2020 -- H 7924 | |
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LC004719 | |
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STATE OF RHODE ISLAND | |
IN GENERAL ASSEMBLY | |
JANUARY SESSION, A.D. 2020 | |
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A N A C T | |
RELATING TO HUMAN SERVICES -- MEDICAL ASSISTANCE -- LONG-TERM CARE | |
SERVICE AND FINANCE REFORM | |
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Introduced By: Representatives Serpa, Lima, and Bennett | |
Date Introduced: February 26, 2020 | |
Referred To: House Finance | |
It is enacted by the General Assembly as follows: | |
1 | SECTION 1. Section 40-8.9-9 of the General Laws in Chapter 40-8.9 entitled "Medical |
2 | Assistance - Long-Term Care Service and Finance Reform" is hereby amended to read as follows: |
3 | 40-8.9-9. Long-term-care rebalancing system reform goal. |
4 | (a) Notwithstanding any other provision of state law, the executive office of health and |
5 | human services is authorized and directed to apply for, and obtain, any necessary waiver(s), waiver |
6 | amendment(s), and/or state-plan amendments from the secretary of the United States Department |
7 | of Health and Human Services, and to promulgate rules necessary to adopt an affirmative plan of |
8 | program design and implementation that addresses the goal of allocating a minimum of fifty percent |
9 | (50%) of Medicaid long-term-care funding for persons aged sixty-five (65) and over and adults |
10 | with disabilities, in addition to services for persons with developmental disabilities, to home- and |
11 | community-based care; provided, further, the executive office shall report annually as part of its |
12 | budget submission, the percentage distribution between institutional care and home- and |
13 | community-based care by population and shall report current and projected waiting lists for long- |
14 | term-care and home- and community-based care services. The executive office is further |
15 | authorized and directed to prioritize investments in home- and community-based care and to |
16 | maintain the integrity and financial viability of all current long-term-care services while pursuing |
17 | this goal. |
18 | (b) The reformed long-term-care system rebalancing goal is person centered and |
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1 | encourages individual self-determination, family involvement, interagency collaboration, and |
2 | individual choice through the provision of highly specialized and individually tailored home-based |
3 | services. Additionally, individuals with severe behavioral, physical, or developmental disabilities |
4 | must have the opportunity to live safe and healthful lives through access to a wide range of |
5 | supportive services in an array of community-based settings, regardless of the complexity of their |
6 | medical condition, the severity of their disability, or the challenges of their behavior. Delivery of |
7 | services and supports in less costly and less restrictive community settings, will enable children, |
8 | adolescents, and adults to be able to curtail, delay, or avoid lengthy stays in long-term care |
9 | institutions, such as behavioral health residential-treatment facilities, long-term-care hospitals, |
10 | intermediate-care facilities, and/or skilled nursing facilities. |
11 | (c) Pursuant to federal authority procured under § 42-7.2-16, the executive office of health |
12 | and human services is directed and authorized to adopt a tiered set of criteria to be used to determine |
13 | eligibility for services. Such criteria shall be developed in collaboration with the state's health and |
14 | human services departments and, to the extent feasible, any consumer group, advisory board, or |
15 | other entity designated for such purposes, and shall encompass eligibility determinations for long- |
16 | term-care services in nursing facilities, hospitals, and intermediate-care facilities for persons with |
17 | intellectual disabilities, as well as home- and community-based alternatives, and shall provide a |
18 | common standard of income eligibility for both institutional and home- and community-based care. |
19 | The executive office is authorized to adopt clinical and/or functional criteria for admission to a |
20 | nursing facility, hospital, or intermediate-care facility for persons with intellectual disabilities that |
21 | are more stringent than those employed for access to home- and community-based services. The |
22 | executive office is also authorized to promulgate rules that define the frequency of re-assessments |
23 | for services provided for under this section. Levels of care may be applied in accordance with the |
24 | following: |
25 | (1) The executive office shall continue to apply the level of care criteria in effect on June |
26 | 30, 2015, for any recipient determined eligible for and receiving Medicaid-funded, long-term |
27 | services in supports in a nursing facility, hospital, or intermediate-care facility for persons with |
28 | intellectual disabilities on or before that date, unless: |
29 | (i) The recipient transitions to home- and community-based services because he or she |
