Incremental Practice Expenses.

Dues and Subscriptions:

• Pro-rated costs of professional dues for the recruited physician directly

related to the recruited specialty during the Incentive Period are allowable Incremental Practice Expenses.

• Allowable pro-rated subscription costs for reimbursement during the

Incentive Period will include professional material for the exclusive



use of the recruited physician that is directly related to the recruited specialty.

• Country club, fitness club or social organization membership fees are

not allowable Incremental Practice Expenses. Advertising and Marketing:

• The existing physician or group practice is required to hold a minimum of

one (1) open house for the recruited physician’s relocated practice within the first (1st) six (6) months of the Effective Practice Date of the recruitment agreement.

• Where the existing physician or group practice maintains a Yellow

Pages advertisement, the expense for renewal of the existing physician or group practice’s advertisement is not an allowable Incremental Practice Expense regardless of any modification to the advertisement to identify the recruited physician. Costs related to creating the modification to the advertisement will be an allowable Incremental Practice Expense.

• Where the existing physician or group practice does not maintain a

Yellow Pages advertisement and is required by the recruitment agreement to maintain a Yellow Pages advertisement, the expense for creating and publishing the advertisement in the Yellow Pages is an allowable Incremental Practice Expense.

• Pro-rated costs of reasonable advertising and marketing limited

exclusively to the recruited physician’s practice during the Incentive Period are allowable Incremental Practice Expenses. Examples of such costs include advertising for the recruited physician alone in the Yellow Pages, white pages, newspapers, magazines and hosting open houses at the recruited physician’s office.

• Advertising and marketing for the existing physician or group practice

during the Incentive Period that are modified to include the recruited physician are not allowable Incremental Practice Expenses. However, the expenses and costs associated with modifying existing advertising and marketing to include the recruited physician are allowable Incremental Practice Expenses.

• DistrictKaweah Delta will reimburse costs associated with a maximum of

two (2) open houses for the recruited physician’s relocated practice held during the Incentive Period. Open house reimbursement for the recruited physician is capped at an aggregate of three four thousand



dollars ($4,000.00). Allowance is available only for open houses hosted for the recruited physician alone. If an openan houseopen ishouse is hosted for the existing physician or group practice and the recruited physician is included as a physician providing service with the group, costs and expenses for such an open house would not be an allowable Incremental Practice Expense.

Billing and Collections:

• Monthly service fees paid to billing and collection companies related to

the recruited physician’s relocated practice during the Incentive Period are allowable Incremental Practice Expenses.

Automobile Expenses:

• Automobile expenses, including mileage, are not considered allowable

Incremental Practice Expenses. Debt Service:

• During the Incentive Period, the reimbursed amount for the recruited

physician’s student loans will be the amount identified as the minimum payment in the account statement for the recruited physician’s student loans from an accredited education lending organization. DistrictKaweah Delta will not allow as an Incremental Practice Expense any of the recruited physician’s student loan payment obligations that are not identified as held by an accredited education lending organization.

• All other debt service unless identified as allowable in Leased Equipment

or Maintenance will not be an allowable Incremental Practice Expense.

Late Fees:

• Late fees are not an allowable Incremental Practice Expense.

/ / / / / /



Donations/Charitable Contributions:

• Costs of participation in fundraisers or charitable contributions from the recruited physician, existing physician or group practice will not be an allowable Incremental Practice Expense.

Business Credit Cards:

• Business credit cards in the name of the recruited physician with

annual membership fees will be an allowable Incremental Practice Expenses up to an annual cap of one hundred dollars ($100.00).

Tail Coverage:

• Professional liability tail coverage for the recruited physician’s previous

medical practice is not an allowable Incremental Practice Expense unless specifically identified in the recruitment agreement and approved by the Chief Executive Officer prior to the execution of the joint recruitment agreement.

Business Meals:

• Business meals are not an allowable Incremental Practice Expense.


Policy Submission Summary

Manual Name: Human Resources Date: 8/21/18 Support Staff Name: Blanca Bedolla

Policy/Procedure Title

#

Status (New, Revised,

Reviewed, Deleted)

Name and Phone # of person who wrote

the new policy or revised an existing policy

Physician Recruitment Policy

AP.126 Revised Brittany Taylor, Sr. Physician Recruiter 624-2899

Personnel Files and Employee Health Records

HR.96 Revised Dianne Cox, VP HR 624-2362

Job Descriptions HR.95 Revised Dianne Cox, VP HR 624-2362

Performance Management and Competency Assessment Program


Notification Requirements, Pre-Determination Process and Appeal Process for Involuntary Termination, Suspension without Pay for More Than Five Days and Demotion


Tetanus, Diphtheria and Pertussis (Tdap) Policy for Health Care Workers

EHS.07 New Dianne Cox, VP HR 624-2362

Employee Health Standing Orders

EHS.08 New Dianne Cox, VP HR 624-2362

Extended Illness Bank (EIB) Donations

HR.239 Reviewed Dianne Cox, VP HR 624-2362

Temporary Transitional Work

HR.116 Delete Dianne Cox, VP HR 624-2362

Changes in Personal Status HR.97 Delete Dianne Cox, VP HR 624-2362

Outside Employment and/or Volunteer Efforts


Garnishments, Wage Attachments, Levy’s


Alcohol and/or Drug Rehabilitation Leave


Human Resources

Policy Number: HR.96 Date Created: 06/01/2007 Document Owner: Dianne Cox (VP Human Resources)


Approvers: Board of Directors (Administration), Debbie Wood (VP Human Resources)

Human Resources Employee FilesPersonnel Files and Employee Health Records

Printed copies are for reference only. Please refer to the electronic copy for the latest version.

