CDPAP - Consumer Directed Personal Assistant Program

You are a Consumer in New York's Consumer Directed Personal Assistance Program ("CDPAP"). Renaissance Home Health Care ("Renaissance") is your Fiscal Intermediary. You are allowed to appoint a Designated Representative. You may be required by your Managed Care Organization, Managed Long Term Care Plan, or Local District of Social Services to appoint a Designated Representative if you are unable to direct your own workers.

A Designated Representative is an adult the Consumer has delegated authority to instruct, supervise and direct a Consumer's Personal Assistant(s) and to perform the Consumer's responsibilities specified in the Memorandum of Understanding with Renaissance and under applicable law, and who is willing and able to perform these responsibilities.The Designated Representative may not be a Consumer's Personal Assistant or an employee, representative, or affiliated person of Renaissance.

A. INTRODUCTION

New York State's Consumer Directed Personal Assistance Program ("CDPAP") is intended to permit chronically ill or physically disabled individuals receiving home care services under Medicaid greater flexibility and freedom of choice in obtaining such services. Renaissance Home Health Care is a Fiscal Intermediary and [CONSUMER] is a Consumer.

A Consumer and/or a Consumer's Designated Representative is the employer of a Consumer’s Personal Assistant(s). A Fiscal Intermediary is not the employer, in a sole or joint capacity, of a Consumer's Personal Assistant(s) and only provides limited services to a Consumer as a payroll agent, billing a Consumer's Managed Care Organization, Managed Long Term Care Plan, or Local District of Social Services, as applicable and processing payments to Personal Assistant(s).

Renaissance Home Health Care ("Renaissance") and [CONSUMER] (" You" ) Hereby agree as follows:

B. CONSUMER RESPONSIBILITIES

You have made an informed decision to receive care services under CDPAP. You are the sole employer of your Personal Assistant(s). You will
fulfill the following responsibilities:

1. Recruit, hire, employ, supervise and schedule enough qualified individual s as Personal Assistants to provide the services set forth in your plan of care.
2. Not discriminate in your hiring, provide equal employment opportunities, and comply with labor law.
3. Review your plan of care with each Personal Assistant to ensure your Personal Assistant(s) only perform the tasks authorized by your plan of care during hours authorized by your plan of care.
4. Provide as much training as necessary for your Personal Assistant(s) so they are able to competently and safely provide services.
5. Develop and maintain a contingency plan for substitute coverage when your Personal Assistant(s) are temporarily unavailable.
6. Notify Renaissance and your Managed Care Organization, Managed Long Term Care Plan, or Local District of Social Services, as applicable, within five (5) business days of any change in your status or condition, including but not limited to hospitalization or address change, or any change in the employment status of your Personal Assistant(s).
7. Review your Personal Assistant’s time sheets, attest that they are accurate, and reflect only authorized services that were provided.
8. Comply with Renaissance's Policies and Procedures for Consumers.
9. Distribute paychecks to your Personal Assistant(s), or help set up a direct deposit arrangement between Renaissance and your Personal Assistant(s).
10. Enter into this memorandum of understanding with Renaissance as the Fiscal Intermediary.

C. FISCAL INTERMEDIARY RESPONSIBILITIES

Renaissance is not the employer or joint employer of your Personal Assistant(s). Renaissance will fulfill the following responsibilities:

1. Bill your Managed Care Organization or Managed Long Term Care Plan and process your Personal Assistant(s) process payments for authorized hours worked by your Personal Assistant(s).
2. Process your Personal Assistant(s)'s wage and benefits, including all required taxes, withholdings, and insurance requirements.
3. Make sure your Personal Assistant(s) have completed pre-employment and annual health assessments.
4. Maintain personnel records, including a separate health assessments file, for your Personal Assistant(s) , as well as relevant records and authorizations for you as a Consumer.
5. Monitor your ongoing ability to fulfill your responsibilities under CDPAP.
6. Report any problems or suspected problems to your Managed Care Organization and/or Managed Long Term Care Plan.
7. Enter into this memorandum of understanding with you as the Consumer.

Renaissance will not fulfill any Consumer Responsibilities.

I, or my authorized representative, request that health information regarding my care and treatment as set forth on this form:

In accordance with New York State Law and the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), I understand that:

     1. This authorization may include disclosure of information relating to ALCOHOL and DRUG ABUSE, MENTAL HEALTH TREATMENT, except psychotherapy notes, and CONFIDENTIAL HIV* RELATED INFORMATION only if I place my initials on the appropriate line in Item 9(a). In the event the health information described below includes any of these types of information, and I initial the line on the box in Item 9(a), I specifically authorize release of such information to the person(s) indicated in Item 8.
     2. If I am authorizing the release of HIV-related, alcohol, or drug treatment, or mental health treatment information, the recipient is prohibited from redisclosing such information without my authorization unless permitted to do so under federal or state law. I understand that I have the right to request a list of people who may receive or use my HIV-related information without authorization. If I experience discrimination because of the release or disclosure of HIV-related information, I may contact the New York State Division of Human Rights at (212) 480-2493 or the New York City Commission of Human Rights at (212) 306-7450. These agencies are responsible for protecting my rights.
     3. I have the right to revoke this authorization at any time by writing to the health care provider listed below. I understand that I may revoke this authorization except to the extent that action has already been taken based on this authorization.
     4. I understand that signing this authorization is voluntary. My treatment, payment, enrollment in a health plan, or eligibility for benefits will not be conditioned upon my authorization of this disclosure.
     5. Information disclosed under this authorization might be re-disclosed by the recipient (except as noted above in Item 2), and this re-disclosure may no
longer be protected by federal or state law.
     6. THIS AUTHORIZATION DOES NOT AUTHORIZE YOU TO DISCUSS MY HEALTH INFORMATION OR MEDICAL CARE WITH ANYONE OTHER THAN THE ATTORNEY OR GOVERNMENTAL AGENCY SPECIFIED IN ITEM 9 (b).

