Text of MD SB 920 (2025)

EXPLANATION: CAPITALS INDICATE MATTER ADDED TO EXISTING LAW. [Brackets] indicate matter deleted from existing law. *sb0920* SENATE BILL 920 J1, J3 5lr2424 CF HB 1142 By: Senator Gile Introduced and read first time: January 28, 2025 Assigned to: Finance A BILL ENTITLED AN ACT concerning 1 Public Health – Maryland Interested Parties Advisory Group – Establishment 2 FOR the purpose of establishing the Maryland Interested Parties Advisory Group to ensure 3 adequate access to applicable home– and community–based services and the 4 existence of an adequate direct care workforce in the State; requiring the Maryland 5 Department of Health to provide certain support to the Advisory Group; and 6 generally relating to the Maryland Interested Parties Advisory Group. 7 BY adding to 8 Article – Health – General 9 Section 15–1201 through 15–1205 to be under the new subtitle “Subtitle 12. 10 Maryland Interested Parties Advisory Group” 11 Annotated Code of Maryland 12 (2023 Replacement Volume and 2024 Supplement) 13 SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 14 That the Laws of Maryland read as follows: 15 Article – Health – General 16 SUBTITLE 12. MARYLAND INTERESTED PARTIES ADVISORY GROUP. 17 15–1201. 18 (A) IN THIS SUBTITLE THE FOLLOWING WORDS HAVE THE MEANINGS 19 INDICATED. 20 (B) “ADVISORY GROUP” MEANS THE MARYLAND INTERESTED PARTIES 21 ADVISORY GROUP ESTABLISHED UNDER § 15–1202 OF THIS SUBTITLE AND 22 REQUIRED UNDER 42 C.F.R. § 447.203. 23 2 SENATE BILL 920 (C) “APPLICABLE SERVICE CATEGORIES” MEANS HOMEMAKER SERVICES, 1 HOME HEALTH AIDE SERVICES, PERSONAL CARE SERVICES, AND HABILITATION 2 SERVICES. 3 (D) “CONSUMER” MEANS AN APPLICANT FOR, A RECIPIENT OF, OR AN 4 INDIVIDUAL ELIGIBLE FOR MEDICAID HOME– AND COMMUNITY–BASED SERVICES, 5 OR THE INDIVIDUAL’S AUTHORIZED REPRESENTATIVE. 6 (E) “CONSUMER ORGANIZATION” MEANS A STATE OR LOCAL CONSUMER 7 ADVOCACY GROUP OR OTHER COMMUNITY–BASED ORGANIZATION THAT 8 REPRESENTS THE INTERESTS OF, OR PROVIDES DIRECT SERVICES TO, CONSUMERS 9 OF MEDICAID HOME– AND COMMUNITY–BASED SERVICES. 10 (F) “DIRECT CARE WORKER” MEANS AN INDIVIDUAL: 11 (1) EMPLOYED BY A MEDICAID PROVIDER, STATE AGENCY, OR THIRD 12 PARTY; 13 (2) WHO CONTRACTS WITH A MEDICAID PROVIDER, STATE AGENCY, 14 OR THIRD PARTY; 15 (3) DELIVERING SERVICES UNDER A SELF–DIRECTED SERVICES 16 DELIVERY MODEL; OR 17 (4) WHO IS PAID TO PROVIDE HOME– AND COMMUNITY–BASED 18 SERVICES THROUGH AN APPLICABLE SERVICE CATEGORY. 