2007 Legislation
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HOUSE BILL NO. 167 – Personal assistance services

HOUSE BILL NO. 167

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Bill Status



H0167aa...............................................by HEALTH AND WELFARE
PERSONAL ASSISTANCE SERVICES - Amends and repeals existing law relating to
personal assistance services to revise definitions; to provide that
personal care services be included in Medicaid services as described in
Idaho Code; to permit a single provider to operate as both a personal
assistance agency and a fiscal intermediary agency; to provide for personal
assistance agency responsibilities; to provide for fiscal intermediary
agency responsibilities; and repealing provisions regarding the effect of
personal assistance agency rates and a determination to be made by the
director of the Department of Health and Welfare.
                                                                        
02/09    House intro - 1st rdg - to printing
02/12    Rpt prt - to Health/Wel
03/01    Rpt out - to Gen Ord
03/05    Rpt out amen - to engros
03/06    Rpt engros - 1st rdg - to 2nd rdg as amen
03/07    2nd rdg - to 3rd rdg as amen
03/08    3rd rdg as amen - PASSED - 66-0-4
      AYES -- Anderson, Andrus, Barrett, Bedke, Bell, Bilbao, Black, Block,
      Bock, Boe, Bolz, Brackett, Bradford, Chadderdon, Chavez, Chew,
      Collins, Crane, Durst, Edmunson, Eskridge, Hagedorn, Hart, Harwood,
      Henbest, Henderson, Jaquet, Killen, King, Labrador, Lake, LeFavour,
      Loertscher, Luker, Marriott, Mathews, McGeachin, Mortimer, Moyle,
      Nielsen, Nonini, Pasley-Stuart, Patrick, Pence, Raybould, Ring,
      Ringo, Roberts, Ruchti, Rusche, Sayler, Schaefer, Shepherd(2),
      Shepherd(8), Shirley, Shively, Smith(30), Smith(24), Stevenson,
      Thayn, Trail, Vander Woude, Wills, Wood(27), Wood(35), Mr. Speaker
      NAYS -- None
      Absent and excused -- Bayer, Clark, Kren, Snodgrass
    Floor Sponsor - Rusche
    Title apvd - to Senate
03/09    Senate intro - 1st rdg - to Health/Wel
03/15    Rpt out - rec d/p - to 2nd rdg
03/16    2nd rdg - to 3rd rdg
03/20    3rd rdg - PASSED - 34-0-1
      AYES -- Andreason, Bair, Bastian, Bilyeu, Broadsword, Burkett,
      Cameron, Coiner, Corder, Darrington, Davis, Fulcher, Geddes, Goedde,
      Hammond, Heinrich, Hill, Jorgenson, Kelly, Keough, Langhorst, Little,
      Lodge, Malepeai, McGee, McKague, McKenzie, Pearce, Richardson,
      Schroeder, Siddoway, Stegner, Stennett, Werk
      NAYS -- None
      Absent and excused -- Gannon
    Floor Sponsor - Broadsword
    Title apvd - to House
03/21    To enrol - Rpt enrol - Sp signed
03/22    Pres signed - To Governor
03/27    Governor signed
         Session Law Chapter 222
         Effective: 07/01/07

Bill Text


                                                                        
                                                                        
  ]]]]              LEGISLATURE OF THE STATE OF IDAHO             ]]]]
 Fifty-ninth Legislature                   First Regular Session - 2007
                                                                        
