Direct Support Professionals Fairness and Security Act of 2005 - Amends title XIX (Medicaid) of the Social Security Act to provide funds to States to enable them to increase the wages paid to targeted direct support professionals in providing services to individuals with disabilities under the Medicaid program.
Directs the Secretary of Health and Human Services, through the Inspector General of the Department of Health and Human Services, to audit a sample from among the States in order to assess the effectiveness of progress made in reducing or eliminating the wage gap between targeted and reference direct support professionals through funds under this Act.
Requires the Comptroller General to study and report to Congress on the wage equalization and recruitment and retention of direct support professionals who are providing services and supports to individuals with disabilities.
[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1264 Introduced in House (IH)]
109th CONGRESS
1st Session
H. R. 1264
To amend title XIX of the Social Security Act to provide funds to
States to enable them to increase the wages paid to targeted direct
support professionals in providing services to individuals with
disabilities under the Medicaid program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 10, 2005
Mr. Terry (for himself, Mrs. Capps, and Mrs. Maloney) introduced the
following bill; which was referred to the Committee on Energy and
Commerce
_______________________________________________________________________
A BILL
To amend title XIX of the Social Security Act to provide funds to
States to enable them to increase the wages paid to targeted direct
support professionals in providing services to individuals with
disabilities under the Medicaid program.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; FINDINGS.
(a) Short Title.--This Act may be cited as the ``Direct Support
Professionals Fairness and Security Act of 2005''.
(b) Findings.--Congress finds the following:
(1) Direct support professionals are the primary providers
of long term care services for millions of individuals who have
physical or mental disabilities. Direct support professionals
provide assistance with activities of daily living,
instrumental activities of daily living, assistance with
rehabilitation, habilitation, training needs and other tasks.
All provide essential supports that help keep individuals with
disabilities connected to their communities.
(2) These workers who provide intimate supports are
predominately female and many are the sole breadwinners of
their families. Although working and paying taxes, many women
in these jobs remain impoverished and are eligible for many of
the same Federal and state public assistance programs upon
which the very individuals with disabilities to whom they
provide supports must depend.
(3) Throughout the nation, there is a critical shortage of
direct support professionals. Vacancy and turn over rates are
high. In many parts of the country, individuals with
disabilities are unable to access the services they need,
thereby jeopardizing their health and quality of life, placing
even greater burdens on their family members and informal
caregivers and creating long waiting lists for community
placement.
(4) The crisis that the nation faces today will only get
worse. Over the next 30 years, there will be a rapid rise of
the population over 65 years of age. At the same time, advances
in medical science and drug therapy are increasing the number
of people, of all ages, living with severe disabilities. Thus,
while demand for direct support professional services is
increasing, the pool of younger, entry level workers is
shrinking. By 2010, more than 780,000 additional workers must
be found to fill long-term direct support staff positions.
(5) To stabilize and increase the number of direct support
professionals in the work force, the wages and benefits of
direct support professionals must be improved and made
equitable among long term support options.
(6) Medicaid is the single-largest payor of long-term
supports and services for people with disabilities. Enhanced
Federal Medicaid matching funds should be available to assist
states committed to addressing wage differentials among direct
support professionals by increasing the wages of direct support
professionals and supporting and improving the stability of the
direct support professional workforce.
SEC. 2. MEDICAID AMENDMENT.
(a) Authorizing Establishment of Direct Support Professional Wage
Enhancement Plans.--Title XIX of the Social Security Act is amended--
(1) by redesignating section 1936 as section 1937; and
(2) by inserting after section 1935 the following new
section:
``direct support professional wage enhancement plan
``Sec. 1936. (a) State Option.--As a condition for the receipt of
increased funding described in subsection (f), a State is required to
provide for the implementation of a direct support professional wage
enhancement plan under this section.
``(b) Direct Support Professional Wage Enhancement Plan.--
``(1) In general.--For purposes of this section, the term
`direct support professional wage enhancement plan' means a
plan of a State that the Secretary determines meets the
following requirements:
``(A) Deadline for submission.--The plan is
submitted to the Secretary not later than 120 days
after the date the Secretary provides notice to States
under paragraph (3).
