• Supplemental Payment Request Form

  • ***Due the 2nd and 17th each month by 5pm***

    Please complete all sections marked by an "*"

    Submissions later than 30 days will not be approved

  • Discipline*
  • Please DO NOT submit Weekend/After Hours rotation or Zone/Optimal In-service meetings on this form.

  • Supplemental Payment Specifics*
  •  Please do not type below this line. Office only.


     

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  • Supplemental Payment Details

     

    Please read the below Supplemental pay Details. When submitting a JotForm please use the drop-down categories below. If your submission doesn’t fall under any of below options, you may select premium.

    1. Travel: Clinicians who are using their own private vehicle and do not use an Optimal gas card will now be reimbursed $0.40 per mile for all mileage traveling to a patient’s home. You will not be reimbursed for the mileage between your last visit of the day and your home.

    2. Drive By: Payment is only paid for SOC/ROC and/or when there is a concern for the patients' welling.  You must have preapproval from your supervisor to check in on them and all efforts should be made to confirm the appt with the patient prior to arriving. Any visit made outside these guidelines should be a Missed Visit, not a Drive By. Approved by Clinical Supervisor  

    An approved Drive By is reimbursed $20 for Therapists & Nurses and $10 for CNA'S, Assistants and LPN's.

    3. Patient Cancellation: If a patient is not available when a Clinician arrives or cancels a previously confirmed visit at the last minute, the patient will be charged a cancellation fee. The Clinician will be reimbursed $20 for Therapists and Nurses and $15 for CNA'S, Assistants and LPN's.  Patient payment will be collected by the Care Team and verification of payment will be sent to HR prior to processing Clinician's payment. 

    4. Training (New Staff Ride Along): For new hire orientation ride along or current staff development.  Paid at a per visit rate. Approved by Clinical Supervisor 

    5. Marketing: Exercise Classes, In-Services, Resident Reviews and Wellness Clinics at offsite facilities are all paid at one full regular visit rate per hour.  Approved by Regional Marketing Manager. If a meeting or class is 30 minutes this will be a ½ visit.  Safety checks for 6 residents with marketing form completed will be paid at one full visit rate as this task should take approximately one hour.  This may be coordinated with your ALF marketer due to various restrictions in ALFs with this process.

    There is not a supplemental payment for patient chart reviews as this is part of the SOC/eval

    6. SOC Incentive Rate 
     
    Any SOC clinician (RN, PT, ST, OT, BHRN) will be paid $50 for each SOC over their 5 contracted SOCs.  

    7. Premium: Premium pay is indeed a term used to describe additional compensation that is paid on top of an employee's normal or standard pay rate. This is typically given to employees for various reasons, such as working on holidays, taking on hazardous duties, or working during non-standard hours. Premium pay is designed to provide extra incentive or compensation for employees when they engage in work that is outside the typical scope of their regular job duties or outside of regular working hours.

     

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