Signs & Postings in Hospitals. Manual

Signs & Postings in Hospitals Manual 2013

Published by Wisconsin Hospital Association, Inc. www.wha.org Copyright All rights reserved.

WHA Signs & Postings in Hospitals Manual The following manual was drafted in October 2012 and is based on the laws or the proposed laws in effect at that time. This manual does not reflect changes to the law since October 2012. Users should determine whether the laws or proposed laws discussed in this manual have been updated. A non-exhaustive list of areas of the law that have been updated or had proposed updates released since October 2012 appears at the end of this manual. Table of Contents I. Scope... 5 II. Emergency Treatment & Active Labor Act... 5 a. EMTALA Rights... 5 i. Location... 5 ii. Wording... 5 iii. Sample language... 6 b. Medicaid... 6 c. No Physician Presence Twenty-Four Hours per Day, Seven Days per Week... 7 i. In General... 7 ii. Content... 7 iii. Location... 7 III. Pricing & Payment... 7 a. Signs Pertaining to Financial Assistance (Proposed IRS Rules)... 7 i. Conspicuous Public Displays & Other Measures... 7 1. Content & Wording... 8 2. Examples... 8 ii. Internet... 9 b. Signs Pertaining to Hospital Charges... 9 i. Display & Signage Requirements... 10 ii. Hospital Disclosure of Charges... 10 iii. Hospital Quality Information... 10 iv. Health Care Provider Charge Information... 10 v. Health Care Provider Quality Information... 11 vi. Good-Faith Estimate of Out-of-Pocket Costs from Insurer... 11 1

IV. Confidentiality... 11 a. Header... 12 b. Uses & Disclosures... 12 c. Individual Rights... 13 d. Covered Entity s Duties... 13 e. Complaints... 13 f. Contact... 13 g. Effective Date... 13 h. Optional Elements... 14 V. Rights of Patients Receiving Treatment for Mental Illness, Developmental Disabilities, Alcoholism, or Drug Dependency... 14 a. Notice Regarding Confidentiality of Treatment Records... 14 b. Rights of Patients in a Treatment Facility or Unit... 14 VI. Employment-Related Signs... 15 a. Employment Related Signs Unique to Hospitals & Health Care Providers... 15 i. Whistleblower Protection... 15 1. Protected Reporting... 15 2. Approved Form... 15 b. Employment Related Signs Wisconsin Law... 16 i. Wisconsin Business Closing & Mass Layoff... 16 ii. Honesty Testing Devices... 16 iii. Fair Employment Law... 16 iv. Family & Medical Leave Law... 16 v. Minimum Wage Rates... 17 vi. Minimum Wage for Workers with Disabilities... 17 vii. Hours of Work for Minors... 17 viii. Cessation of Health Care Benefits... 17 ix. Unemployment Benefits... 17 x. Hazardous Chemicals, Toxic Substances, Infectious Agents & Pesticides... 18 c. Signs Applicable to Employers Federal Law... 18 i. Employee Polygraph Protection Act... 18 ii. Federal Minimum Wage/Fair Labor Standard Act of 1938... 19 2

iii. Occupational Safety & Health Act... 19 iv. Uniformed Services Employment & Reemployment Rights Act... 19 v. Family & Medical Leave Act... 20 vi. Workers with Disabilities Paid at Special Minimum Wages... 20 vii. Equal Employment Opportunity... 20 viii. Genetic Information Non-Discrimination Act (GINA)... 21 ix. Employee Rights Under the National Labor Relations Act... 21 1. Employers... 21 2. Federal Government Contractors & Subcontractors... 22 VII. Signs Regarding Independent Contractors... 23 a. In General... 23 b. Emergency Room... 23 i. Beyond the Emergency Room... 24 VIII. Radiation Areas... 24 a. In General... 24 b. Posting of Radiation Caution Signs... 24 c. Radiation Symbol... 25 d. Exceptions... 25 e. Posting of Notices to Workers... 26 IX. Other Health Care-Related Signs & Postings... 27 a. Operating Rooms... 27 b. Pharmacy Licenses Display... 27 c. Physician & Physician Assistants Display of Registrations... 27 d. Nursing Homes... 27 e. Respiratory Care... 27 f. Medicare Provider-Based Departments... 27 X. Other Non-Health Care Related Signs & Postings... 28 a. Food-Related Signs... 28 i. Posting Menus in Kitchen Medicare Conditions of Participation/Interpretive Guidance... 28 ii. Food Permits... 28 b. No Smoking Signs... 28 3

i. In General... 28 ii. Sign... 28 iii. Content... 29 c. Weapon on Premises... 29 d. Fire-Related Signage.... 29 i. Direction for Escape; Exit Lights & Signs... 29 1. Direction for Escape... 29 2. Alternative Exits... 30 3. Exit Doors & Signs... 30 4. Stairs... 30 ii. Firewall Signs... 30 e. Conveyances... 30 XI. Federal & State Contractors and Other Entities Receiving Federal or State Financial Assistance... 31 XII. Manual Updates... 31 4