``(B) Contents.--
``(i) Equalization of hourly wage rates.--
The plan must describe how the State intends to
use the funds made available under this section
to increase the hourly wage rate of targeted
direct support professionals so that by the end
of the 5-year implementation period (as defined
in subsection (g)(4)) such rate is equal to the
average hourly wage rate of reference direct
support professionals.
``(ii) Additional provisions.--The plan
must include the additional information
described in subsection (c).
``(C) Implementation.--The plan must be developed
and implemented in accordance with subsection (d).
``(D) Annual reports.--The State must provide for
annual assessments and reports in accordance with
subsection (e).
``(2) Modification of plan.--Nothing in this section shall
be construed as preventing a State from time to time and with
the approval of the Secretary from modifying a direct support
professional wage enhancement plan so long as such plan, as
modified, continues to meet the requirements of paragraph (1).
``(3) Notice.--Not later than 90 days after the date of the
enactment of this section, the Secretary shall provide notice
to States regarding the provisions of this section, including
the availability of enhanced funding to implement direct
support professional wage enhancement plans.
``(c) Contents of Plan.--A direct support professional wage
enhancement plan shall include, consistent with the other requirements
of this section, the following:
``(1) A description of how the State intends to use funds
provided under this section to meet the requirement of
subsection (b)(1).
``(2) A description of the prevailing hourly wage rates for
targeted direct support professionals before the implementation
of such plan and any hourly wage rate differentials between
targeted direct support professionals and reference direct
support professionals.
``(3) The impact of wage differentials and labor market
conditions on the recruitment and retention of targeted direct
support professionals, including current or projected labor
shortages.
``(4) The identification of a specific, five-year
performance goal to increase the hourly wage rate of targeted
direct support professionals so as to eliminate any wage rate
differential between targeted and reference direct support
professionals and the methodology to be used by the State to
achieve its goal.
``(5) The annual performance goals and targets that the
State will monitor to track progress toward achieving its five-
year performance goal.
``(6) Current efforts to increase and stabilize the State's
direct support professional labor force and how the plan shall
be coordinated with such efforts.
``(7) Methods for assuring that funds provided under this
section shall be spent in accordance with such plan, and shall
not be used to supplant existing funds for wages and benefits
or to reduce the State's expenditures below the amount that the
State would have paid had the plan not been in effect.
``(8) A description of the stakeholders and collaborative
process used consistent with subsection (d) to develop the plan
and the means by which such collaboration shall continue during
the implementation of the plan.
``(9) Assurances satisfactory to the Secretary that upon
the expiration of the 5-year implementation period, the State
shall provide funding necessary to maintain the wage rates
attained under the plan for targeted direct support
professionals at the five-year performance goal increased
annually thereafter by a percentage that is not less than the
annual percent increase in the employment cost index (as
published quarterly by the Bureau of Labor Statistics).
``(d) Development and Implementation of Plan.--A direct support
professional wage enhancement plan shall be developed and implemented
in collaboration with--
``(1) targeted individuals with disabilities and family
representatives;
``(2) targeted direct support professionals;
``(3) agencies or provider organizations that serve
targeted individuals with disabilities and employ targeted
direct support professionals; and
``(4) individuals and organizations representing the
interests of those described in paragraphs (1) through (3).
``(e) Annual Assessment and Report.--
``(1) In general.--A State shall--
``(A) perform an assessment of the
operation of the direct care support
professional wage enhancement plan in the State
in each fiscal year; and
``(B) report to the Secretary by January 1
following the end of the fiscal year, on the
results of such assessment.
``(2) Contents.--Each such assessment shall include the
following:
``(A) An assessment of the effectiveness of the
plan in increasing the wages of targeted direct support
professionals and reducing or eliminating the wage gap
with reference direct support professionals.
``(B) An assessment of the State's progress in
meeting its annual performance goals under the plan.
