AB 208 — Establishes a program to provide structured family caregiving to certain recipients of Medicaid. (BDR 38-297)

EXEMPTAssembly (ReprintedBill withNo. amendments adopted on April 17, 2023) FIRST REPRINT A.B.

208208–Committee Aon SSEMBLYHealth Band ILLNHuman O.Services CHAPTER..........

208–COMMITTEE ON H EALTH AND HUMAN SERVICES (ON B EHALF OF THE LEGISLATIVE COMMITTEE ON SENIOR CITIZENS, VETERANS AND ADULTS W ITHS PECIAL NEEDS ) FEBRUARY 21, 2023 ____________ Referred to Committee on Health and Human Services SUMMARY—Establishes a program to provide structured family caregiving to certain recipients of Medicaid.

(BDR 38-297) FISCAL NOTE:

Effect on Local Government:

No.

Effect on the State:

Yes.

~ EXPLANATION – Matter in bolded italics is new;

matter between brackets [omitted material] is material to be omitted.

making appropriations to and authorizing expenditures by certain divisions of the Department of Health and Human Services;

Federal law authorizes a state to apply for a waiver that allows the state to receive financial contributions from the Federal Government toward the cost of providing certain home and community-based services for recipients of Medicaid whoDepartment areof elderlyHealth orand disabled.Human Services to apply for such a waiver coveringhe certain home and community-based services for recipients of Medicaid with physical disabilities.

(42(NRS U.S.C.422.396) Section 1 of this bill requires the Department to apply to the United States Secretary of Health and Human Services for a home and community-based services waiver to include structured family caregiving for recipients of Medicaid suffering the waiver:

§(1) 1396n(c))an Existingauthorization lawfor requiresan theapplicant Department of Health and Human Services to apply for suchor a waiverrecipient covering certain home and community-based services for recipients of Medicaid withtor phySectionchoose 1his ofor thisher billcaregiver requiresand the Departmentresidence towhere apply to the Unitedrecipient Stateswill Secretaryreceive ofthe Health and Human Services for a home and community-based services waiver to include structured family caregivingcaregiving; for recipients of Medicaid suffering from dementia.

Sectionand 1(2) requiresa requirement that the Departmentcaregiver includebe inor itsbecome applicationan foremployee of an agency to provide personal care services in the waiver:home or an intermediary service organization and receive a daily stipend through that employer.

(1) an authorization for an applicant for or a recipient of Medicaid to choose his or her caregiver and the residence where the recipient will receive the structured family caregiving;

and (2) a requirement that the caregiver be or become intermediary service organization and receive a daily stipend through thatan employer.

Section 2 of this bill makes a conforming change to indicate that section 1 will be - *AB208_R1* – 2 – administered in the same manner as other provisions of existing law governing Medicaid.

Section 2.3 of this bill makes appropriations to, and authorizesing expenditures by, the Division of Health Care Financing and Policy of the Department for costs relating to including such structured family caregiving as medical assistance under Medicaid.

Section 2.6 of this bill makes appropriations to, and authorizes expenditures by, the Division of Welfare and Supportive Services of the Department for costs relating to system modifications to implement this bill.

EXPLANATION – Matter in bolded italics is new;

matter between brackets [omitted material] is material to be omitted.

The waiver must authorize the Department to include structured family caregiving for- persons82nd Session (2023) – 2 – Medicaid.ns suffering from dementia as medical assistance under Medicaid.2.

2.

(c) Establish a per diem rate to be paid to an agency to provide personal care services in the home or an intermediary service org(d) Require an agency to provide personal care services in the home or intermediary service organization that employs a caregiver pursuant to paragraph (b);(b) to provide to the caregiver a daily stipend that is at least 65 percent of the per diem rate paid to the agency to provide personal care services in the home or intermediary service organization;

(d) Require an agency to provide personal care services in the home or intermediary service organization that employs a caregiver pursuant to paragraph (b) to provide to the caregiver a daily stipend that is at least 65 percent of the per diem rate paid to the agency to provide personal care services in the home or intermediary service organization;

- *AB208_R1* – 3 – (b) If the Federal Government approves the waiver, adopt regulations necessary to carry out the provisions of this section, including, without limitation, the criteria to be used in determining eligibility for an applicant for or a recipient of Medicaid suffering from dementia to receive structured family caregiving pursuant to this section;

- 82nd Session (2023) – 3 – (a) “Agency to provide personal care services in the home” has the meaning ascribed to it in NRS 449.0021.