All items on this form has been completed and my questions about this form have been answered. In addition, I have been provided a copy of the form.

Renaissance Horne Health Care ("Renaissance") has developed policies and procedures to enable it to administer payroll and benefits for your Personal Assistants. They are set forth below.
Pursuant to the Memorandum of Understanding between you and RENAISSANCE, you must follow these policies and procedures.

RENAISSANCE reserves the right, in its sole discretion, to interpret, administer, change, modify, or delete any of these policies or procedures at any time. No changes can be made to these policies and procedures unless approved in writing by the [Executive Director] of RENAISSANCE.

After reviewing the policies and procedures, please sign the acknowledgement below.
Note: If you have appointed a Designated Representative to fulfill your responsibilities as a Consumer: “you” as used herein, also refers to your Designated Representative and your Designated Representative must sign the acknowledgment

1. OVERVIEW
Personal Assistants. Renaissance, as your agent, processes payroll and administers benefits for your Personal Assistants. You, as a Consumer, are the sole employer of your Personal Assistants. Renaissance is your Fiscal Intermediary and is not a sole or joint employer of your Personal Assistants.

2. APPLICABLE DEFINITIONS

-“personal assistant” means an adult who provides consumer directed personal assistance to a consumer under the consumer's instruction, supervision and direction or under the instruction, supervision and direction of the consumer’s designated representative. A consumer's spouse, parent or designated representative may not be the consumer directed personal assistant for that consumer; however, a consumer directed personal assistant may include any other adult relative of the consumer who does not reside with the consumer or any other adult relative who resides with the consumer because the amount of care the consumer requires makes such relative presence necessary.

-"designated representative" means an adult to whom a self-directing consumer has delegated authority to instruct, supervise and direct the consumer directed personal assistant and to
perform the consumer's responsibilities specified in subdivision (g) of Section 505.28 of Title18 of the New York Code, Rules and Regulations ("NYCRR") and ,who is willing and
able to perform these responsibilities. With respect to a non-self-directing consumer, a “designated representative” means the consumer's patent, legal guardian or a responsible adult surrogate who is willing and able to perform such responsibilities on the consumer behalf. The designated representative may not be the consumer directed personal assistant or a fiscal intermediary employee, representative or affiliated person.

-"fiscal intermediary" ("FI") means an entity that has a contract with AN MCO to provide wage and benefit processing for consumer directed personal assistants and other fiscal intermediary responsibilities specified in subdivision (i) of Section 505.28 of Title 18 of the NYCRR.

-"self-directing consumer" means a consumer who is capable of malting choices regarding the consumer's activities. Of daily living and the type, quality and management of his or her
consumer directed personal assistance, understand the impact of these choices; and assumes responsibility for results of these choices.

-"Managed Care Company" or "MCO" means a managed care organization, managed long term care plan, or local district of social services.

3. PAYROLL
     1. WORK WEEK AND PAYDAY
          a. Policy
               I. RENAISSANCE’S NORMAL WORKWEEK IS SEVEN DAYS, [Sunday through Saturday].
               II. Your Personal Assistant will be paid weekly. Renaissance’s payday is [THURSDAY].
               III. Pay stubs will be distributed to your Personal Assistants by [UPS Mail]. If enrolled into direct deposit a pay stub will not be generated.
          b. Procedure
               I. Wages for your Personal Assistant enrolled in direct deposit will be deposited in their designated account on payday. Your Personal Assistant not enrolled in direct deposit will be paid by check.
               II. If your Personal Assistants do not receive their direct deposit payment or pay check, you must notify RENAISSANCE immediately.
               III. Pay stubs will be distributed to your Persona l Assistant [ups mail] Your Personal Assistants should review their pay stubs and direct deposits or pay checks for errors each week.
               IV. You may also review your Personal Assistants' pay stubs each week. If you or your Personal Assistant (s) find an error, you must report it to RENAISSANCE immediately. If there has been an erroneous overpayment or underpayment, RENAISSANCE will correct it as soon as possible.

2. PAYROLL DEDUCTIONS
     a. Policy
          I. RENAISSANCE is required by law to make certain deductions from your Personal Assistant’s pay each pay period, Including:
                Federal and state income taxes.
                Social Security (FICA) taxes.
                State disability insurance taxes.
                Deductions required by wage garnishment or child support orders.
                Other authorized deductions.
           II. No unauthorized deductions will be made.
           III. All deductions for overpayments will be made in accordance with New York State Law.
     b. Procedure
          I. All deductions from your Personal Assistants' pay will be identified on your Personal Assistants' pay stubs.