``(C) An assessment of the effectiveness of the
State's collaboration with stakeholders on plan
development and implementation issues.
``(D) A review and assessment of State activities
to coordinate the plan with other activities in the
State to improve and stabilize the direct support
professional workforce.
``(E) Recommendations for improving the plan.
``(F) Such other information as the Secretary may
specify.
``(f) Increase in Payment to Implement Plan.--
``(1) In general.--Subject to paragraph (2), for each
calendar quarter during the 5-year implementation period in
which a direct support professional wage enhancement plan is in
effect under this section in a State, the amount of payment for
medical assistance under section 1903(a)(1) shall be increased
by the wage enhancement incentive percentage (as defined in
paragraph (3)(G)) multiplied by the portion of total funds
expended during the quarter for the provision of direct support
services to targeted individuals that are attributable to the
wages of targeted direct support professionals.
``(2) Limitation.--
``(A) In general.--Payments made under paragraph
(1) shall be used only to increase the wages of
targeted direct support professionals.
``(B) Treatment of employee benefits and salary
related benefits.--For purposes of subparagraph (A),
payments for costs of employee benefits and other
salary related benefits (including mandatory employment
taxes and benefits) shall be treated as payments to
increase the wages of targeted direct support
professionals so long as payments attributable to such
non-wage benefits do not exceed 20 percent of the total
amounts that increase the wages of targeted direct
support professionals.
``(3) Definitions.--For purposes of this subsection:
``(A) Annual rate differential percentage.--The
term `annual rate differential percentage' means, with
respect to a State for a year in which the direct
support professional wage enhancement plan is in
effect, the percent of the direct support professional
wage rate differential (as defined in subparagraph (E))
to be paid under plan for the year.
``(B) Average reference direct support professional
hourly wage rate.--The term `average reference direct
support professional hourly wage rate' means, for a
year under a direct support professional wage
enhancement plan, the average direct support
professional hourly wage rate (as defined in
subparagraph (D)), including any projected increase,
paid in the year to reference direct support
professionals who are employed by the State or, if
there are no such employees, to reference direct
support professionals who are employed by local
governments in the State, or, when necessary to meet
the purpose of the plan, any other reference wage rate
defined by the State and as approved by the Secretary.
``(C) Base-year average targeted direct support
professional hourly wage rate.--The term `average
targeted direct support professional hourly wage rate'
means, for a State, the average direct support
professional hourly wage rate (as defined in
subparagraph (D)) paid to targeted direct support
professionals under the State plan in the 12-month-
period immediately preceding the 5-year implementation
period.
``(D) Direct support professional hourly wage
rate.--The term `direct support professional hourly
wage rate' means--
``(i) the rate of hourly wage paid to a
direct support professional; plus
``(ii) mandatory employment taxes and
benefits (as defined in subparagraph (F)) paid
(as computed and applied on an hourly basis)
with respect to such employment.
``(E) Direct support professional wage rate
differential.--The term `direct support professional
wage rate differential' means, for a State for a year,
the amount by which--
``(i) the average reference direct support
professional hourly wage rate (as defined in
subparagraph (B)) for the State and year,
exceeds
``(ii) the base-year average targeted
direct support professional hourly wage rate
(as defined in subparagraph (C)) for the State.
``(F) Mandatory employment taxes and benefits.--The
term `mandatory employment taxes and benefits' means
taxes under section 3111 of the Internal Revenue Code
of 1986 (relating to the employer share of FICA taxes)
and the employer's share of unemployment compensation
and worker's compensation payments.
``(G) Wage enhancement incentive percentage.--The
term `wage enhancement incentive percentage' means--
``(i) the product of (I) the total direct
support professional wage rate differential (as
defined in subparagraph (E), and (II) annual
rate differential percentage (as defined in
subparagraph (A)); divided by
``(ii) the average reference direct support
professional hourly wage rate (as defined in
subparagraph (B)).