I. Scope This Manual provides a broad overview of requirements for posting notices and signage in hospitals, including requirements in federal law and state law. The scope of this Manual includes signage and notices addressed to patients as well as signage and notices addressed to employees. There may be additional signage-related requirements depending on each hospital s particular facts and circumstances. This Manual discusses the requirements as of the date of publication. Changes to signage requirements may occur from time to time. II. Emergency Treatment & Active Labor Act As described more fully in the WHA Patient Discharge & Transfer Manual, the Emergency Medical Treatment and Active Labor Act (EMTALA) and its implementing regulations protect persons who come to the hospital s emergency department requesting examination or treatment for a medical condition. In addition to screening, stabilizing, and transfer requirements, EMTALA includes signage requirements as discussed in this section. a. EMTALA Rights EMTALA requires Medicare-participating hospitals to post signs conspicuously in emergency departments and other various locations specifying the rights of individuals (including those who are not Medicare beneficiaries) under EMTALA to examination and treatment for an emergency medical condition and women in labor. See 42 C.F.R. 489.20(q)(1). i. Location Hospitals must post the signs in the following places: (1) emergency departments; (2) places likely to be noticed by all individuals entering the emergency department; and (3) places likely to be noticed by individuals waiting for examinations and treatment in areas other than traditional emergency departments (e.g., entrance, admitting areas, waiting rooms, and treatment areas). See 42 C.F.R. 489.20(q)(1). ii. Wording The wording on the sign must be clear and in simple terms and language, understandable to the population served by the hospital. See State Operations Manual, Appendix V Interpretive Guidelines Responsibilities of Medicare Participating Hospitals in Emergency Cases, Tag A- 2402/C-2402 (Rev. 46, 05/29/09). Additionally, the sign must satisfy the following criteria: (1) it must specify the rights of individuals with emergency conditions and women in labor who come to the emergency department for health care services; (2) it must indicate whether the facility participates in the Medicaid program; (3) it must be printed in English and other languages that are common to the population of the area served; and (4) the letters within the signs must be 5

clearly readable at a distance of at least twenty feet or the expected vantage point of the emergency department patients. See Medicare General Information, Eligibility, and Entitlement, Chapter 5, Section 10.1.10 Posting of Signs in Hospital Emergency Departments. iii. Sample language CMS provides the following language below as a sample, but it may be adapted. A best practice would be to use CMS s sample language, which is presented below. See id. IT S THE LAW IF YOU HAVE A MEDICAL EMERGENCY OR ARE IN LABOR YOU HAVE THE RIGHT TO RECEIVE, WITHIN THE CAPABILITIES OF THIS HOSPITAL S STAFF AND FACLITIES: An appropriate medical SCREENING EXAMINATION Necessary STABILIZING TREATMENT (including treatment for an unborn child) And if necessary An appropriate TRANSFER to another facility Even if YOU CANNOT PAY OR DO NOT HAVE MEDICAL INSURANCE OR YOU ARE NOT ENTITLED TO MEDICARE OR MEDICAID This hospital (does/does not) participate in the Medicaid program b. Medicaid Hospitals must also post conspicuously, in a form specified by the Secretary of U.S. Department of Health and Human Services (DHHS), information indicating whether the hospital participates in the Medicaid Program. See 42 C.F.R. 489.20(q)(2). The wording must be clear and in simple terms and language understandable to the population served by the hospital. See State Operations Manual, Appendix V Interpretive Guidelines Responsibilities of Medicare Participating Hospitals in Emergency Cases, Tag A-2402/C-2402 (Rev. 46, 05/29/09). The sample language from CMS above also satisfies the Medicaid notice requirement. 6

c. No Physician Presence Twenty-Four Hours per Day, Seven Days per Week i. In General Hospitals with a dedicated emergency department must post a notice if a doctor of medicine or doctor of osteopathy is not present twenty-four hours per day, seven days per week. See 42 C.F.R. 489.20(w)(5). A dedicated emergency department means any department or facility of the hospital (on campus or off campus) that satisfies one of the following requirements: (1) it is licensed by the State under applicable law as an emergency room or emergency department; (2) it is held out to the public (by name, signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a scheduled appointment; or (3) during the immediately preceding calendar year, based on a sample of patient visits, it provides at least one third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment. See 42 C.F.R. 489.24(5). ii. Content The notice must state that the hospital does not have a doctor of medicine or osteopathy present in the hospital twenty-four hours per day, seven days per week. The notice must also indicate how the hospital will satisfy the needs of any patient with an emergency medical condition at a time when there is no doctor in the hospital. See 42 C.F.R. 489.20(w)(5). iii. Location The hospital must post the notice conspicuously in a place or places likely to be noticed by all individuals entering the dedicated emergency department. See id. III. Pricing & Payment a. Signs Pertaining to Financial Assistance (Proposed IRS Rules) As described in the WHA Special Issues Facing Tax-Exempts Manual, I.R.C. 501(r)(4) requires hospital organizations to establish a written financial assistance policy (FAP). Among other requirements, the FAP must include measures to widely publicize the FAP within the community served by the hospital organization. See I.R.C. 501(r)(4). Proposed regulations issued by the IRS would require hospitals to address four types of measures that they will take to widely publicize the FAP. See 77 Fed. Reg. 38,148, 38,152, 38,161 (June 26, 2012) (proposed rules). Two of the proposed measures require posting of the FAP as described below. i. Conspicuous Public Displays & Other Measures 7