POLICY: The District maintains a Human Resources file for each employee. All information contained within this file is considered confidential and, therefore, access to the file is limited. PROCEDURE: I. Contents of File

Each employees Human Resources file will contain information that is necessary for the District to conduct its business, as well as information required by federal, state or local law and/or regulatory agencies. This information typically includes, but is not limited to: employment application form; payroll information, salary changes, position status changes; performance appraisals; disciplinary records; and education and training records. required license and certification Medical information obtained by way of the pre- employment medical examination and/or subsequent testing medical examinations, and benefits eligibility records where appropriate, are contained in a separate confidential file. Appropriateness of Contents

Employees Human Resources files will be reviewed

randomly by the Human Resources Department’s representatives to ensure that the file contains only Information that is relevant to the individual's employment with the District. Retention of File

Each employee file will be retained during the entire tenure of that individual's employment with the District. Retention beyond that point shall be in compliance with applicable federal and state law(s) and regulatory agencies. Employees Access to File

Each employee and former employee shall be allowed to inspect and obtain copies of information contained within their Human Resources file, with the exception of references and/or criminal history information. However, employees and former employees will not be permitted to write on or modify any existing document. A request to review and/or copy the record will be directed to the Human Resources Department front desk. Requests to review Human Resource’s files should be at least twenty-four (24) hours in advance. A time for inspection that is convenient for both the employee and the Human Resources Department will be scheduled within a reasonable time, but no later than 30 days after a written request and for payroll records no later than 21 calendar days from date of the request. At no time shall the record be available outside of regular Human Resources Department office hours. If an employee is required to inspect or receive a copy of his/her personnel file at a location other than the place where he or she reports to work, no loss of compensation to the employee is permitted because of the time needed for the employee to travel from the site where the employee normally reports to work. A Human Resources Department representative will be present at all times when the file is being inspected. Human Resources is not required to comply with more than one request per year by a former employee to

inspect or to receive a copy of his or her personnel file. Copies produced must include the form that the employee has signed relating to the obtaining or holding of employment. Dispute of Information Contained Within File

If, after inspecting the file, the employee believes that certain material is not relevant or is inaccurate, the employee may submit a written request to the Vice President of Human Resources to have the material removed from the file. The employee will be informed regarding the outcome of their request. Access to File

Access to an employees Human Resources Department file is limited to: the employee; The employee’s designated representative; The representative must be authorized, in writing, by the employee (or former employee) to inspect, or receive a copy of, his or her personnel records. Human Resources will take reasonable steps to verify the identity of a requestor. Reasonable steps include identity verification by means of a driver’s license or other government identification card that includes a photograph. the employees immediate supervisor, manager or director; any department supervisor, manager or director who oversees a work unit to which the employee has requested a transfer; the Chief Executive Officer and/or his/her designee; anyone specified with an appropriate court order or subpoena to review as well as appropriate governmental or regulatory officials when mandated by law or regulation; and, Human Resources Department employees.

Outside Requests for Information The District will not disclose any information from an employee’s personal file for law enforcement and/or government officials without proof that a legally executed subpoena or court order has been issued for such information. The records employees and former employees are entitled to see and/or copy are: Application for employment; Payroll authorization form; Notices of commendation, warning, discipline, and/or termination; Notices of layoff, leave of absence, and vacation; Notices of wage attachment or garnishment; Education and training notices and records; Performance appraisals/reviews; and Attendance records.

Update of Information

In order to keep Human Resources records up to date, personnel shall notify the Human Resources Department in writing of any changes in personal status including name, address, telephone number, marital status or beneficiary designation.

POLICY: This policy provides guidelines on the appropriate retention and review of Personnel Files and Employee Health Records, ensures the confidentiality of same, and indicates access requirements for an employee or previous employee of their own Personnel File and/or certain Employee Health Records. Kaweah Delta maintains a system for retaining employee Personnel Files and Employee Health Records to assure compliance with all Federal and State regulatory requirements and to serve as reference documents when needed. Personnel Files are retained after an employee leaves employment; Employee Health records, including Workers’ Compensation Files, are retained for at least 30 years post-employment. The Human Resources and Employee Health departments maintain a Personnel File and separate Employee Health Record for each employee. The Personnel File includes such information as the employee’s job application, resume, W-4’s, records of training, records

Formatted: Font: Arial, 12 pt





of benefit plan enrollment, documentation of performance appraisals and salary increases, and other employment records. The Employee Health Record includes the post-offer health history and related documentation as well as ongoing immunization records, such as TB screenings. Personnel Files and Employee Health Records are the property of Kaweah Delta and are confidential. Access to the information contained in these files is restricted. Only supervisors and management personnel of Kaweah Delta who have a legitimate reason to review information in a file are allowed to do so. Employee Health Records are maintained by the Employee Health Manager or designee. These records are available to employees of the Human Resources and Employee Health departments for purposes of responding to employee requests for documentation or other job-related reasons. Review and/or removal of a Personnel File from Human Resources will be controlled within Human Resources; the same for Employee Health Records which are controlled by Employee Health. A File may only be requested and/or removed from Human Resources or Employee Health by authorized individuals. Authorized Individuals:

1. The following individuals are authorized to review an employee’s Personnel file within Human Resources:

a. Current or former employee - review and research, may request a copy b. Human Resources or Employee Health staff for their respective files and

records - review, research, filing c. Supervisor or department management – review of their staff or if

considering an employee for transfer to their department d. Kaweah Delta legal counsel - review for appropriate legal action e. State and Federal agencies - for subpoena of records, inspection of file for

compliance with regulations as and law; The Joint Commission, CMS, and the State Department of Health.