                                                                        
                              IN THE HOUSE OF REPRESENTATIVES
                                                                        
                                     HOUSE BILL NO. 167
                                                                        
                              BY HEALTH AND WELFARE COMMITTEE
                                                                        
  1                                        AN ACT
  2    RELATING TO PERSONAL ASSISTANCE SERVICES; AMENDING THE HEADING FOR CHAPTER 56,
  3        TITLE 39, IDAHO CODE; AMENDING SECTION 39-5602, IDAHO CODE, TO REVISE DEF-
  4        INITIONS; AMENDING SECTION 39-5603, IDAHO CODE, TO PROVIDE  THAT  PERSONAL
  5        CARE SERVICES BE INCLUDED IN MEDICAID SERVICES AS DESCRIBED IN IDAHO CODE,
  6        TO  PERMIT  A  SINGLE  PROVIDER  TO  OPERATE AS BOTH A PERSONAL ASSISTANCE
  7        AGENCY AND A FISCAL INTERMEDIARY AGENCY, TO PROVIDE  FOR  PERSONAL  ASSIS-
  8        TANCE  AGENCY  RESPONSIBILITIES  AND  TO  PROVIDE  FOR FISCAL INTERMEDIARY
  9        AGENCY RESPONSIBILITIES; REPEALING SECTION 39-5607, IDAHO CODE,  REGARDING
 10        THE  EFFECT  OF  PERSONAL  ASSISTANCE  AGENCY  RATES; AND AMENDING SECTION
 11        39-5609, IDAHO CODE, TO DELETE LANGUAGE REGARDING A  DETERMINATION  TO  BE
 12        MADE BY THE DIRECTOR OF THE DEPARTMENT OF HEALTH AND WELFARE.
                                                                        
 13    Be It Enacted by the Legislature of the State of Idaho:
                                                                        
 14        SECTION 1.  That the Heading for Chapter 56, Title 39, Idaho Code, be, and
 15    the same is hereby amended to read as follows:
                                                                        
 16                                      CHAPTER 56
 17                          PERSONAL CARE ASSISTANCE SERVICES
                                                                        
 18        SECTION  2.  That  Section 39-5602, Idaho Code, be, and the same is hereby
 19    amended to read as follows:
                                                                        
 20        39-5602.  DEFINITIONS. As used in this chapter, the following terms  shall
 21    have the following meanings:
 22        (1)  "Attendant  care"  means  services provided under a medicaid home and
 23    community-based services waiver that involve personal and medically orientated
 24    tasks dealing with the functional needs of the participant  and  accommodating
 25    the  participant's  needs for long-term maintenance, supportive care or IADLs.
 26    These services may include, but are not limited to,  personal  assistance  and
 27    medical  tasks  that  can  be done by unlicensed persons or delegated to unli-
 28    censed persons by a health care professional or participant. Services shall be
 29    based on the participant's abilities and limitations, regardless of age, medi-
 30    cal diagnosis or other category of disability.
 31        (2)  "Case management" means a service which coordinates multiple services
 32    for individual participants through a process of assessment, planning, arrang-
 33    ing for and monitoring services.
 34        (32)  "Department" means the department of health and welfare of the state
 35    of Idaho.
 36        (43)  "Director" means the director of the department of health  and  wel-
 37    fare.
 38        (54)  "Eligible  participant"  or "participant" means an individual deter-
 39    mined eligible by the department for Idaho medicaid services, as authorized by
 40    title XIX, of the social security act, as amended.
 41        (65)  "Fiscal intermediary services agency" means an entity that  provides
                                                                        