First, under the proposed regulations, the hospital organization s FAP must include measures that the hospital organization will take to inform and notify visitors about the FAP through conspicuous public displays or other measures reasonably calculated to attract the attention of visitors to the hospital. See 77 Fed. Reg. at 38,163. Whether a measure is reasonably calculated to attract attention would depend on all facts and circumstances, including the primary languages spoken by residents of the community served by the hospital, along with other attributes of the community and the facility. See id. 1. Content & Wording At a minimum, the measures have to notify the reader that the hospital offers financial assistance under a FAP and inform the reader about how or where to obtain more information. See 77 Fed. Reg. at 38,163. Thus, a display would not have to provide visitors with the FAP itself or all of the information in it but could instead provide a summary of the FAP or notify visitors of its existence and provide instructions on how to obtain more information. See 77 Fed. Reg. at 38,152. 2. Examples To notify visitors of the FAP, the IRS suggests conspicuously posting signs and displaying brochures in public locations of the hospital. See 77 Fed. Reg. at 38,152. The IRS provides the following as an illustration of an appropriate public display under the proposed rules: The hospital conspicuously displays a sign in large font regarding the FAP in its billing office, admission and registration areas, and emergency room. The sign says: Uninsured? Having trouble paying your hospital bill? You may be eligible for financial assistance. The sign also provides the URL of the Web page where [the facility s] FAP and FAP application form can be accessed. In addition, the sign provides a telephone number and room number of [the facility] that individuals can call or visit with questions about the FAP or the FAP application process. Underneath each sign, [the facility] conspicuously displays copies of a brochure that contains all of the information required to be included in a plain language summary of the FAP [as described in the proposed regulations]. See 77 Fed. Reg. at 38,163. As a second example, for a community in which 11 percent of the community speaks Spanish, the IRS provides that the hospital also displays Spanish versions of the documents. Based on the foregoing, a publicly displayed sign could look as follows: Uninsured? 8

Having Trouble Paying Your Hospital Bill? You may be eligible for financial assistance. Our facility has in place a financial assistance policy. You may access our financial assistance policy and application forms at [web page]. You may also call [phone number] or stop by with any questions on our financial assistance policy or the application process. Please take a brochure below for additional information. The hospital organization could also provide the same language and information in alternative languages at the bottom of the sign. ii. Internet Second, the proposed regulations require the hospital to make the FAP, application form, and a plain language summary of the FAP widely available on the hospital s web site or the web site of the hospital organization that operates the hospital if it does not have its own web site. See 77 Fed. Reg. at 38,152-53, 38,163. The hospital would have to conspicuously post complete and current versions of the documents in English and in the primary language of any populations with limited English proficiency that comprise more than 10 percent of residents of the community served by the facility. See id. The hospital could also post the documents on another entity s web site, as long as the web site of the hospital or hospital organization provides a conspicuously displayed link to the web page on which the document is posted, along with clear instructions for accessing the document on the web site. See 77 Fed. Reg. at 38,163. Under the proposed rules, any individual with access to the internet would have to be able to access, download, view, and print a hard copy of the documents without requiring special computer hardware or software and without paying a fee to the hospital, hospital organization, or other entity. See id. b. Signs Pertaining to Hospital Charges In January 2011, a price and quality transparency law became effective for health care providers and hospitals in Wisconsin, requiring them to disclose certain charge and quality information. See 2009 Wis. Act 146. A summary of the law and its signage requirements are discussed in this section. For purposes of the law, health care provider means a nurse, chiropractor, dentist, physician, physician assistant, physical therapist, podiatrist, athletic trainer, optometrist, pharmacist, psychologist, speech language pathologist or audiologist, a partnership, corporation or limited liability company of such providers, a hospice, a clinic, and an ambulatory surgery center, among other providers. See Wis. Stat. 146.81(1)(a)-(L), 146.903(c). Wisconsin s price 9

and quality disclosure requirements do not apply to providers that: (1) practice individually or in association with not more than two other individual providers or (2) are an association of three or fewer individual providers. See Wis. Stat. 146.903(3)(g). i. Display & Signage Requirements Each hospital and health care provider must prominently display a statement informing consumers that they have the right to (1) the information on charges as described below; (2) the information on quality as described below, if applicable; and (3) in certain circumstances, a good-faith estimate from their insurers of their out-of-pocket costs for a specified service according to the individual s benefit terms and the geographic region in which the service will be performed. See Wis. Stat. 146.903(3)(f), (4)(e). The hospital or health care provider must display the statement in an area of the hospital or health care provider s practice or facility that is most commonly frequented by consumers. See id. ii. Hospital Disclosure of Charges For hospitals, the sign must notify consumers that the following charge information is available at no cost upon the request of the consumer (but need not provide the underlying charge information): (1) the hospital s median billed charges, (2) the average allowable payment under Medicare, (3) and the average allowable payment from private third-party payers for seventyfive diagnosis related groups (DRGs) and seventy-five outpatient surgical procedures. The seventy-five inpatient DRGs must consist of the seventy-five DRGs for which hospitals in Wisconsin most frequently provide inpatient care, as identified by the Wisconsin Hospital Association, Inc. (WHA). See Wis. Stat. 146.903(4)(a),(e), 153.21(3). Likewise, the seventyfive outpatient surgical procedures must consist of the seventy-five outpatient surgical procedures most frequently performed by hospitals in the state, as determined by WHA. See id. iii. Hospital Quality Information If a hospital submits data to a health care information organization, the display for such hospital must also notify consumers that the following quality information is available at no cost to consumers upon request (but need not provide the underlying quality information): any public information reported by a health care information organization regarding the hospital s quality relating to the seventy-five DRGs or seventy-five outpatient surgical procedures for which the hospital must provide its charge data, compared to the quality of such health care services provided by other hospitals. See Wis. Stat. 146.903(4)(am),(e). A health care information organization is an organization that gathers data from health care providers or hospitals regarding utilization and the quality of health care services and produces reports on the comparative quality of services. Wis. Stat. 146.903(1)(br). iv. Health Care Provider Charge Information 10

