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SENATE BILL 103
57
TH LEGISLATURE
-
STATE
OF
NEW
MEXICO
-
FIRST SESSION
,
2025
INTRODUCED BY
Antoinette Sedillo Lopez
AN ACT
RELATING TO HEALTH CARE; REQUIRING ENTITIES PARTICIPATING IN
MEDICAID PERSONAL CARE SERVICES PROGRAMS TO REPORT TO THE
HEALTH CARE AUTHORITY ON THE STATUS OF THE DIRECT CARE
WORKFORCE; REQUIRING THE HEALTH CARE AUTHORITY TO DEVELOP
REPORTS ON THE DIRECT CARE WORKFORCE.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
SECTION 1. [NEW MATERIAL] DIRECT CARE WORKFORCE REPORTING
REQUIREMENTS--HEALTH CARE AUTHORITY DUTIES.--
A. As used in this section:
(1) "agency-based community benefit" means the
personal care services program provided to eligible medicaid
recipients who do not wish to self-direct their community
benefit services;
(2) "authority" means the health care
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authority;
(3) "direct care worker" means a non-
administrative employee who spends the majority of working
hours providing personal care services to eligible medicaid
recipients;
(4) "eligible medicaid recipient" means a
person whom the authority has determined to be eligible to
receive medicaid-related personal care services either through
the agency-based community benefit program or the self-directed
community benefit program;
(5) "financial management agency" means an
entity that contracts with a medicaid managed care organization
to provide the fiscal administration functions for eligible
medicaid recipients participating in the self-directed
community benefit program;
(6) "personal care service provider agency"
means an entity that:
(a) has entered into a medicaid provider
participation agreement with the authority and: 1) is
contracted with a medicaid managed care organization to provide
personal care services to eligible medicaid recipients; or 2)
provides personal care services to eligible medicaid recipients
through fee-for-service arrangement;
(b) is reimbursed for personal care
services provided to eligible medicaid recipients; and
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(c) employs direct care workers to
provide personal care services to eligible medicaid recipients;
(7) "personal care services" means services
provided to an eligible medicaid recipient to assist the
eligible medicaid recipient with the instrumental activities of
daily living; and
(8) "self-directed community benefit" means
the personal care services program provided to eligible
medicaid recipients who choose to self-direct their community
benefit services.
B. By March 1, 2026, and annually thereafter, each
personal care service provider agency shall, in a form and
manner prescribed by the authority, submit data on the direct
care workers providing agency-based community benefits at the
personal care service provider agency. The data shall include
information on the:
(1) total number of:
(a) full-time direct care workers
employed by the personal care service provider agency;
(b) part-time direct care workers
employed by the personal care service provider agency;
(c) direct care workers who are
independent contractors contracted with the personal care
service provider agency;
(d) direct care workers who have ceased
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providing personal care services for the personal care service
provider agency in the previous twelve months;
(e) vacant full-time and part-time
direct care worker positions as of the end of the previous
calendar year; and
(f) hours of overtime pay received by
each direct care worker;
(2) percentage of the previous calendar year
that each direct care worker was employed at the personal care
service provider agency, either as an employee or independent
contractor;
(3) total length of employment for each
employee as of the end of the previous calendar year;
(4) hourly wage paid to each direct care
worker during the previous calendar year;
(5) total amount of money paid to direct care
workers for travel in the previous twelve months;
(6) availability of fringe benefits for direct
care workers employed at the personal care service provider
agency. Data on fringe benefits shall include the number and
percentage of full-time and part-time employees that receive:
(a) health insurance;
(b) dental insurance;
(c) vision insurance;
(d) life insurance;
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(e) disability insurance;
(f) tuition reimbursement;
(g) retirement benefits;
(h) paid leave other than sick leave;
and
(i) any other type of fringe benefit
that the personal care service provider agency offers;
(7) other expenditures paid by personal care
service provider agencies related to direct care workers,
including:
(a) training for direct care workers;
(b) discretionary travel benefits; and
(c) personal protective equipment; and
(8) demographics of the direct care workers
employed by the personal care service provider agency,
including each direct care worker's:
(a) age;
(b) gender;
(c) race and ethnicity;
(d) highest educational level attained;
(e) certifications; and
(f) duration of direct care work
experience.
C. By March 1, 2026, and annually thereafter, each
medicaid managed care organization and financial management
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agency shall, in a form and manner prescribed by the authority,
submit data on the direct care workers providing self-directed
community benefits. The data shall include information on the:
(1) total number of:
(a) full-time direct care workers
providing personal care services through the self-directed
community benefit program;
(b) part-time direct care workers
providing personal care services through the self-directed
community benefit program;
(c) direct care workers who are
independent contractors contracted to provide personal care
services through the self-directed community benefit program;
(d) direct care workers who have ceased
providing personal care services through the self-directed
community benefit program in the previous twelve months; and
(e) hours of overtime pay received by
each direct care worker providing personal care services
through the self-directed community benefit program;
(2) percentage of the previous calendar year
that each direct care worker was employed at the provider
agency, either as an employee or independent contractor;
(3) hourly wage paid to each direct care
worker during the previous calendar year; and
(4) demographics of the direct care workers
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providing personal care services through the self-directed
community benefit program, including each direct care worker's:
(a) age;
(b) gender;
(c) race and ethnicity;
(d) highest educational level attained;
(e) certifications; and
(f) duration of direct care work
experience.
D. By July 1, 2026, and annually thereafter, the
authority shall review and analyze the data submitted pursuant
to this section and shall submit a report on the data to the
interim legislative health and human services committee, the
legislative finance committee, the governor and the interested
parties advisory group established pursuant to this section.
E. By January 1, 2030, the authority shall perform
a study for the purposes of determining the cost of providing
personal care services and recommending the reimbursement rates
to be paid for personal care services. The results of the
study shall be provided to the interim legislative health and
human services committee, the legislative finance committee,
the governor and the interested parties advisory group
established pursuant to this section. The study shall consider
federal requirements related to payment adequacy and the level
of reimbursement required to:
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(1) stabilize the direct care workforce;
(2) reduce direct care workforce vacancies;
(3) allow direct care workers to receive an
hourly wage of at least one hundred fifty percent of the state
minimum wage; and
(4) ensure adequate access to personal care
services for eligible medicaid recipients.
F. The authority shall establish an interested
parties advisory group that meets at least every two years to
advise and provide recommendations to the authority on
reimbursement rates for personal care, home health aide,
homemaker and habilitation services. The authority shall
publish the advisory group's recommendations on the authority's
website. The advisory group shall consist of persons who have
an interest in the payment rates, including:
(1) direct care workers;
(2) eligible medicaid recipients or the
eligible medicaid recipients' authorized representatives; and
(3) authority staff.
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