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Registration of Temporary Health Care Services Agencies and Health Care Technology Platforms Frequently Asked Questions

1. Entities required to register

1.1 Important Definitions from Statute:

PHL §2999-ii: 8. Temporary health care services agencies and Health Care Technology Platforms that provide or procure temporary employment of "health care personnel" for "health care entities" must register with DOH.

PHL §2999-ii: 3. "Health care entity" means an agency, corporation, facility, or an individual providing medical or health care services.

PHL §2999-ii: 6: "direct care worker" means an individual who is responsible for patient/resident handling or patient/resident assessment as a regular or incidental part of their services, including any licensed or unlicensed health care worker.

PHL §2999-ii: 4: "Health care personnel" is broadly defined to include both licensed and unlicensed direct care staff providing temporary services in a health care entity.

1.2 Does an agency need to register if…. it procures government contracts to staff the Veterans Affairs (VA) sites in New York State

Yes, PHL §2999-ii(3) defines "health care entity" as "an agency, corporation, facility, or individual providing medical or health care services." The U.S. Department of Veterans Affairs is a federal agency providing medical or health care services in New York State.

1.3 Does an agency need to register if…. it is a home care agency?

Per the statute, temporary health care services agencies do NOT include home care agencies licensed under Article 36.

1.4 Does an agency need to register if…. It is based out of State or internationally but procures temporary health care personnel for New York health care entities?

Yes. NYS Public Health Law (PHL) § 2999-ii defines Temporary Health Care Services Agencies (or agencies) as a person, firm, corporation, partnership, association, or other entity in the business of providing or procuring temporary employment of health care personnel for health care entities. This includes: a nurses' registry licensed under Article Eleven of the General Business Law; and entities that utilize apps or other technology-based solutions to provide or procure temporary employment of health care personnel in health care entities. All agencies in the business of providing or procuring temporary employment of health care personnel for health care entities in New York State are considered temporary health care services agencies and therefore required to register with the Department of Health.

1.5 Do locum tenens companies, in the business of providing or procuring the temporary services of physicians, physician assistants or nurse practitioners to fill gaps in a health care provider's coverage, need to register?

1.6 Are health care professionals who are independent contractors included in requirements?

Individuals who only provide their own services on a temporary basis to health care entities, including health care practitioners that offer temporary coverage to other health care practitioners, are not included in the definition of Temporary Health Care Services Agency and therefore are not required to register.

1.7 A health system client has a professional limited liability company that is part of the health system network. The PLLC employs only network staff to work only for hospitals within the network. For example, an RN employed by one hospital in the network could be employed by the PLLC to work at another hospital in the network. The nurses are employed as per diems. Our client's arrangement is basically the network hiring nurses for itself. Must the PLLC register under the new Public Health Law Article 29-K?

Yes. The PLLC in this instance would be considered an agency in the business of providing or procuring temporary employment of health care personnel for health care entities in New York State and is therefore considered a temporary health care services agency and required to register with the Department of Health.

1.8 Do staffing & recruiting firms or agencies that operate in other industries (i.e. technology, professional services staffing) need to register?

NYS Public Health Law (PHL) § 2999-ii defines Temporary Health Care Services Agencies (or agencies) as a person, firm, corporation, partnership, association, or other entity in the business of providing or procuring temporary employment of health care personnel for health care entities. All agencies in the business of providing or procuring temporary employment of health care personnel for health care entities in New York State are considered temporary health care services agencies and therefore required to register with the Department of Health.

1.9 Does "health care personnel" include health care titles not listed in the statute (e.g., Advanced Practice Nurses, Nurse Practitioners, Physicians' Assistants, Physicians)?

Yes, "health care personnel" means nurses, certified nurse aides and licensed or unlicensed direct care workers provided by the temporary health care services agency to provide temporary services in a health care entity. "Direct care worker" is defined as any individual who is responsible for patient/resident handling or patient/resident assessment as a regular or incidental part of their services, including any licensed or unlicensed health care worker. If the personnel the agency procures for health care entities in New York State fits this definition, the agency must register with the Department of Health.

1.10 What is meant by direct patient care?

Pursuant to PHL §2999-ii(6), "direct care worker" means an individual who is responsible for patient/resident handling or patient/resident assessment as a regular or incidental part of their services, regardless of their license status. Examples include but are not limited to the following: nurses, certified nurse aides, physicians, nurse practitioners, and physician assistants.

Please note that only job duties that include direct patient care should be included in quarterly reporting data. Examples of non-direct care worker titles that would be excluded from quarterly reporting may include but are not limited to the following: Clinical Lab Scientist, Cytotechnologist, Histology Tech, Medical Coder, Medical Lab Scientist, Medical Lab Technician, Medical Technologist, Sterile Tech, or a Nurse who is only working on insurance billing/approving.

