1998 Legislation
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HOUSE BILL NO. 598 – Personal care providers/pymt method


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Daily Data Tracking History

H0598.................................................by HEALTH AND WELFARE
PERSONAL CARE PROVIDERS - Amends and repeals existing law to govern the
methods of payment to providers for personal care services and to delete
inclusion of independent providers of personal care services.

02/03    House intro - 1st rdg - to printing
02/04    Rpt prt - to Health/Wel
02/19    Rpt out - rec d/p - to 2nd rdg
02/20    2nd rdg - to 3rd rdg
02/24    3rd rdg - PASSED - 69-0-1
      AYES -- Alltus, Barraclough, Barrett, Bell, Bieter, Bivens,
      Black(15), Black(23), Boe, Bruneel, Callister, Campbell, Chase,
      Clark, Crane, Crow, Cuddy, Deal, Denney, Ellsworth, Field(13),
      Field(20), Gagner, Geddes, Hadley, Hansen, Henbest, Hornbeck, Jaquet,
      Jones(9), Jones(22), Jones(20), Judd, Kellogg, Kempton, Kendell,
      Kjellander, Kunz, Lake, Linford, Loertscher, Mader, Marley, McKague,
      Meyer, Miller, Mortensen, Newcomb, Pischner, Pomeroy, Reynolds,
      Richman, Ridinger, Robison, Sali, Schaefer, Stevenson, Stoicheff,
      Stone, Stubbs, Taylor, Tilman, Tippets, Trail, Watson, Wheeler, Wood,
      Zimmermann, Mr Speaker
      NAYS -- None
      Absent and excused -- Gould
    Floor Sponsor - Black(15)
    Title apvd - to Senate
02/25    Senate intro - 1st rdg - to Health/Wel
03/04    Rpt out - rec d/p - to 2nd rdg
03/05    2nd rdg - to 3rd rdg
03/17    3rd rdg - PASSED - 31-0-4
      AYES--Andreason, Boatright, Branch, Bunderson, Burtenshaw, Cameron,
      Danielson, Darrington, Deide, Dunklin, Frasure, Geddes, Hawkins,
      Ingram, Ipsen, Keough, King, Lee, McLaughlin, Noh, Parry, Richardson,
      Risch, Sandy, Schroeder, Sorensen, Stennett, Sweeney, Thorne, Twiggs,
      Absent and excused--Crow, Hansen, Riggs, Whitworth
    Floor Sponsor - Ipsen
    Title apvd - to House
03/18    To enrol
03/18    Rpt enrol - Sp signed
03/19    Pres signed - to Governor
03/20    Governor signed
         Session Law Chapter 224
         Effective: 07/01/98

Bill Text


 ||||              LEGISLATURE OF THE STATE OF IDAHO             ||||
Fifty-fourth Legislature                 Second Regular Session - 1998

                             IN THE HOUSE OF REPRESENTATIVES

                                    HOUSE BILL NO. 598

                             BY HEALTH AND WELFARE COMMITTEE

 1                                        AN ACT

10    Be It Enacted by the Legislature of the State of Idaho:

11        SECTION 1.  That Section 39-5602, Idaho Code, be, and the same  is  hereby
12    amended to read as follows:

13        39-5602.  DEFINITIONS.  As used in this chapter, the following terms shall
14    have the following meaning:
15        (1)  "Associated services"  means  those  tasks  performed  which  do  not
16    require hands-on care such as incidental housekeeping, cooking, laundry, shop-
17    ping, and transportation included in the care plan.
18        (2)  "Case management" means a service which coordinates multiple services
19    for  individual  clients  through a process of assessment, planning, arranging
20    for and monitoring services.
21        (3)  "Department" means the department of health and welfare of the  state
22    of Idaho.
23        (4)  "Director"  means  the  director of the department of health and wel-
24    fare.
25        (5)  "Eligible recipient" or "recipient" means  an  individual  determined
26    eligible  by  the  department  for the services provided in the state plan for
27    medicaid, as authorized by title XIX, of the social security act, as amended.
28        (6)   "Independent provider" means a  personal  care  attendant  that
29    provides personal care services as an independent contractor.
30        (7)  "Independent  contractor"  means  a sole proprietorship, partnership,
31    corporation or other business entity approved in the state of Idaho to conduct
32    business and meeting all federal and state criteria as an independent contrac-
33    tor.
34        (8)   "Personal care attendant" means a person whose name appears on
35    the Idaho state board of nurse's registry of certificated nurse aid's (CNA) or
36    is determined by the director to meet equivalent requirements  and  holds,  or
37    works for a provider agency that holds, a valid Idaho medicaid provider agree-
38    ment    for personal care services ; and provides hands-on personal
39    care services.
40        ( 9  7 )  "Personal care  services"  means  services
41    that involve personal and medically orientated tasks dealing with the physical
42    requirements  of the patient performed in the patient's home and accommodating
43    the patient's needs for long-term maintenance, supportive care  or  associated