For health care providers, the display must notify consumers that the following charge information is available at no cost upon request (but need not provide the underlying charge data): - The provider s median billed charge (assuming no complications) for a health care service, diagnostic test, or procedure that is specified by the consumer and furnished by the provider. See Wis. Stat. 146.903(3)(a),(f); and - The provider s (1) median billed charge, (2) Medicare payment to the provider (if Medicare-certified), and (3) average allowable payment from private third-party payors for twenty-five conditions identified by Wisconsin Department of Health Services (DHS). See Wis. Stat. 146.903(3)(b),(f). v. Health Care Provider Quality Information If the health care provider submits data to a health care information organization, the display must also notify consumers that the following quality information is available at no cost upon request (but need not provide the underlying quality information): public information reported by the health care information organization regarding the provider s quality of care relevant to the service, test, or procedure identified by the consumer or to the twenty-five presenting conditions identified by DHS, compared to the quality of health care services furnished by other providers. See Wis. Stat. 146.903(3)(am),(bm). vi. Good-Faith Estimate of Out-of-Pocket Costs from Insurer The display for hospitals and health care providers must also inform consumers that, in certain circumstances, they may receive a good-faith estimate from their insurers of their out-of-pocket costs for a specified service. See Wis. Stat. 146.903(3)(f), (4)(e). The sign itself does not have to provide the estimate, but must inform consumers that the estimate may be available. To provide some background, an insurer or self-insured plan must provide the estimate as of the date of the request, assuming no medication complications or modifications to the insured s treatment plan. See id. Before providing the information, the insurer or self-insured plan may require the insured to provide in writing: (1) the name of the provider performing the service, (2) the facility at which the service will be performed, (3) the date the service will be performed, (4) the health care provider s estimate of the charge for the service, and (5) the CPT codes for the service. See Wis. Stat. 632.798(2)(d). IV. Confidentiality The WHA Managing Health Information Manual discusses confidentiality of patient health information (PHI), including requirements for providing a Notice of Privacy Practices and posting such notice on the covered entity s website. Because hospitals are covered entities under the Health Insurance Portability and Accountability Act (HIPAA) with direct treatment 11

relationships with individuals and maintain physical service delivery sites, they must post a Notices of Privacy Practices. See 45 C.F.R. 164.520(c)(2)(iii)(B). (Section V.a below discusses confidentiality of records created in the course of providing services for mental illness, developmental disabilities, alcoholism, or drug dependency.) The covered entity must post the Notice of Privacy Practices at the service delivery site, in a clear and prominent location where it is reasonable to expect individuals seeking service from the covered entity to be able to read the Notice of Privacy Practices. Id. The Notice of Privacy Practices must be written in plain language and include the following information. a. Header The Notice must include the following language as a header or otherwise prominently displayed: THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. b. Uses & Disclosures The Notice must include: - A description, including at least one example, of the types of uses and disclosures that the covered entity is permitted under the HIPAA Privacy Rule to make for each of the following purposes: (1) treatment, (2) payment, and (3) health care operations. If a use or disclosure is prohibited or materially limited by other applicable law, the description of such use or disclosure must reflect the more stringent law. The description must be of sufficient detail to place the individual on notice of the uses and disclosures that are permitted or required by the Privacy Rule or other applicable law; - A description of each of the other purposes for which the covered entity is permitted or required under the Privacy Rule to use or disclose PHI without the individual s written authorization. If a use or disclosure is prohibited or materially limited by other applicable law, the description of such use or disclosure must reflect the more stringent law. The description must be of sufficient detail to place the individual on notice of the uses and disclosures that are permitted or required by the Privacy Rule or other applicable law; - A statement that the covered entity will make other uses and disclosures only with the individual s written authorization and that the individual may revoke such authorization; - If the covered entity intends to engage in any of the following activities, the description of the uses and disclosures must include a separate statement that: o The covered entity may contact the individual to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to the individual; o The covered entity may contact the individual to raise funds for the covered entity; or 12