PROCEDURE: The following procedures apply to files of current and terminated employees:

1. The employee may request to inspect or have a copy made of his/her Personnel file by completing the form ”Request to Inspect or Copy Personnel File” in Human Resources. For copies of Employee Health Records, the employee must complete the “Employee Health Records Information Release” Form. For current employees, Human Resources has 48 hours to complete the request. For terminated employees, Human Resources attempts to provide the copied files within 4-5 days, but reserves the right to complete the request within 30 days. The employee must review the file in Human Resources and is not allowed to remove the file under any circumstances.






2. Employee Health Records are not contained in the Personnel File. These records are confidential; Kaweah Delta will safeguard them from disclosure and will disclose such information only as allowed by law or as required for Workers’ Compensation or regulatory agency purposes.

3. A file removed from Human Resources or Employee Health must be hand carried

to the requesting party by the authorized individual or designee. A representative from Human Resources or Employee Health will typically remain with the file and ensure the return.

4. Files and records must be returned within a timely manner. A Human Resources

Representative or designee will monitor the tracking form to ensure the file is returned.

5. To keep Personnel records up to date, employees are required to notify the

Human Resources department in writing of any changes in personal status including:

a. name b. address c. telephone number d. marital status and dependents if covered under employee benefits e. beneficiary designation for any of the insurance plans f. persons to be notified in case of emergency

"These guidelines, procedures, or policies herein do not represent the only medically or legally acceptable approach, but rather are presented with the recognition that acceptable approaches exist. Deviations under appropriate circumstances do not represent a breach of a medical standard of care. New knowledge, new techniques, clinical or research data, clinical experience, or clinical or bio-ethical circumstances may provide sound reasons for alternative approaches, even though they are not described in the document."


Human Resources



Approvers: Board of Directors (Administration), Debbie Wood (VP Human Resources)

Job Descriptions


POLICY: The District maintains current job descriptions for all District jobs.

PROCEDURE: I. Human Resources will provide all newly hired

employees and employees transferred into new positions with a copy of their job description.

II. Each job description will contain the job title, job responsibilities, experience and/or educational requirements, license/certification required at the time of hire, as well as responsibilities related to service excellence compliance and other District standards.

III. Job descriptions are used by Human Resources to

determine salary grades for jobs, recruitment, ADA compliance, and performance evaluations.

IV. Job descriptions should be reviewed annually by

management and revised, if necessary, to ensure they accurately reflect the job.

POLICY:

This policy provides department heads with appropriate guidelines for defining the qualifications and performance expectations for all staff positions. The Job Description is combined with and used as a part of the annual Performance Evaluation form.

Department heads are responsible to create and maintain current Performance Evaluation/Job Descriptions for each position in their department. Each job description will contain a job summary, job duties and performance standards, and minimum position qualifications including education, experience, required certification and/or registration, and the position’s essential functions and physical demands. PROCEDURE: 1. Each employee is entitled to a copy of the most recent Job Description for his/her position

and will be required to sign an Acknowledgment of receipt upon hire and upon a change in position.

Formatted: Indent: Left: 2.17", Hanging: 0.5", Nobullets or numbering


2. Human Resources will assist department heads in updating existing Job Descriptions and creating Job Descriptions for new positions.

3. Human Resources will maintain the most current copy of each Job Description in the Human

Resources’ system. Department heads must notify Human Resources of any changes in Job Descriptions in order to update these files.


Human Resources



Approvers: Board of Directors (Administration)

Performance Management Program and Competency Assessment Program


POLICY: The District maintains a formal performance management and competency assessment program to encourage excellent employee performance.

Performance management is the formal written review, evaluation, and discussion of individual performance against previously agreed upon performance measures, expectations and standards derived from the job description.

Competency assessment is the review of an individual’s ability to perform specific responsibilities of their job duties.

PROCEDURE: I. Human Resources Coordination

Overall coordination of the performance management program is the responsibility of the Human Resources Department. Coordination includes, but is not limited to:

• notification to supervisor of upcoming appraisal • follow-up when reviews are delinquent • records maintenance • salary adjustment, where appropriate, based on

evaluation results.

II. Management’s Responsibilities

A. Initial Competency Evaluation:

During face-to-face discussion, management must assess and document the initial competency of employees who provide patient care. Initial competency documentation is maintained in the department files and must be completed by evaluation due date.

Performance Management Program and Competency Assessment Program 2

B. Competency Assessment Guidelines- Examination and Remediation Pathway:

Examination through cognitive evaluation is an integral segment in assuring competency of staff members. These are the established guidelines for utilization when developing examinations to assess, evaluate and monitor performance competency. The purpose of the pathway is to assist in eliminating variation in application of standards. And may include the following elements:

• Staff will be advised in advance of the

examination if the purpose is for educational needs assessment only or for competency validation.

• Prior to competency examinations staff members will be provided with:

o Adequate time to prepare for the exam

o Access to study materials and an outline of exam content

o Additional resources for examination preparation as requested

[Acceptable passing score will be communicated]

• In the event of not successfully passing an

exam, the remediation plan will be readily communicated.

o Specific time frames for repeat of exams and support study resources for assistance will be communicated

o Expected time frames for additional sequential testing will be predetermined and communicated

• Professional Certifications that are a

requirement for employment within specific departments may serve as a core equivalent to competency examination.

o Refer to HR Policy HR.50/Professional Certification

o Support for successful completion of a required certification will mirror the guidelines defined above.

C. Annual Competency Evaluation:


The District will have an annual competency fair. All employees must attend the competency fair or one of the make-up sessions. Documentation of attendance is recorded in the HR Online database and written documentation is maintained in the department files. Management is responsible for ensuring employees complete the fair and for obtaining and maintaining documentation of completion.

III. Performance Evaluation Program

A. Performance evaluations include:

Evaluation of employee's overall performance against performance measures, expectations, and standards

Documentation of past performance and plan for future performance targets

Formulation of a development plan to maintain or improve performance and productivity

Performance rating to serve as the basis for Human Resources planning and designing merit salary actions

Discussion in which the employee's overall performance, measures, expectations and performance points received are discussed

Evaluation of employees competencies appropriate to the specific responsibilities of their job.