``(g) Inspector General Audit.--The Secretary, through the
Inspector General of the Department of Health and Human Services, shall
audit a sample from among the States in order to assess the
effectiveness of progress made in reducing or eliminating the wage gap
between targeted and reference direct support professionals through
funds under this section.
``(h) GAO Study.--
``(1) Study.--The Comptroller General of the United States
shall conduct a study concerning the wage equalization and
recruitment and retention of direct support professionals who
are providing services and supports to individuals with
disabilities.
``(2) Reports.--The Comptroller General shall submit to
Congress reports, in the third and fifth years in which this
section is being implemented, on progress made by States, and
the impact of payments under this section, on providing wage
equalization and in improving recruitment and retention of
direct support professionals.
``(i) Definitions.--For purposes of this section:
``(1) Direct support professional.--The term `direct
support professional' means an individual who, whether in a
supervisory or non-supervisory capacity, provides services and
supports, as needed, to an individual with a disability to
assist in acquiring, maintaining or enhancing skills necessary
to perform activities of daily living or instrumental
activities of daily living and health-related functions through
hands-on assistance, supervision, or cueing. Such term
includes, among others, individuals who may be classified as
nurses aides, home health aides, home care aides, personal care
aides and personal assistants, in-home support workers,
homemakers, behavioral specialists, habilitation specialist,
mental health rehabilitation technicians, independent living
skills specialists, crisis program workers, qualified mental
health or mental retardation professionals, and educational
technicians.
``(2) Direct support professional wage enhancement plan.--
The term `direct support professional wage enhancement plan' is
defined in subsection (b)(1).
``(3) Direct support services.--The term `direct support
services' means a range of services and supports, provided by
one or more persons, designed to provide support and health-
related services to an individual with a disability to enable
them to perform, acquire, maintain or enhance skills necessary
to perform activities of daily living, instrumental activities
of daily living (IADL) and health-related functions. Such term
includes personal care services, consumer-directed personal
assistance services, rehabilitation services, habilitation
services, and respite care.
``(4) Individual with a disability.--The term `individual
with a disability' means an individual who meets (or is
regarded as meeting) the criteria for being disabled under the
supplemental security income program under title XVI. Such term
includes an individual who, regardless of age, is eligible for
and receiving medical assistance under this title for any
benefits described in paragraph (i)(8).
``(5) 5-year implementation period.--The term `5-year
implementation period' means, with respect to a State and a
direct support professional wage enhancement plan under this
section, the period of 20 calendar quarters beginning with the
first full calendar quarter in which such plan is implemented
in the State under this section. Each of the five 4-calendar-
quarter periods within such period shall be treated as a year
for purposes of this section.
``(6) Reference direct support professional.--The term
`reference direct support professional' means a direct support
professional who--
``(A) is employed by a State or local government
entity; and
``(B) provides direct support services to targeted
individuals with disabilities under this title.
``(7) Targeted direct support professional.--The term
`targeted direct support professional' means a direct support
professional who--
``(A) is not employed by a State or local
government entity; and
``(B) provides direct support services to targeted
individuals with disabilities under this title.
``(8) Targeted individual with a disability.--The term
`targeted individual with a disability' means an individual
with a disability who is eligible for and is receiving medical
assistance under this title for personal care services under
section 1905(a)(23), for rehabilitative services under section
1905(a)(13), for home health care services, for home and
community-based services under a waiver approved under section
1915(c) or section 1115, or for intermediate care facility
services for the mentally retarded.''.
(b) Conforming Amendment.--Section 1903(a)(1) of such Act (42
U.S.C. 1396b(a)(1)) is amended by inserting ``and section 1936(f)''
after ``1923(f)''.
(c) Authorization of Planning Grants.--The Secretary of Health and
Human Services is authorized to award State planning grants in an
amount not to exceed, in the aggregate, $3,000,000, in order to assist
States in establishing direct support professional wage enhancement
plans under section 1936 of the Social Security Act, as inserted by
subsection (a).
<all>
Introduced in House
Introduced in House
Referred to the House Committee on Energy and Commerce.
Referred to the Subcommittee on Health.
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