o A group health plan, or a health insurance issuer or HMO with respect to a group health plan, may disclose PHI to the sponsor of the plan. c. Individual Rights The Notice must include a statement of the individual s rights with respect to PHI and a brief description of how the individual may exercise such rights, as follows: - The right to request restrictions on certain uses and disclosures of PHI, including a statement that the covered entity is not required to agree to a requested restriction; - The right to receive confidential communications of PHI, as applicable; - The right to inspect and copy PHI; - The right to amend PHI; - The right to receive an accounting of disclosures of PHI; and - The right of an individual, including an individual who has agreed to receive the Notice electronically, to obtain a paper copy of the Notice from the covered entity upon request. d. Covered Entity s Duties The Notice must contain: - A statement that the covered entity is required by law to maintain the privacy of PHI and to provide individuals with notice of its legal duties and privacy practices with respect to PHI; - A statement that the covered entity is required to abide by the terms of the Notice currently in effect; and - For the covered entity to apply a change in privacy practice that is described in the Notice that the covered entity created or received prior to issuing a revised Notice, a statement that it reserves the right to change the terms of its Notice and to make the new Notice provisions effective for all PHI that it maintains. The statement must also describe how the covered entity will provide individuals with a revised notice. e. Complaints The Notice must contain: (1) a statement that the individual may complain to the covered entity and to the Secretary of DHHS if the individual believes his or her privacy rights have been violated, (2) a brief description of how the individual may file a complaint with the covered entity, and (3) a statement that the individual will not be retaliated against for filing a complaint. f. Contact The Notice must contain the name, or title, and telephone number of a person or office to contact for further information. The contact typically will be the hospital s privacy officer. g. Effective Date 13

The Notice must contain the date on which the Notice is first in effect, which may not be earlier than the date on which the Notice is printed or otherwise published. h. Optional Elements If a covered entity elects to limit a use or disclosure that it is permitted to make under the Privacy Rule, the covered entity may describe its more limited uses or disclosures in its Notice. However, the covered entity may not include in its Notice a limitation affecting its rights to make a use or disclosure that is: (1) required by law or (2) necessary to prevent or lessen a serious and imminent threat to the health and safety of a person or the public and made to a person or persons reasonably able to prevent or lessen the threat, including the target. See 45 C.F.R. 164.520. V. Rights of Patients Receiving Treatment for Mental Illness, Developmental Disabilities, Alcoholism, or Drug Dependency a. Notice Regarding Confidentiality of Treatment Records As described in the WHA Mental Health Issues Manual, Wisconsin law addresses the confidentiality of treatment records created in the course of providing services to individuals with a mental illness, developmental disability, alcoholism, or drug dependency and maintained by treatment facilities. Treatment facilities and service providers must prominently display and make available for inspection and copying a notice describing their treatment record access procedures. See Wis. Admin. Code DHS 92.03(1)(d). A treatment facility is any publicly or privately operated facility or unit thereof providing treatment of alcoholic, drug dependent, mentally ill, or developmentally disabled persons including inpatient and outpatient treatment programs. See Wis. Stat. 51.01(19). Where both federal and state laws protect the confidentiality of patient medical records, disclosure can only be made where the requirements of both laws are satisfied. b. Rights of Patients in a Treatment Facility or Unit As discussed in the WHA Mental Health Issues Manual, treatment facilities must post copies of section 51.61 of the Wisconsin Statutes, which addresses patient rights for individuals receiving services for mental illness, developmental disabilities, alcoholism, or drug dependency. See Wis. Stat. 51.61(1)(a). Treatment facilities must post the copies conspicuously in each patient area and make copies available to the patient s guardian and immediate family. See id. The posting requirement regarding patient rights is generally not necessary for hospital emergency rooms or hospital outpatient departments, unless such department is otherwise a treatment facility. This is because the term patient as used in the statute generally does not include any individual who 14

receives treatment in a hospital emergency room or on an outpatient basis at a private hospital or public general hospital. See Wis. Stat. 51.61(1). VI. Employment-Related Signs Various signage requirements exist for hospitals in their capacity as employers. This section provides a broad overview of employment-related signage requirements. Failure to post required notices may result in fines or cause claims not to be barred by the relevant statute of limitations. Additional requirements may exist, particularly for federal and/or state contractors. a. Employment Related Signs Unique to Hospitals & Health Care Providers i. Whistleblower Protection Wisconsin law requires all health care providers and health care facilities, including hospitals, to post a notice setting forth employees rights under section 146.997 of the Wisconsin Statutes. The health care facility must post the notice in one or more conspicuous places where notices to employees are customarily posted. 1. Protected Reporting Section 146.997 protects employees of a facility or health care provider who in good faith report the following information, unless prohibited by law: - Potential violations of any state or federal law by the provider or an employee of the provider; or - Any situation in which the quality of health care services furnished by the provider or any employee of the provider violates any standard established by state or federal law or any clinical or ethical standard established by a professionally recognized accrediting body or standard-setting body and poses a potential risk to public health and safety. See Wis. Stat. 146.997. The law protects reporting to the following persons and entities: - A professionally recognized accrediting or standard-setting body that accredited, certified, or otherwise approved the provider; - Any officer or director of the facility; or - Another employee of the provider who is in a supervisory capacity or a position to take corrective action. See id. The provider may not take or threaten disciplinary action against any person who reports the information in good faith. See id. 2. Approved Form 15

