SENATE BILL 103

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

INTRODUCED BY

Antoinette Sedillo Lopez and Pamelya Herndon and Kathleen Cates

 

 

 

 

 

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:

                     (a) full-time direct care workers employed by the personal care service provider agency;

                     (b) part-time direct care workers employed by the personal care service provider agency;

                     (c) direct care workers who are independent contractors contracted with the personal care service provider agency;

                     (d) direct care workers who have ceased providing personal care services for the personal care service provider agency in the previous twelve months;

                     (e) vacant full-time and part-time direct care worker positions as of the end of the previous calendar year; and

                     (f) hours of overtime pay received by each direct care worker;

                (2) percentage of the previous calendar year that each direct care worker was employed at the personal care service provider agency, either as an employee or independent contractor;

                (3) total length of employment for each employee as of the end of the previous calendar year;

                (4) hourly wage paid to each direct care worker during the previous calendar year;

                (5) total amount of money paid to direct care workers for travel in the previous twelve months;

                (6) availability of fringe benefits for direct care workers employed at the personal care service provider agency. Data on fringe benefits shall include the number and percentage of full-time and part-time employees that receive:

                     (a) health insurance;

                     (b) dental insurance;

                     (c) vision insurance;

                     (d) life insurance;

                     (e) disability insurance;

                     (f) tuition reimbursement;

                     (g) retirement benefits;

                     (h) paid leave other than sick leave; and

                     (i) any other type of fringe benefit that the personal care service provider agency offers;

                (7) other expenditures paid by personal care service provider agencies related to direct care workers, including:

                     (a) training for direct care workers;

                     (b) discretionary travel benefits; and

                     (c) personal protective equipment; and

                (8) demographics of the direct care workers employed by the personal care service provider agency, including each direct care worker's:

                     (a) age;

                     (b) gender;

                     (c) race and ethnicity;

                     (d) highest educational level attained;

                     (e) certifications; and

                     (f) duration of direct care work experience.

          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 information on the:

                (1) total number of:

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

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

                     (c) direct care workers who are independent contractors contracted to provide personal care services through the self-directed community benefit program;

                     (d) direct care workers who have ceased providing personal care services through the self-directed community benefit program in the previous twelve months; and

                     (e) hours of overtime pay received by each direct care worker providing personal care services through the self-directed community benefit program;

                (2) percentage of the previous calendar year that each direct care worker was employed at the provider agency, either as an employee or independent contractor;

                (3) hourly wage paid to each direct care worker during the previous calendar year; and

                (4) demographics of the direct care workers providing personal care services through the self-directed community benefit program, including each direct care worker's:

                     (a) age;

                     (b) gender;

                     (c) race and ethnicity;

                     (d) highest educational level attained;

                     (e) certifications; and

                     (f) duration of direct care work experience.

          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. The study shall consider federal requirements related to payment adequacy and the level of reimbursement required to:

                (1) stabilize the direct care workforce;

                (2) reduce direct care workforce vacancies;

                (3) allow direct care workers to receive an hourly wage of at least one hundred fifty percent of the state minimum wage; and

                (4) ensure adequate access to personal care services for eligible medicaid recipients.

          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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