2018 -- H 7792

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LC004866

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2018

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J O I N T   R E S O L U T I O N

APPROVING A LEGISLATIVE ENACTMENT REQUIRED BY THE MEDICAID REFORM

ACT OF 2008

     Introduced By: Representatives Marshall, Bennett, Edwards, McKiernan, and O'Brien

     Date Introduced: February 28, 2018

     Referred To: House Environment and Natural Resources

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

Rhode Island Medicaid Reform Act of 2008"; and

     WHEREAS, A legislative enactment is required pursuant to Rhode Island General Laws

§ 42-12.4-1, et seq.; and

     WHEREAS, Rhode Island General Law § 42-7.2-5(3)(a) provides that the Secretary of

the Executive Office of Health and Human Services ("Executive Office") is responsible for the

review and coordination of any Medicaid section 1115 demonstration waiver requests and

renewals as well as any initiatives and proposals requiring amendments to the Medicaid state plan

or category II or III changes as described in the demonstration, "with potential to affect the scope,

amount, or duration of publicly-funded health care services, provider payments or

reimbursements, or access to or the availability of benefits and services provided by Rhode Island

general and public laws"; and

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

fiscally sound and sustainable, the Secretary requests legislative approval of the following

proposals to amend the demonstration:

     (a) Provider Rates - Adjustments. The Executive Office proposes to:

     (1) Maintain in-patient and out-patient hospital payment rates at SFY 2018 levels.

     (2) The nursing facility rate adjustment that would otherwise take effect on October 1,

2018 will not exceed an increase of one percent; and

     (3) Reduce rates for Medicaid managed care plan administration.

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

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

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

     (b) Section 1115 Demonstration Waiver - Implementation of Existing Authorities. To

achieve the objectives of the State's demonstration waiver, the Executive Office proposes to

implement the following approved authorities:

     (1) Upon meeting federal guidelines for the timely processing of applications, elimination

of retroactive coverage for Medicaid beneficiaries, except for pregnant women and newborn

infants, and promulgate rules, regulations, and/or procedures that establish criteria to provide a

hardship exemption for eligible persons who have a significant need;

     (2) Expanded expedited eligibility for long-term services and supports (LTSS) applicants

who are transitioning to a home or community-based setting from a health facility, including a

hospital or nursing home; and

     (3) Institute the multi-tiered needs-based criteria for determining the level of care and

scope of services available to applicants with developmental disabilities seeking Medicaid home

and community-based services in lieu of institutional care.

     (4) In the division of elderly affairs of the department of human services increase

maximum income limit for copay program eligibility from two hundred percent (200%) of the

Federal Poverty Level to two hundred fifty percent (250%) of the Federal Poverty Level and

obtain federal financial participation for costs-otherwise not matchable for certain Medicaid

dementia care services provided to otherwise ineligible participants in its copay program with

income up to two hundred and fifty (250%) percent of the Federal Poverty Level who meet all

other program requirements.

     (c) Section 1115 Demonstration Waiver - Extension Request - The Executive Office

proposes to seek approval from our federal partners to extend the Section 1115 demonstration as

authorized in chapter 12.4 of title 42. In addition to maintaining existing waiver authorities, the

Executive Office proposes to seek additional federal authorities to:

     (1) Further the goals of LTSS rebalancing set forth in chapter 8.9 of title 40, by

expanding the array of health care stabilization and maintenance services eligible for federal

financial participation which are available to beneficiaries residing in home and community-

based settings. Such services include adaptive and home-based monitoring technologies,

transition help, and peer and personal supports that assist beneficiaries in better managing and

optimizing their own care. The Executive Office proposes to pursue alternative payment

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strategies financed through the Health System Transformation Project (HSTP) to cover the state's

share of the cost for such services and to expand on-going efforts to identify and provide cost-

effective preventive services to persons at-risk for LTSS and other high cost interventions.

     (2) Leverage existing resources and the flexibility of alternative payment methodologies

to provide integrated medical and behavioral services to children and youth at risk and in

transition, including targeted family visiting nurses, peer supports, and specialized networks of

care.

     (d) Financial Integrity - Asset Verification and Transfers. To comply with federal

mandates pertaining to the integrity of the determination of eligibility and estate recoveries, the

Executive Office plans to adopt an automated asset verification system which uses electronic data

sources to verify ownership and the value of the financial resources and real property of

applicants and beneficiaries and their spouses who are subject to asset and resource limits under

Title XIX.

     In addition, the Executive Office proposes to adopt new or amended rules, policies and

procedures for LTSS applicants and beneficiaries, inclusive of those eligible pursuant to chapter

8.12 of title 40, that conform to federal guidelines related to the transfer of assets for less than fair

market value established in Title XIX and applicable federal guidelines. State plan amendments

are required to comply fully with these mandates.

     (e) Service Delivery. To better leverage all available health care dollars and promote

access and service quality, the Executive Office proposes to:

     (1) Restructure delivery systems for dual Medicare and Medicaid eligible LTSS

beneficiaries who have chronic or disabling conditions to provide the foundation for

implementing more cost-effective and sustainable managed care LTSS arrangements. Additional

state plan authorities may be required.

     (2) Expand the reach of the Rite Share premium assistance program through amendments

to the Medicaid state plan to cover all adults, ages nineteen (19) years and older, who have access

to a cost-effective Executive Office approved employer-sponsored health insurance program.

     (t) Non-Emergency Transportation Program (NEMT). To implement cost effective

delivery of services and to enhance consumer satisfaction with transportation services by:

     (1) Expanding reimbursement methodologies; and

     (2) Removing transportation restrictions to align with Title XIX of Federal law.

     (g) Community First Choice (CFC). To seek Medicaid state plan and any additional

waiver authority necessary to implement the CFC option.

     (h) Alternative Payment Methodology. To develop, in collaboration with the Department

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of Behavioral Healthcare, Development Disabilities and Hospitals (BHDDH), a health home for

providing conflict freeperson-centered plam1ing and a quality and value based alternative

payment system that advances the goal of improving service access, quality and value.

     (i) Opioid and Behavioral Health Crisis Management. To implement in collaboration with

the Department of Behavioral Healthcare, Development Disabilities and Hospitals (BHDDH), a

community based alternative to emergency departments for addiction and mental health

emergencies.

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

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

2010 (PPACA) and various other recently enacted federal laws and pursue any changes in the

Rhode Island Medicaid program that promote service quality, access and cost-effectiveness that

may warrant a Medicaid State Plan amendment or amendment under the terms and conditions of

Rhode Island's Section 1115 Waiver, its successor, or any extension thereof. Any such actions by

the Executive Office shall not have an adverse impact on beneficiaries or cause there to be an

increase in expenditures beyond the amount appropriated for state fiscal year 2019; Now,

therefore, be it

     RESOLVED, That the General Assembly hereby approves proposals; and be it further

     RESOLVED, That the Secretary of the Executive Office is authorized to pursue and

Implement any waiver amendments, State Plan amendments, and/or changes to the applicable

department's rules, regulations and procedures approved herein and as authorized by chapter 12.4

of title 42; and be it further

     RESOLVED, That this Joint Resolution shall take effect upon passage.

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