                                       2
                                                                        
  1    services that allow the participant receiving personal assistance services, or
  2    his  designee  or legal representative, to choose the level of control he will
  3    assume in recruiting, selecting, managing, training, and dismissing  his  per-
  4    sonal  assistant  regardless  of who the employer of record is, and allows the
  5    participant control over the manner in which services are delivered.
  6        (76)  "Individual service plan" means a document which outlines  all  ser-
  7    vices  including,  but not limited to, personal assistance services and IADLs,
  8    required to maintain the individual in his or her home and community.
  9        (87)  "Instrumental activities of daily living (IADL)" means those activi-
 10    ties performed in supporting the activities of daily  living,  including,  but
 11    not limited to: managing money, preparing meals, shopping, light housekeeping,
 12    using the telephone, or getting around in the community.
 13        (98)  "Personal  assistance  agency" means an entity that recruits, hires,
 14    fires, trains, supervises, schedules, oversees quality of work, takes  respon-
 15    sibility  for  services  provided,  provides payroll and benefits for personal
 16    assistants working for them, is the employer of record and in  fact,  and  may
 17    provide fiscal intermediary services.
 18        (109)  "Personal  assistance  services"  includes both attendant care ser-
 19    vices and personal care services and means services that involve personal  and
 20    medically  oriented tasks dealing with the functional needs of the participant
 21    and accommodating the participant's needs for long-term  maintenance,  suppor-
 22    tive  care  or IADLs. These services may include, but are not limited to, per-
 23    sonal assistance and medical tasks that can be done by unlicensed  persons  or
 24    delegated  to unlicensed persons by a health care professional or participant.
 25    Services shall be  based  on  the  participant's  abilities  and  limitations,
 26    regardless of age, medical diagnosis or other category of disability.
 27        (110) "Personal  assistant" means an individual who directly provides per-
 28    sonal assistance services.
 29        (12) "Personal care services" means services ordered  by  a  physician  or
 30    authorized provider that involve personal and medically orientated tasks deal-
 31    ing  with  the  functional  needs  of  the  participant  and accommodating the
 32    participant's needs for long-term maintenance, supportive care or IADLs. These
 33    services may include, but are not limited to, personal assistance and  medical
 34    tasks  that  can be done by unlicensed persons or delegated to unlicensed per-
 35    sons by a health care professional or participant. Services shall be based  on
 36    the  participant's abilities and limitations, regardless of age, medical diag-
 37    nosis or other category of disability.
 38        (131) "Provider" means a personal assistance agency, a fiscal intermediary
 39    agency or both.
 40        (142) "Representative" means an employee of the department of  health  and
 41    welfare.
 42        (153) "Voucher service option" means a method of service provision whereby
 43    the participant receives vouchers to pay for personal assistance services.
                                                                        
 44        SECTION  3.  That  Section 39-5603, Idaho Code, be, and the same is hereby
 45    amended to read as follows:
                                                                        
 46        39-5603.  STANDARDS FOR PROVISION OF  PERSONAL  ASSISTANCE  SERVICES.  The
 47    director shall have the power and it shall be his duty to promulgate and adopt
 48    appropriate  rules  necessary to implement and enforce standards for provision
 49    of personal assistance services.
 50        The following standards for provision of personal assistance services  and
 51    other  provisions  contained  throughout this chapter and rules shall apply to
 52    participants and providers receiving or providing personal assistance services
 53    either as a medicaid option service or a waivered service,  unless  prohibited
                                                                        
                                       3
                                                                        
  1    by federal law or contents of the federal waiver agreement.
  2        (1)  Personal  care  services  shall  be  included as a state plan service
  3    under in the medicaid services described in section 56-255(3) and  (4),  Idaho
  4    Code.
  5        (2)  Attendant care shall be included as a service under medicaid home and
  6    community-based waiver(s).
  7        (3)  All  attendant  care services must be authorized by the department or
  8    its designee.
  9        (4)  The department will establish by rule maximum hours per month of per-
 10    sonal care services available to the individual participant  under  the  state
 11    medicaid plan.
 12        (5)  The  department  shall  enter  into agreements with providers for the
 13    provision of personal assistance services. A single provider  may  operate  as
 14    both  a  personal  assistance  agency  and  a  fiscal intermediary agency. The
 15    department may deny provider status or revoke that status when a  provider  is
 16    found  to endanger the health, person or property of the participant, or is in
 17    violation of rules promulgated by the department or the provider agreement.
 18        (6)  A provider personal assistance agency shall have  the  responsibility
 19    for the following:
 20        (a)  Recruitment,  hiring, firing, training, supervision, scheduling, pay-
 21        roll, and the assurance of quality of service, of its personal assistants;
 22        (b)  Complying with state and federal labor and tax laws, rules and  regu-
 23        lations;
 24        (c)  Maintaining liability insurance coverage;
 25        (d)  Provision of an appropriately qualified nurse when required;
 26        (e)  Assignment  of a qualified personal assistant to each authorized par-
 27        ticipant after consultation with and prior approval of that participant;
 28        (f)  Assuring all personal assistants providing services  meet  the  stan-
 29        dards and qualifications of this chapter;
 30        (g)  Billing medicaid for services approved and authorized;
 31        (h)  Collecting any participant contribution due;
 32        (i)  Referring  participants  to  case management services based on estab-
 33        lished criteria;
 34        (ij)  Providing for care by a qualified replacement when the regular  per-
 35        sonal assistant is unable to provide the services, and providing for unan-
 36        ticipated  services approved on the individual service plan when requested
 37        by the participant; and
 38        (jk)  Conducting, at least annually, participant satisfaction/quality con-
 39        trol reviews available to the department and general public.
 40        (7)  A personal assistance agency that provides fiscal  intermediary  ser-
 41    vices agency shall have the responsibility for the following:
 42        (a)  To  assure  compliance with legal requirements related to the employ-
 43        ment of participant/family directed personal assistants; and
 44        (b)  To offer supportive services to enable participants  or  families  to
 45        perform required employer tasks themselves; and
 46        (c)  To  bill the medicaid program for services approved and authorized by
 47        the department; and
 48        (d)  To collect any participant contribution due; and
 49        (e)  To pay personal assistants for services; and
 50        (f)  To perform all necessary withholding as required by state and federal
 51        labor and tax laws, rules and regulations; and
 52        (g)  To offer a full range of services and perform all services  contained
 53        in  a  written  agreement  between the participant and the provider assure
 54        that all personal assistants providing services  meet  the  standards  and
 55        qualifications of this chapter;
                                                                        