1.11 Do staffing and recruiting firms or agencies that place foreign-educated health care professionals at healthcare facilities within New York for placements longer than 12 months meet the definition of a "temporary" health care services agency and need to register with the Department? What constitutes "temporary" for purposes of the statute?

1.12 Do companies that only provide or procure temporary health care personnel to management service organizations, management groups or other organizations responsible for staffing health care entities, need to register with the Department?

Yes. Pursuant to PHL § 2999-ii(3) a health care entity is defined broadly to mean "an agency, corporation, facility, or individual providing medical or health care services." As such, if an agency provides or procures health care personnel on a temporary basis for the purpose of providing medical or health care services within a health care entity, the agency will need to register with the Department.

1.13 Do apps or other technology-based solutions that connect health care personnel with health care entities for the purpose of temporary coverage within the health care entity, need to register with the Department?

Yes. PHL § 2999-ii(8) defines temporary health care services agencies (or agencies) to include entities that utilize apps or other technology-based solutions to provide or procure temporary employment of health care personnel in health care entities. This does not require that the temporary health care services agency be the one that employs the health care personnel. To the extent an app or technology-based solution is in the business of providing or procuring temporary health care personnel for health care entities, it would need to register with the Department as a temporary health care services agency.

1.14 Do entities that utilize apps or technology-based solutions to connect health care personnel with health care entities to fill individual shifts, need to register with the Department as a temporary health care services agency?

Yes. Pursuant to PHL 2999-ii(8) "temporary health care services agency" or "agency" means an entity in the business of providing or procuring temporary employment of health care personnel for health care entities and includes entities that utilize apps or other technology-based solutions. For purposes of meeting the definition of an agency under Article 29-k, the Department interprets "temporary employment" very broadly. As such, if an agency contracts with a health care entity for the provision or procurement of health care personnel for health care entities, that entity, app or technology platform needs to register with the Department, regardless of whether it employs temporary health care personnel in a traditional sense (i.e. W-2 employee) or contracts with health care personnel (i.e. 1099).

1.15 Do entities that provide staffing outside of hospitals or nursing homes have to register?

Yes. PHL 2999-jj requires, "any person who operates a temporary health care services agency" to register with DOH. PHL 2999-ii(8) defines a "temporary health care services agency" as any entity that provides or procures temporary employment of health care personnel for "health care entities." "Health care entity" is defined by PHL 2999-ii(3) as "an agency, corporation, facility, or individual providing medical or health care services."

2. Timeline

2.1 When did this requirement go into effect?

The requirement for temporary health care services agencies and health care technology platforms to register with the Department, as set forth in Article 29-K of the PHL, went into effect on August 1, 2023.

2.2 When is the registration period?

Annual registration began August 1, 2023, the day the statute went into effect. Each registration year runs from August 1st through July 31st. Agencies may register for an upcoming year as early as June 01^st. Any temporary health care services agency or health care technology platform providing or procuring temporary employment of health care personnel for New York State health care entities must register with the Department of Health. To register, an Agency must submit:

the registration application form
the annual fee of $1,000
the appendices for registration identified on the Home Page Registration of Temporary Health Care Services Agencies and Health Care Technology Platforms

2.3 Will agencies be given proof of submitting a registration application?

Yes, agencies will be given proof of submitting a registration application. After the Department receives a registration application and the annual fee, it reviews the application and sends an email to the Controlling Person identified on the Registration application form stating either:

Approval of the registration application, in which case the email will include a certificate of registration, or
Non-approval of the registration application, in which case the email will identify the outstanding requirements needed for approval of the application.

A list of registered agencies is maintained on the THCSA website

2.4 How long does it take for a registration application to be reviewed?

The timeline to review registration materials is typically less than 4 weeks. Inquiries about applications can be sent to TempAgencyRegistration@health.ny.gov

2.5 Can agencies procure or place temporary workers in New York State before having an approved registration application (before receiving their "certificate of registration"?)

An agency should have its Certificate of Registration prior to procuring or placing temporary workers in New York State.

2.6 What happens if an agency procures or places health care workers at New York health care entities without being registered?

Agencies that fail to register with the Department are subject to penalties and fines of up to $2,000 for every day they fail to register.

3. Submission and required materials

3.1 How do agencies submit appendices, contracts, and invoices?

The Department is collecting data using the secure file transfer tool, SendVault. To submit documents, please follow the SendVault instructions (PDF)

4. Registration

4.1 On the Registration Form, does the agency address need to be an address in New York State?

The agency's address does not need to be a New York State address.

4.2 If the agency's owner(s) and family members do not own nor manage any health care entities, how should the agency complete Item E of the Registration Form?