 1    services.
 2        ( 10  8 ) "Plan of care" means a document which out-
 3    lines  all  services,  including  but  not limited to, personal care services,
 4    required to maintain the individual in his or her community.
 5         (9)  "Provider" means a personal care attendant or provider  agency.
 7        (1  1    0  ) "Provider agency" means an entity that
 8    recruits, hires,  fires, trains, supervises, schedules,  oversees  quality  of
 9    work,  takes  responsibility for care given, and provides payroll and benefits
10    for care providers working for them.
11        (1 2  1 ) "Representative" means an employee of  the
12    department of health and welfare.

13        SECTION  2.  That  Section 39-5603, Idaho Code, be, and the same is hereby
14    amended to read as follows:

15        39-5603.  STANDARDS FOR PROVISION OF PERSONAL  CARE.  The  director  shall
16    have  the  power  and it shall be his duty to promulgate and adopt appropriate
17    rules necessary to implement and enforce standards for provision  of  personal
18    care services.
19        The  following standards for provision of personal care services and other
20    provisions contained throughout this chapter and rules shall apply to  recipi-
21    ents  and  providers receiving or providing personal care services either as a
22    medicaid option service or a waivered service, unless  prohibited  by  federal
23    law or contents of the federal waiver agreement.
24        (1)  Personal  care  services  shall  be  included as a state plan service
25    under medicaid. Services under a waiver shall be available to those  individu-
26    als  who would not qualify for medicaid in the absence of a waiver or to those
27    whose needs cannot be met with personal care services under the plan.
28        (2)  Personal care services shall be ordered by a physician.
29        (3)  The department will establish by rule maximum hours per month of per-
30    sonal care services available to the individual recipient.
31        (4)  The department shall  enter  into    contracts  and/or  provider
32      agreements  with   independent contractors   providers
33     for the provision of personal care services. The  department  may  deny
34    provider status or revoke that status when a provider is found to endanger the
35    health, person or property of the recipient , or is in violation of rules
36    promulgated by the department or the provider agreement .
37        (5)  A  n  independent contractor   provider agency 
38    shall have the responsibility for the following:
39        (a)  Recruitment, hiring, firing, training, supervision, scheduling,  pay-
40        roll, and the assurance of quality of service, of its personal care atten-
41        dants;
42        (b)  Complying  with state and federal labor and tax laws, rules and regu-
43        lations;
44        (c)  Maintaining liability insurance coverage;
45        (d)  Provision of an appropriately qualified nurse to complete the plan of
46        care and ongoing supervision of the recipients care;
47        (e)  Assignment of a qualified personal care attendant to each  authorized
48        recipient after consultation with and prior approval of that recipient;
49        (f)  Assuring  all  personal  care  attendants providing services, whether
50        themselves or their agent, meet the standards and qualifications  of  this
51        chapter;
52        (g)  Billing medicaid for services approved and authorized by them;
53        (h)  Making referrals for personal care service recipients to case manage-