                                       4
                                                                        
  1        (h)  To  refer  participants  to  case management services based on estab-
  2        lished criteria;
  3        (i)  To maintain liability insurance coverage; and
  4        (j)  To conduct, at least annually, participant satisfaction  and  quality
  5        control reviews which shall be available to the department and to the gen-
  6        eral public.
  7        (8)  Personal assistants are not employees of the state.
  8        (9)  Case  management  shall be made available to personal assistance par-
  9    ticipants where and when appropriate. In order to avoid a conflict  of  inter-
 10    est,  case  management  shall not be provided by the same agency that provides
 11    personal assistance services to the participant.
 12        (10) The department's regional medicaid staff shall review and approve the
 13    individual service plan, authorize personal assistance services, the hours  of
 14    service, and make appropriate referrals for case management for eligible indi-
 15    viduals.
 16        (11) The  department  shall  establish  and maintain a community awareness
 17    program that will educate Idaho citizens regarding the purpose and function of
 18    all long-term care alternatives including, but not limited to, personal assis-
 19    tance services and individual participant rights. This program will be  devel-
 20    oped  in  cooperation with other state agencies including, but not limited to,
 21    the commission on aging and the state independent living council.
 22        (12) It shall be the responsibility of the participant or his designee  or
 23    legal  representative,  when  appropriate,  to select the provider of personal
 24    assistance services.
 25        (13) The department shall provide the participant, his designee  or  legal
 26    representative, with a list of available providers of personal assistance ser-
 27    vices; however, this does not relieve the participant or his designee or legal
 28    representative of the responsibility of provider selection.
 29        (14) In  those cases where the participant or his designee or legal repre-
 30    sentative cannot arrange for personal assistance services or asks for help  in
 31    making  arrangements,  a  representative  of the department may arrange for or
 32    help arrange for personal assistance services on behalf of the participant.
                                                                        
 33        SECTION 4.  That Section 39-5607, Idaho Code, be, and the same  is  hereby
 34    repealed.
                                                                        
 35        SECTION  5.  That  Section 39-5609, Idaho Code, be, and the same is hereby
 36    amended to read as follows:
                                                                        
 37        39-5609.  PERSONAL ASSISTANCE OVERSIGHT COMMITTEE.  The  department  shall
 38    establish, as part of the medical care advisory committee (MCAC), an oversight
 39    subcommittee  consisting of providers of personal assistance services and par-
 40    ticipants of such services and advocacy organizations representing  such  par-
 41    ticipants, and other interested parties, for the purpose of planning, monitor-
 42    ing,  and  recommending changes to the medicaid waiver and personal assistance
 43    programs to the MCAC. At least fifty-one percent (51%) of the  committee  mem-
 44    bership  shall  be  participants  or their representatives. The director shall
 45    determine when and if this role shall be performed by the MCAC.

