Senate File 2305 - Introduced SENATE FILE 2305 BY CELSI , DONAHUE , DOTZLER , BISIGNANO , BOULTON , T. TAYLOR , PETERSEN , WEINER , QUIRMBACH , JOCHUM , TRONE GARRIOTT , WINCKLER , KNOX , WAHLS , and BENNETT A BILL FOR An Act relating to support of direct care services and the 1 direct care workforce, establishing a state minimum hourly 2 wage for direct care workers under the Medicaid program, and 3 including applicability provisions. 4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 5 TLSB 5053XS (16) 90 pf/ko
S.F. 2305 DIVISION I 1 DIRECT CARE WORKER MINIMUM WAGE REQUIREMENTS MEDICAID 2 PROGRAM 3 Section 1. DIRECT CARE WORKER MINIMUM WAGE REQUIREMENTS 4 MEDICAID PROGRAM. 5 1. a. Notwithstanding section 91D.1, the state hourly wage 6 for an employee employed as a direct care worker by a provider 7 reimbursed under the Medicaid program shall be at least $15.00 8 beginning July 1, 2025; at least $16.00 beginning July 1, 9 2026; at least $17.00 beginning July 1, 2027; at least $18.00 10 beginning July 1, 2028; at least $19.00 beginning July 1, 2029; 11 and at least $20.00 beginning July 1, 2030. On or after July 12 1, 2031, the state hourly wage for an employee employed as a 13 direct care worker by a provider reimbursed under the Medicaid 14 program shall be increased by a cost-of-living adjustment as 15 determined by applying the percent change in the consumer price 16 index for urban wage earners and clerical workers, United 17 States city average, as published annually in October in the 18 federal register by the federal department of labor, bureau of 19 labor statistics. 20 b. Paragraph a shall not be construed to authorize a 21 provider that employs a direct care worker whose current hourly 22 wage is above the minimum wage pursuant to paragraph a, to 23 decrease the direct care workers current hourly wage. 24 2. For the purposes of this section, direct care worker 25 means an individual who provides supportive services and care 26 in home-based, community-based, or facility settings to people 27 experiencing health conditions, illness, or a disability, 28 and who receives compensation for such services. Direct 29 care worker includes but is not limited to direct support 30 professionals, supported community living workers, home health 31 aides, universal workers, hospice aides, personal assistants, 32 patient care technicians, consumer directed attendant care 33 providers, senior helpers or companions, and certified nursing 34 assistants. 35 -1- LSB 5053XS (16) 90 pf/ko 1/ 5
S.F. 2305 Sec. 2. CONTINGENT EFFECTIVE DATE. This division of this 1 Act takes effect upon the effective date of an increased 2 appropriation to the department of health and human services 3 for the Medicaid program to provide a reimbursement rate 4 increase to Medicaid providers who are subject to payment of 5 the required minimum wage for direct care workers under this 6 division of this Act in an amount that offsets the increase in 7 the required minimum wage paid by such Medicaid providers. 8 DIVISION II 9 DIRECT CARE WORKFORCE SUPPORT PROGRAMS 10 Sec. 3. NURSING FACILITY FUNDING REVIEW AND 11 REPORTING. The department of health and human services shall 12 do all of the following: 13 1. Review the appropriation made pursuant to 2023 Iowa 14 Acts, chapter 112, section 30, subsection 1, paragraph a, 15 subparagraph (1), subparagraph division (a), for the fiscal 16 period beginning July 1, 2023, and ending June 30, 2025, for 17 rebasing of case-mix nursing facilities including the fifteen 18 million dollars provided for this purpose, to identify how the 19 additional funding was utilized by the nursing facilities and 20 the extent to which the wages of direct care workers as defined 21 in section 249L.2 were increased as a result of the additional 22 funding. The department shall report initial findings and 23 recommendations by December 15, 2024, and final findings and 24 recommendations by December 15, 2025, to the governor and the 25 general assembly. 26 2. Review the outcomes of initiatives funded through the 27 federal American Rescue Plan Act of 2021, Pub. L. No. 117-2, to 28 support the health care workforce including use of the funds to 29 increase the pay and benefits of direct support professionals, 30 and train, recruit, retain, and expand the direct support 31 professional workforce, to determine if the initiatives 32 should be continued. The department shall report findings and 33 recommendations to the governor and the general assembly by 34 December 15, 2024. 35 -2- LSB 5053XS (16) 90 pf/ko 2/ 5
