Bill Summary – FastDemocracy

FILED SENATE
                                                                                            Apr 6, 2021
                           GENERAL ASSEMBLY OF NORTH CAROLINA
                                                                  S.B. 610
                                       SESSION 2021           PRINCIPAL CLERK
     S                                                                     D
                               SENATE BILL DRS35247-MRa-97A
     Short Title:    Address Direct Sup. Staffing Crisis/Medicaid.                                 (Public)
     Sponsors:       Senators Burgin, Krawiec, and Perry (Primary Sponsors).
     Referred to:
                                      A BILL TO BE ENTITLED
 AN ACT TO ADDRESS THE STAFFING CRISIS IMPACTING INTERMEDIATE CARE
      FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES.
              Whereas, staffing turnover rates for direct support personnel providing services and
 support to individuals with intellectual and other developmental disabilities have increased
 substantially during the past two years; and
              Whereas, direct support personnel are front-line health care service providers who are
 responsible for all aspects of the day-to-day habilitation, care, and support of persons with
 intellectual and other developmental disabilities; and
              Whereas, it is the intent of the General Assembly to preserve and improve the quality
 and consistency of care for persons with intellectual and other developmental disabilities who
 receive services and support in intermediate care facilities for individuals with intellectual
 disabilities (ICF/IIDs), including ICF/IID group homes; and
              Whereas, it is the intent of the General Assembly to improve the retention rates and
 hiring rates for qualified direct support personnel who are the front line of care provision and
 service delivery in ICF/IIDs; and
              Whereas, because recruitment and retention of qualified direct support personnel are
 critical to the delivery of quality, effective habilitation and support services, it is imperative that
 the hourly wages paid to direct care personnel be competitive and comparable to the hourly wages
 paid to employees in retail, food service, and State-operated developmental centers; Now,
 therefore,
 The General Assembly of North Carolina enacts:
              SECTION 1.(a) ICF/IID Support Personnel. – The Department of Health and
 Human Services, Division of Health Benefits (DHB), shall adjust the per member per month
 (PMPM) capitation amount paid to local management entity/managed care organizations
 (LME/MCOs) operating capitated contracts for mental health, intellectual and other development
 disabilities, and substance abuse services to include amounts sufficient to increase wages paid to
 direct support personnel working in intermediate care facilities for individuals with intellectual
 disabilities (ICF/IIDs), including ICF/IID group homes, to align the wages paid to these direct
 support personnel with the current wages paid to State employees in State-owned developmental
 centers. The following shall apply to PMPM capitation amount adjustments made under this
 section:
              (1)     The adjustments shall be consistent with the North Carolina Medicaid State
                      Plan requirements to provide for actuarially sound rates sufficient to operate
                      and provide safe and effective services.
                                   *DRS35247-MRa-97A*
     General Assembly Of North Carolina                                                    Session 2021
            (2)       DHB shall validate the actual amounts necessary to adjust the relevant portion
                      of the LME/MCO PMPM capitation payment to align wages paid to direct
                      support personnel with current wages paid to State employees in State-owned
                      developmental centers.
              (3)     The adjustments shall be considered directed payments made to LME/MCOs
                      under 42 C.F.R. § 438.6, in order to assure that the increased amounts are used
                      for wage increases.
              (4)     Providers receiving any increase in funds from LME/MCOs to be used for
                      wage increases shall attest and provide verification that those increased funds
                      are being used for the purpose of increasing wages paid to direct support
                      personnel and employees who support direct support personnel. LME/MCOs
                      may require verifiable methods of accounting, such as payroll-based journals.
              After the implementation of this section, DHB shall continue to work with
 stakeholders and service providers to develop an appropriate methodology for tracking progress
 towards increasing direct support personnel wages and to determine if any additional resources
 are necessary to achieve alignment of these wages with the current wages paid to State employees
 in State-owned developmental centers.