19 (G) “HOME– AND COMMUNITY–BASED SERVICES” MEANS MEDICAID 20 HOME– AND COMMUNITY–BASED SERVICES DELIVERED THROUGH THE STATE PLAN, 21 A WAIVER UNDER § 1915(C) OF THE FEDERAL SOCIAL SECURITY ACT, A MANAGED 22 CARE PROGRAM, OR OTHER DEMONSTRATION PROGRAM. 23 (H) “PERSONAL CARE” HAS THE MEANING STATED UNDER § 19–301 OF THIS 24 ARTICLE. 25 (I) “PROVIDER ASSOCIATION” MEANS A TRADE ASSOCIATION EXEMPT 26 FROM FEDERAL INCOME TAXATION UNDER § 501(C)(6) OF THE INTERNAL REVENUE 27 CODE THAT REPRESENTS DIRECT CARE EMPLOYERS. 28 (J) “WORKER ORGANIZATION” MEANS AN ORGANIZATION THAT: 29 SENATE BILL 920 3 (1) IS EXEMPT FROM FEDERAL INCOME TAXATION UNDER §§ 1 501(C)(3) THROUGH (6) OF THE INTERNAL REVENUE CODE; 2 (2) IS NOT DOMINATED, CONTROLLED, OR FUNDED BY A DIRECT CARE 3 EMPLOYER; AND 4 (3) HAS AT LEAST 2 YEARS OF DEMONSTRATED EXPERIENCE 5 ENGAGING WITH AND ADVOCATING FOR DIRECT CARE WORKERS. 6 15–1202. 7 (A) THERE IS A MARYLAND INTERESTED PARTIES ADVISORY GROUP 8 WITHIN THE DEPARTMENT. 9 (B) THE PRIMARY PURPOSE OF THE ADVISORY GROUP IS TO ENSURE: 10 (1) MEDICAID PAYMENT RATES ARE SUFFICIENT TO PROVIDE 11 ADEQUATE ACCESS TO APPLICABLE SERVICE CATEGORIES; AND 12 (2) THE EXISTENCE OF AN ADEQUATE AND QUALIFIED DIRECT CARE 13 WORKFORCE TO PROVIDE SERVICES IN THE STATE. 14 15–1203. 15 (A) THE ADVISORY GROUP CONSISTS OF: 16 (1) THE DEPUTY SECRETARY, HEALTH CARE FINANCING, OR THE 17 DEPUTY SECRETARY’S DESIGNEE; 18 (2) THE FOLLOWING MEMBERS APPOINTED BY THE SECRETARY: 19 (I) THREE CONSUMERS; 20 (II) TWO REPRESENTATIVES OF CONSUMER ORGANIZATIONS; 21 (III) THREE DIRECT CARE WORKERS; 22 (IV) TWO REPRESENTATIVES OF WORKER ORGANIZATIONS; 23 (V) ONE REPRESENTATIVE OF A PROVIDER ASSOCIATION; AND 24 (VI) ONE REPRESENTATIVE OF THE GENERAL PUBLIC; AND 25 4 SENATE BILL 920 (3) ONE NONVOTING ADVISORY MEMBER FROM THE DIVISION OF 1 HEALTH CARE FINANCING AND MEDICAID WITH ADVANCED DATA LITERACY TO 2 ADDRESS ANY QUESTION OR ISSUE RELATED TO THE DATA EXAMINED BY THE 3 ADVISORY GROUP. 4 (B) TO THE EXTENT PRACTICABLE, THE MEMBERS APPOINTED TO THE 5 ADVISORY GROUP SHALL REFLECT THE DIVERSITY OF LIVED EXPERIENCE WITH 6 DISABILITY, AS WELL AS THE GEOGRAPHIC, RACIAL, ETHNIC, CULTURAL, GENDER, 7 SEXUAL ORIENTATION, GENDER IDENTITY, GENDER EXPRESSION, AGE, AND 8 SOCIOECONOMIC DIVERSITY OF THE STATE. 9 (C) (1) THE SECRETARY SHALL ESTABLISH AN APPLICATION PROCESS 10 THAT IS ACCESSIBLE TO THE GENERAL PUBLIC FOR THE RECRUITMENT OF 11 MEMBERS. 12 (2) THE APPLICATION AND CRITERIA FOR SELECTION SHALL BE 13 PUBLISHED ON THE DEPARTMENT’S WEBSITE. 