1 Quality Home Care Authority Presented by Department of Health Services October 13, 2009

2 Established in Budget Act 28 creates the Quality Home Care Authority (QHCA) as an independent public authority governed by a board 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.

3 Applicability Applies to individual providers employed directly by consumers who self-direct home care in Family Care, IRIS (Include, Respect, I Self-Direct) and to individual providers employed by consumers in other home and community-based waiver programs in counties that elect to participate. Home care under the QHCA provisions includes both personal care and supportive home care.

4 QHCA Duties 1. Establish and maintain one or more registries of home care providers and provide referral/matching services for consumers in need of home care. 2. Apply qualification criteria for home care providers who seek placement on the registry. All current qualifications for individual providers of care will apply. 3. Develop and operate recruitment and retention programs to expand the pool of providers.

5 QHCA Duties (continued) 4. Provide orientation activities and skills training for home care providers. 5. Provide training for consumers in the duties and responsibilities of employers. 6. Inform consumers of the background and qualifications of providers on the registry and providers identified by consumers for employment.

6 QHCA Duties (continued) 7. Develop and operate a system of backup and respite referrals, including a 24/7 on- call service for consumers. 8. Conduct other activities to improve supply and quality of direct care workers.

7 The Registry Provides a resource for consumers looking for providers and providers looking for work. Workers on the registry will meet minimum qualifications and have undergone a background check. The registry should not be confused with the list of providers who are part of the bargaining unit described in next slides.

8 Potential Union Formation Creates potential to form a union: – The statute permits, but does not require, workers to form a union. – All individual providers defined in the statute would be part of the bargaining unit, but would not be required to join a union if formed. – To conduct an election for union representation, there must be a “showing of interest” by 30% of the total number of people eligible for the bargaining unit.

9 Union Provisions If a union is formed: – Providers would not be required to join a union if formed, but all would be represented by the union. – Any “maintenance of membership” or “fair share” agreement regarding payment of union dues must be authorized by eligible employees voting in a referendum. – The law prohibits strikes by any union that may be formed.

10 Collective Bargaining Bargaining provisions: – Department of Health Services is 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 consumer is still the employer of record and retains the ability to hire and fire providers and set conditions of employment.

11 Bargaining Agreement Bargaining agreement: – The bargaining agreement is subject to legislative approval. – A collective bargaining agreement cannot become effective before July – The wage rate(s) under the collective bargaining would set the minimum rate of pay. Consumers could choose to pay providers more than the minimum rate.

12 Employer Requirements The employer is the program participant/consumer who employs one or more direct care workers. Employers of independent home care workers must: – Provide information about workers to the QHCA/Department and – Pay workers at a level that is consistent with any collective bargaining agreement.

13 Payer Requirements Payers include managed care organizations, the Department and counties that elect to participate. Payers must: – Provide information about workers to the QHCA/Department and – Ensure that workers are paid at a level consistent with any collective bargaining agreement.

14 What to Expect-QHCA Governor will make Board appointments. Organizational meetings will be held. QHCA board will: – make decisions regarding staffing; – develop by-laws, policies, etc.; and – begin to carry out responsibilities.

15 What to Expect-Bargaining Home care workers may be contacted by a labor organization. If enough workers agree, a union may form. If a union forms and bargaining occurs, no changes to wages and benefits will occur until the biennium.

16 For more information Department of Health Services constituent relations: or Website: