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2005 Testimony

Testimony Before The Senate Human Services Committee

Judy Lee, Chairman

HB 1148 - Personal Care Services for Eligible Medicaid Recipients

February 28, 2005

Chairman Lee, members of the committee, I am David Zentner, Director of Medical Services for the Department of Human Services. I appear to provide information, and support this proposed legislation.

This bill will make the personal care option a permanent service available through the North Dakota Medicaid program, and includes an emergency clause so the law can become effective as of July 1, 2005.

During the previous session, the Legislature authorized the Department to implement the Workers with Disability Program, and provide a personal care option for individuals residing in their own homes. The bill contained a sunset clause. Previous to this legislation, the personal care option in the Medicaid program was limited to personal care provided in Basic Care Facilities through a federally approved state plan amendment. Personal care was also available through the home and community based waivers approved by the federal government.

Personal care services consist of hands on care and/or cueing for individuals who need assistance with activities of daily living, or instrumental activities of daily living.

A State Plan Amendment was submitted in August 2003 that requested approval to provide personal care services in a home setting and in a basic care facility. Staff from the Centers for Medicare and Medicaid Services (CMS) were initially going to deny the plan because we wished to continue to pay for personal care services in Basic Care. After many months of discussion they finally agreed that indeed services provided in a Basic Care Facility constituted personal care services. We then had a great deal of discussion over what costs could be included in calculating a personal care rate in each facility. After more months of discussions we have finally received word that the plan has been approved. We still have not received the official written notification of the approval.

As a result, we have been unable to claim any federal funds for providing personal care services in the home setting. The Department will now be able to claim funds back to September 2003 for those instances that we can identify as qualifying for personal care services.

The bill was amended to require the Department to seek a waiver to permit nonlicensed providers to provide personal care services if requested by the recipient and authorized by the Department. Currently non-licensed providers can deliver personal care services relating to activities of daily living. The complicating factor is the delivery of services that require some medical intervention such as suctioning.

The Department is sensitive to the desire of disabled and elderly persons to live in their own homes and also be able to direct their own care if they are able. For that reason, we suggest a wording change to the amended section starting on line 10 of page 1. The proposed amendment language is attached.

The Executive Budget to maintain the personal care option for the 2005-2007 biennium is $14.7 million of which $5.2 million is general funds as noted in the attached fiscal note. Medicaid recipients who would have otherwise received these services through Service Payments for the Elderly and Disabled (SPED), Expanded SPED, and the three home and community based Medicaid waivers will receive the services through the Medicaid personal care option. In addition other Medicaid recipients who meet established criteria are eligible to receive personal care services.

In order to continue to claim federal funds for Basic Care Facilities, CMS has indicated that it is necessary to also have a personal care option for individuals in their own homes. The budget for the 2005-2007 biennium for Basic Care is $13 million of which $5.4 million is federal funds. If we don’t make the law permanent we will lose these funds and will need to replace them with general funds.

For the above reason, we support making the personal care option a permanent service available to Medicaid recipients and we recommend a do pass on this proposed legislation.

I would be happy to respond to any questions you may have.


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