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art.019/4/019/3/031/1

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ARTICLE 19 AS AMENDED

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RELATING TO MEDICAID REFORM ACT OF 2008

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     SECTION 1. Rhode Island Medicaid Reform Act of 2008.

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     WHEREAS, The General Assembly enacted Chapter 12.4 of Title 42 entitled “The

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Rhode Island Medicaid Reform Act of 2008”; and

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     WHEREAS, A Joint Resolution is required pursuant to Rhode Island General Laws § 42-

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12.4-1, et seq.; and

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     WHEREAS, Rhode Island General Law § 42-12.4-7 provides that any change that

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requires the implementation of a rule or regulation or modification of a rule or regulation in

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existence prior to the implementation of the global consumer choice section 1115 demonstration

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(“the demonstration”) shall require prior approval of the general assembly; and further provides

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that any category II change or category III change as defined in the demonstration shall also

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require prior approval by the general assembly; and

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     WHEREAS, Rhode Island General Law § 42-7.2-5 provides that the Secretary of the

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Office of Health and Human Services is responsible for the “review and coordination of any

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Global Consumer Choice Compact Waiver requests and renewals as well as any initiatives and

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proposals requiring amendments to the Medicaid state plan or category I or II changes” as

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described in the demonstration, with “the potential to affect the scope, amount, or duration of

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publicly-funded health care services, provider payments or reimbursements, or access to or the

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availability of benefits and services provided by Rhode Island general and public laws”; and

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     WHEREAS, In pursuit of a more cost-effective consumer choice system of care that is

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fiscally sound and sustainable, the Secretary requests general assembly approval of the following

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proposals to amend the demonstration:

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      (a) Medicaid Managed Care Plan Refinements – New Components. The Medicaid single

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state agency proposes to reduce hospital readmissions, promote better health and nutrition and

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encourage non-invasive approaches to address obesity by incorporating a nutritional education

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and exercise component into the benefit package offered to certain Medicaid beneficiaries.

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Establishing a targeted benefit requires amendments to or new rules, regulations and procedures

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pertaining to coverage for the Medicaid populations affected as well as a Category II change to

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the Global Consumer Choice Compact Waiver in those areas where additional authority is

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warranted under the terms and conditions of the demonstration agreement;

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     (b) Medicaid Rate Change – Durable Medical Equipment. The Medicaid single state

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agency proposes to reduce the payment for durable medical equipment provided to beneficiaries

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to 85 percent of the Medicare payment rate. Implementation of this change requires a Category II

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change under the terms and conditions of the Global Consumer Choice Waiver. The Medicaid

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single state agency is instructed to review the appropriateness and relevance of its current

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package of approved durable medical equipment (DME) to ensure the equipment is accessible

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and reliable. The Medicaid single state agency is to consider the purchase of any additional or

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alternative equipment and is to explore group purchasing opportunities to access DME. The

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Medicaid single state agency is to review agreements with DME providers to ensure standards

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governing the maintenance and durability of DME are established and monitored; and

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     (c) Medicaid Requirements and Opportunities under U.S. Patient Protection and

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Affordable Care Act (ACA) of 2010. The Medicaid agency proposes to pursue any requirements

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and/or opportunities established under the ACA that may warrant a Category II or III change

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under the terms and conditions of the Global Consumer Choice Waiver. Any such actions the

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Medicaid agency takes shall not have an adverse impact on beneficiaries or cause there to be an

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increase in expenditures beyond the amount appropriated for state fiscal year 2013; now

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therefore, be it

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     RESOLVED, That the general assembly hereby approves proposals (a) through (c) listed

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above to amend the demonstration; and be it further

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     RESOLVED, That the secretary of the office of health and human services is authorized

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to pursue and implement any waiver amendments, category II or category III changes, state plan

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amendments and/or changes to the applicable department’s rules, regulations and procedures

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approved herein and as authorized by § 42-12.4-7; and be it further

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     RESOLVED, That this joint resolution shall take effect upon passage.

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     SECTION 2. The executive office of health and human services shall provide a report to

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the chairpersons of the house and senate finance committees by January 1, 2013 that analyzes and

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evaluates the current dental benefits program for Medicaid eligible individuals and includes the

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number of recipients, types of services provided, reimbursement rates and the settings. The report

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shall also examine the opportunities for improved quality, access and value of potential

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partnerships with private entities and shall propose a five (5) year plan for dental services for

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Medicaid-eligible adults.

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     SECTION 3. This article shall take effect upon passage.