If the controlling persons and family members of controlling persons do not own nor manage any health care entities, complete Item E by selecting the box "No".

4.3 Are conversion fees charged to the health care entity (not the health care personnel) prohibited?

Yes. Pursuant to PHL § 2999-jj(3)(d), temporary health care services agencies are prohibited from requiring the payment of liquidated damages, employment fees, or other compensation should health care personnel be permanently hired by a health care entity. This prohibition applies to "any contract with any health care personnel or health care entity or otherwise." As such, "conversion fees" and other similar fees may not be a part of any temporary health care services contracts the agency may have with health care personnel or health care entities.

4.4 Can a temporary health care services agency require a health care entity, by contract, to reimburse recruitment and placement costs in the event a worker is hired on a permanent basis by the health care entity?

No. Pursuant to PHL § 2999-jj(3)(d), temporary health care services agencies are prohibited from requiring the payment of liquidated damages, employment fees, or other compensation should health care personnel be permanently hired by a health care entity. This prohibition applies to "any contract with any health care personnel or health care entity or otherwise." This would include typical recruitment and placement costs, such as, but not limited to, advertising, identifying candidates, recruiting candidates, credentials checks, backgrounds checks, drug testing, and medical clearances.

4.5 Are there specific examples or suggested documentation on what the minimum licensing, training, and continuing education are?

Temporary health care services agencies must maintain documentation that all health care personnel are properly licensed and in good standing. Documentation may include, but is not limited to, a copy of personnel's state licensure, education transcripts, certificates of good standing, verification of registration status, copies of a verification search from the State Education Department's website, and/or proof that personnel have completed continuing education requirements.

4.6 Does the agency need to submit an Appendix with documentation showing that personnel are properly licensed and in good standing?

No. Documentation that personnel meet minimum licensing, training, and continuing education standards must be maintained by temporary health care services agencies as a condition of registration. Pursuant to PHL § 2999-jj(3)(e), these records must be maintained for six years and be made available to the Department upon request. However, applicants need to submit the agency's policies on license verification, training, and continuing education.

4.7 What makes an administrator "qualified" to operate the agency?

The applicant should be able to demonstrate that the administrator has training, experience or education in a field that qualifies them to oversee the operation of a temporary health care services agency. This may include, but is not limited to, training, experience or education in health care, management, business administration, or human resources.

4.8 Are administrators required for agencies' satellite offices?

Yes. The law requires that each separate temporary health care services agency location have its own administrator. If an agency has a satellite office, the satellite will need to appoint a separate administrator.

4.9 How does an agency change its registration information after it has registered?

If agency information (address, phone, email, etc.) changes after registration please submit an updated Registration Form and mark the box for "Agency Information Change" in Item A. If ownership interest of 10% or more has changed, or if the agency has changed its Employee Identification Number (EIN), then a full re-registration is due, including the $1000 annual registration and renewal fee and appendices. Otherwise, just the Registration Form marked "Agency Information Change" will suffice and no fee nor submission of appendices are due.

4.10 Can registrations transfer from one agency to another?

Sale or transfer of interest of 10% or more of the ownership interest, or management, requires the submission of a new registration application and annual fee. Registration can be transferred for thirty days to the new owner or operator, or until the new owner or operator applies and is granted or denied a new registration, whichever is sooner.

4.11 Does an agency need to submit contracts with a different temporary health care services agency?

Pursuant to PHL § 2999-kk, temporary health care services agencies must submit to the Department copies of all contracts between the agency and health care entities to which it assigns or refers health care personnel, and copies of all invoices to health care entities. Contracts with other temporary health care services agencies do not need to be submitted to the Department.

4.12 Do agencies need to submit contracts with health care entities outside New York state?

No. The requirements of Article 29-K of the PHL only apply to contracts with health care entities located within New York State.

4.13 Has New York set maximum rates that can be charged by a temporary health care services agency?

No.

4.14 Is there a specific format for how contracts should be transmitted to the DOH?

Please submit all contracts in PDF format, complete and not redacted. Note that pursuant to PHL § 2999-kk(3), contracts sent to the Department are not subject to disclosure under Article 6 of the Public Officers Law (Freedom of Information Law).

4.15 Could an agency submit a report with all active clients and pertinent contract details, rather than entire contracts?

No. Pursuant to PHL § 2999-kk(3), copies of all contracts between the agency and a health care entity to which it assigns or refers health care personnel must be submitted to the Department, in addition to copies of all invoices to health care entities. Contracts must be transmitted to the Department without redactions in order to be considered to be in compliance with the statute. Note that pursuant to PHL § 2999-kk(3), contracts sent to the Department are not subject to disclosure under Article 6 of the Public Officers Law (Freedom of Information Law).