B. Effective Dates:

1. Annual Performance and Competency Evaluation:

Employees will normally receive an annual evaluation effective the first day of the pay period following the anniversary date of their employment. Annual evaluation dates may be changed in some circumstances.


a. Change of Job

When an employee changes jobs their evaluation date may also change. See policy entitled TRANSFERS (HR. 31).

b. Extended Leave of Absence

If an employee is away from the work place for greater than twelve weeks on a Leave of Absence, the performance evaluation review date will change by the number of days over eighty five days that the employee is away.

Exception: Employees away from the work place as a result of Short Term (Reserve) Military Training Leave and/or Military Leave will not experience a delay in either preparation of their performance evaluation and/or subsequent merit increase or merit lump-sum. For further discussion, see policy entitled SHORT TERM (RESERVE) MILITARY TRAINING AND MILITARY LEAVE OF ABSENCE (HR.151).

2. Additional Performance Evaluations with no

eligibility for monetary reward:


Additional performance reviews may be completed at any time during the rating period at the discretion of the supervisor with discussion with the Human Resources Department representative.

C. Merit Salary Adjustments

1. Annual Performance:

Merit salary increases to hourly rates and/or merit lump-sum awards will be based on the total points received on the performance evaluation. The percentage of the merit increase or merit lump-sum will be in accordance with the Merit Increase Pool established annually by the Board of Directors.

At no time shall an employee be eligible for an annual merit salary adjustment more often than once annually.

a. Merit Increases to Hourly Rate

Employees who achieve a sufficient overall rating on their performance evaluation and demonstrate competence and whose hourly rate is below the maximum of the salary range to which their job classification is assigned, will be eligible for an increase in their hourly rate. This increase will be in accordance with the Merit Increase Pool established annually by the Board of Directors.

b. Merit Lump-Sum Awards

Employees who qualify for a raise based on performance will receive a raise to the maximum of the salary grade assigned to their job. The remainder will be paid as a merit lump sum (MLS).

Merit Lump-Sum Awards will be calculated as the maximum of the salary range, multiplied by the


percentage derived from the Merit Increase Pool, multiplied by the total productive and non-productive hours paid during the rating period. Standby, overtime, and/or call-back hours are not considered in this calculation.

D. The completed performance evaluation will be

saved in electronic form within the assessment program retained for use by the District.

E. Employees are free to make written comments

during the completion of their performance evaluation. These written comments will remain as a permanent part of the performance evaluation.

POLICY: It is the policy of the Kaweah Delta to assess, maintain, develop and improve employee performance and competence on an ongoing basis. Performance is formally evaluated on an annual basis through an employee self- evaluation, peer evaluations as appropriate, and a manager evaluation. Competency is the demonstrated ability to integrate the knowledge, skills, and attitudes required in a designated role or setting. Competency is verified through utilization of techniques such as demonstration, review of policy/procedure, verbalization, and/or written testing. The performance evaluation and competency assessment process ensures that the requirements of the position are met, that each individual is provided opportunities for professional development, and allows for merit increase opportunities consistent with the compensation program in place at the time of the performance evaluation. In conjunction with the populations served, Job Descriptions are combined to make one Performance Evaluation tool. Upon hire or a position change, a review date for the annual performance Evaluation is established for each employee. The Kaweah Delta requires annual mandatory training in compliance with regulatory agency requirements as well as Kaweah Delta policy. All employees must successfully complete all required training by the due dates established to avoid suspension and termination of employment. Documentation of completion is recorded in the HR systems and written documentation may be maintained in Human Resources or department employees files. Management is responsible for ensuring employees complete the requirements and for obtaining and maintaining documentation of completion. However, employees are ultimately responsible for meeting job requirements and mandatory training by established due dates. Failure to complete requirements and mandatory training may result in Disciplinary Action up to and including termination of employment. PROCEDURE: Annual Performance Evaluations:



1. The annual Performance Evaluation is a tool utilized by both management and the

employee to identify and communicate the performance of the employee and the future annual expectations of the position, and to determine ways to improve performance or to gain advanced knowledge, including development opportunities. The Performance Evaluation is to be discussed with the employee in a face-to-face meeting. The employee is encouraged to provide additional feedback, written comments, and share development interests.

2. The Performance Evaluation form includes the Job Description, overall job requirements relevant to all positions, overall comments, and goals to be used for training and development and to describe actions which will be used to develop skills and improve the employee’s performance, such as additional training or work assignments.

3. Employees are required to complete an honest and timely self-evaluation of their

performance. Management may also request peer evaluation of the employee’s commitment to the Kaweah Care Behavioral Standards of Performance.

4. The final review will be electronically signed by both the employee and individual

completing the evaluation. The evaluation must be signed by a person who has the expertise at least equal to the individual being observed or tested.

5. At the completion of the annual evaluation, the overall performance rating will be

consistent with the definitions noted on the performance evaluation tool. Failure to successfully meet expectations of performance may result in the employee being placed on Disciplinary Action, up to and including termination of employment.

Review Date and Applicable Merit Increases:

1. Department management is notified by the HR system when their employee is due for an annual evaluation. It is the responsibility of employees to complete a timely and thoughtful self-evaluation. It is expected that department management will complete evaluations on time.

2. At the time the employee is hired or changes to a different position, he/she will be

provided with a copy of the Job Description/Performance Evaluation and Physical Demands forms that will be used to evaluate his/her performance. The employee signs an acknowledgment of receipt. The employee will also be provided with a copy of the form by the manager.

3. Completion of the annual review is defined as the employee’s electronic signature

in the Human Resources system. Human Resources will process any associated merit increase. Merit increases are effective the first day of the pay period following the effective date of the annual evaluation.

