SB 0070

This bill establishes limits for the rate charged by temporary help services for work provided to licensed heath care facilities. This bill requires persons providing direct care temporary help services to be licensed by the commissioner of the department of heath and human services.

This bill grants rulemaking authority to the commissioner of the department of health and human services for the purposes of the bill.

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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

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

1 Statement of Intent. The general court finds that a crisis exists in the staffing of facilities which provide long-term health care to New Hampshire citizens. These facilities typically are highly regulated by the state and federal governments and rely on payment from government sources to fund a large portion of patient needs. Among other factors, because of the low wages which these facilities are able to pay their permanent employees in light of current state funding levels, many of these permanent employees have turned to work for temporary help services which pay higher wages. Thus, the health care facilities have been forced to look to temporary help from these services in order to fully staff their facilities. The general court finds that, as a result, the quality of care which such facilities have been able to provide has been diminished. Not only has this system led to far higher costs for the health care facilities and thus to state government, but the increased reliance on temporary employees often means that caregivers no longer develop a personal relationship with patients or residents. The absence of that personal relationship diminishes the caregiver's knowledge of the needs of the individual patients and residents, and deprives patients and residents of a sense of continuity and contact with the community outside the facility. Therefore, the general court hereby adopts this act to preserve and to enhance the dignity of New Hampshire citizens who are cared for in these facilities.

2 New Section; Rates for Temporary Help Services; Licensure Required for Direct Care Temporary Help Services. Amend RSA 126-A by inserting after section 5 the following new section:

I. The commissioner shall establish on an annual basis the limit for the rate charged by temporary help services for work provided to licensed health care facilities. Under no circumstances shall the rate for services provided by temporary help services to licensed health care facilities exceed 135 percent of the median salary cost per hour for direct care staff employed by such facilities. The commissioner shall calculate a separate rate annually for registered nurses, licensed practical nurses, and certified nursing assistants. The commissioner may establish separate rates by geographic region. The commissioner shall determine the rate limit through the use of salary data collected from cost reports submitted annually by health care facilities or, if necessary, via other collection tools. In establishing this rate, the commissioner shall also take into consideration reasonable administrative expenses and an allowance which shall provide a reasonable return on equity. The commissioner shall establish procedures whereby temporary help services which provide direct care services to licensed health care facilities shall submit accountable cost reports, which may be subject to audit, to the commissioner for the purpose of establishing such rates.

II. Individuals and organizations shall not provide direct care temporary help services to health care facilities without being licensed to do so by the commissioner. The commissioner, through the bureau of health facilities administration, shall establish by rule, pursuant to RSA 541-A, licensure requirements and procedures for all individuals and organizations providing direct care temporary help services to health care facilities.

III. In this section, "temporary help service" means an organization which hires its own employees and assigns them to clients to support or supplement the client work fare in special work situations such as employee absences, temporary skill shortages, seasonal workloads, and special assignments and projects.

3 Rulemaking Added; Licensure Requirements for Temporary Help Services. Amend RSA 126-A:16, II(i) to read as follows:

(i) Licensure requirements and procedures relative to temporary help services which provide direct care services to licensed health care facilities.

(j) Such other matters as may be necessary for the administration of the department.

4 Interim Rates. If the commissioner of health and human services is unable to obtain the information necessary to establish the rate limit prior to September 1, 2001, the commissioner shall establish interim rates until such time as the commissioner obtains the required information. The rate limit shall not exceed the 135 percent limit set forth in RSA 126-A:5-a as inserted by section 2 of this act. The commissioner shall establish the first permanent annual rate no later than January 1, 2002.

The Department of Health and Human Services indicated this bill will increase state expenditures by an indeterminable amount in FY 2002 and each year thereafter. There will be an indeterminable fiscal impact on state revenues and county expenditures. There will be no impact on county and local revenues or local expenditures.

The Department states two additional full-time employees and associated operating expenses will be necessary to implement this bill. A Health Care Facilities Program Reviewer would be responsible for the licensing function, including writing rules. An Internal Auditor II would audit the salary data from the temporary service providers. The Department assumed a licensing fee of $50 would be charged to the temporary help services. There may be some savings to the Medicaid Program resulting from the reduction in allowable costs. The Department is not able to determine the number of temporary help services that will be licensed or the potential savings to the Medicaid Program. The known costs have been estimated as follows:

FY 2002 FY 2003 FY 2004 FY 2005

Health Care Facilities Program

(LG 18, max) w/benefits $ 42,794 $ 42,794 $ 42,794 $ 42,794

Internal Auditor I

(LG 20, max) w/ benefits 46,537 46,537 46,537 46,537

Operating Expenses

(supplies, postage,

telephone ,mileage) 9,530 9,530 9,530 9,530

Equipment

(Workstation, computer, etc.) 12,320 0 0 0 Total $111,181 $ 98,861 $ 98,861 $ 98,861