How SB 1041 changes current law

AI-generated reading aid from the bill's amendatory text — verify against the official bill.

This bill establishes a new program for medical assistance for complex care assistant services provided by family members of recipients.

• Section 443.16

  Medical Assistance for Complex Care Assistant Services.--(a) No later than one year after the effective date of this subsection and subject to Federal approval, the department shall establish a program in which a family member of a recipient of medical assistance may be certified as a complex care assistant and, after receiving the certification may, under the direction of a registered nurse, provide complex care assistant services to the recipient through a home health agency under the reimbursement rates specified under subsection (g). The program shall operate as a home health care service benefit under the medical assistance program.

  This introduces a new section to create a program for family members to receive certification as complex care assistants.

• Section 443.16

  For the purpose of the program, a recipient shall meet any of the following criteria: (1) The recipient shall be younger than twenty-one years of age. (2) The recipient shall qualify for private duty nursing services under the medical assistance program. (3) The recipient can receive both complex care assistance and private duty nursing services if it is deemed medically necessary. Complex care assistance services are meant as a supplement to private duty nursing and not a replacement.

  This specifies eligibility criteria for recipients participating in the program.

• Section 443.16

  (b) The department shall develop an assessment tool to identify recipients who meet the criteria specified under subsection (a).

  This mandates the development of an assessment tool to identify eligible recipients.

• Section 443.16

  (c) (1) A complex care assistant must meet the training and competency evaluation program standards for home health aides established at 42 CFR 483.151 (relating to state review and approval of nurse aide training and competency evaluation programs), 483.152 (relating to requirements for approval of a nurse aide training and competency evaluation program), 483.154 (relating to nurse aide competency evaluation) and 484.80 (relating to condition of participation: home health aide services), including completing seventy-five hours of training and a competency evaluation.

  This details the training requirements for complex care assistants.

• Section 443.16

  (g) Complex care assistant services provided by a family member of a recipient who becomes certified as a complex care assistant under the program shall be reimbursed to a home health agency under the medical assistance program at a provider rate of no less than forty-five dollars ($45) per hour.

  This establishes a reimbursement rate for complex care assistant services.

• Section 443.16

  (h) The parent or guardian of a medical assistance enrollee shall choose whether to participate in the program. A Medicaid-enrolled home health provider may choose whether to participate in the program.

  This allows recipients and providers to opt in to the program.

• Section 443.16

  (i) Medical assistance shall seek Federal approval, including seeking the appropriate Federal waiver or State plan amendment, to exclude income earned through employment as a complex care assistant from the family's countable income.

  This aims to ensure that earnings from complex care assistance do not impact the overall countable income for eligibility.

• Section 443.16

  (j) Medical assistance shall convene an advisory working group of stakeholders to provide guidance and expertise regarding implementing the complex care assistant program.

  This requires the establishment of a working group to guide program implementation.

• Section 443.16

  (k) No later than three years after the date the program is established under this section, the Deputy Secretary of the Office of Medical Assistance Programs shall prepare and submit a report to the Governor and the General Assembly concerning the viability of the program and recommendations concerning the program.

  This mandates a report on the program's viability after three years.

• Section 443.16

  (l) The department shall seek a State plan amendment or Federal waiver as necessary for the purpose of implementing this section.

  This authorizes the department to seek necessary approvals for program implementation.

• Section 443.16

  (m) The department shall promulgate regulations as necessary to implement this section.

  This allows the department to create regulations to manage the new program.

• Section 443.16

  (n) As used in this section, the following words and phrases shall have the meanings given to them in this subsection unless the context clearly indicates otherwise: 'Family member' includes a legal guardian, an individual related by blood or marriage and any other individual with a close association that is the equivalent of a family relationship. 'Skilled tasks' means tasks involving medical administration, enteral care and therapy.

  This defines key terms relevant to the program.