Application Guidance
Hospital and Skilled Nursing Facility COVID-19 Worker Retention Payments
Application guidance is for Covered Entities (CEs), Covered Services Employers (CSEs), Physician Group Entities (PGEs), and Independent Physicians that have successfully registered for Hospital and Skilled Nursing Facility COVID-19 Worker Retention Payments (WRP). Every entity must have registered prior to applying for retention payments on behalf of their eligible, direct employees.
If you have not yet registered for WRP, please visit the
WRP webpage to link to registration and supporting guidance. The registration deadline is December 23, 2022.
General Guidance:
On November 29, 2022, all successfully
registered CEs, CSEs, PGEs, and Independent Physicians will receive a link to the application for submitting eligible, direct employee information. If you register on or after November 29, 2022, you will receive the link to the application once your registration has been accepted.
The link to apply and all follow-up communications will be distributed to the email address provided by the registrant during the registration process.
To begin the application, you must accept the Disclosure and Privacy Statements.
If you are submitting more than two (2) eligible employees for payment, you must gather and submit all eligible employee information using the appropriate Excel templates (see below) provided by DHCS.
Refer to instructions for details on how to save the completed Excel template as a PDF. The saved PDF file will need to be uploaded within the application where requested to do so.
If you are submitting payment for two (2) employees or less, or are applying as an Independent Physician on behalf of yourself, you are not required to fill out the templates. Instead, you will need to complete the questions as directed on the application. Please refer to the Non-Physician Employees and Physician section below for required data fields.
To complete your submission, CEs, CSEs, PGEs, and Independent Physicians must read and accept the attestation statement by entering your first and last name along with your title.
After application submission, CEs, CSEs, PGEs, and Independent Physicians (who registered and applied directly) will each receive an email from DHCS (DoNotReplyWRP@dhcs.ca.gov) either confirming that the application has been accepted or detailing additional information still required. If more information or corrections are requested, you may resubmit the application and upload the entire Excel template(s), as a PDF, again including the corrected details.
If it has been more than 10 working days since you registered and you have not received a confirmation email of successful registration and/or do not appear on the successfully registered entity list, please email DHCS at wrp@dhcs.ca.gov and include “Missing Application Link” in the subject line.
All applications must be submitted no later than 5 p.m. (PST) on January 6, 2023. DHCS encourages early submission to allow ample time for validation and processing before application submission deadline.
Things to know before you get started:
Please keep your browser open until you have completed the application.
If you close your browser prior to completion, you will need to start over from the beginning.
You must click 'Next' on most pages to continue to the next page.
You can return to the previous page by clicking 'Prev'.
Documents and information to gather before starting the application process:
Entity Tax Identification Number (TIN) or Federal Employer Identification Number (FEIN) provided during the registration process.
All required employee information; refer to the Non-Physician Employees and Physician data fields section below.
Complete the Excel Template:
If the CE, CSE, or PGE has more than two (2) physicians or non-physician employees, you must provide eligible employee information on the DHCS provided templates.
Please note: make no adjustments to the columns or rows. If adjustments are made to columns or rows, it could delay processing or result in the rejection of the application.
The following data fields are included in the excel templates and are required.
Non-Physician Employees:
|
Eligible Employee Name - First | Yes | First name of the employee employed by the organization as it appears on the W2.
|
|
Eligible Employee Name - Last | Yes | Last name of the employee employed by the organization as it appears on the W2. |
|
Last 4-digits of SSN/ITIN | Yes | Last four digits of either the employee's Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN) issued by the IRS. |
|
Date of Birth | Yes | Date format must follow MM/DD/YYYY. |
|
Address | Yes | Must reflect as it appears on the employee's W2. |
|
City | Yes | Must reflect as it appears on the employee's W2. |
|
State | Yes | Must reflect as it appears on the employee's W2. Two alpha characters. |
|
ZIP | Yes | Must reflect as it appears on the employee's W2. |
|
Time Base | Yes | Select one of the following options:
PT – part-time
FT – full-time |
|
Hours worked onsite during the qualifying period
(between 7/30/2022 - 10/28/2022) | Yes | Round up the hours (no decimal). No more than three digits total. 100-399 hours = part-time time base above 400 hours and above = full-time time base above
Add approved leave hours, if applicable (vacation,
sick, etc.). Please refer to Eligibility
FAQs for information on identifying time base for eligible workers.
|
|
Amount employer paid/will pay to employee as bonus contribution
(between 12/1/2021 -12/31/2022) | No | Bonus contribution employer paid to the employee rounded to the nearest dollar (no decimal).
If no employer paid bonus contributions, leave blank. Does not include pay. Please refer to
Payment Information FAQs for more information on employer bonus contribution. |
|
Date employer paid bonus contribution or will pay employee | No
| Date format must follow MM/DD/YYYY. If there is more than one date and space allows, separate each with a semi-colon. If there are too many dates, enter the last bonus payment date within the 12/1/2021-12/31/2022 period.
If no contributions, leave blank. |
Physicians:
|
Eligible Physician Name - First | Yes
| First name of the physician employed by the organization as it appears on the W2. |
|
Eligible Physician Name - Last | Yes | Last name of the physician employed by the organization as it appears on the W2. |
|
NPI
(Type 1- individual) | Yes | 10-digit National Provider Identification number associated with the physician. |
|
Medical License Number | Yes | California Medical License number of the physician. |
|
Last 4-digits of SSN/ITIN | Yes | Last four digits of either the employee's Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN) issued by the IRS. |
|
Date of Birth | Yes | Date format must follow MM/DD/YYYY.
|
Once the templates have been completed with all required data, please refer to
instructions for details on converting the Excel template to a PDF document to upload and submit with the application.