14 (D) (1) THE DEPUTY SECRETARY, HEALTH CARE FINANCING, OR THE 15 DEPUTY SECRETARY’S DESIGNEE, SHALL CHAIR THE ADVISORY GROUP. 16 (2) THE DEPARTMENT SHALL PROVIDE STAFF AND SUPPORT FOR 17 THE ADVISORY GROUP, INCLUDING APPROPRIATE LOGISTICAL, INFORMATIONAL, 18 AND FINANCIAL SUPPORT TO ENSURE MEANINGFUL PARTICIPATION OF DIRECT 19 CARE WORKERS AND CONSUMERS IN THE ADVISORY GROUP. 20 (E) (1) THE TERM OF AN APPOINTED MEMBER OF THE ADVISORY GROUP 21 IS 3 YEARS. 22 (2) THE SECRETARY SHALL ENSURE THAT MEMBERS SERVE 23 STAGGERED TERMS. 24 (3) AT THE END OF A TERM, AN APPOINTED MEMBER CONTINUES TO 25 SERVE UNTIL A SUCCESSOR IS APPOINTED AND QUALIFIES. 26 (4) A MEMBER WHO IS APPOINTED AFTER A TERM HAS BEGUN SERVES 27 ONLY FOR THE REST OF THE TERM AND UNTIL A SUCCESSOR IS APPOINTED AND 28 QUALIFIES. 29 (5) THE SECRETARY MAY REMOVE OR SUSPEND A MEMBER OF THE 30 ADVISORY GROUP FOR MISCONDUCT, INCOMPETENCE, OR NEGLECT OF DUTIES 31 AFTER AN OPPORTUNITY FOR THE MEMBER TO BE HEARD. 32 SENATE BILL 920 5 (F) A MEMBER OF THE ADVISORY GROUP: 1 (1) MAY NOT RECEIVE COMPENSATION AS A MEMBER OF THE 2 ADVISORY GROUP; BUT 3 (2) IS ENTITLED TO REIMBURSEMENT FOR EXPENSES UNDER THE 4 STANDARD STATE TRAVEL REGULATIONS, AS PROVIDED IN THE STATE BUDGET. 5 (G) (1) BEGINNING NOVEMBER 1, 2025, THE ADVISORY GROUP SHALL 6 MEET ON A QUARTERLY BASIS. 7 (2) MEETING DATES, TIMES, AND LOCATIONS SHALL BE SELECTED TO 8 MAXIMIZE MEMBER ATTENDANCE. 9 15–1204. 10 (A) (1) THE DEPARTMENT SHALL ESTABLISH STANDARDIZED 11 PROCEDURES FOR THE ADMINISTRATION OF THE ADVISORY GROUP AND MAKE THE 12 PROCEDURES AVAILABLE TO THE PUBLIC ON A DEDICATED PAGE OF THE 13 DEPARTMENT’S WEBSITE. 14 (2) THE DEDICATED PAGE ON THE DEPARTMENT’S WEBSITE SHALL 15 ALSO INCLUDE: 16 (I) A LIST OF CURRENT ADVISORY GROUP MEMBERS; 17 (II) THE APPLICATION PROCESS AND SELECTION CRITERIA FOR 18 ADVISORY GROUP MEMBERS; 19 (III) THE LOCATION, DATE, AND TIME OF EACH ADVISORY 20 GROUP MEETING WITH AT LEAST 30 CALENDAR DAYS’ ADVANCE NOTICE; 21 (IV) OPTIONS FOR VIRTUAL PARTICIPATION IN MEETINGS OF 22 THE ADVISORY GROUP; 23 (V) PROCEDURES TO ENSURE MEANINGFUL PARTICIPATION 24 FOR INDIVIDUALS WITH DISABILITIES AND LIMITED ENGLISH PROFICIENCY; 25 (VI) A NOTATION OF AT WHICH MEETINGS THE GENERAL PUBLIC 26 WILL HAVE AN OPPORTUNITY TO TESTIFY OR MAKE COMMENTS; AND 27 6 SENATE BILL 920 (VII) IN ACCORDANCE WITH THE OPEN MEETINGS ACT, THE 1 AGENDA AND MEETING MINUTES OF THE PREVIOUS MEETING OF THE ADVISORY 2 GROUP, INCLUDING A LIST OF MEETING ATTENDEES. 