The threshold levels were determined by balancing the direct support costs to the entire revenue for that bucket of services based on the framework assumptions for each rate. These amounts were passed by the Legislature.
Remote monitoring technology (equipment, software, etc.) costs would not be included in what qualifies as compensation. While wages of the remote worker would be included in the compensation, the costs of technology would not be included because they aren’t truly compensation.
Yes, payments for supervision and licensed direct care workers (i.e. nurses) would qualify as compensation in our analyses when they are providing direct care activities. Both types of workers perform direct care activities and could thus be considered under the new thresholds. As with other positions, time allocated to non-direct care activities would not count toward the threshold regardless of position type.
Yes, compensation for all direct care activities will be considered in the compensation thresholds. Please note that providers participating in cost reporting will need to allocate the administrative staff time to direct care activities for appropriate accreditation. As with other positions, time allocated to non-direct care activities would not count toward the threshold regardless of position type.
Non-wage compensation may include any additional benefits provided by the employer that can be used at the discretion of the staff on their own time. Examples include tickets to sporting events used outside of work hours, gym memberships, child care funding assistance or student loan payment support.
Typically, one-off events with food provided would not count as compensation because the employees are unable to select their choice of food/meal or consume it during their personal time away from work. The definition of non-wage compensation includes additional benefits that an employee can use at their own discretion, on their own time. If your organization allots funding for food/meals for each individual employee to purchase meals for themselves whenever they want, this could fall under the umbrella of non-wage compensation because the employees are free to choose when to buy and eat the meals.
In the majority of cost reports, this would not count toward the compensation thresholds because providers report their actualized costs. If your organization tracks all costs on an accrual basis, you could report all PTO regardless of use as a benefit and thus compensation. However, if you track costs on an accrual basis you will need to indicate so to us in Cost Report Notes and elsewhere. If you have further questions about types of accounting, we suggest that you speak with a financial professional.
Beginning during the 2026 DWRS cost reporting period, DHS will use the cost data submitted by providers in their cost reports to confirm adherence to the DWRS compensation threshold requirements.
All wages and benefits recorded in a DWRS cost report with a DWRS direct care services allocation will count toward the compensation threshold requirement. Providers can see this breakdown on their cost report summary page within their report.
The Access Rule and the compensation thresholds policy were developed independently of each other. DHS will provide additional updates as CMS releases more information about the Access Rule and its potential impacts on the current compensation threshold policy.
