Consumer-Directed Care Act
Summary: The Consumer-Directed Care Act creates a program which allows Medicaid recipients of in-home and community-based services to select the services they need and the providers they want.
SECTION 1. SHORT TITLE
This Act shall be called the “Consumer-Directed Care Act.”
SECTION 2. FINDINGS AND PURPOSE
(A) FINDINGS—The legislature finds that:
1. The state should encourage alternatives to institutional care, such as in-home and community-based care, for appropriate Medicaid recipients.
2. Giving Medicaid recipients of in-home and community-based services the opportunity to select the services they need and the providers they want, including family and friends, enhances their sense of dignity and autonomy.
3. Pilot projects have found that consumer-directed care is both popular among and beneficial to Medicaid recipients of in-home and community-based services.
(B) PURPOSE—This law is enacted to enhance the health and welfare of Medicaid recipients by giving them more choices in and greater control over the purchased long-term care services they receive.
SECTION 3. CONSUMER-DIRECTED CARE
After section XXX, the following new section XXX shall be inserted:
(A) DEFINITIONS—In this section:
1. “Budget allowance” means the amount of money made available each month to a consumer to purchase needed long-term care services, based on the results of a functional needs assessment.
2. “Consultant” means an individual who provides technical assistance to consumers in meeting their responsibilities under this section.
3. “Consumer” means a person who has chosen to participate in the program, has met the enrollment requirements, and has received an approved budget allowance.
4. “Department” means the Department of [Health].
5. “Fiscal intermediary” means an entity approved by the agency that helps the consumer manage the consumer’s budget allowance, retains the funds, processes employment information, if any, and tax information, reviews records to ensure correctness, writes paychecks to providers, and delivers paychecks to the consumer for distribution to providers and caregivers.
6. “Provider” means a person licensed or otherwise permitted to render services eligible for reimbursement under this program for whom the consumer is not the employer of record, or a consumer-employed caregiver for whom the consumer is the employer of record.
7. “Representative” means an uncompensated individual designated by the consumer to assist in managing the consumer’s budget allowance and needed services.
(B) ESTABLISHMENT AND OPERATION
1. The Department shall establish the consumer-directed care program to allow enrolled persons to choose the providers of services and to direct the delivery of services, to best meet their long-term care needs. The Department shall establish interagency cooperative agreements with and shall work with the Departments of [Elderly Affairs and Human Services] to implement and administer the program.
2. Persons who are enrolled in one of the Medicaid home- and community-based waiver programs and are able to direct their own care, or to designate an eligible representative, may choose to participate in the consumer-directed care program.
3. Consumers enrolled in the program shall be given a monthly budget allowance based on their assessed functional needs and the financial resources of the program. Consumers shall receive the budget allowance directly from an agency-approved fiscal intermediary. Each department shall develop purchasing guidelines, approved by the agency, to assist consumers in using the budget allowance to purchase needed, cost-effective services.
4. Consumers shall use the budget allowance only to pay for home- and community-based services that meet the consumer’s long-term care needs and are a cost-efficient use of funds. Such services may include, but are not limited to, the following:
a. Personal care.
b. Homemaking and chores, including housework, meal preparation, shopping and transportation.
c. Home modifications and assistive devices which may increase the consumer’s independence or make it possible to avoid institutional placement.
d. Assistance in taking self-administered medication.
e. Day care and respite care services, including those provided by licensed nursing home facilities or by licensed adult day care facilities.
f. Personal care and support services provided in an assisted living facility.
5. Consumers shall be allowed to choose the providers of services, as well as when and how the services are provided. Providers may include a consumer’s neighbor, friend, spouse or relative.
6. In cases where a consumer is the employer of record, the consumer’s roles and responsibilities include, but are not limited to, the following:
a. Developing a job description.
b. Selecting caregivers and submitting information for the background screening as required.
c. Communicating needs, preferences, and expectations about services being purchased.
d. Providing the fiscal intermediary with all information necessary for provider payments and tax requirements.
e. Ending the employment of an unsatisfactory caregiver.
7. In cases where a consumer is not the employer of record, the consumer’s roles and responsibilities include, but are not limited to, the following:
a. Communicating needs, preferences, and expectations about services being purchased.
b. Ending the services of an unsatisfactory provider.
c. Providing the fiscal agent with all information necessary for provider payments and tax requirements.
8. The Department’s roles and responsibilities include, but are not limited to, the following:
a. Assessing each consumer’s functional needs, helping with the service plan, and providing ongoing assistance with the service plan.
b. Offering the services of consultants who shall provide training, technical assistance, and support to the consumer.
c. Completing the background screening for providers.
d. Approving fiscal intermediaries.
e. Establishing the minimum qualifications for all caregivers and providers and being the final arbiter of the fitness of any individual to be a caregiver or provider.
9. The fiscal intermediary’s roles and responsibilities include, but are not limited to, the following:
a. Providing recordkeeping services.
b. Retaining the consumer-directed care funds, processing employment and tax information, if any, reviewing records to ensure correctness, writing paychecks to providers, and delivering paychecks to the consumer for distribution.
(C) ADMINISTRATION
1. The Department shall promulgate rules needed to administer this program.
2. The Department shall take all necessary action to ensure state compliance with federal regulations.
3. The Department shall apply for any necessary federal plan amendments, waivers or waiver amendments needed to implement the program.
(D) REPORTS
1. The Department shall, on an ongoing basis, review and assess the implementation of the consumer-directed care program.
2. By January 15 of each year, the Department shall submit a written report to the legislature that includes a review of the program and contains recommendations for improvements to the program.
SECTION 4. EFFECTIVE DATE
This Act shall take effect on July 1, 2007.