3 (B) THE DEPARTMENT SHALL PROVIDE SUFFICIENT DATA AND RESOURCES 4 AT LEAST 30 DAYS IN ADVANCE OF A MEETING TO SUPPORT INFORMED 5 PARTICIPATION IN ADVISORY GROUP DISCUSSIONS, INCLUDING: 6 (1) DISTRIBUTING INFORMATION COLLECTED BY THE MARYLAND 7 DEPARTMENT OF LABOR UNDER § 15–156 OF THIS TITLE, INCLUDING DATA 8 COLLECTED BY RESIDENTIAL SERVICE AGENCIES RELATED TO DIRECT CARE 9 WORKFORCE: 10 (I) STABILITY, INCLUDING TOTAL NUMBERS OF FULL–TIME 11 AND PART–TIME HOME CARE WORKERS, PERCENTAGE OF THE YEAR THAT THE 12 EMPLOYEES WERE EMPLOYED, AVERAGE LENGTH OF EMPLOYMENT, TURNOVER 13 RATE, VACANCIES, AND UNSTAFFED HOURS MEASURED BY HOURS ALLOTTED IN 14 PLANS OF SERVICE FOR WHICH THE CONSUMER IS NOT RECEIVING CARE; 15 (II) COMPENSATION AND BENEFITS, INCLUDING THE HIGHEST, 16 LOWEST, MEDIAN, AND AVERAGE HOURLY WAGE PAID BY PROVIDER AGENCIES, 17 NUMBER OF HOURS AUTHORIZED FOR OVERTIME PAY, NUMBER OF HOURS PAID FOR 18 TRAVEL TIME BETWEEN CLIENTS, AND AVERAGE DAYS OF EARNED SICK AND SAFE 19 LEAVE PAID TO HOME CARE WORKERS EACH YEAR; 20 (III) EMPLOYEE BENEFITS, INCLUDING HEALTH, DENTAL, AND 21 VISION BENEFITS, LIFE AND DISABILITY INSURANCE, PAID LEAVE, RETIREMENT, 22 AND TUITION REIMBURSEMENT; 23 (IV) PROVIDER COSTS RELATED TO THE WORKFORCE, 24 INCLUDING COSTS OF REQUIRED TRAININGS, TRAVEL COSTS FOR DIRECT CARE 25 WORKERS SUCH AS MILEAGE REIMBURSEMENT OR PUBLIC TRANSPORTATION 26 SUBSIDIES, AND COSTS OF PERSONAL PROTECTIVE EQUIPMENT FOR DIRECT CARE 27 WORKERS; AND 28 (V) DEMOGRAPHIC INFORMATION INCLUDING AGE, GENDER, 29 RACE AND ETHNICITY, HIGHEST EDUCATIONAL LEVEL ATTAINED, CERTIFICATIONS 30 HELD, AND NUMBER OF YEARS OF DIRECT CARE WORK EXPERIENCE; 31 (2) FEDERALLY REQUIRED INFORMATION WITH A DETAILED 32 EXPLANATION OF THE METHODOLOGY AND DATA LIMITATIONS FOR EACH REPORT, 33 INCLUDING: 34 SENATE BILL 920 7 (I) HOME– AND COMMUNITY–BASED SERVICES PAYMENT 1 TRANSPARENCY REPORTS; 2 (II) PAYMENT ADEQUACY REPORTS AS REQUIRED UNDER 42 3 C.F.R. § 441.311(E); AND 4 (III) ACCESS–TO–CARE DATA, AS REQUIRED UNDER 42 C.F.R. § 5 441.311(D)(2); 6 (3) BUREAU OF LABOR STATISTICS PUBLICLY AVAILABLE WAGE 7 DATA AND OTHER LABOR MARKET AND WORKFORCE DATA; 8 (4) BENCHMARKING AND RATE STUDIES FOR HOME– AND 9 COMMUNITY–BASED SERVICES CONDUCTED BY THE DEPARTMENT; 10 (5) RATE INFORMATION FROM NEIGHBORING OR SIMILARLY 11 SITUATED STATES; AND 12 (6) ACCESS–TO–CARE METRICS, INCLUDING: 13 (I) THE NUMBER OF CONSUMERS RECEIVING APPLICABLE 14 SERVICES; 15 (II) THE NUMBER OF UTILIZATION HOURS FOR APPLICABLE 16 SERVICE CATEGORIES; 17 (III) A DESCRIPTION OF HOW THE STATE MAINTAINS THE 18 MEDICAID WAIVER WAITING LIST FOR HOME– AND COMMUNITY–BASED SERVICES; 19 (IV) THE NUMBER OF INDIVIDUALS ON THE WAITING LIST; 20 (V) THE AVERAGE LENGTH OF TIME NEW WAIVER ENROLLEES 21 WAITED TO ENROLL; AND 22 (VI) THE NUMBER OF TIMES INDIVIDUALS MUST RE–APPLY TO 23 RECEIVE SERVICES. 