HB 1474

Official digest

Adds additional duties to a workgroup currently organized concerning the pathways for aging risk based managed care program (program). Requires the office of the secretary of family and social services (office of the secretary) to determine the base reimbursement rate structure, methodology, and reimbursement rates for provider payment by managed care organizations under the program. Allows the office of the secretary to perform claims reviews of claims under the program. Requires a managed care organization participating in the program to do the following: (1) Contract with nursing facilities if certain conditions are met under the same terms for a specified time frame. (2) Submit monthly reports for claims that had a denial rate of at least five percent in the previous month. (3) Pay minimum reimbursement rates to providers. (4) Pay interest on unpaid claims that are later determined to be clean claims. Sets forth the powers and duties of the office of the secretary concerning Medicaid home and community based services waivers. Requires a provider of services under a home and community based services waiver to follow any waiver requirements under federal law and developed by the office of the secretary. Establishes requirements for home and community based services waivers. Relocates provisions requiring reimbursement for assisted living services for individuals who are aged and disabled and receiving services under a Medicaid waiver. Specifies that: (1) these provisions apply to a home and community based services waiver that included assisted living services as an available services before July 1, 2025; (2) these provisions apply to an individual receiving services under a home and community based services waiver; and (3) reimbursement is required for certain services that are part of the individual's home and community based service plan. Relocates provisions establishing limitations concerning assisted living services provided in a home and community based services program. Relocates a provision requiring the office of the secretary to annually determine any state savings generated by home and community based services. Removes a provision allowing the division of aging to adopt rules concerning an appeals process for a housing with services establishment provider's determination that the provider is unable to meet the health needs of a resident and allows the office of the secretary to adopt rules concerning the appeals process. Requires an individual who provides attendant care services for compensation from Medicaid to register with the office of the secretary. Removes the requirement that the division of aging administer programs established under Medicaid waivers for in-home services for treatment of medical conditions. Provides that provisions of law concerning the statewide waiver ombudsman apply to an individual who has a disability and receives services administered by the bureau of disabilities services. (Current law specifies that these provisions apply to an individual who has a developmental disability and receives services under the federal home and community based services program.) Specifies that these provisions do not apply to an individual served by the long term care ombudsman program. Changes references from "statewide waiver ombudsman" to "statewide bureau of disabilities services ombudsman". Requires the unit of services for the deaf and hard of hearing and the division (rather than the unit and the board of interpreters) to adopt rules creating standings for interpreters. Removes provisions concerning the board of interpreters. Repeals a provision providing that licensed home health agencies and licensed personal services agencies are approved to provide certain services under a Medicaid waiver granted to the state under federal law that provides services for treatment of medical conditions. Repeals language concerning a long term care services eligibility screen for purposes of the Community and Home Options to Institutional Care for the Elderly and Disabled program (CHOICE). Authorizes the division of disability and rehabilitative services to charge an authorized service provider that employs a direct service professional an annual fee. Establishes the direct support professional training program fund and appropriates money in the fund.