Amendment


                                                                        
                                                                        
  ]]]]              LEGISLATURE OF THE STATE OF IDAHO             ]]]]
 Fifty-ninth Legislature                   First Regular Session - 2007
                                                                        
                                                                        
                                                     Moved by    Loertscher          
                                                                        
                                                     Seconded by Rusche              
                                                                        
                                                                        
                              IN THE HOUSE OF REPRESENTATIVES
                              HOUSE AMENDMENT TO H.B. NO. 167
                                                                        
                                                                        
  1                               AMENDMENTS TO SECTION 2
  2        On page 2 of the printed bill, delete lines 4 and  5  and  insert:  "sonal
  3    assistant. regardless of who the employer of record is, and allows the partic-
  4    ipant  control  over the manner in which services are delivered."; in line 38,
  5    delete "," and insert: "or"; and in line 39, delete "or both".
                                                                        
  6                               AMENDMENTS TO SECTION 3
  7        On page 3, in line 14, following "agency." insert:  "However,  the  agency
  8    must  clearly document whether it is operating as a personal assistance agency
  9    or as a fiscal intermediary for each participant."; in line 32, following "to"
 10    insert: "the department for"; and in line 44, delete "supportive" and  insert:
 11    "supportive".
 12        On  page 4, in line 3, delete "and"; in line 6, following "public" insert:
 13    "; and
 14        (k)  To maintain documentation that the participant or his legal represen-
 15        tative agrees in writing that he  takes  responsibility  for  and  accepts
 16        potential  risks, and any resulting consequences, for his choice to manage
 17        his own personal assistance services".

Engrossed Bill (Original Bill with Amendment(s) Incorporated)


                                                                        
                                                                        
  ]]]]              LEGISLATURE OF THE STATE OF IDAHO             ]]]]
 Fifty-ninth Legislature                   First Regular Session - 2007
                                                                        
                                                                        
                              IN THE HOUSE OF REPRESENTATIVES
                                                                        
                               HOUSE BILL NO. 167, As Amended
                                                                        
                              BY HEALTH AND WELFARE COMMITTEE
                                                                        
  1                                        AN ACT
  2    RELATING TO PERSONAL ASSISTANCE SERVICES; AMENDING THE HEADING FOR CHAPTER 56,
  3        TITLE 39, IDAHO CODE; AMENDING SECTION 39-5602, IDAHO CODE, TO REVISE DEF-
  4        INITIONS; AMENDING SECTION 39-5603, IDAHO CODE, TO PROVIDE  THAT  PERSONAL
  5        CARE SERVICES BE INCLUDED IN MEDICAID SERVICES AS DESCRIBED IN IDAHO CODE,
  6        TO  PERMIT  A  SINGLE  PROVIDER  TO  OPERATE AS BOTH A PERSONAL ASSISTANCE
  7        AGENCY AND A FISCAL INTERMEDIARY AGENCY, TO PROVIDE  FOR  PERSONAL  ASSIS-
  8        TANCE  AGENCY  RESPONSIBILITIES  AND  TO  PROVIDE  FOR FISCAL INTERMEDIARY
  9        AGENCY RESPONSIBILITIES; REPEALING SECTION 39-5607, IDAHO CODE,  REGARDING
 10        THE  EFFECT  OF  PERSONAL  ASSISTANCE  AGENCY  RATES; AND AMENDING SECTION
 11        39-5609, IDAHO CODE, TO DELETE LANGUAGE REGARDING A  DETERMINATION  TO  BE
 12        MADE BY THE DIRECTOR OF THE DEPARTMENT OF HEALTH AND WELFARE.
                                                                        
 13    Be It Enacted by the Legislature of the State of Idaho:
                                                                        
 14        SECTION 1.  That the Heading for Chapter 56, Title 39, Idaho Code, be, and
 15    the same is hereby amended to read as follows:
                                                                        