30 | would no longer meet the level of care criteria in effect on June 30, 2015; or |
31 | (ii) The recipient chooses home- and community-based services over the nursing facility, |
32 | hospital, or intermediate-care facility for persons with intellectual disabilities. For the purposes of |
33 | this section, a failed community placement, as defined in regulations promulgated by the executive |
34 | office, shall be considered a condition of clinical eligibility for the highest level of care. The |
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1 | executive office shall confer with the long-term-care ombudsperson with respect to the |
2 | determination of a failed placement under the ombudsperson's jurisdiction. Should any Medicaid |
3 | recipient eligible for a nursing facility, hospital, or intermediate-care facility for persons with |
4 | intellectual disabilities as of June 30, 2015, receive a determination of a failed community |
5 | placement, the recipient shall have access to the highest level of care; furthermore, a recipient who |
6 | has experienced a failed community placement shall be transitioned back into his or her former |
7 | nursing home, hospital, or intermediate-care facility for persons with intellectual disabilities |
8 | whenever possible. Additionally, residents shall only be moved from a nursing home, hospital, or |
9 | intermediate-care facility for persons with intellectual disabilities in a manner consistent with |
10 | applicable state and federal laws. |
11 | (2) Any Medicaid recipient eligible for the highest level of care who voluntarily leaves a |
12 | nursing home, hospital, or intermediate-care facility for persons with intellectual disabilities shall |
13 | not be subject to any wait list for home- and community-based services. |
14 | (3) No nursing home, hospital, or intermediate-care facility for persons with intellectual |
15 | disabilities shall be denied payment for services rendered to a Medicaid recipient on the grounds |
16 | that the recipient does not meet level of care criteria unless and until the executive office has: |
17 | (i) Performed an individual assessment of the recipient at issue and provided written notice |
18 | to the nursing home, hospital, or intermediate-care facility for persons with intellectual disabilities |
19 | that the recipient does not meet level of care criteria; and |
20 | (ii) The recipient has either appealed that level of care determination and been |
21 | unsuccessful, or any appeal period available to the recipient regarding that level of care |
22 | determination has expired. |
23 | (d) The executive office is further authorized to consolidate all home- and community- |
24 | based services currently provided pursuant to 42 U.S.C. § 1396n into a single system of home- and |
25 | community-based services that include options for consumer direction and shared living. The |
26 | resulting single home- and community-based services system shall replace and supersede all 42 |
27 | U.S.C. § 1396n programs when fully implemented. Notwithstanding the foregoing, the resulting |
28 | single program home- and community-based services system shall include the continued funding |
29 | of assisted-living services at any assisted-living facility financed by the Rhode Island housing and |
30 | mortgage finance corporation prior to January 1, 2006, and shall be in accordance with chapter 66.8 |
31 | of title 42 as long as assisted-living services are a covered Medicaid benefit. |
32 | (e) The executive office is authorized to promulgate rules that permit certain optional |
33 | services including, but not limited to, homemaker services, home modifications, respite, and |
34 | physical therapy evaluations to be offered to persons at risk for Medicaid-funded, long-term care |
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1 | subject to availability of state-appropriated funding for these purposes. |
2 | (f) To promote the expansion of home- and community-based service capacity, the |
3 | executive office is authorized to pursue payment methodology reforms that increase access to |
4 | homemaker, personal care (home health aide), assisted living, adult supportive-care homes, and |
5 | adult day services, as follows: |
6 | (1) Development of revised or new Medicaid certification standards that increase access to |
7 | service specialization and scheduling accommodations by using payment strategies designed to |
8 | achieve specific quality and health outcomes. |
9 | (2) Development of Medicaid certification standards for state-authorized providers of |
10 | adult-day services, excluding such providers of services authorized under § 40.1-24-1(3), assisted |
11 | living, and adult supportive care (as defined under chapter 17.24 of title 23) that establish for each, |
12 | an acuity-based, tiered service and payment methodology tied to: licensure authority; level of |
13 | beneficiary needs; the scope of services and supports provided; and specific quality and outcome |
14 | measures. |
15 | The standards for adult-day services for persons eligible for Medicaid-funded, long-term |