The facility or provider must post the notice in a form approved by the DHS. Wisconsin s Department of Workforce Development (DWD) provides the poster that health care facilities and providers may use at: http://dwd.wisconsin.gov/dwd/posters.htm. b. Employment Related Signs Wisconsin Law i. Wisconsin Business Closing & Mass Layoff Employers with fifty or more employees in Wisconsin must post, in one or more conspicuous places where notices to employees are customarily posted, a notice in a form approved by the DWD setting forth employees rights with respect to business closings and mass layoffs. Wis. Stat. 109.07(7); Wis. Admin. Code DWD 279.07. Notably, the term employer for purposes of this law does not include any charitable or tax-exempt institutions. See Wis. Admin. Code DWD 279.01(d). The approved form is available at: http://dwd.wisconsin.gov/dwd/posters.htm. ii. Honesty Testing Devices Employers who administer lie detector tests, or have a lie detector test administered, must post a notice prepared by DWD. See Wis. Stat. 111.37(3). Lie detector includes a polygraph, deceptograph, voice stress analyzer, psychological stress evaluator, or other similar device, whether mechanical or electrical, that is used to render a diagnostic opinion about the honesty or dishonesty of the individual. See Wis. Stat. 111.37(1). The employer must post the notice in conspicuous places on its premises where notices to employees and applicants for employment are customarily posted. See Wis. Stat. 111.37(3). Because of Wisconsin s stringent laws concerning honesty testing devices, many employers choose not to use such testing. DWD s prepared notice is available at: http://dwd.wisconsin.gov/dwd/posters.htm. iii. Fair Employment Law Every employer, employment agency, and licensing agency must post in conspicuous places on its premises a poster prepared by DWD relating to Wisconsin s fair employment law. See Wis. Admin. Code DWD 218.23. DWD s prepared poster is available at: http://dwd.wisconsin.gov/dwd/posters.htm. iv. Family & Medical Leave Law Employers with at least fifty employees must post, in one or more conspicuous places where notices to employees are customarily posted, a notice approved by DWD setting forth employees rights under Wisconsin law relating to family and medical leave. See Wis. Stat. 103.10(1)(c), (14). DWD s approved form is available at: http://dwd.wisconsin.gov/dwd/posters.htm. 16

Additionally, persons employing at least twenty-five individuals must post, in one or more conspicuous places where notices to employees are customarily posted, a notice describing its policy with respect to family and medical leave. Wis. Stat. 103.10(1)(c), (14). v. Minimum Wage Rates DWD provides an informational poster relating to minimum wage rates at: http://dwd.wisconsin.gov/dwd/posters.htm. Posting of this poster is optional. vi. Minimum Wage for Workers with Disabilities An employer operating under a special minimum wage license must display at all times and make available to employees a poster required by DWD. See Wis. Admin. Code DWD 272.09(10). The poster must explain, in general terms, the conditions under which special minimum wages may be paid. See id. The employer must post the poster in a conspicuous place on the employer s premises where it may be readily observed by workers with disabilities, the parents and guardians of workers, and other employees. See id. Alternatively, the employer may provide a copy of the poster directly to each applicable employee who is subject to the poster s terms. See id. DWD provides the required poster at: http://dwd.wisconsin.gov/dwd/posters.htm. vii. Hours of Work for Minors Employers must post a summary of Wisconsin s rules on hours and days of labor for minors in a form required by DWD. See Wis. Admin. Code DWD 270.03. The employer must post the notice in a conspicuous place in all places of employment where minors are employed or permitted to work. See id. DWD provides the required poster at: http://dwd.wisconsin.gov/dwd/posters.htm. viii. Cessation of Health Care Benefits Each employer that employs fifty or more persons in Wisconsin must post a notice in a form approved by DWD setting forth the rights of employees, retirees, and dependents under Wisconsin law regarding notices of cessation of health care benefits. See Wis. Stat. 109.075. The employer must post the notice in one or more conspicuous places where notices to employees are customarily posted. See id. DWD s provides the poster at: http://dwd.wisconsin.gov/dwd/posters.htm. ix. Unemployment Benefits Employers must inform employees about Wisconsin s unemployment benefits by posting notices supplied by DWD. See Wis. Admin. Code DWD 120.01. The employer must permanently post the notices at suitable points in each of the employer s work places and establishments in Wisconsin. See id. Suitable points for posting the required posters include bulletin boards, near 17

time clocks, and other places where employees will readily see the posters. See id. DWD provides the poster at: http://dwd.wisconsin.gov/dwd/posters.htm. x. Hazardous Chemicals, Toxic Substances, Infectious Agents & Pesticides Employers who use, study, or produce a toxic substance, infectious agent, or pesticide must post a sign. See Wis. Stat. 101.581(1). The sign must inform employees that the employer must, upon request, provide an employee or employee representative with the following: - The identity of any toxic substance or infectious agent which an employee works with or is likely to be exposed to; - A description of any hazardous effect of the toxic substance or infectious agent; - Information regarding precautions to be taken when handling the toxic substance or infectious agent; - Information regarding procedures for emergency treatment in the event of overexposure to the toxic substance or infectious agent; and - Access to the information contained on the label of any pesticide with which the employee works or is likely to be exposed. See id. The employer must post the notice in every workplace at the location where notices to employees are usually posted. See id. A poster from the Wisconsin Department of Safety and Professional Services is available at: http://dsps.wi.gov/sb/sb-divforms.html. c. Signs Applicable to Employers Federal Law i. Employee Polygraph Protection Act Employers must post on their premises (in every establishment of the employer) a notice explaining the Employee Polygraph Protection Act, which includes prohibitions on lie-detector use with respect to employees or prospective employees. See 29 C.F.R. 801.4. The law applies to employers engaged in or affecting commerce or in the production of goods for commerce. See 29 C.F.R. 801.3. Commerce means trade, transportation, transmission, or communication among the states or between any state and any place outside of the state. See 29 C.F.R. 801.2. Lie detector test includes a polygraph, deceptograph, voice stress analyzer, psychological stress evaluator, or any other similar device that is used, or the results of which are used, for the purpose of rendering a diagnostic opinion regarding the honesty or dishonesty of an individual. Lie detector test does not include medical tests used to determine the presence of controlled substances or alcohol in bodily fluids, written or oral tests commonly referred to as honesty or paper and pencil tests, or handwriting tests. See id. Employers must post the notice in a prominent and conspicuous place where it can be readily observed by employees and applicants. See 29 C.F.R. 801.6. The Wage and Hour Division 18

