HOUSE BILL 55

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

INTRODUCED BY

Pamelya Herndon

 

 

 

FOR THE LEGISLATIVE HEALTH AND HUMAN SERVICES COMMITTEE

 

AN ACT

RELATING TO LABOR; REQUIRING THE HEALTH CARE AUTHORITY TO SET A MINIMUM MEDICAID FEE SCHEDULE FOR REIMBURSING PERSONAL CARE SERVICES; REQUIRING AT LEAST SEVENTY PERCENT OF MEDICAID REIMBURSEMENT FOR PERSONAL CARE SERVICES TO BE USED FOR COMPENSATING DIRECT CARE WORKERS; MAKING AN APPROPRIATION.

 

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

     SECTION 1. A new section of the Public Assistance Act is enacted to read:

     "[NEW MATERIAL] MEDICAID REIMBURSEMENT FOR PERSONAL CARE SERVICES.--

          A. For the purposes of this section:

                (1) "compensation" means all payments and benefits provided to direct care workers, including:

                     (a) salary, wages, overtime pay and other remunerations;

                     (b) health, dental, life and disability insurance;

                     (c) paid leave, retirement benefits and tuition reimbursement; and

                     (d) the employer share of payroll taxes;

                (2) "direct care worker" means a non-administrative employee of a personal care services provider agency who spends the majority of the employee's work hours providing personal care services;

                (3) "medicaid" means the medical assistance program established pursuant to Title 19 of the federal act and regulations issued pursuant to that act;

                (4) "personal care services" means services provided to an individual to assist with activities of daily living; and

                (5) "personal care services provider agency" means an entity that:

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

                     (b) is reimbursed for personal care services provided to individuals covered by medicaid; and

                     (c) employs direct care workers to provide personal care services to individuals covered by medicaid.

          B. The authority shall implement a minimum medicaid fee schedule for personal care services that requires managed care organizations and fee-for-service arrangements to reimburse personal care services provider agencies at least twenty-three dollars fifty cents ($23.50) per hour for providing personal care services.

          C. A personal care services provider agency that receives medicaid reimbursement for providing personal care services shall use at least seventy percent of the medicaid reimbursement as compensation to direct care workers for furnishing their services.

          D. Before calculating the minimum amount of medicaid reimbursement that a personal care services provider agency is required to use to compensate direct care workers, the costs of providing training, travel and personal protective equipment to direct care workers shall be deducted from the total amount of medicaid reimbursement that the personal care services provider agency receives."

     SECTION 2. APPROPRIATION.--Twenty million eight hundred thousand dollars ($20,800,000) is appropriated from the general fund to the health care authority for expenditure in fiscal year 2026 to update the medicaid personal care services fee schedule and increase medicaid reimbursement for personal care services pursuant to Section 1 of this act. Any unexpended or unencumbered balance remaining at the end of fiscal year 2026 shall revert to the general fund.

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