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Rawson |
DATE TYPED: |
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HB |
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SHORT TITLE: |
Consumer Direction Act |
SB |
839 |
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APPROPRIATION
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Additional Impact |
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Non-Rec |
Fund Affected |
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FY04 |
FY03 |
FY04 |
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Indeterminate See Narrative |
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(Parenthesis
( ) Indicate Expenditure Decreases)
Relates
to SB392, SB332, SB338.
Responses
Received From
Department
of Health (DOH)
Health
Policy Commission (HPC)
Human
Services Department (HSD)
Governor’s
Committee on Concerns for the
Handicapped (GCCH)
SUMMARY
Synopsis
of Bill
SB839 enacts the Consumer Direction Act, which
gives consumers or their surrogates the right to direct their own care and
personal assistance services by hiring, supervising and training the
attendant(s) of their choosing. The purpose of the Act is to maximize personal
assistance service availability and satisfaction.
Significant
Issues
Under SB 839, PAS is defined as a prescribed course of
personal care, including activities of daily living assistance (bathing,
dressing, grooming, eating, toileting, shopping, transporting, medication
administration and communicating), hygiene and mobility that permit individuals
to remain in their home, rather than living in a long term care institution,
where similar services would be rendered in a congregate living setting.
SB 839 would require all departments and agencies providing
PAS to implement a consumer directed program utilizing personal attendants and
fiscal intermediaries. The rising cost
of Medicaid has opened policy makers to consider PAS and other consumer
directed models of care that have proven to be cost effective, particularly in
the Medicaid Personal Care Option Program.
As part of
The
DOH, Long Term Services Division has initiated a “Self-Directed Pilot Program” through State
General Funds that provides services to a small group of individuals with
developmental disabilities. An annual
budget of up to $2,600 is available to purchase services and support to address
the individual’s disability needs. This consumer directed pilot program uses a
fiscal intermediary to support individuals in paying for services and managing
employer related responsibilities, including payroll deductions.
In
addition, SJM 54 requested the Governor’s Committee on Concerns of the
Handicapped (GCCH) to convene a task force to develop a comprehensive,
coordinated and effective state plan in response to Olmstead. The GCCH submitted its report to the Health
and Human Services Interim Committee, developing a draft Initial Olmstead State
Report, on
If SB 839 were enacted, all Medicaid programs, which offer personal assistance services to Medicaid clients, would be affected. For example the Developmentally Disabled, Disabled &Elderly, Medically Fragile and HIV/Aids Waivers would have to be changed to offer consumers the option of directing his/her own care under these waivers. The current language in SB 839 would put waiver programs in violation of the terms and conditions with the Center for Medicare and Medicaid Services (CMS), which do not permit a consumer-directed option. SB 839 would also create a fiscal intermediary requirement to contract with the department, and to provide services between the consumer and the department.
FISCAL IMPLICATIONS
Enacting SB 839 could demonstrate cost
savings to the DOH, allowing more consumers to be served and reducing waiting
lists.
ADMINISTRATIVE IMPLICATIONS
The redirection of current contract dollars would involve
DOH staff time, but could be handled with existing staff.
SB
839 would create a requirement that HSD contract with a fiscal intermediary to
provide services between the consumer and HSD.
Reports would have to be provided to the Legislative Finance Committee
and Legislative Health and Human Services annually on services provided by
HSD. A comparison and evaluation of the
effectiveness of the program would also need to be done annual. Additionally, a consumer satisfaction survey
would need to be completed with respective means of service delivery.
SB 839 would require the DOH to assess
its current programs and develop a plan for the provision of consumer directed
care, regardless of funding source.
Consumer directed options could result in a redirection of current
contract dollars. SB 839 does not
include any appropriation. Consumer
directed service and support options would have to be made available under
current levels of funding for both the Medicaid Home and Community Based
Waivers (DD and D&E) Programs and State General Fund programs.
RELATIONSHIP
Relates to:
SB392, Medicaid Self-Directed
Option, requiring
that the Human Services Department establish a Self-Directed Care option in the
Disabled and Elderly (D&E) and Developmentally Disabled (DD) Medicaid
Waiver Programs, which would allow clients to direct their own care services
and still have those services reimbursable by Medicaid.
SB332, Medicaid Reform Committee Program,
requesting the HSD to initiate studies and pilot projects based on the Medicaid
Reform Committee recommendations, which includes a Personal Care Option.
SB338, Medicaid Reform
Committee Recommendations, directing the HSD to implement program changes based
on the Medicaid Reform Committee recommendations, which includes a Personal
Care Option
TECHNICAL ISSUES
The
definition of “attendant” includes “allowable family member,” but “allowable”
is not defined.
OTHER SUBSTANTIVE ISSUES
DOH
reports that PAS programs have become a part of national focus since the 1999
U.S. Supreme Court decision in the Olmstead v. L.C., with the President
Bush weighing in on this issue. As part
of his New Freedom Initiative to remove barriers to equality for 54 million
Americans with disabilities and to promote full access to community life, he
issued Executive Order 13217. This Order
requires the departments of Justice, Health and Human Services (HHS), Education,
Labor and Housing and Urban Development and the Social Security Administration
to "evaluate the policies, programs, statutes and regulations of their
respective agencies to determine whether any should be revised or modified to
improve the availability of community-based services for qualified individuals
with disabilities" and to report back to the President with their
findings. Health and Human Services,
Secretary Tommy G. Thompson submitted Delivering on the Promise: Preliminary
Report of Federal Agencies' Actions to Eliminate Barriers and Promote Community
Integration, in December 2001.
CMS has addressed
President Bush’s New Freedom Initiative, through the creation of the Independence
Plus Option for Self-Directed Medicaid Waivers. Components of the CMS definition of
self-directed service option, which are not part of the current New Mexico DE
Waiver and DD Waiver program framework, include: a fiscal agent and a brokerage
agency to support families and individuals as they direct their own services;
and / or allowing eligible families and individuals to receive a cash allowance
to purchase services.
The GCCH reported to the Health and Human Services Interim
Committee, in FY 00 the average annual cost for the 4,667 people served in
nursing homes was $40,000.00; while the average annual cost for the 5,300
people through the PCO was $15,000 for consumer directed and $19,000 for
consumer delegated (based on 100 hours of PCA services/month). Nearly 100% of
stakeholders surveyed would not chose to live in a
nursing home, yet 76% of service placements were to nursing homes in 2000. According to the Home and Community Based
Services Resource Network, surveys indicate that savings are achieved with
independent providers and consumer choice was significantly associated with
consumer satisfaction.
In 2002, the NM Governor’s Committee on the Concerns of the Handicapped created a task force of stakeholders to study the implementation of the Olmstead Plan in the state (Initial State Olmstead Plan in response to SJM54, October 16, 2002) The stakeholders’ report and recommendations to the Legislative Health & Human Services Interim Committee included (but were not limited to) the following:
· Pass a Consumer Direction Bill that would mandate that the waiver programs include a consumer directed option.
·
Less
expensive to have services provided by family members or friends, and more
accessible for rural community residents.
·
Cash
& Counseling services allow clients to have control over own money
(programs in Florida, Arkansas and New Jersey).
·
Consumer
direction option saves $4,560 annually per person receiving 100 hours per
month.
·
Develop
training programs for families and other caregivers who desire to be the
provider of services.
HPC states that
consumer-directed services lack quality assurance structures such as training
of the caregivers, professional supervision, and provision of technical
services by professionals. Yet, the
services may be better than agency care because of the ability to make the
services custom-made to suit clients.
In a recent HSD Medicaid
Assistance Division (MAD) symposium held in
BD/yr