S.F. 2305 Sec. 4. IOWA WORKFORCE DEVELOPMENT SURVEY OF DIRECT 1 CARE WORKERS DEPARTMENT OF HEALTH AND HUMAN SERVICES 2 DETERMINATION OF IMPACT OF MINIMUM WAGE INCREASE. 3 1. Iowa workforce development shall replicate the survey 4 entitled Direct Care Workers of Iowa 2019 Wage & Benefit 5 Survey, released in June 2019, to survey wages and benefits 6 for direct care workers in 2024. The survey shall measure the 7 wages and benefits of direct care workers employed through 8 temporary staffing agencies separately from direct care workers 9 employed directly by a facility or employer, and shall measure 10 wages and benefits delineated by direct care workers years 11 of experience to determine the effect of seniority on current 12 wages and benefits. A final report of the results of the 13 survey shall be published by January 15, 2025. 14 2. The department of health and human services shall use 15 the results of the survey published pursuant to subsection 16 1 to determine the appropriate increase in the Medicaid 17 reimbursement rate for Medicaid providers to offset payment of 18 the required minimum wage for direct care workers as specified 19 in division I of this Act, and shall report the reimbursement 20 rate recommendations to the general assembly by March 15, 2025. 21 3. Following implementation of the minimum wage requirement 22 for direct care workers as specified in division I of this 23 Act, the department of health and human services shall use the 24 final report of the results of the survey published pursuant to 25 subsection 1 to develop an ongoing tracking system to determine 26 if the required minimum wage for direct care workers under the 27 Medicaid program is effective in increasing the wages Medicaid 28 providers pay direct care workers, including the extent of the 29 impact of the required minimum wage on wages considering the 30 years of experience of the direct care worker. 31 EXPLANATION 32 The inclusion of this explanation does not constitute agreement with 33 the explanations substance by the members of the general assembly. 34 This bill includes measures to support direct care services 35 -3- LSB 5053XS (16) 90 pf/ko 3/ 5
S.F. 2305 and the direct care workforce. 1 DIVISION I. Division I of the bill requires Medicaid 2 providers to comply with direct care worker minimum wage 3 requirements. The bill provides that notwithstanding Code 4 section 91D.1 (minimum wage requirements exceptions), the 5 state hourly wage for an employee employed as a direct care 6 worker, as defined in the bill, by a Medicaid provider shall be 7 at least $15.00 beginning July 1, 2025, and the minimum shall 8 increase by $1.00 per year to at least $20.00 beginning July 1, 9 2030. The bill provides that the setting of a minimum hourly 10 wage under the bill does not authorize a Medicaid provider 11 who is paying a direct care worker an hourly wage above the 12 required minimum to decrease the direct care workers current 13 hourly wage. On or after July 1, 2031, this state hourly 14 wage shall be increased by a cost-of-living adjustment amount 15 as determined by applying the percent change in the consumer 16 price index for urban wage earners and clerical workers, United 17 States city average, as published annually in October in the 18 federal register by the federal department of labor, bureau 19 of labor statistics. This division of the bill takes effect 20 upon the effective date of an increased appropriation to the 21 department of health and human services (HHS) for the Medicaid 22 program to provide a reimbursement rate increase to Medicaid 23 providers who are subject to payment of the required minimum 24 wage for direct care workers in an amount that offsets the 25 increase in the required minimum wage paid by such Medicaid 26 providers. 27 DIVISION II. Division II of the bill includes provisions 28 relating to support of the direct care workforce. 29 The bill requires HHS to review the funding appropriated 30 for the fiscal period beginning July 1, 2023, and ending 31 June 30, 2025, for rebasing of case-mix nursing facilities 32 to identify how the additional funding was utilized, and the 33 extent to which direct care worker wages were increased as a 34 result of the additional funding. HHS must report initial and 35 -4- LSB 5053XS (16) 90 pf/ko 4/ 5
S.F. 2305 final findings and recommendations to the governor and the 1 general assembly. HHS is also required to review the outcomes 2 of initiatives funded through the federal American Rescue 3 Plan Act to support the health care workforce including the 4 use of the funds to increase the pay and benefits of direct 5 support professionals, and train, recruit, retain, and expand 6 the direct support professional workforce, to determine if 7 the initiatives should be continued, and report findings and 8 recommendations to the governor and the general assembly by 9 December 15, 2024. 10 The bill also requires Iowa workforce development to 11 replicate the survey entitled Direct Care Workers of Iowa 12 2019 Wage & Benefit Survey, released in June 2019, to survey 13 wages and benefits for direct care workers in 2024, and 14 publish a final report of the results of the survey by January 15 15, 2025. The bill requires HHS to use the results of the 16 published survey to determine the appropriate increase in the 17 Medicaid reimbursement rate for Medicaid providers to offset 18 payment of the required minimum wage for direct care workers 19 as specified in the bill, and report the reimbursement rate 20 recommendations to the general assembly by March 15, 2025. 21 Following implementation of the minimum wage requirement as 22 specified in the bill, HHS shall use the report to develop an 23 ongoing tracking system to determine if the required minimum 24 wage is effective in increasing the wages Medicaid providers 25 pay direct care workers, including the extent of the impact of 26 the required minimum wage on such wages considering the years 27 of experience of the direct care worker. 28 -5- LSB 5053XS (16) 90 pf/ko 5/ 5