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2022 SESSION

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22103371D
HOUSE BILL NO. 1294 Offered January 20, 2022 A BILL to amend the Code of Virginia by adding in Article 1 of Chapter 10 of Title 32.1 a section numbered 32.1-331.05, relating to personal care services; requirements for managed care organizations. ---------- Patron-- Gooditis ---------- Referred to Committee on Health, Welfare and Institutions ----------

Be it enacted by the General Assembly of Virginia:

1. That the Code of Virginia is amended by adding in Article 1 of Chapter 10 of Title 32.1 a section numbered 32.1-331.05 as follows:

§ 32.1-331.05. Personal care services; redetermination of authorized hours.

The Department shall include in every contract between the Department and a managed care organization a provision that:

1. 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

2. 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.

2. That the Department of Medical Assistance Services shall seek federal approval to amend the Commonwealth Coordinated Care Plus waiver and, upon receipt of such approval, shall 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.