SB 275
Department of Legislative Services
Maryland General Assembly
2021 Session
FISCAL AND POLICY NOTE
Third Reader - Revised
Senate Bill 275 (Senator Hester, et al.)
Finance Health and Government Operations
Maryland Department of Health – Residential Service Agencies – Training
Requirements
This bill generally requires each residential service agency (RSA) to ensure that, within
45 days after an individual’s start of employment, direct care and supervisory staff receive
three hours of online or in-person training on dementia, beginning July 1, 2022. An RSA
must also ensure staff receive two hours of online or in-person continuing education
training regarding Alzheimer’s disease and dementia each calendar year. Staff already
employed by an RSA on October 1, 2021, who have not received equivalent training, must
complete the three-hour training by August 15, 2022.
Fiscal Summary
State Effect: Medicaid expenditures increase by an indeterminate amount (50% in general
funds and 50% in federal funds) beginning in FY 2023 to account for the new training
requirements; federal matching revenues increase accordingly. This bill increases the cost
of an entitlement program beginning in FY 2023.
Local Effect: The bill is not anticipated to effect local government finances.
Small Business Effect: Meaningful.
Analysis
Bill Summary: The required training may be provided by a supervisory staff member
responsible for developing an individual’s plan of care and assigning appropriate
personnel. The person providing training must issue a certificate of completion to each
individual who completes the training. An RSA must maintain records indicating the type
of training received by each individual who has received a certificate of completion while
employed by the RSA.
An RSA is not required to provide training when an individual has (1) provided
Alzheimer’s disease or dementia-related direct care or supervisory services for at least
24 consecutive months before beginning employment with the RSA and received a
certificate of completion from an RSA or other entity or (2) completed the continuing
education training in the immediately preceding 12 months.
Current Law: An RSA is an agency that provides supportive home care services, such as
assistance with activities of daily living, housekeeping services, and some nursing services.
An RSA may also provide one or more home care services or medical equipment
(e.g., oxygen, wheelchairs, walkers, and hospital beds). RSAs are licensed by the Office of
Health Care Quality in the Maryland Department of Health (MDH).
MDH must adopt regulations that set standards for the care, treatment, health, safety,
welfare, and comfort of individuals who receive home health care services through an RSA.
The regulations must provide for the licensing of RSAs. The regulations must include
provisions that (1) provide for the establishment of RSAs; (2) establish qualifications for
licensure; (3) set minimum standards for individuals who provide home health care
services through an RSA; and (4) require an RSA to screen and verify the character
references of all home health care providers employed by the RSA.
An RSA must ensure that individuals that are referred are trained appropriately to provide
care that is needed by the agency’s clients. At a minimum, training for individuals
providing care in clients’ homes must include:
 instruction and supervised practice in relevant personal care services of the sick or
disabled at home;
 identification of situations that require referral to a registered nurse, including
significant changes in a client’s condition;
 record keeping;
 ethical behavior and confidentiality of information;
 cardiopulmonary resuscitation;
 standard precautions for infection control; and
 prevention of abuse and neglect.
State Fiscal Effect: Medicaid advises that it sets actuarially sound rates for RSAs and
their providers on an annual basis, and the current rate methodology is inclusive of existing
RSA provider training requirements delineated in regulation. Medicaid further advises that,
based on an analysis of RSA provider rates and Medicaid beneficiary utilization data, MDH
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estimates a baseline increase in RSA provider rates of $0.25 per hourly unit to account for
new training requirements. The Department of Legislative Services advises that the extent
to which RSA provider rates increase depends on the number of staff that require training
and the type of training the staff receive. Thus, Medicaid expenditures increase by an
indeterminate amount (50% in general funds and 50% in federal funds) in fiscal 2023 and
subsequent years to comply with additional training requirements under the bill; federal
matching revenues increase correspondingly.
Small Business Effect: Small business RSAs must comply with the new training
requirements under the bill. To the extent Medicaid rates increase under the bill and the
RSAs accept Medicaid, revenues for small business RSAs increase to account for new
training requirements.
Additional Information
Prior Introductions: SB 897 of 2020, a similar bill, received a hearing in the Senate
Finance Committee, but no further action was taken. Its cross file, HB 1168, received a
hearing in the House Health and Government Operations Committee, but no further action
was taken.
Designated Cross File: HB 141 (Delegate Sample-Hughes) - Health and Government
Operations.
Information Source(s): Maryland Department of Health; Department of Legislative
Services
Fiscal Note History: First Reader - January 18, 2021
md/jc Third Reader - March 25, 2021
Revised - Amendment(s) - March 25, 2021
Revised - Clarification - March 25, 2021
Analysis by: Amberly Holcomb Direct Inquiries to:
(410) 946-5510
(301) 970-5510
SB 275/ Page 3