16 | services may differ from those who do not meet the clinical/functional criteria set forth in § 40- |
17 | 8.10-3. |
18 | (3) As the state's Medicaid program seeks to assist more beneficiaries requiring long-term |
19 | services and supports in home- and community-based settings, the demand for home care workers |
20 | has increased, and wages for these workers has not kept pace with neighboring states, leading to |
21 | high turnover and vacancy rates in the state's home-care industry, the executive office shall institute |
22 | a one-time increase in the base-payment rates for home-care service providers to promote increased |
23 | access to and an adequate supply of highly trained home health care professionals, in amount to be |
24 | determined by the appropriations process, for the purpose of raising wages for personal care |
25 | attendants and home health aides to be implemented by such providers. |
26 | (4) A prospective base adjustment, effective not later than July 1, 2018, of ten percent |
27 | (10%) of the current base rate for home care providers, home nursing care providers, and hospice |
28 | providers contracted with the executive office of health and human services and its subordinate |
29 | agencies to deliver Medicaid fee-for-service personal care attendant services. |
30 | (5) A prospective base adjustment, effective not later than July 1, 2018, of twenty percent |
31 | (20%) of the current base rate for home care providers, home nursing care providers, and hospice |
32 | providers contracted with the executive office of health and human services and its subordinate |
33 | agencies to deliver Medicaid fee-for-service skilled nursing and therapeutic services and hospice |
34 | care. |
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1 | (6) A base adjustment, effective not later than July 1, 2020, of sixteen-point-twenty-nine |
2 | percent (16.29%) of the current base rate for home care providers, home nursing care providers, |
3 | and hospice providers contracted with the executive office of health and human services, its |
4 | subordinate agencies and contractors to deliver Medicaid personal care attendant and homemaking |
5 | services to beneficiaries. |
6 | (7) A base adjustment, effective on the same date as any wage increases implemented by |
7 | the executive office of health and human services or within a collective bargaining agreement for |
8 | any person working for a program under §§ 40-8.14 and 40-8.15 of a multiple of one-point-forty- |
9 | two percent (1.42%) of the current base rate for home care providers, home nursing care providers |
10 | and hospice providers contracted with the executive office of health and human services, its |
11 | subordinate agencies and contractors to deliver Medicaid personal care attendant and homemaking |
12 | services to beneficiaries. |
13 | (8) A base adjustment, effective not later than July l, 2020, of ten percent (10%) of the |
14 | current base rate for home care providers, home nursing care providers and hospice providers |
15 | contracted with the executive office of health and human services, its subordinate agencies and |
16 | contractors to deliver Medicaid personal care attendant services, skilled nursing care and |
17 | therapeutic services and hospice care to beneficiaries that reside in a municipality as identified by |
18 | the office of primary care and rural health within the department of health. |
19 | (9) A base adjustment, effective not later than July l, 2020, of ten percent (10%) of the |
20 | current base rate for home nursing care providers and hospice providers contracted with the |
21 | executive office of health and human services, its subordinate agencies and contractors to deliver |
22 | Medicaid skilled nursing care to beneficiaries that have tracheotomies or use ventilators. |
23 | (6)(10) Effective upon passage of this section, hospice provider reimbursement, |
24 | exclusively for room and board expenses for individuals residing in a skilled nursing facility, shall |
25 | revert to the rate methodology in effect on June 30, 2018, and these room and board expenses shall |
26 | be exempted from any and all annual rate increases to hospice providers as provided for in this |
27 | section. |
28 | (7)(11) On the first of July in each year, beginning on July 1, 2019, the executive office of |
29 | health and human services will initiate an annual inflation increase to the base rate for home care |
30 | providers, home nursing care providers, and hospice providers contracted with the executive office |
31 | and its subordinate agencies to deliver Medicaid fee-for-service personal care attendant services, |
32 | skilled nursing and therapeutic services and hospice care. The base rate increase shall be a |
33 | percentage amount equal to the New England Consumer Price Index card as determined by the |
34 | United States Department of Labor for medical care and for compliance with all federal and state |
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1 | laws, regulations, and rules, and all national accreditation program requirements. All Medicaid |