3. RECORDING, SUBMITTING, AND ATTESTING TO HOURS WORKED
     a. Policy
          I. To ensure that RENAISSANCE has accurate time records and that your Personal Assistants are paid in a timely manner, all authorized hours worked by your Personal Assistant must be accurately recorded.
          II. You must review and attest to the accuracy of the hours submitted for payment to your Personal Assistant must be accurately recorded.
          III. RENAISSANCE will make no payments to your Personal Assistants without you attesting the time was actually worked.
          IV. To be paid on [Thursday], hours must be submitted to RENAISSANCE by [Monday].
          V. If hours submitted are incomplete, incorrect, or inconsistent with these policies and procedures, they will be rejected by RENAISSANCE and your Personal Assistant will not be paid for them. For your Personal Assistants to be paid for those hours, they must be completed, corrected and/or made to comply with these policies and procedures, then re-submitted to RENAISSANCE.
          VI. All authorized hours worked, WITHOUT EXCEPTION, INCLUDING ANY CORRECTIONS, must be submitted to RENAISSANCE within 90 days of the date the work was performed. Any hours submitted more than 90 days from the date the work was performed will not be paid to your Personal Assistant(s) by RENAISSANCE. You and/or your Designated Representative will be personally responsible for paying your Personal Assistant for any authorized hours worked that are not submitted to RENAISSANCE within 90
days of the date the work was performed.
     b. Procedure
          I. All authorized hours worked must be recorded using [Call in/out system/ Timesheet when needed.]
          II. RENAISSANCE may send your Personal Assistants time sheets to your MCO any other relevant authority, as part of our responsibility to monitor that you and/or your Designated Representative are able to fulfill your responsibilities under CDPAP.
4. PAYABLE HOURS
     a. Policy
          I. RENAISSANCE will only pay for the number of hours authorized by your RENAISSANCE will NOT pay your Personal Assistants for hours worked exceeding the number of hours authorized by your MCO, even if you, as sole employer, arc legally required to pay your Personal Assistants for those hours. You are personally responsible for paying your Personal Assistant for any hours worked exceeding your authorized hours.
          II. RENAISSANCE will only pay for services authorized by your MCO. RENAISSANCE will NOT pay your Personal Assistants for hours worked providing services that were not authorized by your MCO, even if you, as sole employer, are legally required to pay your PA for those hours. You are personally responsible for paying your Personal Assistant for any hours worked providing services not authorized by your MCO.
          III. RENAISSANCE will NOT pay your Personal Assistants for hours worked that violate any applicable laws, regulations, or administrative guidance, even if you, as sole employer, are legally required to pay your PA for those hours.
          IV. RENAISSANCE will bill your MCO and pay your PA for each authorized hour recorded and submitted in accordance with Section 3, above. All authorized hours worked by your Personal Assistants will count towards your total authorized hours for that authorization period. For example, if your Personal Assistant works from noon on Saturday to noon on Sunday, RENAISSANCE would pay your Personal Assistant for all 24 hours, not 16 or 13 hours. All 24 Hours worked by your Personal Assistant would count against your total authorized hours for that authorization period.
          V. RENAISSANCE will pay your Personal Assistants for submitted hours authorized by your MCO in accordance with New York Labor Law.
     b. Procedure
         I. All hours that qualify), 11, work hours under the law count toward your authorized hours. If you allow your Personal Assistant to work more than your authorized hours for the week, you personally, not us, are liable to pay her for all the extra time she works.

         Work hours under the law included, but are not limited to:
              A. Training time - time your Personal Assistant takes training at your request to learn how to care for you properly is payable time.
              B. Waiting time - time your Personal Assistant waits for you, whether at a doctor's office or senior or day care center, or whatever, at your request, is payable time.
              C. On-call time - time your Personal Assistant must be available and ready on short notice to attend to you is payable time.
              D. Errand time - tune your Personal Assistant does errands for you, such as food shopping before she comes to work is payable time. So is her transportation time from the food market to meet you after she shops for you on a day she works for you.
              E. Travel time - time your Personal Assistant drives you anywhere or accompanies you in a car or train or other means of transportation during her work.

3. OTHER COMPENSATION AND BENEFITS
     a. Policy
          I. If you elect to provide your Personal .Assistants with added compensation or benefits in addition to cash wages, RENAISSANCE will administer such compensation or benefits in accordance with applicable law.
          II. RENAISSANCE will neither administer nor pay for the provision, maintenance, or replacement of personal protective equipment, such as gloves or masks, that you are required to provide your Personal Assistants at no cost to them in accordance with applicable law.
     b. Procedure
          I. RENAISSANCE will institute supplemental policies to effectively administer compensation or benefits in addition to cash wages and will provide you with these supplement policies.

I, the undersigned, acknowledge that on this date, I received a copy of RENAISSANCE’s POLICIES AND PROCEDURES FOR CONSUMERS and that I read it, understood it, and agree to comply with it. I understand that RENAISSANCE CDPAP has the maximum discretion permitted by law to interpret, administer, change, modify or delete this policy at any time.

