HB 1294

Abstract

Personal care services; requirements for managed care organizations. Requires the Department of Medical Assistance Services (the Department) to include in every contract between the Department and a managed care organization a provision that (i) authorizations or reauthorizations of consumer-directed or agency-directed personal care service hours for individuals receiving services through the Commonwealth Coordinated Care Plus waiver shall be required no more frequently than once every 12 months unless warranted by a substantial change in the medical needs of the service recipient and (ii) the managed care organization shall not remove a provider that provides consumer-directed or agency-directed personal care services for individuals receiving services through the Commonwealth Coordinated Care Plus waiver from its provider network without cause, and shall provide a written statement setting forth such cause to the provider prior to such removal. The bill also requires the Department to seek federal approval to amend the Commonwealth Coordinated Care Plus waiver and, upon receipt of such approval, amend the implementing regulations to provide that authorizations and reauthorizations of consumer-directed or agency-directed personal care service hours for individuals receiving services through the Commonwealth Coordinated Care Plus waiver shall be required no more frequently than once every 12 months unless warranted by a substantial change in the medical needs of the service recipient.