(c) “Structured family caregiving” means the provision of services to a person who resides in the same residence as the caregiver on a full-time basis.

and (5)Behavioral TheHealth.nistrator Administratorof the Division of Public and (b) Shall administer, through the divisions of the Department, the provisions of chapters 63, 424, 425, 427A, 432A to 442, inclusive, 446 to 450, inclusive, 458A and 656A of NRS, NRS 127.220 to 127.310, inclusive, 422.001 to 422.410, inclusive, and section 1 of this act, 422.580, 432.010 to 432.133, inclusive, 432B.6201 to 432B.626, inclusive, 444.002 to 444.430, inclusive, and 445A.010 to 445A.055, inclusive, and all other provisions of law relating to the functions of the divisions of the Department, but is not responsible for the clinical activities of the Division of Public and Behavioral Health.Health or the professional line activities of the other divisions.

(b)(c) Shall administer,administer throughany thestate divisionsprogram offor thepersons Department,with thedevelopmental provisionsdisabilities ofestablished chapterspursuant 63, 424, 425, 427A, 432A to 442,the inclusive,- 44682nd toSession 450,(2023) inclusive, 458A and 656A of NRS, NRS 127.220 to 127.310, inclusive, 422.001 to 422.410, inclusive, and section 1 of this act, 422.580, 432.010 to 432.133, inclusive, 432B.6201 to 432B.626, inclusive, 444.002 to 444.430, inclusive, and 445A.010 to 445A.055, inclusive, and all other provisions of - *AB208_R1* – 4 – lawDevelopmental relatingDisabilities toAssistance theand functionsBill of theRights divisionsAct of the2000, Department,42 butU.S.C. is not responsible for the clinical activities of the Division of Public and Behavioral Health or the professional line activities of the other divisions.

(c) Shall administer any state program for persons with developmental disabilities established pursuant to the Developmental Disabilities Assistance and Bill of Rights Act of 2000, 42 U.S.C.

(d) Shall, after considering advice from agencies of local governments and nonprofit organizations which provide social services, adopt a master plan for the provision of human services in this State.

(e) May, by regulation, require nonprofit organizations and state and local governmental agencies to provide information regarding the programs of those organizations and agencies, excluding detailed information relating to their budgets and payrolls, which the Director deems necessary for the performance of the duties imposed upon him or her pursuant to this section.

3.2.3.

ThisThere is hereby appropriated from the State General Fund to the Division of Health Care Financing and Policy of the Department of Health and Human Services for the costs of including structured family caregiving for persons suffering from dementia as medical assistance under Medicaid pursuant to section becomes1 effectiveof uponthis passageact and approval.for personnel, travel, operating, equipment, information services expenses and system costs for changes to the - 82nd Session (2023) – 5 – out the provisions of this act the following sums:with carrying For the Fiscal Year 2023-2024....................................$50,662 For the Fiscal Year 2024-2025..................................$100,400 2.

Expenditure of the following sums not appropriated from the State General Fund or the State Highway Fund is hereby authorized by the Division of Health Care Financing and Policy of the Department of Health and Human Services for the same purpose as set forth in subsection 1:

For the Fiscal Year 2023-2024....................................$85,382 For the Fiscal Year 2024-2025..................................$223,781 3.

Any balance of the sums appropriated by subsection 1 remaining at the end of the respective fiscal years must not be committed for expenditure after June 30 of the respective fiscal years by the entity to which the appropriation is made or any entity to which money from the appropriation is granted or otherwise transferred in any manner, and any portion of the appropriated September 20, 2024, and September 19, 2025, respectively, by either the entity to which the money was appropriated or the entity to which the money was subsequently granted or transferred, and must be reverted to the State General Fund on or before September 20, 2024, and September 19, 2025, respectively.

Sec.