(WHD) of the Department of Labor (DOL) provides the poster at: http://www.dol.gov/whd/regs/compliance/posters/eppa.htm. ii. Federal Minimum Wage/Fair Labor Standard Act of 1938 Employers subject to the Fair Labor Standard Act of 1938 s minimum wage requirements must post a notice explaining the Act in conspicuous places where employees can readily observe it. See 29 C.F.R. 516.4. The Act requires employers to pay a minimum wage to employees who in any work week are engaged in commerce or in the production of goods for commerce or are employed in an enterprise engaged in commerce or in the production of goods for commerce. See 29 U.S.C. 203, 206. DOL provides the poster at: http://www.dol.gov/whd/regs/ compliance/posters/flsa.htm. iii. Occupational Safety & Health Act Employers engaged in a business affecting interstate commerce must post a notice informing employees of the protections and obligations provided for in the Occupational Safety and Health Act and that the employee may contact the employer or DOL for assistance and information. See 29 C.F.R. 1903.2. The employer must post the notice in a conspicuous place or places where notices to employees are customarily posted and take steps to ensure that the notices are not altered, defaced, or covered by other material. See id. The notice is required in each establishment of the employer, which means a physical location where business is conducted or where services are performed. See id. The Occupational Safety and Health Administration provides the required poster. Reproductions of the poster must be at least eight and one-half inches by fourteen inches, and the font size must be at least ten. See id. If the poster size increases, the print size must also increase. See id. The caption or heading must be in large type and generally not less than a thirty-six font size. See id. The required poster is available at DOL s website: http://www.osha.gov/publications/poster.html. iv. Uniformed Services Employment & Reemployment Rights Act Employers must provide a notice to persons entitled to rights and benefits under the Uniformed Services Employment and Reemployment Rights Act. See 38 U.S.C. 4334. The notice must address the rights, benefits, and obligations of such persons and employers under the Act. See id. Employers may satisfy the notice requirement by posting the notice where employers customarily place notices for employees. See id. DOL furnishes the text for the notice. See Appendix to 20 C.F.R. 1002. However, posting one of the notices in 70 Fed. Reg. 75316 (Dec. 19, 2005) is also sufficient. See id. Additionally, DOL indicates that employers may provide the notice in alternative ways that will minimize costs while ensuring that the full text is provided. See http://www.dol.gov/oasam/boc/osdbu/sbrefa/poster/matrix.htm. Examples include distributing the notice by mailing or electronic mail. See id. DOL provides the poster at: http://www.dol.gov/compliance/topics/posters.htm. 19

v. Family & Medical Leave Act Covered employers must post a notice explaining the Family & Medical Leave Act s (FMLA) provisions and providing information on filing complaints for violations of the Act. See 29 C.F.R. 825.300(a). Covered employers include persons who employ fifty or more employees for each working day during twenty or more weeks in the current or proceeding calendar year. See 29 C.F.R. 825.104(a). The employer must post the notice in conspicuous places where employees are employed and prominently where employees and applicants for employment can readily see it. See 29 C.F.R. 825.300(a). The poster and text must be large enough to be easily read, and the text must be fully legible. See id. Electronic posting of the notice may be sufficient (all employees should have access to a computer to view the poster and must be informed that it is available for review on the Intranet). Covered employers must post the notice even if no employees are eligible for FMLA leave. See id. If the workforce includes a significant portion of workers who are not proficient in English, the employer must provide the notice in a language in which the employees are literate. See id. DOL provides the notice. See 29 C.F.R. Pt. 825, App. C; http://www.dol.gov/whd/regs/compliance/posters/fmla.htm. vi. Workers with Disabilities Paid at Special Minimum Wages Every employer with workers employed under special minimum wage certificates must at all times display and make available to employees a poster required by DOL. See 29 C.F.R. 525.14. The poster explains the conditions under which special minimum wages may be paid. See id. The employer must post the poster in a conspicuous place on the employer s premises where the workers with disabilities, the parents and guardians of such workers and other workers may readily observe it. See id. If the employer finds that it is inappropriate to post the notice, the employer may provide the notice directly to all employees who are subject to the notice s terms. See id. DOL provides the notice at: http://www.dol.gov/whd/regs/compliance/posters/disab.htm. vii. Equal Employment Opportunity Employers and federal contractors covered by various non-discrimination and equal employment opportunity laws must post the Equal Employment Opportunity Commission s (EEOC) Equal Employment Opportunity is the Law poster on their premises. See http://www.dol.gov/ofccp/regs/compliance/posters/ofccpost.htm; see also Executive Order 11246; Title VII of the Civil Rights Act of 1964; Age Discrimination in Employment Act of 1967; Americans with Disabilities Act of 1990; 29 C.F.R. 1627.10; 41 C.F.R. 60-1.4, -1.42; 41 C.F.R. 60-250.5; 41 C.F.R. 60-300.5; 41 C.F.R. 60-741.5. Employers and applicable contractors must post the notice prominently where employees (and potentially applicants) can readily see it. See id.; see also http://www.dol.gov/oasam/boc/osdbu/sbrefa/poster/matrix.htm. 20

