House Bill 1056

AN ACT TO AMEND SECTION 43-13-117.1, MISSISSIPPI CODE OF 1972, TO DIRECT THE DIVISION OF MEDICAID TO MAKE APPLICATION FOR AN ELDERLY OR DISABLED WITH CONSUMER DIRECTION WAIVER TO ALLOW THE DIVISION TO PROVIDE FOR COVERAGE OF CONSUMER-DIRECTED PERSONAL CARE SERVICES THAT ARE APPROPRIATE AND MEDICALLY NECESSARY TO MAINTAIN INDIVIDUALS IN THEIR HOMES; TO SPECIFY THE CRITERIA FOR ELIGIBILITY TO RECEIVE THOSE SERVICES AND THE CRITERIA TO QUALIFY AS A CONSUMER-DIRECTED EMPLOYEE; TO PROVIDE THAT CONSUMER-DIRECTED EMPLOYERS AND EMPLOYEES SHALL BE RESPONSIBLE FOR COMPLETING AND SUBMITTING TIMESHEETS AND OTHER REQUIRED DOCUMENTATION; TO REQUIRE THAT INDIVIDUALS RECEIVING CONSUMER-DIRECTED PERSONAL CARE SERVICES MUST RECEIVE SUPPORT FROM A CONSUMER-DIRECTED SERVICES FACILITATOR, WHO WILL ASSIST THE INDIVIDUAL OR HIS OR HER FAMILY/CAREGIVER AS THEY BECOME EMPLOYERS FOR CONSUMER-DIRECTED SERVICES; TO SPECIFY THE FUNCTIONS OF THE SERVICES FACILITATOR AND REQUIRE THE SERVICES FACILITATOR TO MAKE A HOME VISIT TO CONDUCT AN INITIAL ASSESSMENT BEFORE THE START OF CARE FOR ALL INDIVIDUALS REQUESTING SERVICES; TO REQUIRE THE SERVICES FACILITATOR TO MAKE SUPERVISORY VISITS AS OFTEN AS NEEDED TO ENSURE BOTH QUALITY AND APPROPRIATENESS OF SERVICES; AND FOR RELATED PURPOSES.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:

SECTION 1. Section 43-13-117.1, Mississippi Code of 1972, is amended as follows:

43-13-117.1. (1) It is the intent of the Legislature to expand access to Medicaid-funded home- and community-based services for eligible nursing facility residents who choose those services. The Executive Director of the Division of Medicaid is authorized to transfer funds allocated for nursing facility services for eligible residents to cover the cost of services available through the Independent Living Waiver, the Traumatic Brain Injury/Spinal Cord Injury Waiver, the Elderly and Disabled Waiver, and the Assisted Living Waiver programs when eligible residents choose those community services. The amount of funding transferred by the division shall be sufficient to cover the cost of home- and community-based waiver services for each eligible nursing facility * * *~~residents~~ resident who * * *~~choose~~ chooses those services. The number of nursing facility residents who return to the community and home- and community-based waiver services shall not count against the total number of waiver slots for which the Legislature appropriates funding each year. Any funds remaining in the program when a former nursing facility resident ceases to participate in a home- and community-based waiver program under this provision shall be returned to nursing facility funding.

(2) The Division of Medicaid shall make application to the Centers for Medicare and Medicaid Services (CMS) under Section 1915(c) of the federal Social Security Act for an Elderly or Disabled with Consumer Direction Waiver (EDCD Waiver) to allow the division to provide for coverage of consumer-directed (CD) personal care services that are appropriate and medically necessary to maintain individuals in their homes. In order to qualify for personal care services under this subsection (2), the individual must demonstrate a need in activities of daily living, reminders to take medication, or other medical needs, or monitoring health status or physical condition. Individuals receiving consumer-directed personal care services must meet the requirements for consumer direction as provided in subsections (3), (4) and (5) of this section and receive support from a CD services facilitator as provided in subsection (6) of this section.

(3) Individuals who are eligible for consumer-directed personal care services must have the capability to hire, train and fire their consumer-directed employees and supervise the employee's work performance. If an individual is unable to direct his or her own care or is younger than eighteen (18) years of age, a family/caregiver may serve as the employer on behalf of the individual.

(4) Each consumer-directed employee must have the required skills to perform services as specified in the individual's plan of care, and may not be the parents of individuals who are minors or the individual's spouse. Family members who are approved to be reimbursed for providing this service must meet the qualifications required by the division.

(5) Consumer-directed employers and employees shall be responsible for completing and submitting timesheets and other documentation required by the division through the CD services facilitator.

(6) (a) Individuals receiving consumer-directed personal care services must receive support from a CD services facilitator, who will assist the individual or his or her family/caregiver, as appropriate, as they become employers for consumer-directed services. If the CD services facilitator is not a registered nurse, the CD services facilitator must inform the primary health care provider that services are being provided and request skilled nursing or other consultation as needed.

(b) The functions of the CD services facilitator include providing the individual or his family/caregiver, as appropriate, with management training, and routine visits to monitor the employment process. The CD services facilitator shall assist the individual/employer with employer issues as they arise. (c) The CD services facilitator must make a home visit to conduct an initial assessment before the start of care for all individuals requesting services. The CD services facilitator must make supervisory visits as often as needed to ensure both quality and appropriateness of services, with the minimum frequency of those visits being every thirty (30) to ninety (90) calendar days depending on individual needs.

(7) The division shall adopt such regulations as may be necessary to fully implement the EDCD Waiver.

SECTION 2. This act shall take effect and be in force from and after July 1, 2018.