Changes can only be made if approved in writing by the Executive Director of RENAISSANCE. I also understand that any delay or failure by RENAISSANCE to enforce any policy or rule will not constitute a waiver of RENAISSANCE’s right to do so in the future.

Renaissance Home Health Care is committed to maintaining a workplace free from sexual harassment. Sexual harassment is a form of workplace discrimination. All employees are required to work in a manner that prevents sexual harassment in the workplace. This Policy is one component of Renaissance Home Health Care commitment to a discrimination-free work environment. Sexual harassment is against the law[1] and all employees have a legal right to a workplace free from sexual harassment and employees are urged to report sexual harassment by filing a complaint internally with Renaissance Home Health Care. Employees can also file a complaint with a government agency or in court under federal, state or local antidiscrimination laws.

Policy: 

1.       Renaissance Home Health Care policy applies to all employees, applicants for employment, interns, whether paid or unpaid, contractors and persons conducting business, regardless of immigration status, with Home Attendant Services of Hyde Park. In the remainder of this document, the term “employees” refers to this collective group. 

2.       Sexual harassment will not be tolerated. Any employee or individual covered by this policy who engages in sexual harassment or retaliation will be subject to remedial and/or disciplinary action (e.g., counseling, suspension, termination).

3.       Retaliation Prohibition: No person covered by this Policy shall be subject to adverse action because the employee reports an incident of sexual harassment, provides information, or otherwise assists in any investigation of a sexual harassment complaint. Renaissance Home Health Care will not tolerate such retaliation against anyone who, in good faith, reports or provides information about suspected sexual harassment. Any employee of Renaissance Home Health Care who retaliates against anyone involved in a sexual harassment investigation will be subjected to disciplinary action, up to and including termination. All employees paid or unpaid interns, or non-employees[2] working in the workplace who believe they have been subject to such retaliation should inform a supervisor, manager, or Director of Human Resources. All employees, paid or unpaid interns or non-employees who believe they have been a target of such retaliation may also seek relief in other available forums, as explained below in the section on Legal Protections.

4.       Sexual harassment is offensive, is a violation of our policies, is unlawful, and may subject Renaissance Home Health Care to liability for harm to targets of sexual harassment. Harassers may also be individually subject to liability. Employees of every level who engage in sexual harassment, including managers and supervisors who engage in sexual harassment or who allow such behavior to continue, will be penalized for such misconduct.

5.       Renaissance Home Health Care will conduct a prompt and thorough investigation that ensures due process for all parties, whenever management receives a complaint about sexual harassment, or otherwise knows of possible sexual harassment occurring. Renaissance Home Health Care will keep the investigation confidential to the extent possible. Effective corrective action will be taken whenever sexual harassment is found to have occurred. All employees, including managers and supervisors, are required to cooperate with any internal investigation of sexual harassment.

6.       All employees are encouraged to report any harassment or behaviors that violate this policy. Renaissance Home Health Care will provide all employees a complaint form for employees to report harassment and file complaints.

7.       Managers and supervisors are required to report any complaint that they receive, or any harassment that they observe or become aware of, to Director of Human Resources.

8.       This policy applies to all employees, paid or unpaid interns, and non-employees and all must follow and uphold this policy. This policy must be provided to all employees and should be posted prominently in all work locations to the extent practicable (for example, in a main office, not an offsite work location) and be provided to employees upon hiring.

What Is “Sexual Harassment”?

Sexual harassment is a form of sex discrimination and is unlawful under federal, state, and (where applicable) local law. Sexual harassment includes harassment on the basis of sex, sexual orientation, self-identified or perceived sex, gender expression, gender identity and the status of being transgender.

Sexual harassment includes unwelcome conduct which is either of a sexual nature, or which is directed at an individual because of that individual’s sex when:

• Such conduct has the purpose or effect of unreasonably interfering with an individual’s work performance or creating an intimidating, hostile or offensive work environment, even if the reporting individual is not the intended target of the sexual harassment;
• Such conduct is made either explicitly or implicitly a term or condition of employment; or
• Submission to or rejection of such conduct is used as the basis for employment decisions affecting an individual’s employment.

A sexually harassing hostile work environment includes, but is not limited to, words, signs, jokes, pranks, intimidation or physical violence which are of a sexual nature, or which are directed at an individual because of that individual’s sex. Sexual harassment also consists of any unwanted verbal or physical advances, sexually explicit derogatory statements or sexually discriminatory remarks made by someone which are offensive or objectionable to the recipient, which cause the recipient discomfort or humiliation, which interfere with the recipient’s job performance.

Sexual harassment also occurs when a person in authority tries to trade job benefits for sexual favors. This can include hiring, promotion, continued employment or any other terms, conditions or privileges of employment. This is also called “quid pro quo” harassment.

Any employee who feels harassed should report so that any violation of this policy can be corrected promptly. Any harassing conduct, even a single incident, can be addressed under this policy.

