2015 -- S 0551

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LC001373

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2015

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A N   A C T

RELATING TO HUMAN SERVICES -- LONG-TERM MANAGED CARE

ARRANGEMENTS

     Introduced By: Senators McCaffrey, Lynch, and Walaska

     Date Introduced: March 03, 2015

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

     SECTION 1. Section 40-8.13-5 of the General Laws in Chapter 40-8.13 entitled "Long-

Term Managed Care Arrangements" is hereby amended to read as follows:

     40-8.13-5. Financial savings under managed care. -- To the extent that financial

savings are a goal under any managed long-term care arrangement, it is the intent of the

legislature to achieve such savings through administrative efficiencies, care coordination, and

improvements in care outcomes, rather than through reduced reimbursement rates to providers.

Therefore, any managed long-term care arrangement shall include a requirement that the

managed care organization reimburse providers for services in accordance with the following:

      (1) For a duals demonstration project, the managed care organization:

      (i) Shall not combine the rates of payment for post-acute skilled and rehabilitation care

provided by a nursing facility and long-term and chronic care provided by a nursing facility in

order to establish a single payment rate for dual eligible beneficiaries requiring skilled nursing

services;

      (ii) Shall pay nursing facilities providing post-acute skilled and rehabilitation care or

long-term and chronic care rates that reflect the different level of services and intensity required

to provide these services; and

     (iii) For purposes of determining the appropriate rate for the type of care identified in

subsection (1)(ii) of this section, the managed care organization shall pay no less than the rates

which would be paid for that care under traditional Medicare and Rhode Island Medicaid for

these service types.

     The state shall not enter into any agreement with a managed care organization in

connection with a duals demonstration project unless that agreement conforms to this section, and

any existing such agreement shall be amended as necessary to conform to this subsection.

      (2) For a managed long-term care arrangement that is not a duals demonstration project,

the managed care organization shall reimburse providers in an amount not less than the rate

amount that would be paid for the same care by EOHHS under the Medicaid program. The

managed care organization shall not, however, be required to use the same payment methodology

as EOHHS.

     (3) Notwithstanding any provisions of the general or public laws to the contrary, the

protections of subsections (1) and (2) of this section may be waived by a nursing facility in the

event it elects to accept a payment model developed jointly by the managed care organization and

skilled nursing facilities, that is intended to promote quality of care and cost effectiveness,

including, but not limited to, bundled payment initiatives, value-based purchasing arrangements,

gainsharing, and similar models.

     SECTION 2. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO HUMAN SERVICES -- LONG-TERM MANAGED CARE

ARRANGEMENTS

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     This act would provide a payment methodology for managed care organizations engaged

in a duals demonstration project providing post-acute skilled and rehabilitative care or long-term

chronic care.

     This act would take effect upon passage.

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