4. Merit increases are based on the salary range and merit increase percentages in effect on the due date of the evaluation, not the day the evaluation is presented to Human Resources. The merit increase will be paid retroactively if the evaluation is completed late.





5. Merit increases that place an employee’s rate at the maximum of the range will result in the application of a Merit Lump Sum amount, equivalent to the employee’s productive and non-productive hours (excluding standby, overtime, doubletime or callback hours) multiplied by the hourly rate in place for the employee prior to the evaluation. An employee may receive a partial merit increase to the maximum of salary range and a partial Merit Lump Sum.

6. If an employee takes a paid or unpaid Leave of Absence exceeding twelve (12)

weeks (84 days) in a twelve-month rolling period, the employee’s review date may be adjusted by the number of calendar days exceeding 85 days. This provision will not apply in the case of an employee who is on an approved Short-Term (Reserve) Military Training and/or Military Leave of Absence.

Competence Assessment:

1. During the first of 48 hours of employment, all employees will complete the 48-

hour checklist for departmental orientation.

2. Competency is the demonstrated ability to integrate the knowledge, skills, and attitudes required for performance in a designated role or setting. Competency is verified through utilization of techniques such as demonstration, review of policy/procedure, verbalization, written testing, etc. For the initial competency evaluation at the time of hire or transfer, a face-to-face discussion will occur to assess and document the initial competency of an employee who provides patient care. Initial competency documentation is maintained in the department files or Human Resources as determined by the department. All items must be reviewed, checked and signed for competency by a person who has the expertise at least equal to the individual being observed or tested. An employee must be deemed competent to perform a skill prior to them performing the skill independently.

3. Patient care and related employees will complete an annual clinical competency assessment for their position as applicable. All items must be reviewed, documented and signed for competency by a person who has the expertise at least equal to the individual being observed or tested.

4. In addition, employees must be deemed competent when new procedures or equipment are introduced into the clinical setting, and this information will be maintained in the Human Resources or department file.

Remediation:

1. If an employee falls below expected levels of performance or is not deemed competent of a requirement or skill, the employee will be provided with opportunities for improvement.

2. The remediation plan may be included in a Disciplinary Action/Performance Notice, or a separate remediation plan may be developed. Time frames for follow up and requirements will be noted as applicable, and may include meetings, testing, review of policies, and other appropriate actions to ensure performance and competency. Failure to comply with or successfully complete the plan may result in further Disciplinary Action up to and including termination of employment.






Human Resources, Human Resources


Date Approved: Not Approved Yet

Approvers: Board of Directors (Administration), Dianne Cox (VP Human Resources)

Notification Requirements, Pre-Determination Process and Appeal Process for Involuntary Termination, Suspension without Pay for More Than Five Days and

Demotion Printed copies are for reference only. Please refer to the electronic copy for the latest version.

POLICY:

Employees of the District by statute serve at the pleasure of the Board of Directors (see Health and Safety Code Section 32121(h)). When an employee who has passed his/her six (6) month introductory period is informed of his/her involuntary termination, suspension of five days or more or demotion, the employee will be provided the opportunity for a pre-determination review of a Notice of Intent, written notice of the pre-determination review process, and the District’s post-determination review and appeal process.

The purpose of a pre-determination review is to provide employees the opportunity to appeal before a decision is made to terminate, demote, or suspend for more than five (5) days. Nothing in this policy should be interpreted as modifying or diminishing in any way the District’s right to terminate or discipline an employee “at will” that is for any reason which the District considers to be sufficient in its sole discretion. DEFINITIONS:

I. Pre-Determination Review: A meeting in which an employee is given the

opportunity to respond to a Notice of Intent by submitting a written and/or verbal statement to an appointed Reviewer. If the employee chooses to respond, the Reviewer has the responsibility to recommend whether the proposed action should be upheld, overturned, or modified.

II. Reviewer: Except as otherwise noted, the “Reviewer” shall be a Vice

President or other executive appointed by the Vice President of Human Resources.

III. Post-Determination Review: Appeal process after the pre-determination

review.

Notification Requirements and Appeal Process for Involuntary Termination and Demotion 2 PROCEDURE:

I. Initial Notice of Intent

If an employee who has passed the initial six (6) month introductory period, is subject to termination, suspension for more than five (5) days or demotion, the management of the employee, or the Vice President of Human Resources or designee, shall cause to be served on the employee a written notice (“Notice of Intent”). The following is a recommended list of the items that should be contained in this document, but no “Notice of Intent” will be invalid if it does not contain all of the items on this list. The purpose of the document is to provide the employee with an outline of the proposed action along with a fair summary of the reasons for taking the action:

A. the proposed action (i.e., termination, suspension for more than five

(5) days or demotion) and the effective date of the proposed action;

B. the reasons supporting the proposed action;

C. a summary of the facts upon which the charges are based;

D. notification that the employee is entitled to a pre-determination meeting to respond, either orally or in writing, to a review (“pre-dterminationdetermination Rreviewer”). The Pre-determination Reviewer (“Reviewer”) will be appointed by the Vice President of Human Resources or his/her designee.

E. the name of the Reviewer and his/her contact information; and

F. notification that the proposed action will become final and that the

employee will waive his/her rights to a pre-determination review and a post-determination hearing of the matter if the employee does not contact the Reviewer by 4:00 p.m. of the next working day after service of such notice. A form to be used for such notice will be provided by Human Resources. "Working day" as used herein shall mean any day, Monday through Friday, holidays excluded.

G. The provisions contained in Section F are advisory and within the

sole discretion of the District. The District’s failure to comply with any of the provisions of this Section shall not invalidate any disciplinary action taken.

