3/23/00 3826s

30april00......4116h

17may00.....4479h

2000 SESSION

00-2679

08/01

SENATE BILL 324

COMMITTEE: Public Institutions, Health and Human Services

AMENDED ANALYSIS

This bill allows certain individuals and families of these individuals the option of receiving personal care services, including consumer-directed services, from a home health agency or other qualified agency. This bill gives the commissioner of health and human services rulemaking authority relative to requirements for the use of consumer-directed services for department programs and the provision of personal care services. This bill also requires the department of health and human services to provide a quarterly report relative to the number of clients served and expenditures under the home and community-based care waiver for the elderly and chronically ill, and an annual report on qualitative measures on the care delivered as the department deems appropriate.

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Explanation: Matter added to current law appears in bold italics.

Matter removed from current law appears [in brackets and struckthrough.]

Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

3/23/00 3826s

30april00......4116h

17may00.....4479h

00-2679

08/01

STATE OF NEW HAMPSHIRE

In the Year of Our Lord Two Thousand

Be it Enacted by the Senate and House of Representatives in General Court convened:

255:1 New Chapter; Personal Care Services. Amend RSA by inserting after chapter 161-H the following new chapter:

CHAPTER 161-I

PERSONAL CARE SERVICES

161-I:1 Purpose.

I. Many individuals require assistance with eating, bathing, dressing, personal hygiene, and activities of daily living to maintain their independence and dignity. Personal care services are non-medical, hands-on supports that substitute for the loss of an individual's physical or cognitive functioning.

II. Many individuals requiring personal care services and families who have children with special health care needs want to choose who delivers personal care services and how and when these services are delivered.

III. This chapter provides individuals and families with the option of receiving personal care services, including consumer-directed services, from a home health agency or other qualified agency.

161-I:2 Definitions. In this chapter:

I. "Commissioner" means the commissioner of the department of health and human services.

II. "Consumer-directed services" means personal care services under which the eligible consumer or his or her representative is responsible for:

(a) Participating in the development of the eligible consumer's service plan;

(b) Selecting the eligible consumer's personal care services provider;

(c) Setting the terms and conditions of work;

(d) Training, supervising, and evaluating the personal care services provider; and

(e) Terminating his or her relationship with the personal care services provider.

III. "Department" means the department of health and human services.

IV. "Eligible consumer" means a child with special health care needs eligible for in-home supports or a person eligible for the home and community-based care waiver for the elderly and chronically ill.

V. "Eligible setting" means a home, apartment, residential facility, day program, or other community setting, but does not include a hospital, nursing facility, or other institutional setting.

VI. "Home health agency" means a home health care provider licensed under RSA 151.

VII. "Intermediary services" means an array of fiscal and supportive services to facilitate the delivery of consumer-directed services. Such services shall include:

(a) Fiscal intermediary services, including but not limited to:

(1) Computing of tax withholdings.

(2) Filing and depositing employment taxes.

(3) Preparing and disbursing payroll checks.

(4) Collecting and verifying worker timesheets.

(5) Processing and paying non-labor related invoices.

(6) Processing criminal background checks on prospective workers.

(7) Overseeing the verification of workers' citizenship/legal alien status.

(8) Generating standardized reports depending on program design.

(b) Supportive services, including but not limited to:

(1) Skills and advocacy training for the eligible consumer or representative.

(2) Assistance with recruiting, screening, hiring, and training personal care services providers.

(3) Creating and maintaining work registries.

(4) Assessing and reassessing service needs.

(5) Counseling and support.

(6) Monitoring consumer satisfaction.

VIII. "Legally responsible relative" means a parent of a minor child or a spouse.

IX. "Other qualified agency" means those entities authorized to offer personal care services and/or intermediary services by the department in accordance with rules adopted pursuant to RSA 541-A.

X. "Plan of care" means a state-authorized guide to the provision of services to an eligible consumer.

XI. "Personal care services" means services furnished by a personal care services provider that assist an eligible consumer in maintaining himself or herself in an eligible setting. Such services may include, but are not limited to, basic personal care and grooming, assistance with basic toileting and toileting hygiene measures, assistance with oral and topical medications, assistance with nutrition, including meal preparation, and essential household services.

XII. "Personal care services provider" means a person who:

(a) Is selected by:

(1) The eligible consumer;

(2) The eligible consumer's legal guardian;

(3) The eligible consumer's representative; or

(4) A person granted power of attorney by the eligible consumer; and

(b) Is employed by a home health agency or other qualified agency to provide personal care services; and

(c) Is not:

(1) The eligible consumer's legally responsible relative;

(2) The eligible consumer's legal guardian;

(3) The eligible consumer's representative; or

(4) A person granted power of attorney by the eligible consumer.