24 (C) THE DEPARTMENT SHALL CONSULT THE ADVISORY GROUP BEFORE 25 MAKING CHANGES TO PAYMENT RATES FOR APPLICABLE SERVICE CATEGORIES AND 26 SHALL AFFORD DEFERENCE TO THE ADVISORY GROUP’S RECOMMENDATIONS. 27 (D) (1) TO SUPPORT THE ADVISORY GROUP AND ENGAGE THE BROADER 28 DIRECT CARE WORKFORCE AND CONSUMERS ACROSS THE STATE, THE 29 8 SENATE BILL 920 DEPARTMENT SHALL DEVELOP A PUBLIC EDUCATION AND COMMUNICATION PLAN 1 TO INFORM DIRECT CARE WORKERS AND DIRECT CARE CONSUMERS OF: 2 (I) THE ADVISORY GROUP, ITS PURPOSE, MEETINGS, AND 3 OPPORTUNITIES FOR INPUT; AND 4 (II) A SUMMARY OF ITS ANNUAL REPORT AND ANY 5 RECOMMENDATIONS. 6 (2) THE PUBLIC EDUCATION AND COMMUNICATION PLAN MUST: 7 (I) ENSURE BROAD LANGUAGE ACCESS AND BE CULTURALLY 8 COMPETENT; 9 (II) USE TARGETED METHODS THAT WILL EFFECTIVELY 10 ENGAGE DIRECT CARE WORKERS AND DIRECT CARE CONSUMERS, INCLUDING 11 ADVERTISING AND OTHER MARKETING TOOLS; 12 (III) INCLUDE AN OPTION FOR DIRECT CARE WORKERS AND 13 DIRECT CARE CONSUMERS TO PROVIDE INFORMATION, INCLUDING A MAILING 14 ADDRESS, E–MAIL ADDRESS, OR TELEPHONE NUMBER, FOR PURPOSES OF 15 RECEIVING ONGOING COMMUNICATION FROM THE DEPARTMENT CONCERNING THE 16 ADVISORY GROUP AND OPPORTUNITIES FOR ENGAGEMENT WITH THE ADVISORY 17 GROUP; AND 18 (IV) REQUIRE EACH RESIDENTIAL SERVICE AGENCY TO 19 PROVIDE INFORMATION REGARDING THE ADVISORY GROUP DIRECTLY TO ITS 20 EMPLOYEES. 21 15–1205. 22 (A) THE ADVISORY GROUP SHALL: 23 (1) EVALUATE THE SUFFICIENCY OF MEDICAID PAYMENT RATES FOR 24 APPLICABLE SERVICE CATEGORIES; 25 (2) EXAMINE WORKING CONDITIONS FOR THE DIRECT CARE 26 WORKFORCE, INCLUDING CURRENT WAGE RATES AND OFFERED BENEFITS, 27 INITIATIVES FOR RETENTION AND RECRUITMENT OF WORKERS, TRAINING 28 REQUIREMENTS, AND ACCESS TO WORKER ORGANIZATIONS; 29 (3) EVALUATE CHALLENGES TO ACCESSING CARE FOR APPLICABLE 30 MEDICAID HOME– AND COMMUNITY–BASED SERVICES; AND 31 SENATE BILL 920 9 (4) DEVELOP A COMMUNICATION PLAN FOR THE DEPARTMENT’S 1 ENGAGEMENT WITH DIRECT CARE WORKERS AND CONSUMERS. 2 (B) (1) ON OR BEFORE SEPTEMBER 1 EACH YEAR, BEGINNING IN 2026, 3 THE ADVISORY GROUP SHALL REPORT ITS ACTIVITIES AND RECOMMENDATIONS TO 4 THE GOVERNOR AND, IN ACCORDANCE WITH § 2–1257 OF THE STATE GOVERNMENT 5 ARTICLE, THE GENERAL ASSEMBLY. 