Examples of sexual harassment 

The following describes some of the types of acts that may be unlawful sexual harassment and that are strictly prohibited:

-Physical acts of a sexual nature, such as:

• Touching, pinching, patting, kissing, hugging, grabbing, brushing against another employee’s body or poking another employee’s body;
• Rape, sexual battery, molestation or attempts to commit these assaults.

-Unwanted sexual advances or propositions, such as:

• Requests for sexual favors accompanied by implied or overt threats concerning the target’s job performance evaluation, a promotion or other job benefits or detriments;
• Subtle or obvious pressure for unwelcome sexual activities.

-Sexually oriented gestures, noises, remarks or jokes, or comments about a person’s sexuality or sexual experience, which create a hostile work environment.

-Sex stereotyping occurs when conduct or personality traits are considered inappropriate simply because they may not conform to other people's ideas or perceptions about how individuals of a particular sex should act or look.

-Sexual or discriminatory displays or publications anywhere in the workplace, such as:

• Displaying pictures, posters, calendars, graffiti, objects, promotional material, reading materials or other materials that are sexually demeaning or pornographic. This includes such sexual displays on workplace computers or cell phones and sharing such displays while in the workplace.

Hostile actions taken against an individual because of that individual’s sex, sexual orientation, gender identity and the status of being transgender, such as:

• Interfering with, destroying or damaging a person’s workstation, tools or equipment, or otherwise interfering with the individual’s ability to perform the job;
• Sabotaging an individual’s work;
• Bullying, yelling, name-calling.

Who can be a target of sexual harassment?

Sexual harassment can occur between any individuals, regardless of their sex or gender. New York Law protects employees, paid or unpaid interns, and non-employees, including independent contractors, and those employed by companies contracting to provide services in the workplace. Harassers can be a superior, a subordinate, a coworker or anyone in the workplace including an independent contractor, contract worker, vendor, client, customer or visitor.

Where can sexual harassment occur? 

Unlawful sexual harassment is not limited to the physical workplace itself. It can occur while employees are traveling for business or at employer sponsored events or parties. Calls, texts, emails, and social media usage by employees can constitute unlawful workplace harassment, even if they occur away from the workplace premises, on personal devices or during non-work hours.

Retaliation

Unlawful retaliation can be any action that could discourage a worker from coming forward to make or support a sexual harassment claim. Adverse action need not be job-related or occur in the workplace to constitute unlawful retaliation (e.g., threats of physical violence outside of work hours).

Such retaliation is unlawful under federal, state, and (where applicable) local law. The New York State Human Rights Law protects any individual who has engaged in “protected activity.” Protected activity occurs when a person has:

• made a complaint of sexual harassment, either internally or with any anti-discrimination agency;
• testified or assisted in a proceeding involving sexual harassment under the Human Rights Law or other anti-discrimination law;
• opposed sexual harassment by making a verbal or informal complaint to management, or by simply informing a supervisor or manager of harassment;
• reported that another employee has been sexually harassed; or
• encouraged a fellow employee to report harassment.

Even if the alleged harassment does not turn out to rise to the level of a violation of law, the individual is protected from retaliation if the person had a good faith belief that the practices were unlawful. However, the retaliation provision is not intended to protect persons making intentionally false charges of harassment.

Reporting Sexual Harassment

Preventing sexual harassment is everyone’s responsibility. Renaissance Home Health Care cannot prevent or remedy sexual harassment unless it knows about it. Any employee paid or unpaid intern or non-employee who has been subjected to behavior that may constitute sexual harassment is encouraged to report such behavior to a supervisor, manager or Director of Human Resources. Anyone who witnesses or becomes aware of potential instances of sexual harassment should report such behavior to a supervisor, manager or Director of Human Resources.

Reports of sexual harassment may be made verbally or in writing. A form for submission of a written complaint is attached to this Policy, and all employees are encouraged to use this complaint form. Employees who are reporting sexual harassment on behalf of other employees should use the complaint form and note that it is on another employee’s behalf.

Employees, paid or unpaid interns or non-employees who believe they have been a target of sexual harassment may also seek assistance in other available forums, as explained below in the section on Legal Protections.

Supervisory Responsibilities

All supervisors and managers who receive a complaint or information about suspected sexual harassment, observe what may be sexually harassing behavior or for any reason suspect that sexual harassment is occurring, are required to report such suspected sexual harassment to Director of Human Resources.

In addition to being subject to discipline if they engaged in sexually harassing conduct themselves, supervisors and managers will be subject to discipline for failing to report suspected sexual harassment or otherwise knowingly allowing sexual harassment to continue.

Supervisors and managers will also be subject to discipline for engaging in any retaliation.

Complaint and Investigation of Sexual Harassment

All complaints or information about sexual harassment will be investigated, whether that information was reported in verbal or written form. Investigations will be conducted in a timely manner, and will be confidential to the extent possible.

An investigation of any complaint, information or knowledge of suspected sexual harassment will be prompt and thorough, commenced immediately and completed as soon as possible. The investigation will be kept confidential to the extent possible. All persons involved, including complainants, witnesses and alleged harassers will be accorded due process, as outlined below, to protect their rights to a fair and impartial investigation.

Any employee may be required to cooperate as needed in an investigation of suspected sexual harassment. Renaissance Home Health Care will not tolerate retaliation against employees who file complaints, support another’s complaint or participate in an investigation regarding a violation of this policy.