II. Effective Date

The Notice of Intent as described in this document shall become effective when:

A. The employee has been served with a copy of the notice specified

above and has failed to contact the assigned Reviewer to schedule a

Notification Requirements and Appeal Process for Involuntary Termination and Demotion 3

review of the proposed action, by 4:00 p.m. of the next working day after service of the notice; or,

B. The employee contacts the assigned Reviewer, the Vice President of

Human Resources or his/her designee or the Director of his/her Department and explicitly states he/she does not want to schedule a pre-determination review of the proposed action; or,

C. The employee properly requests a pre-determination review and the

Reviewer issues a written recommendation after the pre-determination meeting in which he/she recommends upholding the proposed demotion, suspension or termination and the employee does not request a post-determination hearing with a Hearing Officer, or;

D. The employee properly requests and obtains a post-determination

hearing where the Hearing Officer upholds the decision of the Reviewer and the employee does not request a review by the CEO; or

E. The employee properly requests and obtains appellate review by the

CEO and he/she upholds the decision of the Reviewer.

III. Arranging the Pre-determination Meeting

A. The Notice of Intent will identify the Pre-determination Reviewer “Reviewer” and provide the Reviewer’s contact information. It will advise the employee that he/she may respond directly to the Reviewer, either orally or in writing, and will set out the time limit within which the response should be submitted. The Notice of Intent will also advise the employee how he/she can contact the Reviewer to arrange a meeting.

B. If the employee wishes to meet, it is his/her responsibility to contact

the Reviewer and arrange the meeting; the meeting should be scheduled no later than three (3) calendar days following the date of the request.

C. As an alternative to a meeting, an employee may submit a written

response. The Reviewer may disregard an untimely response. D. If it occurs, the pre-determination meeting will be informal. The

Reviewer will lead the meeting. The employee may provide such evidence or information as he/she wishes and tell his/her side of the story. After the meeting, the Reviewer will recommend whether the proposed action should be upheld, modified, or revoked. Matters related to the Pre-determination Reviewer’s recommendation are addressed in Part IV, below.

E. On occasion, employees may request that a scheduled pre-

determination meeting date be extended, or that the standard pre-


determination response period be increased. Although the Reviewer may grant or deny these requests, he/she should consult with Human Resources prior to doing so. Since employees may be on leave with pay during the pre-determination period, it is important to consider the stated need for the extension, along with the financial implications of the request, before issuing a decision.

IV. Recommendations for Conducting the Pre-determination Meeting

PREPARATION FOR THE MEETING: The Reviewer should read the notice of the intended action Notice of Intent, supporting documents, this Policy; , District policies and procedures relating to the intent intended action, and any written response submitted by the employee and any documents the employee has submitted. At the meeting, the Pre-determination Reviewer will: Introduce all persons present1; explain the purpose of the meeting; explain that, upon completing the meeting, he/she will consider the information provided and then make a recommendation to uphold, modify, or revoke the proposed action; explain that his/her recommendations, if any, are not binding, but are simply recommendations that may be accepted or rejected by the District. The Reviewer should then invite the employee to respond to the charges and advise that the employee’s response may be submitted in writing, if the employee desires, or a combination of verbal and written responses. The reviewer Reviewer should allow the employee to present all relevant facts and arguments including documents. The pre-determination meeting is not a formal hearing and there will be no witnesses testifying under oath. If the employee believes there are other employees who can support his/her facts/arguments, he/she may, with the permission of the Reviewer, bring them to the meeting and ask that they be heard. Such oral statements are in the discretion of the Reviewer. The Reviewer may limit the number of “witnesses” or place time limitations of on the length of such verbal statements.

Neither the District nor the employee shall have the right to be represented by counsel or any other person not an employee of the District. The employee, is in his/her discretion, may bring a current District employee to support him/her at the meeting.

It is often helpful to invite the Manager/Supervisor initiating the action to sit in on a pre-determination meeting for the purpose of providing clarification. However, the attendance of any person is at the sole discretion of the Reviewer. The Reviewer may ask questions of the Manager/Supervisor or

1 The Reviewer may request the attendance and assistance of a member of Human Resources staff at the meeting.


allow the employee to ask questions of the Manager/Supervisor. Such questioning, however, should be permitted only if the Reviewer finds it of value. AFTER THE PRE-DETERMINATION MEETING After the meeting, the Reviewer evaluates all of the information. If the Reviewer concludes that additional information is needed, he/she will contact the Vice President of Human Resources or his/her designee for advice and assistance.

After reviewing all of the documentation and information, the Reviewer evaluates whether in his/her judgment there is a reason to believe the employee engaged in the conduct charged and whether the proposed action is appropriate. The Reviewer may confer with the Manager/Supervisor who initiated the action. If this evaluation involves policy issues, the Vice President of Human Resources or his/her designee should be consulted. Depending on the results of his/her evaluation, the Reviewer then makes a recommendation to uphold, modify, or revoke the proposed action.

The Reviewer will prepare his/her written recommendation within three (3) working days of the meeting or such longer time as is necessary. The letter will be hand delivered to the employee during the a final meeting with their manager and the Human Resources representative. If the employee refuses to attend a the final meeting with their manager and the Human Resources representative, the letter will be sent to the employee by regular and certified mail.

PAY STATUS In most cases, the employee will continue to remain on pay status until the review process is completed and the action is implemented, implemented in modified form, or revoked.

Requesting a Hearing An employee may appeal the District’s final determination of Reviewer’s recommendation supporting substantial action (demotion, suspension of more than five (5) days, termination) by submitting a request for appeal to the Vice President of Human Resources or his/her designee. The employee’s written request for appeal must be received no later than five (5) calendar days from the date of the document containing the final action. The five (5) calendar days requirement applies even if the letter with the Reviewer’s of written recommendation is delivered by mail.

