August
8, 2001
MB-AASA-AAA/HCS/DDD/RCS-01-27
MANAGEMENT BULLETIN
TO: Area
Agency on Aging Directors
Home
and Community Services Regional Administrators
Division
of Developmental Disabilities Regional Administrators
SUBJECT: HOME CARE RATE INCREASES, LEGISLATIVE ADJUSTMENTS and CONTRACTING REQUIREMENTS
Reference: MB-AASA-AAA/HCS/RCS/DDD-99-27
MB-AASA-AAA/HCS/RCS/DDD-01-23
In-home agency and individual provider services
authorized with SSPS service codes that use hours as a unit will be
automatically increased to implement the new minimum hourly rates. All in-home agency hourly rates are $13.30
and individual provider hourly rates are $7.68 effective July 1, 2001.
Remember, the purpose of
funding these new minimums is to assure direct care workers receive a wage
increase. The in-home agency provider rate increase of $.68/hr is to give an
average wage increase of $.50/hr across the identified eligible employee group.
The remaining $.18/hr is to be utilized to pay the employer share of
unemployment and social security taxes on the associated wage increases, and to
pay for other general administration costs. The budget proviso does not require
that each worker get the same increase. It is up to the provider and the AAA
how the resources are distributed, provided the increase, in aggregate, has
gone to direct care worker wages.
The AAA must require the
provider to demonstrate that its salary policy and schedules have been adjusted
in accordance with the new wage requirements. The AAA must also monitor to
assure that those policies have been implemented in a way that complies with
the legislation. AAA’s should continue to stipulate in contract that misused
funds could be recaptured. The new vendor rate will be the same for all
providers throughout the state.
August 8, 2001
Page Two
The average increase is to apply to the wage pool of all direct care workers as determined by the home care agency salary policy and schedule. All direct care workers can receive a wage increase, regardless of the number of hours worked per week. The hours paid for all direct care workers must be included in the base against which the $.50 average increase is calculated. The home care agency must demonstrate that it’s direct service workers have, on average, benefited by a $.50 salary increase.
Private Pay Rates of Contracted Vendors
All
home care agencies, as with other contractors accepting state and federal
dollars for services, continue to be subject to 42 CFR 447.325. It states “The
agency (department) may pay the customary charges of the provider but must not
pay more than the prevailing charges in the locality for comparable services
under comparable circumstances.”
The
CFR (Code of Federal Regulations) is the basis of the policy that a provider
cannot charge less for its services than what the state agency pays the
provider for services. The analysis of
whether non-compliance exists requires more than comparing the provider’s
charges for services with the state agency’s payment rates. A number of factors need to be analyzed:
1.
Is
the service package that the private pay client purchases equal to the service
package that the state purchases? If
the private pay client is getting fewer services for its payment, then the
state agency is not paying more for comparable services. An example of this might be a service
package to a private pay client that is for housekeeping only and does not
include personal care services.
2.
If
the overall costs of the service is equal to or greater than the rate the state
agency, but the charges are legitimately split between payors. An example would be a sliding fee scale
where the client is paying $10.00 per hour for the service and another funding
source such as the fundraising department or other local source is paying $3.30
per hour or higher.
The
important thing is that Medicaid is not paying more than the prevailing charges
in the locality and that Medicaid dollars are not being used to subsidize other
funding sources for the delivery of comparable services (i.e. a sliding fee
scale home care service). This also applies to other contracts in place for the
same service (ADC, HDM, etc). A program may charge and be paid a higher rate
based upon cost reports or other AAA required justifications but it cannot
charge or be paid less than the customary charge paid by the Medicaid provider.
The
web site for CFR’s is http://www.access.gpo.gov/nara/cfr/cfr-table-search.html
MB-AASA-AAA/HCS/DDD/RCS-01-27
August 8, 2001
Page
Three
Vendor Rate Increase Also Applies to Respite Services
The vendor rate increase does apply to the Respite Program. Providers of personal care (level 2) in the Respite Program are covered by the legislated personal care rate and the worker wage enhancement requirements that accompany it. The rate should reflect the same wage for the same service provision.
Additional respite funding will be provided to meet this obligation. The increase needed will be relatively small because only a portion of respite funds pay for direct service worker wages. The amount and distribution will be reflected in the SF02 budget amendments.
The average $.50 wage increase applies to an agency that provides home care through the Respite program regardless of whether the agency is a sole contractor of respite only services or contracts for MPC, COPES, CHORE and Respite.
In June 2001 AASA provided an information sheet about
“Minimum Hourly Payment for New Home Care Agency Contractor Aides”. Upon
further research it does not appear that there is legislative authority for
implementing this viewpoint as a policy.
In the event an AAA has referenced the contents of this information
sheet in any of the home care agency contracts it needs to be removed. There is
no statewide minimum wage requirement for new home care agencies other than
what is required of all employers in this state. Individual AAA’s may place
other wage requirements on their providers as part of their procurement
process.
If you have
any questions regarding these adjustments, contact your Area Agency on Aging
State Unit on Aging representative or Marietta Bobba at 360-725-2553 or bobbam@dshs.wa.gov
For questions on Respite Care contact Hilari Hauptman at 360-725-2556 or haupthp@dshs.wa.gov
__________________________________ _______________________________________
Penny Black, Director Denise Gaither,
Director
Home and Community Services Division Management Services
Division
cc: Sue
Poltl, DDD
Hank
Balderrama, MHD
James
Reddick, DCFS