While the process may vary from case to case, investigations should be done in accordance with the following steps:

• Upon receipt of complaint, Director of Human Resources will conduct an immediate review of the allegations, and take any interim actions (e.g., instructing the respondent to refrain from communications with the complainant), as appropriate. If complaint is verbal, encourage the individual to complete the “Complaint Form” in writing. If he or she refuses, prepare a Complaint Form based on the verbal reporting.
• If documents, emails or phone records are relevant to the investigation, take steps to obtain and preserve them.
• Request and review all relevant documents, including all electronic communications.
• Interview all parties involved, including any relevant witnesses;
• Create a written documentation of the investigation (such as a letter, memo or email), which contains the following:A list of all documents reviewed, along with a detailed summary of relevant documents;
  • A list of names of those interviewed, along with a detailed summary of their statements;
  • A timeline of events;
  • A summary of prior relevant incidents reported or unreported; and
  • The basis for the decision and final resolution of the complaint, together with any corrective action(s).
• Keep the written documentation and associated documents in a secure and confidential location.
• Promptly notify the individual who reported and the individual(s) about whom the complaint was made of the final determination and implement any corrective actions identified in the written document.
• Inform the individual who reported of the right to file a complaint or charge externally as outlined in the next section.

Legal Protections And External Remedie

Sexual harassment is not only prohibited by Renaissance Home Health Care but is also prohibited by state, federal, and, where applicable, local law.

Aside from the internal process at ACS Home Care, employees may also choose to pursue legal remedies with the following governmental entities. While a private attorney is not required to file a complaint with a governmental agency, you may seek the legal advice of an attorney.

In addition to those outlined below, employees in certain industries may have additional legal protections.

State Human Rights Law (HRL)

The Human Rights Law (HRL), codified as N.Y. Executive Law, art. 15, § 290 et seq., applies to all employers in New York State with regard to sexual harassment, and protects employees, paid or unpaid interns and non-employees, regardless of immigration status. A complaint alleging violation of the Human Rights Law may be filed either with the Division of Human Rights (DHR) or in New York State Supreme Court.

Complaints with DHR may be filed any time within one year of the harassment. If an individual did not file at DHR, they can sue directly in state court under the HRL, within three years of the alleged sexual harassment. An individual may not file with DHR if they have already filed a HRL complaint in state court.

Complaining internally to Renaissance Home Health Care does not extend your time to file with DHR or in court. The one year or three years is counted from date of the most recent incident of harassment.

You do not need an attorney to file a complaint with DHR, and there is no cost to file with DHR.

DHR will investigate your complaint and determine whether there is probable cause to believe that sexual harassment has occurred. Probable cause cases are forwarded to a public hearing before an administrative law judge. If sexual harassment is found after a hearing, DHR has the power to award relief, which varies but may include requiring your employer to take action to stop the harassment, or redress the damage caused, including paying of monetary damages, attorney’s fees and civil fines.

DHR’s main office contact information is: NYS Division of Human Rights, One Fordham Plaza, Fourth Floor, Bronx, New York 10458. You may call (718) 741-8400 or visit: www.dhr.ny.gov.

Contact DHR at (888) 392-3644 or visit dhr.ny.gov/complaint for more information about filing a complaint. The website has a complaint form that can be downloaded, filled out, notarized and mailed to DHR. The website also contains contact information for DHR’s regional offices across New York State.

Civil Rights Act of 1964

The United States Equal Employment Opportunity Commission (EEOC) enforces federal anti-discrimination laws, including Title VII of the 1964 federal Civil Rights Act (codified as 42 U.S.C. § 2000e et seq.). An individual can file a complaint with the EEOC anytime within 300 days from the harassment. There is no cost to file a complaint with the EEOC. The EEOC will investigate the complaint and determine whether there is reasonable cause to believe that discrimination has occurred, at which point the EEOC will issue a Right to Sue letter permitting the individual to file a complaint in federal court.

The EEOC does not hold hearings or award relief, but may take other action including pursuing cases in federal court on behalf of complaining parties. Federal courts may award remedies if discrimination is found to have occurred. In general, private employers must have at least 15 employees to come within the jurisdiction of the EEOC.

An employee alleging discrimination at work can file a “Charge of Discrimination.” The EEOC has district, area, and field offices where complaints can be filed. Contact the EEOC by calling 1-800-669-4000 (TTY: 1-800-669-6820), visiting their website at www.eeoc.gov or via email at info@eeoc.gov.

If an individual filed an administrative complaint with DHR, DHR will file the complaint with the EEOC to preserve the right to proceed in federal court.

Local Protections

Many localities enforce laws protecting individuals from sexual harassment and discrimination. An individual should contact the county, city or town in which they live to find out if such a law exists. For example, employees who work in New York City may file complaints of sexual harassment with the New York City Commission on Human Rights. Contact their main office at Law Enforcement Bureau of the NYC Commission on Human Rights, 40 Rector Street, 10th Floor, New York, New York; call 311 or (212) 306-7450; or visit www.nyc.gov/html/cchr/html/home/home.shtml.