The required Equal Employment Opportunity is the Law poster is available from EEOC at: http://www.dol.gov/ofccp/regs/compliance/posters/ofccpost.htm. viii. Genetic Information Non-Discrimination Act (GINA) Employers must post and keep posted a notice prepared or approved by EEOC that sets forth excerpts or summaries of regulatory provisions relating to GINA and information for filing a complaint. See 29 C.F.R. 1635.10(c). The employer must post the notice in conspicuous places upon its premises where notices to employees and applicants for employment are customarily posted. See id. GINA protects employees and employment applicants from discrimination based on genetic information, restricts an employer s ability to acquire genetic information, and limits disclosure of genetic information. See 29 C.F.R. 1635.1-1635.12. GINA is addressed in EEOC s Equal Employment Opportunity is the Law poster. ix. Employee Rights Under the National Labor Relations Act Federal law requires most employers and federal contractors and subcontractors to post a notice relating to employee rights under the National Labor Relations Act (NLRA), as described below. The notice requirements applicable to most employers are temporarily on hold as of the date this section was drafted (October 3, 2012). 1. Employers The National Labor Relations Board (NLRB) has issued a Final Rule with notice requirements for many private sector employers. The Final Rule requires employers subject to the NLRA to post notices informing employees of their rights under the NLRA, NLRB contact information, and information concerning enforcement procedures. See 76 Fed. Reg. 54,006, 54,046-48 (August 30, 2011). Hospitals, blood banks, physician offices, dentist offices, and other health care facilities with a gross annual volume of at least $250,000 are subject to the NLRB s jurisdiction and must post the notice. See id. Nursing homes with a gross annual volume of at least $100,000 are subject to the NLRB s jurisdiction and must post the notice. See id. Applicable employers must post the notice in conspicuous places where employees can readily see it, including all places where notices to employees concerning personnel rules or policies are customarily posted by the employer. See id. The notices must be at least eleven inches by seventeen inches in size and in a format, type size, and style required by NLRB. See id. If 20 percent or more of the employer s workforce does not speak English, the employer must post the notice in the language employees speak. See id. However, if an employer requests a notice from NLRB, but it is not available in the applicable language, the employer is not responsible for compliance until the notice is available from NLRB in the requested language. See id. NLRB provides an FAQ on the notice rule at https://www.nlrb.gov/faq/poster. 21

NLRB provides the poster at: http://nlrb.gov/poster. Employers may use commercial services to consolidate the notice into a poster with other federally mandated labor and employment notices, as long as the consolidation does not alter the size, content, or format of the poster or the size and style of the type. Employers who customarily communicate with employees via an internet or intranet about personnel rules or policies must also post the notice on such site. 76 Fed. Reg. at 54,046-48. The employer would satisfy the electronic posting requirement by prominently displaying (no less prominent than other notices) on the site an exact copy of the poster or a link to NLRB s website that contains the poster. See id. The link to NLRB s website must state Employer Rights under the National Labor Relations Act. See id. NRLB s Final Rule was originally scheduled to take effect November 14, 2011, but the D.C. Circuit Court of Appeals has temporarily enjoined the Final Rule. See http://nlrb.gov/poster. As of October 3, 2012, NRLB s website indicates that the notice requirement is still on hold until legal issues are resolved. See id. 2. Federal Government Contractors & Subcontractors Additionally, federal government contracting departments and agencies must include a provision in the contract requiring the contractor to post a notice relating to employee rights under federal labor laws. See Executive Order 13496; 29 C.F.R. 471.2. The notice addresses rights of employees of federal contractors and subcontractors under the NLRA, including rights to organize and bargain collectively with employers. See id. Contractors or subcontractors who post notices to employees physically must post the notice physically. See 29 C.F.R. 471.2(d). The contractor must place the notice in conspicuous places in plants and offices so that it is prominent and employees can readily see it. See id. The contractor must place the notice in areas where employees covered by the Act engage in activities relating to the contract. See id. The contractor or subcontractor must also provide the notice in languages that employees speak if a significant portion of the contractor s workforce is not proficient in English. See id. Contractors or subcontractors that customarily post notices to employees electronically must also post the required notice electronically. See 29 C.F.R. 471.2(f). The contractor or subcontractor would satisfy the electronic posting requirement by displaying prominently a link to DOL s website containing the poster on any website maintained by the contractor or subcontractor and customarily used for notices to employees regarding terms and conditions of employment. See id. The link to DOL s website must read Important Notice about Employee Rights to Organize and Bargain Collectively with Their Employers. See id. DOL provides the posters at: http://www.dol.gov/olms/regs/compliance/eo13496.htm. 22