6 (2) THE REPORT OF THE ADVISORY GROUP SHALL ADDRESS: 7 (I) RECOMMENDATIONS FOR INCREASING MEDICAID 8 PAYMENT RATES FOR APPLICABLE SERVICE CATEGORIES; 9 (II) EMPLOYMENT STANDARDS FOR DIRECT CARE WORKERS, 10 INCLUDING A WAGE FLOOR AND EFFORTS TO COMBAT MISCLASSIFICATION OF 11 EMPLOYEES; 12 (III) REMOVING BARRIERS TO ACCESS TO CARE AND 13 RECOMMENDATIONS ON HOW TO IMPROVE ACCESS TO QUALITY AND CONTINUOUS 14 CARE; 15 (IV) MEANS THE STATE CAN USE TO COMMUNICATE 16 INFORMATION TO DIRECT CARE WORKERS AND CONSUMERS ABOUT THE PURVIEW 17 OF THE ADVISORY GROUP, ITS PURPOSE, ITS MEETINGS AND HEARINGS, AND 18 OPPORTUNITIES TO PROVIDE INPUT; AND 19 (V) THE ADVISORY GROUP’S REVIEW OF ANY RACIAL, GENDER, 20 OR ECONOMIC DISPARITIES IMPACTING DIRECT CARE WORKERS OR CONSUMERS 21 AND EXAMPLES OF RATES AND DELIVERY SYSTEMS FOR APPLICABLE SERVICES IN 22 OTHER STATES WITH FAVORABLE CONDITIONS FOR DIRECT CARE WORKERS AND 23 CONSUMERS. 24 (3) ANY RECOMMENDATIONS ADOPTED BY THE ADVISORY GROUP 25 MUST RECEIVE AN AFFIRMATIVE VOTE OF AT LEAST SEVEN MEMBERS. 26 (4) BEFORE THE SUBMISSION OF THE REPORT UNDER PARAGRAPH 27 (1) OF THIS SUBSECTION, THE DEPARTMENT SHALL REVIEW THE REPORT ON 28 RECEIPT FROM THE ADVISORY GROUP AND WITHIN 60 DAYS AFTER RECEIVING THE 29 REPORT RESPOND TO ANY RECOMMENDATION, INCLUDING ANY JUSTIFICATION FOR 30 DECLINING TO IMPLEMENT A RECOMMENDATION OF THE ADVISORY GROUP. 31 10 SENATE BILL 920 (5) FOLLOWING THE DEPARTMENT’S REVIEW OF THE ANNUAL 1 REPORT, THE DEPARTMENT SHALL: 2 (I) PROVIDE THE ADVISORY GROUP WITH AN OPPORTUNITY 3 TO MAKE CHANGES TO THE REPORT; AND 4 (II) POST THE REPORT TO THE DEPARTMENT’S WEBSITE 5 WITHIN 30 DAYS AFTER THE REPORT HAS BEEN FINALIZED. 6 (C) THE ADVISORY GROUP MAY HOLD OPPORTUNITIES TO SOLICIT AND 7 COLLECT TESTIMONY FROM THE PUBLIC AND INVITE INPUT FROM EMPLOYER 8 ORGANIZATIONS, WORKER ORGANIZATIONS, CONSUMER ADVOCACY GROUPS, AND 9 OTHER STAKEHOLDERS IN THE DIRECT CARE INDUSTRY. 10 (D) (1) AN EMPLOYER OR STATE AGENCY MAY NOT TAKE RETALIATORY 11 ACTION AGAINST A DIRECT CARE WORKER OR CONSUMER FOR PARTICIPATION IN 12 THE ADVISORY GROUP. 13 (2) THIS SECTION DOES NOT LIMIT THE RIGHTS OF DIRECT CARE 14 WORKERS UNDER STATE OR FEDERAL EMPLOYMENT OR LABOR LAW, OR 15 COLLECTIVE BARGAINING AGREEMENTS. 16 SECTION 2. AND BE IT FURTHER ENACTED, That the Secretary shall appoint 17 the initial members of the Maryland Interested Parties Advisory Group on or before 18 October 1, 2025. 19 SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall take effect July 20 1, 2025. 21