2019 -- H 5387

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LC001360

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2019

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A N   A C T

RELATING TO HUMAN SERVICES -- MEDICAL ASSISTANCE

     

     Introduced By: Representatives Amore, and Carson

     Date Introduced: February 14, 2019

     Referred To: House Finance

     It is enacted by the General Assembly as follows:

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     SECTION 1. Section 40-8-19 of the General Laws in Chapter 40-8 entitled "Medical

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Assistance" is hereby amended to read as follows:

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     40-8-19. Rates of payment to nursing facilities.

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     (a) Rate reform.

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     (1) The rates to be paid by the state to nursing facilities licensed pursuant to chapter 17 of

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title 23, and certified to participate in Title XIX of the Social Security Act for services rendered to

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Medicaid-eligible residents, shall be reasonable and adequate to meet the costs that must be

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incurred by efficiently and economically operated facilities in accordance with 42 U.S.C. §

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1396a(a)(13). The executive office of health and human services ("executive office") shall

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promulgate or modify the principles of reimbursement for nursing facilities in effect as of July 1,

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2011, to be consistent with the provisions of this section and Title XIX, 42 U.S.C. § 1396 et seq.,

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of the Social Security Act.

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     (2) The executive office shall review the current methodology for providing Medicaid

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payments to nursing facilities, including other long-term-care services providers, and is

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authorized to modify the principles of reimbursement to replace the current cost-based

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methodology rates with rates based on a price-based methodology to be paid to all facilities with

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recognition of the acuity of patients and the relative Medicaid occupancy, and to include the

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following elements to be developed by the executive office:

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     (i) A direct-care rate adjusted for resident acuity;

 

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     (ii) An indirect-care rate comprised of a base per diem for all facilities;

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     (iii) A rearray of costs for all facilities every three (3) years beginning October, 2015, that

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may or may not result in automatic per diem revisions;

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     (iv) Application of a fair-rental value system;

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     (v) Application of a pass-through system; and

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     (vi) Adjustment of rates by the change in a recognized national nursing home inflation

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index to be applied on October 1 of each year, beginning October 1, 2012. This adjustment will

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not occur on October 1, 2013, October 1, 2014, or October 1, 2015, but will occur on April 1,

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2015. The adjustment of rates will also not occur on October 1, 2017, or October 1, 2018.

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Effective July 1, 2018, rates paid to nursing facilities from the rates approved by the Centers for

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Medicare and Medicaid Services and in effect on October 1, 2017, both fee-for-service and

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managed care, will be increased by one and one-half percent (1.5%) and further increased by one

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percent (1%) on October 1, 2018. Said inflation index shall be applied without regard for the

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transition factors in subsections (b)(1) and (b)(2). For purposes of October 1, 2016, adjustment

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only, any rate increase that results from application of the inflation index to subsections (a)(2)(i)

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and (a)(2)(ii) shall be dedicated to increase compensation for direct-care workers in the following

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manner: Not less than 85% of this aggregate amount shall be expended to fund an increase in

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wages, benefits, or related employer costs of direct-care staff of nursing homes. For purposes of

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this section, direct-care staff shall include registered nurses (RNs), licensed practical nurses

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(LPNs), certified nursing assistants (CNAs), certified medical technicians, housekeeping staff,

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laundry staff, dietary staff, or other similar employees providing direct-care services; provided,

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however, that this definition of direct-care staff shall not include: (i) RNs and LPNs who are

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classified as "exempt employees" under the Federal Fair Labor Standards Act (29 U.S.C. § 201 et

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seq.); or (ii) CNAs, certified medical technicians, RNs, or LPNs who are contracted, or

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subcontracted, through a third-party vendor or staffing agency. By July 31, 2017, nursing

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facilities shall submit to the secretary, or designee, a certification that they have complied with

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the provisions of this subsection (a)(2)(vi) with respect to the inflation index applied on October

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1, 2016. Any facility that does not comply with terms of such certification shall be subjected to a

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clawback, paid by the nursing facility to the state, in the amount of increased reimbursement

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subject to this provision that was not expended in compliance with that certification.

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      (b) Transition to full implementation of rate reform. For no less than four (4) years after

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the initial application of the price-based methodology described in subdivision (a)(2) to payment

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rates, the The executive office of health and human services shall implement a transition plan to

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moderate the impact of the rate reform on individual nursing facilities. Said transition shall

 

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include the following components:

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     (1) No nursing facility shall receive reimbursement for direct-care costs that is less than

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the rate of reimbursement for direct-care costs received under the methodology in effect on

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October 1, 2017 at the time of passage of this act; for the year beginning October 1, 2017, the

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reimbursement for direct-care costs under this provision will be phased out in twenty-five-percent

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(25%) increments each year until October 1, 2021, when the reimbursement will no longer be in

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effect. No nursing facility shall receive reimbursement for direct-care costs that is less than the

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rate of reimbursement for direct-care costs received under the methodology in effect at the time

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of passage of this act; and

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     (2) No facility shall lose or gain more than five dollars ($5.00) in its total, per diem rate

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the first year of the transition. An adjustment to the per diem loss or gain may be phased out by

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twenty-five percent (25%) each year; except, however, for the years beginning October 1, 2015,

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there shall be no adjustment to the per diem gain or loss, but the phase out shall resume

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thereafter; and

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     (3) The transition plan and/or period may be modified upon full implementation of

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facility per diem rate increases for quality of care-related measures. Said modifications shall be

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submitted in a report to the general assembly at least six (6) months prior to implementation.

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     (4) Notwithstanding any law to the contrary, for the twelve-month (12) period beginning

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July 1, 2015, Medicaid payment rates for nursing facilities established pursuant to this section

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shall not exceed ninety-eight percent (98%) of the rates in effect on April 1, 2015. Consistent

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with the other provisions of this chapter, nothing in this provision shall require the executive

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office to restore the rates to those in effect on April 1, 2015, at the end of this twelve-month (12)

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period.

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     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 -- MEDICAL ASSISTANCE

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     This act would repeal the automatic phase out of the nursing facility reimbursement price

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based methodology.

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     This act would take effect upon passage.

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