2017 -- H 5835

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2017

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A N   A C T

RELATING TO THE MEDICAID REFORM ACT OF 2008

     

     Introduced By: Representative Teresa A. Tanzi

     Date Introduced: March 02, 2017

     Referred To: House Finance

     (by request)

It is enacted by the General Assembly as follows:

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     SECTION 1. Rhode Island Medicaid Reform Act of 2008 Findings:

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     (1) The General Assembly enacted Chapter 12.4 of Title 42 entitled "The Rhode Island

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Medicaid Reform Act of 2008"; and

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     (2) A legislative enactment is required pursuant to §42-12.4-1, et seq.; and

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     (3) Section 42-7.2-5(3)(a) provides that the Secretary of the Executive Office of Health

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and Human Services ("Executive Office") is responsible for the review and coordination of any

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Medicaid section 1115 demonstration waiver requests and renewals as well as any initiatives and

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proposals requiring amendments to the Medicaid State Plan or category II or III changes as

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described in the demonstration, "with 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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     SECTION 2. Approval:

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     (a) In pursuit of a more cost-effective consumer choice system of care that is fiscally

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sound and sustainable, the legislature hereby grants approval of the following proposals to amend

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the demonstration:

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     (1) Provider Rates -- Adjustments. The Executive Office is authorized to:

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     (i) Eliminate hospital payments by the projected increases in hospital rates that would

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otherwise take effect during the state fiscal year 2018 and reduce the hospital payments by one

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percent (1%) on January 1, 2018.

 

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     (ii) Adjust acuity-based payment rates to nursing facilities and eliminate the annual

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increase in rates that would otherwise take effect on October 1, 2017;

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     (iii) Change the acuity-based policy adjustor for payments to hospitals for behavioral

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health services;

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     (iv) Reduce rates for Medicaid managed care plan administration; and

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     (v) Modify payment methodology for Developmental Disability Services.

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     Implementation of adjustments may require amendments to the Rhode Island's Medicaid

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State Plan and/or Section 1115 waiver under the terms and conditions of the demonstration.

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Further, adoption of new or amended rules, regulations and procedures may also be required.

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     (b) Beneficiary Liability Collection Enhancements – Federal laws and regulations require

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beneficiaries who are receiving Medicaid-funded long-term services and supports (LTSS) to pay

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a portion of their income toward the cost of care. The Executive Office is seeking to enhance the

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agency's capacity to collect these payments in a timely and equitable manner. The Executive

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Office may require federal State Plan and/or waiver authority to implement these enhancements.

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Amended rules, regulations and procedures may also be required.

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     (c) Community Health Centers – Alternative payment methodology. To pursue more

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transparent, better coordinated, and cost-effective care delivery, the Executive Office proposes to

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revise the Rhode Island's Principles of Reimbursement for Federally Qualified Health Centers, as

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amended July 2012, to include in its monthly capitation payments to the health plans the total cost

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of providing care to the Medicaid plan members the Community Health Centers serve. Pursuing

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such revisions may also require amendments to the Medicaid State Plan and/or other federal

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authorities.

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     (d) Healthy Aging Initiative and LTSS System Reform. The Executive Office proposes to

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further the goals of the Healthy Aging Initiative and LTSS system rebalancing by pursuing:

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     (i) Integrated Care Initiative (ICI) – Demonstration amendment. New enrollment patterns

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in managed care and fee-for-services Medicaid that will promote the Healthy Aging Initiative

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goals of achieving greater utilization of home and community-based long-term services and

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supports options.

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     (ii) Process Review and Reform. A review of access to Medicaid-funded LTSS for the

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purpose of reforming existing processes to streamline eligibility determination procedures,

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promote options counseling and person-centered planning, and to further the goals of rebalancing

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the LTSS system while preserving service quality, choice and cost-effectiveness.

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     Implementation of these changes may require Section 1115 waiver authority under the

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terms and conditions of the demonstration. New and/or amended rules, regulations and

 

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procedures may also be necessary to implement this proposal. Accordingly, the Executive Office

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may require the Medicaid State Plan or the Section 1115 waiver to foster greater access to home

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and community-based services. Implementation of such changes may also require the adoption of

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rules, regulations and/or procedures.

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     (e) Adult Dental Services – Delivery system reform. The Executive Office proposes to

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change the payment and delivery system for adult dental services, including rates for oral surgery.

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Changes to the Medicaid State Plan and the Section 1115 waiver are required to implement these

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reforms. New and/or amended rules, regulations and procedures may also be necessary.

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     (f) Estate Recoveries and Liens. Proposed changes in Executive Office policies pertaining

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to estate recoveries and liens may require new or amended Medicaid State Plan and/or Section

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1115 waiver authorities. Implementation of these changes may also require new and/or amended

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rules, regulations and procedures.

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     (g) Asthma Treatment -- Home Asthma Response Program (HARP). HARP is an

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evidence-based asthma intervention program designed to reduce preventable asthma emergency

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department visits and hospitalization among high risk pediatric asthma patients. To obtain

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Medicaid financial participation for implementation of HARP, the Executive Office may be

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required to adopt the Medicaid State Plan amendments and/or additional authorities under the

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terms of the Rhode Island Medicaid State Plan and/or Section 1115 demonstration waiver.

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     (h) Centers of Excellence (COEs) – Opioid Treatment. The Executive Office proposes to

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establish a COE to promote best practices in the prevention and treatment of the Rhode Islanders

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who are addicted to opioids. Pursuing the establishment of COEs financed in part by federal

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matching Medicaid funds requires certain amendments to the Medicaid State Plan and may

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necessitate adoption of new or amended waiver authorities, rules, regulations and procedures.

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     (i) Federal Financing Opportunities. The Executive Office proposes to review Medicaid

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requirements and opportunities under the U.S. Patient Protection and Affordable Care Act of

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2010 (PPACA), 42 U.S.C. §§18001 et seq., and various other recently enacted federal laws and

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pursue any changes in the Rhode Island Medicaid program that promote service quality, access

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and cost-effectiveness that may warrant a Medicaid State Plan amendment or amendment under

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the terms and conditions of Rhode Island Medicaid State Plan and/or the Section 1115 Waiver, its

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successor, or any extension thereof. Any such actions by the Executive Office shall not have an

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adverse impact on beneficiaries or cause there to be an increase in expenditures beyond the

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amount appropriated for state fiscal year 2018.

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     The General Assembly hereby approves proposals and it further authorizes:

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     The Secretary of the Executive Office to pursue and implement any waiver amendments,

 

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the Medicaid State Plan amendments, and/or changes to the applicable department's rules,

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regulations and procedures approved herein and as authorized by §42-12.4-7.

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     SECTION 3. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO THE MEDICAID REFORM ACT OF 2008

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     This act would authorize the secretary of the executive office of health and human

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services to pursue and implement certain waiver amendments, state plan amendments, and/or

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changes to the applicable department's rules, regulations and procedures approved pursuant to the

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Rhode Island Medicaid reform act.

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     This act would take effect upon passage.

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