              SECTION 1.(b) Funds for Rate Adjustments Made Under This Section. – There is
 appropriated from the General Fund to the Department of Health and Human Services, Division
 of Health Benefits, the sum of seventeen million five hundred thousand dollars ($17,500,000) in
 recurring funds for the 2021-2022 fiscal year and the sum of twenty-one million eight hundred
 thousand dollars ($21,800,000) in recurring funds for the 2022-2023 fiscal year to be used to
 adjust the PMPM capitation amount paid to LME/MCOs in accordance with this section. These
 funds shall provide a State match for fifty-nine million four hundred thousand dollars
 ($59,400,000) in recurring federal funds for the 2021-2022 fiscal year and fifty-five million six
 hundred thousand dollars ($55,600,000) for the 2022-2023 fiscal year, and those federal funds
 are appropriated to the Division of Health Benefits to be used to adjust the PMPM capitation
 amount paid to LME/MCOs in accordance with this act.
              In addition to the appropriations under this section, DHB shall maximize the ICF/IID
 assessment, established under Section 10.8(a) of S.L. 2004-124, and, notwithstanding Section
 10.8(c) of S.L. 2004-124, shall utilize the proceeds for the purpose of implementing this act.
              SECTION 1.(c) Cost-of-Living Adjustments. – To the extent practicable, the
 General Assembly recommends that, when setting the PMPM capitation amount paid to
 LME/MCOs for future capitation rate cycles, DHB take into account cost-of-living adjustments
 and wage and hour cost-of-living adjustments for direct support personnel working in ICF/IIDs,
 including ICF/IID group homes, in an amount equal to those adjustments made for similar
 personnel working in State-operated developmental centers.
              SECTION 2. Methodology for Determining Appropriate Wages to Be Paid. – To
 establish a baseline methodology for determining the appropriate wages to be paid in accordance
 with this act, the Department of Health and Human Services, Division of Health Benefits (DHB),
 shall use information from the Office of State Human Resources job classification and wage and
 hour data for the specific employees working at State-operated developmental centers who are
 in comparable job classifications as those direct support personnel working in intermediate care
 facilities for individuals with intellectual disabilities (ICF/IIDs), including ICF/IID group homes.
 DHB shall make appropriate adjustments for health insurance, retirement benefits, and other key
 factors that drive total labor costs. DHB shall also take into consideration market-based wage
 comparisons of direct support personnel working in ICF/IIDs with State employees working in
 the State-operated developmental centers, direct support personnel working in private work
 settings, including health care facilities and health services settings, and employees working in
 private sector businesses that compete to hire the same employees, such as retail and fast food.
 DHB may accept actuarially sound projections of competitive wage and hour data and other cost
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     General Assembly Of North Carolina                                                  Session 2021
 data from non-State entities in order to calculate forward looking wage analysis formulas and
 finalize the exact rates needed to implement this act.
             SECTION 3. Mid-Rate Cycle Adjustments. – If a local management entity/managed
 care organization implements a provider rate increase or adjustment in accordance with this act
 at any time other than the beginning of a rate cycle, then the Department of Health and Human
 Services, Division of Health Benefits, shall provide the funds necessary to sustain that rate
 increase or adjustment in the applicable per member per month capitation amount for the next
 rate cycle.
             SECTION 4. Approval by the Centers for Medicare and Medicaid Services Required
 Before Implementation. – The Department of Health and Human Services, Division of Health
 Benefits (DHB), is directed to seek approval from the Centers for Medicare and Medicaid
 Services (CMS) prior to implementing the rate increases described under Section 1 of this act.
 Upon approval, DHB shall implement the rate increases to the extent allowed by CMS.
             SECTION 5. Effective Date. – Sections 1, 2, and 3 of this act become effective upon
 the approval by CMS required by Section 4 of this act. The Secretary shall notify and provide
 verification to the Office of State Budget and Management and the Fiscal Research Division
 upon receipt of this approval. The remainder of this act becomes effective July 1, 2021. If the
 approval required by Section 4 of this act is not granted by CMS prior to June 30, 2023, then this
 act shall expire on that date.
     DRS35247-MRa-97A                                                                           Page 3