 16                                      CHAPTER 56
 17                          PERSONAL CARE ASSISTANCE SERVICES
                                                                        
 18        SECTION  2.  That  Section 39-5602, Idaho Code, be, and the same is hereby
 19    amended to read as follows:
                                                                        
 20        39-5602.  DEFINITIONS. As used in this chapter, the following terms  shall
 21    have the following meanings:
 22        (1)  "Attendant  care"  means  services provided under a medicaid home and
 23    community-based services waiver that involve personal and medically orientated
 24    tasks dealing with the functional needs of the participant  and  accommodating
 25    the  participant's  needs for long-term maintenance, supportive care or IADLs.
 26    These services may include, but are not limited to,  personal  assistance  and
 27    medical  tasks  that  can  be done by unlicensed persons or delegated to unli-
 28    censed persons by a health care professional or participant. Services shall be
 29    based on the participant's abilities and limitations, regardless of age, medi-
 30    cal diagnosis or other category of disability.
 31        (2)  "Case management" means a service which coordinates multiple services
 32    for individual participants through a process of assessment, planning, arrang-
 33    ing for and monitoring services.
 34        (32)  "Department" means the department of health and welfare of the state
 35    of Idaho.
 36        (43)  "Director" means the director of the department of health  and  wel-
 37    fare.
 38        (54)  "Eligible  participant"  or "participant" means an individual deter-
 39    mined eligible by the department for Idaho medicaid services, as authorized by
 40    title XIX, of the social security act, as amended.
 41        (65)  "Fiscal intermediary services agency" means an entity that  provides
                                                                        
                                       2
                                                                        
  1    services that allow the participant receiving personal assistance services, or
  2    his  designee  or legal representative, to choose the level of control he will
  3    assume in recruiting, selecting, managing, training, and dismissing  his  per-
  4    sonal  assistant.  regardless of who the employer of record is, and allows the
  5    participant control over the manner in which services are delivered.
  6        (76)  "Individual service plan" means a document which outlines  all  ser-
  7    vices  including,  but not limited to, personal assistance services and IADLs,
  8    required to maintain the individual in his or her home and community.
  9        (87)  "Instrumental activities of daily living (IADL)" means those activi-
 10    ties performed in supporting the activities of daily  living,  including,  but
 11    not limited to: managing money, preparing meals, shopping, light housekeeping,
 12    using the telephone, or getting around in the community.
 13        (98)  "Personal  assistance  agency" means an entity that recruits, hires,
 14    fires, trains, supervises, schedules, oversees quality of work, takes  respon-
 15    sibility  for  services  provided,  provides payroll and benefits for personal
 16    assistants working for them, is the employer of record and in  fact,  and  may
 17    provide fiscal intermediary services.
 18        (109)  "Personal  assistance  services"  includes both attendant care ser-
 19    vices and personal care services and means services that involve personal  and
 20    medically  oriented tasks dealing with the functional needs of the participant
 21    and accommodating the participant's needs for long-term  maintenance,  suppor-
 22    tive  care  or IADLs. These services may include, but are not limited to, per-
 23    sonal assistance and medical tasks that can be done by unlicensed  persons  or
 24    delegated  to unlicensed persons by a health care professional or participant.
 25    Services shall be  based  on  the  participant's  abilities  and  limitations,
 26    regardless of age, medical diagnosis or other category of disability.
 27        (110) "Personal  assistant" means an individual who directly provides per-
 28    sonal assistance services.
 29        (12) "Personal care services" means services ordered  by  a  physician  or
 30    authorized provider that involve personal and medically orientated tasks deal-
 31    ing  with  the  functional  needs  of  the  participant  and accommodating the
 32    participant's needs for long-term maintenance, supportive care or IADLs. These
 33    services may include, but are not limited to, personal assistance and  medical
 34    tasks  that  can be done by unlicensed persons or delegated to unlicensed per-
 35    sons by a health care professional or participant. Services shall be based  on
 36    the  participant's abilities and limitations, regardless of age, medical diag-
 37    nosis or other category of disability.
 38        (131) "Provider" means a personal assistance agency or a fiscal intermedi-
 39    ary agency.
 40        (142) "Representative" means an employee of the department of  health  and
 41    welfare.
 42        (153) "Voucher service option" means a method of service provision whereby
 43    the participant receives vouchers to pay for personal assistance services.
                                                                        
