SENATE HEALTH AND PUBLIC AFFAIRS COMMITTEE SUBSTITUTE FOR

SENATE BILL 103

57th legislature - STATE OF NEW MEXICO - first session, 2025

 

 

 

 

 

 

 

AN ACT

RELATING TO HEALTH CARE; REQUIRING ENTITIES PARTICIPATING IN MEDICAID PERSONAL CARE SERVICES PROGRAMS TO REPORT TO THE HEALTH CARE AUTHORITY ON THE STATUS OF THE DIRECT CARE WORKFORCE; REQUIRING THE HEALTH CARE AUTHORITY TO DEVELOP REPORTS ON THE DIRECT CARE WORKFORCE.

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

     SECTION 1. [NEW MATERIAL] DIRECT CARE WORKFORCE REPORTING REQUIREMENTS--HEALTH CARE AUTHORITY DUTIES.--

          A. As used in this section:

                (1) "agency-based community benefit" means the personal care services program provided to eligible medicaid recipients who do not wish to self-direct their community benefit services;

                (2) "authority" means the health care authority;

                (3) "direct care worker" means a non-administrative employee who spends the majority of working hours providing personal care services to eligible medicaid recipients;

                (4) "eligible medicaid recipient" means a person whom the authority has determined to be eligible to receive medicaid-related personal care services either through the agency-based community benefit program or the self-directed community benefit program;

                (5) "financial management agency" means an entity that contracts with a medicaid managed care organization to provide the fiscal administration functions for eligible medicaid recipients participating in the self-directed community benefit program;

                (6) "personal care service provider agency" means an entity that:

                     (a) has entered into a medicaid provider participation agreement with the authority and: 1) is contracted with a medicaid managed care organization to provide personal care services to eligible medicaid recipients; or 2) provides personal care services to eligible medicaid recipients through fee-for-service arrangement;

                     (b) is reimbursed for personal care services provided to eligible medicaid recipients; and

                     (c) employs direct care workers to provide personal care services to eligible medicaid recipients;

                (7) "personal care services" means services provided to an eligible medicaid recipient to assist the eligible medicaid recipient with the instrumental activities of daily living; and

                (8) "self-directed community benefit" means the personal care services program provided to eligible medicaid recipients who choose to self-direct their community benefit services.

          B. By March 1, 2026, and annually thereafter, each personal care service provider agency shall, in a form and manner prescribed by the authority, submit data on the direct care workers providing agency-based community benefits at the personal care service provider agency. The data shall include information on the:

                (1) total number of full-time and part-time direct care workers employed at the personal care service provider agency;

                (2) disaggregated demographic information on direct care workers employed at the personal care service provider agency that includes:

                     (a) age;

                     (b) gender; and

                     (c) race and ethnicity;

                (3) highest, lowest and average hourly wage paid to direct care workers employed at the personal care service provider agency;

                (4) average length of employment for direct care workers employed at the personal care service provider agency;

                (5) vacancy and turnover rates for direct care workers employed at the personal care service provider agency; and

                (6) availability and type of benefits

provided by the personal care service provider agency to direct care workers.

          C. By March 1, 2026, and annually thereafter, each medicaid managed care organization and financial management agency shall, in a form and manner prescribed by the authority, submit data on the direct care workers providing self-directed community benefits. The data shall include:

                (1) the total number of:

                     (a) full-time direct care workers providing personal care services through the self-directed community benefit program; and

                     (b) part-time direct care workers providing personal care services through the self-directed community benefit program;

                (2) the highest, lowest and average hourly wage of direct care workers providing personal care services through the self-directed community benefit program;

                (3) the percentage of eligible medicaid recipients enrolled in the self-directed community benefit program who are unable to receive services due to a shortage of direct care workers; and

                (4) disaggregated demographic information on the direct care workers providing personal care services through the self-directed community benefit program that includes:

                     (a) age;

                     (b) gender; and

                     (c) race and ethnicity.

          D. By July 1, 2026, and annually thereafter, the authority shall review and analyze the data submitted pursuant to this section and shall submit a report on the data to the interim legislative health and human services committee, the legislative finance committee, the governor and the interested parties advisory group established pursuant to this section.

          E. By January 1, 2030, the authority shall perform a study for the purposes of determining the cost of providing personal care services and recommending the reimbursement rates to be paid for personal care services. The results of the study shall be provided to the interim legislative health and human services committee, the legislative finance committee, the governor and the interested parties advisory group established pursuant to this section. Recommended reimbursement rates from the cost study shall include consideration of the following factors:

                (1) federal requirements related to payment adequacy; 

                (2) the additional costs that would be incurred by personal care service provider agencies if direct

care workers employed by personal care service provider agencies were to be paid at least one hundred fifty percent of

the state minimum wage;

                (3) recent and projected changes in costs due to factors that include direct and indirect costs, inflation and changes in the applicable minimum wage; and

                (4) direct care worker vacancies that affect personal care service provider agency costs.

          F. The authority shall establish an interested parties advisory group that meets at least every two years to advise and provide recommendations to the authority on reimbursement rates for personal care, home health aide, homemaker and habilitation services. The authority shall publish the advisory group's recommendations on the authority's website. The advisory group shall consist of persons who have an interest in the payment rates, including:

                (1) direct care workers;

                (2) eligible medicaid recipients or the eligible medicaid recipients' authorized representatives; and

                (3) authority staff.

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