If an employee properly submits a written request for a hearing, it shall be scheduled no later than ten (10) working days following the date of the request by the employee. The ten (10) working day time period may be extended by the Vice President of Human Resources or his/her designee at the request of the employee or the District, upon a showing of good cause, provided that the


District shall have no obligation to pay back wages beyond the ten (10) day period in the event the proposed termination, suspension of five (5) days or more or the demotion is overturned by the Hearing Officer or the if the extension is at the request of the employee. The hearing shall be set for the earliest mutually agreeable date, which shall not be more than thirty (30) calendar days from the date of the request for a hearing was received. The hearing shall be an informal evidentiary hearing attended by the Vice President of Human Resources or his/her designee and by the employee. The hearing shall be presided over by the Personnel Hearing Officer (who serves by appointment of the Board of Directors), or by a Hearing Officer chosen from a panel pre-approved by the District’s Board of Directors and mutually agreed upon by the parties.

At the hearing, both the District and the employee shall have the right to counsel, the right to call and examine witnesses for or against either party, the right to offer appropriate documentary evidence, the right to a reasonable continuance upon a showing of good cause, and all other procedural due process rights applicable to administrative proceedings. Strict rules of evidence shall not apply and the Hearing Officer shall have the discretion to determine what evidence shall be admitted and what weight shall be given to the admitted evidence. At all proceedings before the Hearing Officer, the District shall provide, at the expense of the District, the services of a certified shorthand reporter. The District shall have the burden of and producing proving by a preponderance of the evidence that the termination, suspension for more than five (5) days or demotion was for good cause. At the conclusion of the hearing the matter will be submitted to the Hearing Officer for decision.

The decision of the Hearing Officer shall be in writing and ordinarily shall be rendered no later than five (5) calendar days from submission of the matter for decision. The decision of the Hearing Officer shall be filed with the Vice President of Human Resources or his/her designee who shall promptly serve a copy of the decision on the employee or his/her counsel, if any. The decision shall be effective immediately upon filing of the decision with the Vice President of Human Resources or designee, unless the employee properly complies with the requirements for appellate review. The decision of the Hearing Officer shall be a recommendation to the Chief Executive Officer. The Hearing Officer may recommend to uphold, overrule or modify the proposed actionAction.

VI. The Chief Executive Officer’s Decision (Appellate Review)

Any party affected by the decision of the Hearing Officer shall have the right to a review of by the Chief Executive Officer. Written notice of appeal, including the basis (or bases) for the appeal, must be filed with the Vice President of Human Resources or his/her designee no later than three (3) calendar days following service of the decision of the Hearing Officer on the party requesting the appeal. Failure to file written notice of appeal within said three (3) calendar day time limit shall constitute a waiver of appeal rights. The Chief Executive


Officer shall review and consider the recommendation of the Hearing Officer. After reviewing the recommendation of the Hearing Officer, the Chief Executive Officer in his/her sole discretion may decide to uphold, revoke or modify the proposed action imposed on the employee.

Any party seeking the Chief Executive Officer’s review of the decision must obtain, at the appellant's own expense, two copies of a transcript of the proceedings held before the Hearing Officer. Failure to file such transcripts with the Vice President of Human Resources or his/her designee at least two (2) working days prior to the date set for appellate review shall constitute a waiver of the appeal.

The appellate review before by the Chief Executive Officer shall be scheduled no later than ten (10) calendar days following the date of the receipt by the Vice President of Human Resources or his/her designee of the request for appellate review, or as soon thereafter as it can be scheduled taking into consideration the availability of the Chief Executive Officer and/or the transcript of the hearing. The Chief Executive Officer shall apply the independent judgment test in reviewing the decision of the Hearing Officer. The opposing party appellee shall have five (5) working days to prepare and file a written response to the appeal. The Chief Executive Officer, at its his/her discretion, may determine whether or not it he/she would like to receive any additional oral or written argument. The Chief Executive Officer shall not be empowered to receive new or additional evidence.

The Chief Executive Officer shall affirm, modify, or reverse the decision of the Hearing Officer, and shall file with the Vice President of Human Resources or his/her designee its his/her written decision within two (2) working days following the conclusion of the appellate review.

The decision of the Chief Executive Officer shall become effective immediately upon filing the decision with the Vice President of Human Resources or his/her designee.

The decision of the Chief Executive Officer shall constitute the final administrative proceeding which must be exhausted by either party before seeking judicial review, if any.

Note: If the subject matter of the original Notice of Intent to Terminate included or involved the Chief Executive Officer in a way that might prejudice the employee in this matter, the final review will exclude the Chief Executive Officer and the Kaweah Delta Chairperson President of the Board of Directors of Kaweah Delta Health Care District of will act as the final reviewer. Service of any notice, decision, or any other matter required to be served under these provisions shall be deemed served on the same day it is personally served upon the party to be served, or on the third (3rd) calendar day following deposit in the United States mail of the material to be served, certified mail,


return receipt requested, addressed to the last known address of the party to be served.

This policy shall not extend to employees during their initial introductory period (i.e., less than six months of employment).

These guidelines, procedures, or policies herein do not represent the only medically or legally acceptable approach, but rather are presented with the recognition that acceptable approaches exist. Deviations under appropriate circumstances do not represent a breach of a medical standard of care. New knowledge, new techniques, clinical or research data, clinical experience, or clinical or bio-ethical circumstances may provide sound reasons for alternative approaches, even though they are not described in the document."

