Includes whereas clauses.
Directs the Department of Health and Human Services, Division of Health Benefits (DHB) to adjust the per member per month (PMPM) capitation amount paid to LME/MCOs operating capitated contracts for mental health, intellectual and other development disabilities, and substance abuse services to include amounts sufficient to increase wages paid to direct support personnel working in intermediate care facilities for individuals with intellectual disabilities to align the wages paid to these direct support personnel with the current wages paid to State employees in State-owned developmental centers. Requires the PMPM capitation amount adjustments to be consistent with the Medicaid State Plan requirements, with validation by DHB of actual amounts necessary to align the wages as specified. Deems the adjustments directed payments made to LME/MCOs under specified federal law in order to assure the increased amounts are used for wage increases. Requires providers receiving any increase in funds from LME/MCOs for wage increases to attest and provide verification that the funds are being used for that purpose, with LME/MCOs authorized to require verifiable methods of accounting. Directs DHB, after the implementation of the above directive, to continue to work with stakeholders and service providers to develop an appropriate methodology for tracking progress towards increasing direct support personnel wages and to determine additional resources needed to achieve the described wage alignment, if any.
Appropriates $17.5 million in recurring funds for 2021-22 and $21.8 million in recurring funds for 2022-23 from the General Fund to DHB to be used to adjust the PMPM capitation amount paid to LME/MCOs as directed. Specifies that these funds are a State match to the following recurring federal funds: $59.4 million for 2021-22, and $55.6 million for 2022-23. Appropriates the federal funds to DHB to be used for the same purpose. Additionally directs DHB to maximize the intermediate care facilities for individuals with intellectual disabilities and use proceeds for the purpose of implementing the act.
Recommends DHB take into account, for future capitation rate cycles, cost-of-living adjustments and wage and hour cost-of-living adjustments for direct support personnel working in intermediate care facilities for individuals with intellectual disabilities in an amount equal to those adjustments made for similar personnel working in State-operated development centers.
Directs DHB to use information from the Office of State Human Resources job classification and wage and hour data for specified employees in comparable job classifications as those direct support personnel working in intermediate care facilities for individuals with intellectual disabilities, in order to establish a baseline methodology for determining the appropriate wages to be paid in accordance with the act. Requires DHB to also account for market-based wage comparisons with private sector employees as specified. Authorizes DHB to accept specified competitive wage and hour and cost data from non-State entities in order to calculate forward looking wage analysis formulas and finalize the exact rates needed to implement the act.
Requires DHB to provide the funds necessary to sustain a rate increase or adjustment made by a LME/MCO in accordance with the act at a time other than the beginning of a rate cycle, for the next rate cycle.
Makes the above provisions effective upon approval by the Centers for Medicare and Medicaid (CMS) approval, as required below.
Directs DHB to seek approval from the Centers for Medicare and Medicaid prior to implementing the rate increase, and directs implementation of the rate increase upon CMS approval to the extent allowed by CMS. Requires the DHHS Secretary to notify and provide verification to the Office of State Budget and Management and the specified NCGA division upon receipt of CMS approval. Effective July 1, 2021. Sunsets the act on June 30, 2023, if the required approval of CMS is not granted by that date.
Bill S 610 (2021-2022)Summary date: Apr 7 2021 - View summary