2 | programs operated by the executive office of health and human services, its subordinate agencies |
3 | and contractors shall not reimburse home care providers, home nursing care providers and hospice |
4 | providers less than fee-for-service rates. |
5 | (g) The executive office shall implement a long-term-care options counseling program to |
6 | provide individuals, or their representatives, or both, with long-term-care consultations that shall |
7 | include, at a minimum, information about: long-term-care options, sources, and methods of both |
8 | public and private payment for long-term-care services and an assessment of an individual's |
9 | functional capabilities and opportunities for maximizing independence. Each individual admitted |
10 | to, or seeking admission to, a long-term-care facility, regardless of the payment source, shall be |
11 | informed by the facility of the availability of the long-term-care options counseling program and |
12 | shall be provided with long-term-care options consultation if they so request. Each individual who |
13 | applies for Medicaid long-term-care services shall be provided with a long-term-care consultation. |
14 | (h) The executive office is also authorized, subject to availability of appropriation of |
15 | funding, and federal, Medicaid-matching funds, to pay for certain services and supports necessary |
16 | to transition or divert beneficiaries from institutional or restrictive settings and optimize their health |
17 | and safety when receiving care in a home or the community. The secretary is authorized to obtain |
18 | any state plan or waiver authorities required to maximize the federal funds available to support |
19 | expanded access to such home- and community-transition and stabilization services; provided, |
20 | however, payments shall not exceed an annual or per-person amount. |
21 | (i) To ensure persons with long-term-care needs who remain living at home have adequate |
22 | resources to deal with housing maintenance and unanticipated housing-related costs, the secretary |
23 | is authorized to develop higher resource eligibility limits for persons or obtain any state plan or |
24 | waiver authorities necessary to change the financial eligibility criteria for long-term services and |
25 | supports to enable beneficiaries receiving home and community waiver services to have the |
26 | resources to continue living in their own homes or rental units or other home-based settings. |
27 | (j) The executive office shall implement, no later than January 1, 2016, the following home- |
28 | and community-based service and payment reforms: |
29 | (1) Community-based, supportive-living program established in § 40-8.13-12 or an |
30 | alternative, successor, or substitute program, or delivery option designated for these purposes by |
31 | the secretary of the executive office of health and human services; |
32 | (2) Adult day services level of need criteria and acuity-based, tiered-payment |
33 | methodology; and |
34 | (3) Payment reforms that encourage home- and community-based providers to provide the |
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1 | specialized services and accommodations beneficiaries need to avoid or delay institutional care. |
2 | (k) The secretary is authorized to seek any Medicaid section 1115 waiver or state-plan |
3 | amendments and take any administrative actions necessary to ensure timely adoption of any new |
4 | or amended rules, regulations, policies, or procedures and any system enhancements or changes, |
5 | for which appropriations have been authorized, that are necessary to facilitate implementation of |
6 | the requirements of this section by the dates established. The secretary shall reserve the discretion |
7 | to exercise the authority established under §§ 42-7.2-5(6)(v) and 42-7.2-6.1, in consultation with |
8 | the governor, to meet the legislative directives established herein. |
9 | SECTION 2. This act shall take effect upon passage. |
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LC004719 | |
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EXPLANATION | |
BY THE LEGISLATIVE COUNCIL | |
OF | |
A N A C T | |
RELATING TO HUMAN SERVICES -- MEDICAL ASSISTANCE -- LONG-TERM CARE | |
SERVICE AND FINANCE REFORM | |
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1 | This act would provide for Medicaid home care, home nursing care and hospice base rate |
2 | adjustments for services delivered by professionals and paraprofessionals licensed by the |
3 | department of health to meet the increasing demand for services for medically-complex and rural |
4 | patients and to meet the need to grow and sustain the licensed nurse assistant workforce. This act |
5 | would support the state’s long-term care rebalancing goals by keeping high-acuity or high medical |
6 | necessity patients out of skilled nursing facilities and hospitals and remain safe at home and in the |
7 | community with highly-trained and stable long-term services and support. |
8 | This act would take effect upon passage. |
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LC004719 | |
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