Provides for the suspension of a commercial driver's license if a driver has been convicted of a violation of local laws relating to a designated system of truck routes

2025 Regular Session Introduced by Brian Cunningham

Raises Medicaid PCA weekly cap from 40 to up to 91 hours for beneficiaries needing nursing-level care, expanding home/community care and possibly reducing institutional stays.

REFERRED TO TRANSPORTATION

Purpose

A4090 increases the weekly cap on Medicaid-funded personal care assistant (PCA) services from the current regulatory maximum of 40 hours to up to 91 hours per calendar week for Medicaid beneficiaries who are clinically eligible for nursing-facility level of care. The intent is to enable more beneficiaries to remain in community settings by authorizing more home- and community-based supports.

Key provisions

Raises the PCA services cap to up to 91 hours per week for any Medicaid beneficiary clinically eligible for nursing-facility level of care (notwithstanding contrary regulations).

Requires the Department of Human Services (DHS) to modify the existing PCA assessment tool to reflect the increased hours and related eligibility/needs determinations.

Directs the Commissioner of Human Services to apply for necessary State Plan amendments or federal waivers to obtain federal financial participation for the expanded services.

Requires DHS to adopt implementing rules and regulations under the Administrative Procedure Act.

Committee amendments add:

A requirement that, prior to implementation, the Commissioner provide a separate rate certification for the increase in PCA hours within the State’s managed long-term services and supports (MLTSS) program consistent with federal standards (including 42 C.F.R. 438.4).
A requirement that implementation of an increase during a State Fiscal Year trigger a mid‑year rate adjustment for the MLTSS program.

Definition of PCA services

The bill defines “personal care assistant services” as health-related tasks associated with cueing, supervision, or completion of activities of daily living and related tasks; services must be:
- certified as medically necessary,
- provided under a beneficiary’s written plan of care,
- performed by a qualified individual (typically in the beneficiary’s home, workplace, or post‑secondary setting),
- under the supervision of a registered professional nurse.

Who is affected

Medicaid beneficiaries clinically eligible for nursing-facility level of care (potentially able to receive substantially more home/community PCA hours).

PCA providers and agencies, and supervising nurses.

Managed care organizations participating in the State MLTSS program.

State Medicaid budget and federal/state payment streams (DHS must secure federal match).

Procedural/timeline aspects

Bill takes effect immediately upon enactment.

DHS must pursue federal approvals (State Plan amendments/waivers) and promulgate regulations.

Committee-reported with amendments on 6/24/2024; introduced 3/18/2024; later referred to Transportation (1/31/2025).

Companion bill: S3705; prior-session related bill: A8339.

Potential impact

Increases home/community-based care capacity for high-need beneficiaries and may reduce institutional placements.

Likely increases Medicaid service expenditures unless offset by reduced institutional costs; federal matching funding is sought.

Requires adjustments to MLTSS payment rates and administrative systems (assessment tool, provider payments).

Bill