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S.F. No. 968 - Personal Care Assistance Services Payment Rate Methodology Establishment
 
Author: Senator Jerry Relph
 
Prepared By: Liam Monahan, Senate Analyst (651/296-1791)
 
Date: February 18, 2019



 

S.F. No. 968 replaces the current rate-on-rate reimbursement scheme for personal care assistance services with a fee schedule reimbursement scheme based on data and analysis of the costs associated with providing personal care assistance services. The new rate methodology is effective January 1, 2020, or upon federal approval, whichever is later.

Section 1 (256B.0659, subdivision 1) provides definitions for “commissioner,” “component value,” “enhanced care personal care assistance services,” “median,” and “qualified professional service.” This subdivision also makes conforming changes to other definitions.

Paragraph (i) defines “enhanced care personal care assistance services” as a subset of personal care assistance services provided to a person who qualifies for ten or more hours of personal care assistance services.

Section 2 (256B.0659, subdivision 11) specifies the additional requirements a PCA must meet in order to provide enhanced care personal care assistance services.

Section 3 (256B.0659, subdivision 21) requires a personal care assistance provider agency to document that any PCA billing for enhanced care personal care assistance services has meets the qualifications to provide enhanced care.

Section 4 (256B.0659, subdivision 24) requires a personal care assistance agency to document that the additional revenue generated by billing for enhanced care personal care assistance services is passed through in the form of wages and benefits to the PCAs providing enhanced care.

Section 5 (256B.0659, subdivision 28) requires personal care assistance provider agencies to maintain documentation that PCAs providing enhanced care have completed the required training.

Section 6 (256B.0659, subdivision 32) specifies that the new rate methodology applies to personal care assistance services, enhanced care personal care assistance services, and qualified professional services, as well as community first services and supports when that program replaces the personal care assistance program.

Section 7 (256B.0659, subdivision 33) establishes a base wage index for the three covered services and requires the commissioner to update the base wage index every two years based on updated wage data.

Section 8 (256B.0659, subdivision 34, paragraphs (a) to (c)) specifies the calculation for the total wage index.  The total wage index is the product of the base wage index by service multiplied by a variable competitive workforce factor.  The initial competitive workforce factor for personal care assistance services is eight percent, while the initial competitive workforce factor for qualified professional services is zero.

Paragraph (d) requires the commissioner to recalculate the competitive workforce factor for personal care assistance services every two years, but not increase or decrease the factor by more than three percentage points in any biennium.

Section 9 (256B.0659, subdivision 35) lists component values to be included in the calculation of the rate for services, but as introduced this section leaves the values of those components unspecified.

Section 10 (256B.0659, subdivision 36) specifies how to calculate the total payment rate for each service.

Section 11 (256B.0659, subdivision 37) specifies the data providers are required to submit to the commissioner for purposes of validation and analysis.  The commissioner is permitted to use the analyzed data as the basis of recommendations to the legislature to adjust the rate methodology.

Section 12 (256B.0659, subdivision 38) requires the commissioner to submit an initial set of recommendations to the legislature to adjust the rate methodology by August 1, 2022, and requires the commissioner to issue a report on the impact of the rate methodology on the PCA labor market by August 1, 2025.

Section 13 (256B.0715) requires the commissioner beginning August 1, 2020, to issue an annual report on the labor market for direct care workers providing various home and community-based services.

Section 14 (256B.0915, subdivision 3a, paragraph (f)) requires the commissioner to approve exceptions to the existing monthly case mix budget caps for elderly waiver services to allow an increase in the cap to accommodate any increase in the rates under the new rate methodology for personal care assistance services.

Section 15 (256B.69, subdivision 5a, paragraph (d), clause (2)) requires managed care plans to inform the commissioner of human services and the legislature of the amount of any rate increase the managed care plans pay to personal care assistance provider agencies following any rate increase under the new rate methodology for personal care assistance services.

 
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