XIII. "Representative" means a person:

(a) Chosen by:

(1) The eligible consumer;

(2) The eligible consumer's legal guardian; or

(3) A person granted power of attorney by the eligible consumer; and

(b) Deemed appropriate by the department to act on behalf of the eligible consumer; and

(c) Who:

(1) Is not the personal care services provider; and

(2) Does not have a financial relationship with a home health agency or other qualified agency providing intermediary services to the eligible consumer.

161-I:3 Consumer Choice. An eligible consumer in need of personal care services shall have the option to receive personal care services, including consumer-directed services, through a home health agency or other qualified agency. An individual not eligible for department programs shall have the option to receive personal care services, including consumer-directed services, through a home health care provider or other facility licensed under RSA 151, or through a private arrangement between individuals. Such choice shall be subject to those limitations imposed by federal and state laws, rules, and regulations.

161-I:4 Department Responsibilities.

I. The department shall develop personal care services for department programs that authorize personal care services. Eligible consumers shall be afforded the option to receive their personal care services through a home health agency or other qualified agency and/or a consumer-directed services program.

II. The department shall develop a process for allowing a representative to act on the behalf of an eligible consumer.

III. The department shall develop intermediary services for eligible consumers using consumer-directed services.

IV. Coverage of personal care services under department programs shall be subject to the availability of appropriated funds.

V. Nothing in this section shall be construed to change the personal care program for the severely disabled as set forth in RSA 161-E.

VI. Beginning September 2000, the department shall provide a quarterly report to the governor, the president of the senate, and the speaker of the house of representatives relative to the number of clients served and expenditures under the home and community-based care waiver for the elderly and chronically ill, and beginning in December 2000 an annual report on such qualitative measures on the care delivered as the department deems appropriate.

161-I:5 Personal Care Services Provider Training. Any personal care services provider serving an eligible consumer shall be required to undergo training as required by rule, pursuant to RSA 541-A.

161-I:6 Plans of Care and Service Delivery Oversight. All eligible consumers shall have a plan of care that details the provision of personal care services. The delivery of personal care services, as outlined in the plan of care, to an eligible consumer shall be monitored by a case manager either employed or contracted by the department. Should the delivery of personal care services to an eligible consumer necessitate specialized oversight, this shall be outlined in the plan of care and such oversight of the personal care services provider shall be arranged by the case manager.

161-I:7 Rulemaking. The commissioner shall adopt rules, pursuant to RSA 541-A, relative to:

I. Criteria for approving home health or other qualified agencies to offer personal care services, including but not limited to:

(a) Qualifications and training of providers.

(b) Oversight of providers.

(c) Service definition.

(d) Reporting requirements.

(e) Record-keeping.

(f) Personnel requirements.

(g) Care planning.

(h) Service delivery oversight.

(i) Scope of service.

(j) Quality assurance measures.

(k) Structure of the business entity.

II. The provision of personal care services by personal care services providers, including the provision of consumer-directed personal care services.

III. The provision of intermediary services by a home health agency or other qualified agency to facilitate the delivery of consumer-directed personal care services.

IV. The use of a representative in consumer-directed services.

V. Guidelines for state-authorized plans of care.

255:2 Continued Authorization; Rules. Notwithstanding the repeal by section 3 of this act, the authority for home health care providers to provide personal care services under rules adopted pursuant to RSA 326-B:17, X shall continue until the effective date of rules adopted pursuant to RSA 161-I:7 and RSA 151:9-a.

255:3 Repeal. RSA 326-B:17, X, relative to personal care services, is repealed.

255:4 Residential Care and Health Facility Licensing; Home Health Care Provider. Amend RSA 151:2-b, III to read as follows:

III. Home health care providers that provide only personal care services and no other health care services as listed in paragraph I of this section shall be issued a license limiting their services to personal care services.

IV. "Home health care provider" does not include any organization or agency providing only services pursuant to the provisions of Title III, Part C, of the Older Americans Act; authorized by the department of health and human services pursuant to RSA 161-I; operating only a nutrition program under a federal social services block grant, or under the auspices of a private charity; or volunteer hospices that do not provide, directly or through contract arrangements, home health care services as defined in RSA 151:2-b, I.

255:5 Effective Date. This act shall take effect upon its passage.

(Approved: June 12, 2000)

(Effective Date: June 12, 2000)

LBAO

00-2679

5/5/00

SB 324 FISCAL NOTE

FISCAL IMPACT:

METHODOLOGY: