DLTC INFO MEMO 2009-05
STATE OF WISCONSIN
Department of Health Services
Division of Long Term Care
DLTC Information Memo Series 2009-05
Date: September 24, 2009
Index Title: Quality Home Care Authority Initiative
To: Listserv
For: Area Administrators / Human Services Area Coordinators
County Departments of Community Programs Directors
County Departments of Developmental Disabilities Services Directors
County Departments of Human Services Directors
County Departments of Social Services Directors
County Waiver Coordinators
Tribal Chairpersons
From: Susan Crowley
Administrator
Subject: Quality Home Care Authority Initiative
Document Summary
A county may choose to participate in the provisions of the Quality
Home Care Authority (QHCA) initiative as enacted by the 2009 Wisconsin Act
28. This document describes the initiative and provides information on the
process for a county to notify the Department of Health Services of a
decision to participate.
Introduction
The 2009 Wisconsin Act 28 (2009-2011 budget) creates a Quality Home
Care Authority (QHCA) and establishes new provisions and requirements that
apply to independent home care providers under certain circumstances. The
provisions automatically apply to Family Care, Family Care Partnership,
PACE and IRIS (Include, Respect, I Self-Direct), but apply to other home
and community-based waiver programs for adults only if the county
operating the programs elects to participate through action by the county
board of supervisors. When a county transitions to Family Care, any
independent workers employed by individuals who transition to IRIS, Family
Care, Family Care Partnership or PACE will be subject to the provisions of
the law. Dane County has already implemented provisions similar to those
in the legislation and is able to participate without additional action by
its County Board.
Counties that will transition to Family Care in 2009 and 2010 may want
to consider opting into this initiative. As explained more fully below,
the QHCA provisions permit, but do not require, the formation of a union.
If a county opts in to the QHCA, independent home care workers serving
individuals who will transition to Family Care will be able to have a
voice in any election to form a union. Even if not involved in the
election process, those providers would be automatically included in a
union, should it be formed. Since no collective bargaining agreement can
be effective until the 2011-2013 biennium, the agreement would not affect
the home and community-based waivers operated by the county.
Background
The provisions of the QHCA initiative apply to the following:
- individual home care providers employed directly by adult
consumers who self-direct home care in Family Care, Family Care
Partnership, PACE and IRIS
- individual home care providers employed by consumers in those
counties that elect to participate.
The definition of home care under the QHCA provisions encompasses both
personal care and supportive home care when the provider is employed
directly by the participant. The requirements do not apply to providers
employed by agencies or through co-employment or agency-with-choice
arrangements.
When a county elects to participate in the initiative, the consumer and
county agency paying for the home care are required to provide the name
and address of each independent home care provider serving participants in
these programs to the QHCA which will maintain a list on behalf of the
Department of Health Services. These workers, collectively from all
counties, are designated as a statewide collective bargaining unit and are
enabled by the legislation to form a union, if they so choose, and to
elect a labor organization to bargain with the Department of Health
Services for wages and benefits only. The bargaining process will only be
implemented if the workers in the unit vote to form a union. If bargaining
occurs, the provisions require consumers and home care payers in these
programs to compensate covered providers in accordance with a
legislatively approved and funded collective bargaining agreement.
The language in the legislation maintains the employer/employee
relationship between the consumer and the provider and protects the
ability of the consumer to hire and fire providers and set conditions of
employment. Existing fiscal agent relationships in the covered programs
would also continue.
Quality Home Care Authority
The QHCA is an independent public authority governed by a board
appointed by the Governor with a majority membership of consumers and
their representatives and advocates. The QHCA provides a forum for efforts
to increase the number of individual home care providers in the state and
improve quality of care through access to training. The QHCA will not be
an employer of home care workers or a provider of those services. Services
of the QHCA (including the registry) would be available free of charge to
Medicaid recipients and their individual providers and to individual
providers who want to be included on the registry.
The duties of the QHCA are:
- Establish and maintain one or more registries of home care
providers and provide referral/matching services for consumers in
need of home care.
- Apply qualification criteria for home care providers who seek
placement on the registry and develop criteria and an appeal process
for denial or removal of a provider from the registry consistent
with the terms of Wisconsin's home and community-based waivers and
Medicaid State Plan. All current qualifications for individual
providers of care will apply.
- Develop and operate recruitment and retention programs to expand
the pool of providers.
- Provide orientation activities and skills training for home care
providers.
- Provide training for consumers in the duties and responsibilities
of employers and skills needed to be effective employers.
- Inform consumers of the background and qualifications of providers
on the registry and providers identified by consumers for
employment.
- Develop and operate a system of backup and respite referrals to
providers, including a 24/7 on-call service for consumers.
- Report annually to the Governor on the number of providers on the
registry and/or providing services under the auspices of the QHCA.
- Conduct other activities to improve supply and quality of direct
care workers.
The Registry
The registry that will be operated by the QHCA is a mechanism to recruit
and pre-qualify interested providers and to match consumers looking for
home care providers with qualified providers in their area. Only providers
who are available for and interested in employment would be included on
the voluntary registry. Providers who are not interested in additional
work would not be included on the registry. Consumers could continue to
hire family members, neighbors or friends as they do now. Individuals who
are hired would be part of the bargaining unit described below, but would
not have to join a union, if formed, or be placed on the registry for
purposes of matching with prospective employers. Background checks would
be completed through the mechanisms already established by the county for
providers identified by the consumer. The QHCA would conduct background
checks for potential providers who apply to be placed on the registry.
Collective Bargaining
The statute establishes a statewide collective bargaining unit to allow
the formation of a union, but it does not create or require a union. Home
care workers in the bargaining unit can participate in an election to form
the union. All individual providers defined in the statute would be part
of the bargaining unit, but even if a union is formed would not be
required to join. It will be the responsibility of the QHCA and the
Department to ensure that all eligible home care workers are identified as
part of the bargaining unit.
The language applies provisions of the State Employment Labor Relations
Act (SELRA) to the bargaining unit for purposes of collective bargaining
only (home care providers would not be state employees for other
purposes). The language uses a "showing of interest" provision
to conduct an election for an exclusive representative of the bargaining
unit; that is, permits independent home care providers to unionize. The
showing of interest must be at least 30% of the entire bargaining unit.
An individual provider remains the at-will employee of the consumer.
The Department of Health Services is designated as the employer for
purposes of collective bargaining only. The Department would consult with
consumer members of the QHCA regarding the bargaining process. The terms
of collective bargaining are limited to wages and benefits. The wage
rate(s) that result from the collective bargaining would be the minimum
pay. Consumers could choose to pay providers more than the minimum rate if
it fits within their budget. Any tentative agreement reached at bargaining
must be submitted to the legislature for approval as with other tentative
agreements under SELRA.
Action Steps
If the county chooses to participate, the county board of supervisors must
inform the Department of Health Services of its action. In doing so, the
county agrees to compensate covered providers in accordance with any labor
agreement and to make payroll deductions authorized by the agreement. If
the county decides not to participate, no action is required.
REGIONAL OFFICE CONTACT: DES/Human Service Area Coordinators-LTS
CENTRAL OFFICE CONTACTS:
Gail Propsom
Bureau of Long-Term Support
P.O. Box 7851, Room 450
Madison, WI 53707-7851
(608) 267-2455 phone
(608) 267-2913 fax
gail.propsom@wi.gov
MEMO WEB SITE: http://www.dhs.wisconsin.gov/dsl_info/
Last Revised: September 13, 2010 |
