Print Friendly HOUSE BILL NO. 598 – Personal care providers/pymt method
HOUSE BILL NO. 598
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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
|||| 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
2 RELATING TO THE PROVISION OF PERSONAL CARE SERVICES; AMENDING SECTION 39-5602,
3 IDAHO CODE, TO DELETE AND TO CLARIFY DEFINITIONS; AMENDING SECTION
4 39-5603, IDAHO CODE, TO PROVIDE THAT THE DEPARTMENT SHALL ENTER INTO
5 AGREEMENTS WITH PROVIDERS FOR PERSONAL CARE SERVICES, AND TO PROVIDE FOR
6 REVOCATION OR DENIAL OF PROVIDER STATUS FOR VIOLATION OF RULES; AMENDING
7 SECTION 39-5606, IDAHO CODE, TO PROVIDE FOR PAYMENT TO PROVIDERS AND
8 INCLUDE REFERENCE TO A SUPPLEMENTAL COMPONENT OF THE RATE FOR PERSONAL
9 CARE ATTENDANTS; AND REPEALING SECTION 39-5607, IDAHO CODE.
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-
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-
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
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-
42 (b) Complying with state and federal labor and tax laws, rules and regu-
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
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
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
STATEMENT OF PURPOSE
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.
No fiscal impact is anticipated in as much the PCS program will
continue to operate with minor changes.
CONTACT: Rep. Max Black
STATEMENT OF PURPOSE/FISCAL NOTE
Bill No.H 598