5. Quarterly Reporting

5.1 Do agencies need to submit the quarterly report Excel file if they had no placements during the quarter?

Once an agency is registered it must submit each consecutive quarterly report. The initial tab of the quarterly reporting Excel workbook, "Agency Info," has a line to indicate "No workers during the quarter." Agencies indicating no workers during the quarter do not need to complete the remaining tabs of the workbook.

5.2 Should agencies include only current workers or both past and current workers?

Pursuant to PHL § 2999-mm, on a quarterly basis, agencies must report information for all health care personnel that worked at the entity during the quarter.

5.3 Should agencies include clerical staff information or just health care workers in the quarterly reports?

Health care personnel is defined in PHL § 2999-ii(4) as "nurses, certified nurse aides, and licensed or unlicensed direct care staff provided by the temporary health care services agency to provide temporary services in a health care entity." Information on clerical staff should not be included in quarterly reports.

5.4 If an agency places workers in multiple states and the agency does not itemize expenses by state, how should expenses be reported for New York?

Agencies need to determine and report only those expenses that support the New York State line of business.

5.5 How should an agency report "Total Pay to Worker" and "Total Billed to the Entity" if the payment or billing did not occur within the 90-day quarter?

Revenue (e.g., amounts billed to the entity) and expenses (e.g., amounts paid to the worker) should be reported using an accrual accounting method; that is, report revenue and expenses that were INCURRED during the quarter, whether or not they were realized during the quarter.

5.6 Can information be reported without using the dropdown menus if an agency includes all the information requested.

No, the drop-down menus should be used to the extent possible. If populating the responses using a computerized program, have each response formatted exactly as in the dropdown menu. To find a specific entry in a dropdown menu, enter a few letters to reduce the number of selections to only those outcomes containing the letters entered. For example, entering "Saratoga" in the Entity Name dropdown menu will reduce the list to only those selections containing the string "Saratoga."

5.7 If an agency has staff at an entity that does not appear on the entity dropdown menu, how should the entity name be reported?

Please select "Other Not on List - PFI 99999" from the entity pull-down menu. Type the word "other" into the dropdown box to reduce the number of selections in the dropdown menu. Then select the option for "Other Not on List - PFI 99999."

5.8 For the Pay Type column on the Wages and Billing tab, how does an agency report pay for guaranteed hours, training, bonuses or other pay types not in the dropdown menu?

Pay Types that do not appear on the dropdown menu should be identified on Appendix 6, "Administrative costs," and not on Tab 1 "Wages and Billing".

5.9 How does an agency report what it billed the entity for travel-related expenses travel if the agency bills an All-Inclusive Rate to cover all payments to the workers?

Under Article 29k, travel-related payments to workers must be itemized and billed separately from other pay types. Each "Pay Type or Benefit" identified in the dropdown menu on Tab 1 "Wages and Billing" must be itemized and reported separately from the others.

5.10 On tab 3 "Location Data," how should multiple workers residing in the same zip code be reported? Should each worker have their own separate line?

Yes, each worker must have their own line on tab 3. If an agency has 25 workers there should be 25 rows of information reported.

5.11 Are there examples of administrative charges to be disclosed?

Pursuant to PHL § 2999-mm, temporary health care services agencies must report a full disclosure of charges and compensation. This includes a full description of administrative charges. Administrative charges could encompass a wide range of things, including but not limited to fees charged by an agency for record-keeping; administration of the contract; overhead expenses for things such as rent, utilities, equipment, supplies, insurance policies; or salaries and benefits of administrative staff at the agency. These charges should be identified on the Quarterly Report Appendix 6.

5.12 Do agencies need to submit each invoice sent to New York health care entities?

Copies of all invoices to New York health care entities must be submitted in pdf format, along with Appendix 7's itemized invoice list.

6. Communication between the Department and agencies.

6.1 How may an agency send questions to the Department?

Questions can be sent to our mailbox at TempAgencyRegistration@health.ny.gov. Questions and answers are periodically added to this FAQ page as needed.

6.2 Is information submitted by temporary health care services agencies subject to disclosure under FOIL?

All documents maintained by the Department are subject to FOIL disclosure unless they fit into one or more FOIL exemptions. Upon receipt of a FOIL request, the Department performs a diligent search for responsive documents, which are then reviewed for responsiveness, FOIL exemptions, and legal privileges. Contracts with healthcare entities, which are routinely submitted to the Department by temporary health care services agencies pursuant to Public Health Law Article 29, are specifically protected from disclosure by PHL § 2999-kk(3), and therefore exempt from FOIL disclosure by Public Officers Law § 87(2)(a). Other information, including invoices and quarterly report information, may be subject to FOIL disclosure.

Department of Health