 Contact the Local Police Department

If the harassment involves unwanted physical touching, coerced physical confinement or coerced sex acts, the conduct may constitute a crime. Contact the local police department.

I acknowledge that I have received a copy of Renaissance Home Health Care Sexual Harassment Policy and Training and have read it thoroughly. I understand that the purpose is to summarize policy and procedure and to set forth facts that will be useful to know during my employment here.

As a Fiscal Intermediary in New York State' s a Consumer Directed Personal Assistance Program ("CDPAP"), Renaissance Home Health Care ("Renaissance") is
required by law to comply with all federal and New York state laws and regulations pertaining to New York state Medicaid program providers, including
provisions to prevent fraud, waste and abuse.

Renaissance has procedures in place to prevent and detect fraud, waste and abuse, and actively supports the efforts of New York State and Federal authorities to do
the same.

Furthermore, Renaissance is legally obligated to report all suspected fraud, abuse and false claims to relevant federal, state and/or local authorities for investigation.
If Renaissance suspects a Consumer has committed fraud, abuse or submitted false claims, Renaissance will seek to immediately terminate its relationship with the
Consumer.

Consumers are responsible for understanding what constitutes fraud and working to prevent it. This means:

• Train each of their Personal Assistants about fraud, abuse and false claims;
• Attest to the accuracy and compliance of each time sheet of each Personal Assistant, which includes
  • Ensuring that the time sheet only states the actual time spent providing services
  • Ensuring that the services provided were authorized under the Consumer's plan of care, and;
  • Ensuring that such services were only provided to the Consumer;
• Submit each Personal Assistant's time sheets to Renaissance according to Renaissance's Policies and Procedures for Consumers ;
• Allow Renaissance to monitor Consumer's practices pursuant to law to ensure that there is no fraud, waste or abuse; and
• Immediately report to Renaissance any suspected fraud, waste or abuse. Consumers may do so by calling [Wendy Garcia] at [718-649-3670 Ext 4803].

To ensure all Consumers are aware of what constitutes a false claim and potential penalties under applicable Federal and New York state law, a detailed overview of
relevant statues pertaining to false claims, kickbacks and civil monetary penalties is attached as Appendix A.

I certify that I have received, read, and will comply with the above Fraud Prevention Policy, including Appendix A.

I am a Consumer in New York's Consumer Directed Personal Assistance Program ("CDPAP"). Renaissance Home Health Care ("Renaissance") is my Fiscal
Intermediary. If I have appointed a Designated Representative to fulfill my responsibilities as a Consumer, "I", as used in this agreement refers to both me as the
Consumer and my Designated Representative. Renaissance and I hereby agree:

1. My Plan of Care. I am responsible for and assume all risks for, associated with, or related to administering my Plan of Care and any care I receive through CDPAP.
2. My Personal Assistants. I am responsible for and assume all risks for my own health, safety, and welfare when I employ and receive services from my Personal Assistants.
3. My Work Locations. I am responsible for and assume all risks for any unsafe condition or violation of any safety laws at any locations where I employ and receive services from my Personal Assistants.
4. My Household Members and Third Parties. I am responsible for and assume all my risks for the safety and welfare of my household members and any third parties in any location where I employ and receive services from my Personal Assistant, including but not limited to my home and my vehicle or my Personal Assistants' or other person's vehicle.
5. Insurance. If I permit my Personal Assistants to drive or be a passenger in any car or personal vehicle, I will make sure the car or personal vehicle has insurance in accordance with New York State law.
6. Severability. If any portion of this agreement is declared unenforceable by a court or an authorized governmental agency, the unenforceability of such portion will not make unenforceable the remaining portions of this agreement.
7. Amendment and Waiver. No amendment or modification of this agreement will be valid or binding unless made in writing and signed by both me and an authorized representative of Renaissance.
8. Voluntary Execution. I have carefully read and considered all of the terms of this agreement and have freely, willingly and knowingly entered into this agreement with the intent to be bound by it.

You are a Consumer in New York State' s Consumer Directed Personal Assistance Program ("CDPAP").Renaissance cannot arrange back-up care services or emergency services for you. You are responsible for managing your care, including hiring and scheduling your Personal Assistants, and arranging for back-up care services when your regularly-scheduled Personal Assistant is unavailable for any reason.

For back-up workers to be paid by Renaissance, they must be enrolled as Personal Assistants. Please remember that your spouse, Designated Representative, or any other person legally responsible for you cannot be enrolled as a Personal Assistant. You may choose to have informal back-up workers, but they will NOT be paid by Renaissance.

Please indicate TWO back-up workers below, and whether they will be enrolled Personal Assistants or informal unpaid workers.

I hereby certify:

1. I understand that New York Social Services Law § 365-f (3) prohibits my Personal Assistant from being my spouse, my Designated Representative, or any other person legally responsible for my care and support.
2. The above-named Persona l Assistant is NOT my spouse, my Designated Representative, or any other person legally responsible for my care and support.
3. I understand that if my spouse, my Designated Representative, or any other person legally responsible for my care and support is my Personal Assistant, it may be considered Medicaid fraud. If Medicaid fraud is found, I agree to repay to Renaissance all wages and other compensation fraudulently paid to my Personal Assistant(s) , plus any applicable penalty and interest.
4. I will immediately notify Renaissance if the above-named Personal Assistant becomes my spouse, my Designated Representative, or legally responsible
for my care and support.