 44        SECTION  3.  That  Section 39-5603, Idaho Code, be, and the same is hereby
 45    amended to read as follows:
                                                                        
 46        39-5603.  STANDARDS FOR PROVISION OF  PERSONAL  ASSISTANCE  SERVICES.  The
 47    director shall have the power and it shall be his duty to promulgate and adopt
 48    appropriate  rules  necessary to implement and enforce standards for provision
 49    of personal assistance services.
 50        The following standards for provision of personal assistance services  and
 51    other  provisions  contained  throughout this chapter and rules shall apply to
 52    participants and providers receiving or providing personal assistance services
 53    either as a medicaid option service or a waivered service,  unless  prohibited
                                                                        
                                       3
                                                                        
  1    by federal law or contents of the federal waiver agreement.
  2        (1)  Personal  care  services  shall  be  included as a state plan service
  3    under in the medicaid services described in section 56-255(3) and  (4),  Idaho
  4    Code.
  5        (2)  Attendant care shall be included as a service under medicaid home and
  6    community-based waiver(s).
  7        (3)  All  attendant  care services must be authorized by the department or
  8    its designee.
  9        (4)  The department will establish by rule maximum hours per month of per-
 10    sonal care services available to the individual participant  under  the  state
 11    medicaid plan.
 12        (5)  The  department  shall  enter  into agreements with providers for the
 13    provision of personal assistance services. A single provider  may  operate  as
 14    both  a  personal assistance agency and a fiscal intermediary agency. However,
 15    the agency must clearly document whether it is operating as a personal  assis-
 16    tance  agency or as a fiscal intermediary for each participant. The department
 17    may deny provider status or revoke that status when a  provider  is  found  to
 18    endanger the health, person or property of the participant, or is in violation
 19    of rules promulgated by the department or the provider agreement.
 20        (6)  A  provider  personal assistance agency shall have the responsibility
 21    for the following:
 22        (a)  Recruitment, hiring, firing, training, supervision, scheduling,  pay-
 23        roll, and the assurance of quality of service, of its personal assistants;
 24        (b)  Complying  with state and federal labor and tax laws, rules and regu-
 25        lations;
 26        (c)  Maintaining liability insurance coverage;
 27        (d)  Provision of an appropriately qualified nurse when required;
 28        (e)  Assignment of a qualified personal assistant to each authorized  par-
 29        ticipant after consultation with and prior approval of that participant;
 30        (f)  Assuring  all  personal  assistants providing services meet the stan-
 31        dards and qualifications of this chapter;
 32        (g)  Billing medicaid for services approved and authorized;
 33        (h)  Collecting any participant contribution due;
 34        (i)  Referring participants to the department for case management services
 35        based on established criteria;
 36        (ij)  Providing for care by a qualified replacement when the regular  per-
 37        sonal assistant is unable to provide the services, and providing for unan-
 38        ticipated  services approved on the individual service plan when requested
 39        by the participant; and
 40        (jk)  Conducting, at least annually, participant satisfaction/quality con-
 41        trol reviews available to the department and general public.
 42        (7)  A personal assistance agency that provides fiscal  intermediary  ser-
 43    vices agency shall have the responsibility for the following:
 44        (a)  To  assure  compliance with legal requirements related to the employ-
 45        ment of participant/family directed personal assistants; and
 46        (b)  To offer supportive services to enable participants  or  families  to
 47        perform required employer tasks themselves; and
 48        (c)  To  bill the medicaid program for services approved and authorized by
 49        the department; and
 50        (d)  To collect any participant contribution due; and
 51        (e)  To pay personal assistants for services; and
 52        (f)  To perform all necessary withholding as required by state and federal
 53        labor and tax laws, rules and regulations; and
 54        (g)  To offer a full range of services and perform all services  contained
 55        in  a  written  agreement  between the participant and the provider assure
                                                                        
