General Assembly Substitute Bill No. 498 seeks to improve accountability and transparency in the management of self-directed home care programs funded by Medicaid. Starting July 1, 2026, the bill requires the Commissioner of Social Services to publish quarterly reports on fiscal intermediaries' performance, focusing on their compliance with contractual obligations such as timesheet processing and customer service response times. Additionally, the Secretary of the Office of Policy and Management is tasked with conducting a cost-benefit analysis on the potential transfer of fiscal intermediary duties from private contractors to state management, with a report due by October 1, 2026.

The bill also introduces financial penalties for late payroll processing for personal care attendants, effective August 31, 2026. Contracts for fiscal intermediary services must include these penalties, which are tiered based on the amount of the tardy paycheck, and an interest rate of twelve percent per annum for paychecks that are two or more pay periods late. Furthermore, if damages from tardy payments are documented and approved by the Personal Care Attendant Workforce Council, compensation must be provided for any incurred late fees or bank overdraft charges. The bill establishes penalties for inaccurate electronic visit verification systems and mandates that all communications from state agencies comply with effective communication standards, ensuring they are accessible in relevant languages. These measures aim to enhance the efficiency and reliability of payroll processes and improve overall service delivery for personal care attendants.