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HOUSE BILL 55
57
TH LEGISLATURE
-
STATE
OF
NEW
MEXICO
-
FIRST SESSION
,
2025
INTRODUCED BY
Pamelya Herndon
FOR THE LEGISLATIVE HEALTH AND HUMAN SERVICES COMMITTEE
AN ACT
RELATING TO LABOR; REQUIRING THE HEALTH CARE AUTHORITY TO SET A
MINIMUM MEDICAID FEE SCHEDULE FOR REIMBURSING PERSONAL CARE
SERVICES; REQUIRING AT LEAST SEVENTY PERCENT OF MEDICAID
REIMBURSEMENT FOR PERSONAL CARE SERVICES TO BE USED FOR
COMPENSATING DIRECT CARE WORKERS; MAKING AN APPROPRIATION.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
SECTION 1. A new section of the Public Assistance Act is
enacted to read:
"[NEW MATERIAL] MEDICAID REIMBURSEMENT FOR PERSONAL CARE
SERVICES.--
A. For the purposes of this section:
(1) "compensation" means all payments and
benefits provided to direct care workers, including:
(a) salary, wages, overtime pay and
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other remunerations;
(b) health, dental, life and disability
insurance;
(c) paid leave, retirement benefits and
tuition reimbursement; and
(d) the employer share of payroll taxes;
(2) "direct care worker" means a non-
administrative employee of a personal care services provider
agency who spends the majority of the employee's work hours
providing personal care services;
(3) "medicaid" means the medical assistance
program established pursuant to Title 19 of the federal act and
regulations issued pursuant to that act;
(4) "personal care services" means services
provided to an individual to assist with activities of daily
living; and
(5) "personal care services provider agency"
means an entity that:
(a) has entered into a medicaid provider
participation agreement with the medical assistance division of
the authority and: 1) is contracted with a managed care
organization to provide personal care services to medicaid
recipients; or 2) provides personal care services to medicaid
recipients through fee-for-service arrangements;
(b) is reimbursed for personal care
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services provided to individuals covered by medicaid; and
(c) employs direct care workers to
provide personal care services to individuals covered by
medicaid.
B. The authority shall implement a minimum medicaid
fee schedule for personal care services that requires managed
care organizations and fee-for-service arrangements to
reimburse personal care services provider agencies at least
twenty-three dollars fifty cents ($23.50) per hour for
providing personal care services.
C. A personal care services provider agency that
receives medicaid reimbursement for providing personal care
services shall use at least seventy percent of the medicaid
reimbursement as compensation to direct care workers for
furnishing their services.
D. Before calculating the minimum amount of
medicaid reimbursement that a personal care services provider
agency is required to use to compensate direct care workers,
the costs of providing training, travel and personal protective
equipment to direct care workers shall be deducted from the
total amount of medicaid reimbursement that the personal care
services provider agency receives."
SECTION 2. APPROPRIATION.--Twenty million eight hundred
thousand dollars ($20,800,000) is appropriated from the general
fund to the health care authority for expenditure in fiscal
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year 2026 to update the medicaid personal care services fee
schedule and increase medicaid reimbursement for personal care
services pursuant to Section 1 of this act. Any unexpended or
unencumbered balance remaining at the end of fiscal year 2026
shall revert to the general fund.
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