                                       4
                                                                        
  1        that all personal assistants providing services  meet  the  standards  and
  2        qualifications of this chapter;
  3        (h)  To  refer  participants  to  case management services based on estab-
  4        lished criteria;
  5        (i)  To maintain liability insurance coverage;
  6        (j)  To conduct, at least annually, participant satisfaction  and  quality
  7        control reviews which shall be available to the department and to the gen-
  8        eral public; and
  9        (k)  To maintain documentation that the participant or his legal represen-
 10        tative  agrees  in  writing  that  he takes responsibility for and accepts
 11        potential risks, and any resulting consequences, for his choice to  manage
 12        his own personal assistance services.
 13        (8)  Personal assistants are not employees of the state.
 14        (9)  Case  management  shall be made available to personal assistance par-
 15    ticipants where and when appropriate. In order to avoid a conflict  of  inter-
 16    est,  case  management  shall not be provided by the same agency that provides
 17    personal assistance services to the participant.
 18        (10) The department's regional medicaid staff shall review and approve the
 19    individual service plan, authorize personal assistance services, the hours  of
 20    service, and make appropriate referrals for case management for eligible indi-
 21    viduals.
 22        (11) The  department  shall  establish  and maintain a community awareness
 23    program that will educate Idaho citizens regarding the purpose and function of
 24    all long-term care alternatives including, but not limited to, personal assis-
 25    tance services and individual participant rights. This program will be  devel-
 26    oped  in  cooperation with other state agencies including, but not limited to,
 27    the commission on aging and the state independent living council.
 28        (12) It shall be the responsibility of the participant or his designee  or
 29    legal  representative,  when  appropriate,  to select the provider of personal
 30    assistance services.
 31        (13) The department shall provide the participant, his designee  or  legal
 32    representative, with a list of available providers of personal assistance ser-
 33    vices; however, this does not relieve the participant or his designee or legal
 34    representative of the responsibility of provider selection.
 35        (14) In  those cases where the participant or his designee or legal repre-
 36    sentative cannot arrange for personal assistance services or asks for help  in
 37    making  arrangements,  a  representative  of the department may arrange for or
 38    help arrange for personal assistance services on behalf of the participant.
                                                                        
 39        SECTION 4.  That Section 39-5607, Idaho Code, be, and the same  is  hereby
 40    repealed.
                                                                        
 41        SECTION  5.  That  Section 39-5609, Idaho Code, be, and the same is hereby
 42    amended to read as follows:
                                                                        
 43        39-5609.  PERSONAL ASSISTANCE OVERSIGHT COMMITTEE.  The  department  shall
 44    establish, as part of the medical care advisory committee (MCAC), an oversight
 45    subcommittee  consisting of providers of personal assistance services and par-
 46    ticipants of such services and advocacy organizations representing  such  par-
 47    ticipants, and other interested parties, for the purpose of planning, monitor-
 48    ing,  and  recommending changes to the medicaid waiver and personal assistance
 49    programs to the MCAC. At least fifty-one percent (51%) of the  committee  mem-
 50    bership  shall  be  participants  or their representatives. The director shall
 51    determine when and if this role shall be performed by the MCAC.

Statement of Purpose / Fiscal Impact



                       STATEMENT OF PURPOSE

                            RS 16982

This legislation clarifies the difference between a Personal
Assistance Services Agency and a Fiscal Intermediary Agency. 
Fiscal Intermediary services were developed to give consumers of
personal assistance services control over their employees: 
however, the way the legislation is written, agencies or
organizations providing fiscal intermediary services were forced
to become personal assistance services agencies first.  This
created a conflict for the agencies, consumers, and the Idaho
Department of Health and Welfare.  There are also some changes in
the legislation to make the administration of the Personal
Assistance Services program less complicated.


                          FISCAL IMPACT

There will be some administrative savings.


Contact
Name: Kelly Buckland 
Phone: 334-3800
Name: Representative John Rusche
Phone: 332-1130


STATEMENT OF PURPOSE/FISCAL NOTE                         H 167