6. If the above-named Personal Assistant is currently my relative through blood, marriage or adoption, I will immediately notify Renaissance if the abovenamed Personal Assistant is no longer my relative through blood, marriage or adoption.

2. If the above-named Personal Assistant resides in the same home as me and has NO other residence, I will enter into an agreement with the above-named Personal
Assistant to exclude from compensable worktime periods of complete freedom from duty, as required by the United States Department of Labor.

3. I will immediately notify Renaissance if the residence of the above-named Personal Assistant changes from what I have certified above.

I Certify That all Information Provided Regarding the Above Personal Assistant is True and Accurate.

I have been advised that Renaissance Home Health Care is not liable or responsible for any injury, to persons or property, which might occur as a result of being transported by my Personal Assistant in either my automobile or in the automobile of my Personal Assistant.

I have been further advised that I should verify that my Personal Assistant is a duly licensed driver in the State of New York and has at least the minimum medical and liability coverage on his/her vehicle and its occupants, as required by the laws of the State of NewYork.

I am a Consumer in New York State's Consumer Directed Personal Assistance Program ("CDPAP "). I am the sole employer of my Personal Assistant(s).
Renaissance Home Health Care ("Renaissance" ) is my Fiscal Intermediary, responsible for processing payroll for my Personal Assistants . Renaissance is not an
employer of my Personal Assistants in a joint or sole capacity.

Before my Personal Assistants can provide me services and be pay rolled by Renaissance under CDPAP, my Personal Assistants must provide certain information,
complete certain forms, and be provided with certain notices as required by applicable federal, New York state and local law. It is my responsibility as the sole
employer of my Personal Assistants to collect the required information, ensure completion of required forms, and provide required notices.

The forms and notices include: (1) Wage and Benefit Processing Information; (2) Internal Revenue Service Form W-4; (3) New York State Department of Taxation
and Finance Form IT- 2104; (4) U.S. Citizenship and Immigration Services Form 1-9; (5) Universal Precautions and Hepatitis B Vaccination Acknowledgement; (6)
Notice and Acknowledgement of Pay Rate and Payday Under Section 195.l of the New York State Labor Law; and (7) New York City's Earned Sick Time Act
Notice of Employee Rights (collectively, the "Payroll Fo1ms").

To ensure compliance with law and expedite the commencement of services by my Personal Assistants under CDPAP, I hereby authorize Renaissance to act as my
representative and agent for the following limited purposes: (1) to provide the Payroll Forms to my Personal Assistants; (2) to ensure the Payroll Forms are
appropriately completed and signed; and (3) to complete the sections of the Payroll Forms required of me on my behalf; and (4) to collect and file the payroll Forms,
as appropriate.

I acknowledge that pursuant to 18 NYCRR § 505.28(i)(l )(iii), Renaissance is required to maintain a copy of the Payroll Forms of my Personal Assistants in its
personnel records for each Personal Assistant. I understand that Renaissance may also provide me with a copy of the Payroll Forms.

Nothing herein shall be construed as an assumption of liability by Renaissance of my obligations as the sole employer of my Personal Assistants under applicable
federal, New York state and local law. I understand that Renaissance makes no representations that the Payroll Forms encompass all of my obligations as an
employer.

This authorization will remain in effect until I provide written notice to Renaissance to cancel it.

As a Consumer in New York State’s Consumer Directed Personal Assistance Program ("CDPAP"), you are the sole employer of your Personnel Assistant(s). Renaissance Home Health Care ("Renaissance" ), as your Fiscal Intermediary, is only responsible for paying your Personal Assistants for hours authorized by your Managed Care Organization, Managed Long Term Care Plan, or Local District of Social Services, as applicable, in accordance with Renaissance's Policies and Procedures for Consumers. To enable Renaissance to perform its responsibilities you must take the following steps to comply with the law .

1. Obtaining an EIN.
As the sole employer of your Personal Assistant(s), you are required by federal and New York State law to obtain a Federal Employer Identification Number ("EIN").

To obtain an EIN, you must complete the Internal Revenue Service Form SS-4, attached as Appendix A.

By signing this Employer Withholding Procedure, you authorize Renaissance to apply for and receive your EIN, and to answer questions about the completion of Form SS-4, on your behalf. Renaissance will retain a copy of your signed SS-4.

2. Registering as an employer.
You are required to register as an employer with the New York State Department of Taxation and Finance and the New York State Department of Labor.

To register, you must complete Form NYS 100, attached with instructions as Appendix B.

3. Designating Renaissance as your agent for tax withholding purposes.
As the sole employer of your Personal Assistant(s), you are responsible for withholding federal and New York state tax, and paying local employment taxes for your Personal Assistant(s).

To allow Renaissance to assume these payroll responsibilities on your behalf, you must designate Chad as your agent for that purpose using the Internal Revenue Service Form 2678, attached as Appendix C.

I certify that I have received, read, and will comply with this Employee Withholding Procedure.