Citing patient safety and the need for the proper tools to fight Medicaid fraud, Attorney General Peter F. Kilmartin has submitted legislation that would require national background checks and licenses for personal care attendants. The legislation – H7442, sponsored by Representative Eileen Naughton (D-District 21, Warwick) is scheduled to be heard before the House Committee on Health, Education and Welfare today, Wednesday, March 19, 2014. The senate companion bill (S2665) is sponsored by Senator Frank S. Lombardi (D-District 26, Cranston).
Under the Global Medicaid Waiver, the State of Rhode Island received permission from the Centers for Medicare and Medicaid to offer seniors more options. One goal was to allow them to stay in their own homes longer, and stay out of an institutional nursing home setting. Recognizing that individuals need different levels of care at home, the system relies on the expanded use of personal care attendants. Personal care attendants do not provide any medical services, but do provide services to help consumers stay in their home, such as grooming, household tasks and transportation. "For patient safety, especially due to the vulnerability of our seniors, workers in this field need to be subject to a national background check, training and regulation. As more patients return to home under the Global Medicaid Waiver, we need to ensure the most vulnerable are being treated by professional workers to protect them from victimization and exploitation," said Attorney General Kilmartin.
The legislation requires all personal care attendants to be subject to a national background check as a condition of certification and employment. It also allows for the biannual renewal of registrations, which would be granted as a matter of course with proof of completion of continuing education unless the Department of Human Services ("DHS") finds that the registrant has acted or failed to act in a manner that would constitute grounds for suspension or revocation of a certificate. The legislation allows for DHS to deny, suspend or revoke a person's certificate of registration in any case in which it finds that there has been failure to comply with the requirements, or that the registrant has been convicted of a disqualifying offense. Finally, the legislation provides criminal penalties and fines for those who fraudulently serve as a personal care assistant.
"This is a safety issue for our most vulnerable citizens. Although personal care attendants do not provide medical services, they provide assistance with physical activities, such as grooming and bathing, and financial activities, such as paying bills and shopping, as well as companionship for their clients. I strongly believe it is necessary, due to the intimate physical tasks required of personal care attendants, that they be required to receive a national criminal records check and basic training, as well as individualized training to suit the needs of their client," concluded Kilmartin.
Kilmartin believes this is also a fiscal issue as well. The Office's Medicaid Fraud Unit's colleagues from across the county have stated that over fifty percent of their Medicaid fraud cases are due to home care services. In Rhode Island, home care Medicaid fraud is only one to two percent of the Office's Medicaid Fraud Unit's case load. While it would be optimistic to say that this is because these criminal acts are not occurring, it is likely due to the fact that PCAs are not aptly regulated; therefore, there is not an adequate process to determine whether fraud is taking place. For instance, in September of 2011, a Rhode Island man was convicted in Massachusetts for defrauding the Massachusetts Medicaid program of more than $100,000 for fraudulently providing PCA services when such services were never delivered.
States across the country, including, but not limited to, Minnesota and Pennsylvania, have enacted statutes and regulations for personal care services.