Employee Health

Policy Number: EHS 07 Date Created: 8/13/18 Document Owner: Sarah Amend (RN-Employee Health Nurse)


Approvers: Board of Directors (Employee Health), Dianne Cox (VP Human Resources)

Tetanus, Diphtheria and Pertussis (Tdap) Policy for Health Care Workers

Printed copies are for reference only. Please refer to the electronic copy for the latest version. Policy: Pertussis (whooping cough) is highly contagious. Tetanus, Diphtheria and Pertussis (Tdap) vaccination can help protect Health Care Workers (HCW) against Pertussis and help prevent them from spreading it to their patients. The Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP) recommend the administration of a onetime dose of TDAP for all HCW’s. Health Care workers (HCW) include but are not limited to Physicians, Nurses, Aides, Respiratory Therapists, Radiologists, Technicians, Social Workers, Chaplains, Volunteers, Dietary and Clerical Workers. Procedure:

I. KDHCD will offer a onetime dose of Tdap to Employees working in high risk

areas caring for Infants and children. Tdap vaccination is a requirement for these high risk areas. If the Employee has already received one dose of Tdap, documentation must be provided to Employee Health Services.

II. Priority should be given to those who have direct contact with babies younger

than 12 months (CDC, June 2015), as they are at greatest risk for severe or fatal pertussis. At Kaweah Delta these high risk areas include the NICU, L&D, Mother Baby, Pediatrics, ER, SPC, UC, VMC Pediatrics, and Rural Health Clinic Pediatric Departments.

III. New Hire Employees: During New Hire Physical, Employee Health will request

documentation of prior adult vaccination with the Tetanus, Diphtheria and Pertussis (Tdap) vaccine, regardless of when the HCW last received a tetanus booster and regardless of their age. Tdap vaccine will be offered to those working in high risk areas. The vaccination will be offered at the time of the New Hire Physical Exam and consent must be signed (see attached). All documentation will be part of Employee Health Record. Each person who is to receive a vaccination must receive a copy of the current Vaccine Information (VIS). The vaccination will be offered free of charge.

Tetanus, Diphtheria and Pertussis (Tdap) Policy for Health Care Workers 2

IV. All Tdap vaccinations should be administered by the intramuscular route (IM). The preferred injection site in older children and adults is the deltoid muscle in the upper arm. Use a needle length appropriate for the age and size of the person receiving the vaccine.

V. There are no contraindications to the co-administration of diphtheria, tetanus, and pertussis vaccines. DTaP, DT, Td, and Tdap may be administered with other indicated vaccines during the same visit. However, each vaccine should be administered using a separate syringe and, if possible, at a different anatomic site.

VI. Exposure to Pertussis: If a healthcare worker (HCW) receives Tdap vaccine and is then exposed to someone with pertussis, KDHCD should follow the post-exposure prophylaxis protocol for pertussis exposure recommended by CDC.

VII. Employees may sign a declination for the Tdap vaccination, but they will then be required to wear a mask in high risk areas. VIII. Pre and post vaccination testing for antibodies is not recommended.

References: CDC ( https://www.cdc.gov/vaccines/vpd/pertussis/recs-summary.html) www.cdc.gov/pertussis/outbreaks/guide/index.htmlReference:http://www.immunize.org/askexperts/experts_per.asp Immunization of Health-Care Workers: Recommendations of the Advisory Committee for Immunization Practices (ACIP) and the Hospital Infection Control Practices Advisory (HICPAC). https://www.cdc.gov/mmwr/preview/mmwrhtml/00050577.htm Immunization Action Coalition: www.immunize.org/askexperts/experts_per.asp https://www.cdc.gov/vaccines/hcp/vis/vis-statements/tdap.pdf "These guidelines, procedures, or policies herein do not represent the only medically or legally acceptable approach, but rather are presented with the recognition that acceptable approaches exist. Deviations under appropriate circumstances do not represent a breach of a medical standard of care. New knowledge, new techniques, clinical or research data, clinical experience, or clinical or bio-ethical circumstances may provide sound reasons for alternative approaches, even though they are not described in the document."

Employee Health

Policy Number: EHS 08 Date Created: No Date Set Document Owner: Sarah Amend (RN-Employee Health Nurse)


Approvers: Dianne Cox (VP Human Resources)

Employee Health Standing Orders Printed copies are for reference only. Please refer to the electronic copy for the latest version. Policy: Standing orders for the provision of employee immunizations, TB skin tests, and lab draws by KDHCD Employee Health nursing staff. Procedure: Vaccines may be administered by the Employee Health Nurses or qualified designees, according to CDC guidelines. Give the following doses of vaccines according to the employee’s immunization records or titers.

1. Measles, Mumps, Rubella (MMR) Vaccine A. Route of administration: Subcutaneous B. Standard dose: 0.5 ml, x 2

2. Hepatitis B Vaccine A. Route of administration: Intramuscular B. Standard Adult Dose: 1.0 ml, x 3

3. Varicella Virus Vaccine A. Route of administration: Subcutaneous B. Standard dose: 0.5 ml, x 2

4. Tdap Vaccine A. Route of administration: Intramuscular B. Standard dose: 0.5 ml

5. Flu Vaccination A. Route of administration: Intramuscular B. Standard dose: 0.5 ml

6. TB tests – two step TB test on hire, annual TB test thereafter 7. Blood draws – draw titers for HBSAB, MMR, and Varicella as needed for new

hire employees 8. Draw HIV, HEP C, HEP BSAB as needed for exposures 9. Meningococcal Vaccine –

A. Meningococcal A (Menactra) -1 dose IM, then booster in 5 years B. Meningococcal B (Bexsero) – 2 doses IM one month apart

References:

Employee Health Standing Orders 2 https://www.cdc.gov/vaccines/adults/rec-vac/hcw.html "These guidelines, procedures, or policies herein do not represent the only medically or legally acceptable approach, but rather are presented with the recognition that acceptable approaches exist. Deviations under appropriate circumstances do not represent a breach of a medical standard of care. New knowledge, new techniques, clinical or research data, clinical experience, or clinical or bio-ethical circumstances may provide sound reasons for alternative approaches, even though they are not described in the document."

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