 1        ment services based on established criteria;
 2        (i)  Providing  for  care by a qualified replacement when the regular per-
 3        sonal care attendant is unable to provide the services, and providing  for
 4        unanticipated services approved on the plan of care when requested by  the
 5        recipient; and
 6        (j)  Conducting,  at  least  annually, client satisfaction/quality control
 7        reviews available to the department and general public.
 8        (6)   Independent providers not qualifying as independent contractors
 9    shall not be eligible for medicaid payment after December 31,  1997;  provided
10    however,  that  the  director  may  extend this deadline until the last day of
11    June, 1998. The independent provider will    Personal  care  atten-
12    dants  are   not  be considered an  employee s  of
13    the state .   or the recipient,  but  will  be  considered  an
14    independent  contractor.  As such he shall be responsible to meet requirements
15    established by the department.  The department will provide a  qualified
16    nurse to establish a plan of care and ongoing care supervision, where a n
17    independent  provider   personal care attendant  is providing
18    service.
19        (7)  Case management shall be made  available  to  personal  care  service
20    recipients  where and when appropriate. In order to avoid a conflict of inter-
21    est, case management shall not be provided by the same  agency  that  provides
22    personal  care  services  to the recipient. Services provided by case managers
23    include but are not limited to:
24        (a)  Comprehensive assessment;
25        (b)  Assistance with eligibility and application processes;
26        (c)  Service plan development;
27        (d)  Service plan implementation;
28        (e)  Reassessment and service termination planning; and
29        (f)  Supportive functions which may include client  advocacy,  assistance,
30        consultation,  including  training  to  enable the recipient to manage and
31        evaluate the care they receive, family  support,  crisis  intervention  or
32        follow-up after termination from case management when necessary.
33        (8)  The department's regional medicaid staff shall review and approve the
34    plan of care, authorize personal care services, the hours of service, and make
35    appropriate referrals for case management for eligible individuals.
36        (9)  The  department  shall  establish  a community awareness program that
37    will educate Idaho citizens regarding the purpose and function  of  all  long-
38    term  care  alternatives including, but not limited to, personal care services
39    and individual recipient rights. This program will be developed in cooperation
40    with other state agencies including, but not limited to, the office  on  aging
41    and the division of vocational rehabilitation.
42        (10) It  shall  be  the  responsibility  of  the recipient, his parents or
43    guardian, when possible, to select the provider of personal care services.
44        (11) The department shall provide the recipient, his parents  or  guardian
45    with  a  list  of available providers of personal care services; however, this
46    does not relieve the recipient, his parents or guardian of the  responsibility
47    of provider  selection.
48        (12) In  those  cases  where the recipient, his parents or guardian cannot
49    arrange for personal care services or asks for help in making arrangements,  a
50    representative  of the department may arrange for or help arrange for personal
51    care services on behalf of the recipient.

52        SECTION 3.  That Section 39-5606, Idaho Code, be, and the same  is  hereby
53    amended to read as follows:


 1        39-5606.  PAYMENT  TO  BE MADE TO PROVIDER. Within the appropriations pro-
 2    vided by law,  and as authorized by rule,    the  department  shall
 3    reimburse  the    independent    provider  or provider agency,
 4     for personal care services received by the recipient. To qualify    for
 5    reimbursement, personal care services must be prescribed by a physician deliv-
 6    ered  in  accordance  with  the recipient's plan of care and be provided by an
 7    individual who is:
 8        (a)  A personal care attendant;
 9        (b)  Supervised by a registered nurse; and
10        (c)  Not a member of the recipient's family.
11    The department will establish annually uniform reimbursement rates  for  
12    independent contractors   providers . This rate will be based
13    on  the  prevailing hourly rate paid for comparable positions in the state for
14    nursing home industry employees.  Independent  contractors    
15    Provider agencies  shall also receive a fifty-five percent (55%) supple-
16    mental  component  to  cover  travel, administration, training and all payroll
17    taxes and fringe benefits.  Personal care attendant rates  shall  have  a
18    supplemental  component to cover training, worker's compensation, social secu-
19    rity and liability insurance.  The department  may  establish  different
20    rates  for  associated  services. When the assessment tool referred to in sec-
21    tions 39-3308 and 39-3508, Idaho Code, becomes available, it shall be  applied
22    to establish reimbursement levels.
23          All  references in this chapter made to independent providers shall
24    become null and void effective January 1, 1998;  provided  however,  that  the
25    director may extend this deadline until the last day of June, 1998. 
26        The  director shall promulgate and adopt such necessary rules to implement
27    the requirements of this section.

28        SECTION 4.  That Section 39-5607, Idaho Code, be, and the same  is  hereby
29    repealed.

Statement of Purpose / Fiscal Impact


                          STATEMENT OF PURPOSE
                                RS 07725
    This bill reinstates provisions of the Personal Care 
    Services(PCS)program. Enactment of SB1226 is being delayed 
    which will allow for Home Community Based Services waivers 
    (HCBS) to be developed.
                               FISCAL NOTE
    No fiscal impact is anticipated in as much the PCS program will 
    continue to operate with minor changes.
    CONTACT: Rep. Max Black
             DeeAnne Moore
    Bill No.H 598