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art.012/5/012/4/012/3/012/2/012/1 | ||
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1 | ARTICLE 12 | |
2 | RELATING TO MEDICAL ASSISTANCE | |
3 | SECTION 1. Sections 40-6-27 and 40-6-27.2 of the General Laws in Chapter 40-6 entitled | |
4 | “Public Assistance Act” is hereby amended to read as follows: | |
5 | 40-6-27. Supplemental Security Income. | |
6 | (a)(1) The director of the department is hereby authorized to enter into agreements on | |
7 | behalf of the state with the secretary of the Department of Health and Human Services or other | |
8 | appropriate federal officials, under the Supplementary Security Income (SSI) program established | |
9 | by title XVI of the Social Security Act, 42 U.S.C. § 1381 et seq., concerning the administration and | |
10 | determination of eligibility for SSI benefits for residents of this state, except as otherwise provided | |
11 | in this section. The state's monthly share of supplementary assistance to the Supplementary Security | |
12 | Income program shall be as follows: | |
13 | (i) Individual living alone: $39.92 | |
14 | (ii) Individual living with others: $51.92 | |
15 | (iii) Couple living alone: $79.38 | |
16 | (iv) Couple living with others: $97.30 | |
17 | (v) Individual living in state licensed assisted living residence: $332.00 | |
18 | (vi) Individual eligible to receive Medicaid-funded long-term services and supports and | |
19 | living in a Medicaid-certified state-licensed assisted-living residence or adult supportive-care | |
20 | residence, as defined in § 23-17.24-1, participating in the program authorized under § 40-8.13-12 | |
21 | or an alternative, successor, or substitute program or delivery option designated for such purposes | |
22 | by the secretary of the executive office of health and human services: | |
23 | (A) With countable income above one hundred and twenty (120) percent of poverty: up to | |
24 | $465.00; | |
25 | (B) With countable income at or below one hundred and twenty (120) percent of poverty: | |
26 | up to the total amount established in (v) and $465: $797 | |
27 | (vii) Individual living in state-licensed supportive residential-care settings that, depending | |
28 | on the population served, meet the standards set by the department of human services in conjunction | |
29 | with the department(s) of children, youth and families, elderly affairs and/or behavioral healthcare, | |
30 | developmental disabilities and hospitals: $300.00. | |
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1 | Provided, however, that the department of human services shall by regulation reduce, | |
2 | effective January 1, 2009, the state's monthly share of supplementary assistance to the | |
3 | Supplementary Security Income (SSI) program for each of the above-listed payment levels, by the | |
4 | same value as the annual federal cost of living adjustment to be published by the federal Social | |
5 | Security Administration in October 2008 and becoming effective on January 1, 2009, as determined | |
6 | under the provisions of title XVI of the federal Social Security Act [42 U.S.C. § 1381 et seq.]; and | |
7 | provided further, that it is the intent of the general assembly that the January 1, 2009, reduction in | |
8 | the state's monthly share shall not cause a reduction in the combined federal and state payment | |
9 | level for each category of recipients in effect in the month of December 2008; provided further, | |
10 | that the department of human services is authorized and directed to provide for payments to | |
11 | recipients in accordance with the above directives. | |
12 | (2) As of July 1, 2010, state supplement payments shall not be federally administered and | |
13 | shall be paid directly by the department of human services to the recipient. | |
14 | (3) Individuals living in institutions shall receive a twenty dollar ($20.00) per month | |
15 | personal needs allowance from the state that shall be in addition to the personal needs allowance | |
16 | allowed by the Social Security Act, 42 U.S.C. § 301 et seq. | |
17 | (4) Individuals living in state-licensed supportive residential-care settings and assisted- | |
18 | living residences who are receiving SSI supplemental payments under this section who are | |
19 | participating in the program under § 40-8.13-12 or an alternative, successor, or substitute program | |
20 | or delivery option, or otherwise shall be allowed to retain a minimum personal needs allowance of | |
21 | fifty-five dollars ($55.00) per month from their SSI monthly benefit prior to payment of any | |
22 | monthly fees in addition to any amounts established in an administrative rule promulgated by the | |
23 | secretary of the executive office of health and human services for persons eligible to receive | |
24 | Medicaid-funded long-term services and supports in the settings identified in subsections (a)(1)(v) | |
25 | and (a)(1)(vi). | |
26 | (5) Except as authorized for the program authorized under § 40-8.13-12 or an alternative, | |
27 | successor, or substitute program, or delivery option designated by the secretary to ensure that | |
28 | supportive residential care or an assisted-living residence is a safe and appropriate service setting, | |
29 | the The department is authorized and directed to make a determination of the medical need and | |
30 | whether a setting provides the appropriate services for those persons who: | |
31 | (i) Have applied for or are receiving SSI, and who apply for admission to supportive | |
32 | residential care setting and assisted living residences on or after October 1, 1998; or | |
33 | (ii) Who are residing in supportive residential care settings and assisted living residences, | |
34 | and who apply for or begin to receive SSI on or after October 1, 1998. | |
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1 | (6) The process for determining medical need required by subsection (a)(5) of this section | |
2 | shall be developed by the executive office of health and human services in collaboration with the | |
3 | departments of that office and shall be implemented in a manner that furthers the goals of | |
4 | establishing a statewide coordinated long-term care entry system as required pursuant to the | |
5 | Medicaid section 1115 waiver demonstration. | |
6 | (7) To assure access to high quality coordinated services, the executive office of health and | |
7 | human services is further authorized and directed to establish certification or contract standards | |
8 | that must be met by those state-licensed supportive residential-care settings, including adult | |
9 | supportive-care homes and assisted-living residences admitting or serving any persons eligible for | |
10 | state-funded supplementary assistance under this section or the program established under § 40- | |
11 | 8.13-12. Such certification or contract standards shall define: | |
12 | (i) The scope and frequency of resident assessments, the development and implementation | |
13 | of individualized service plans, staffing levels and qualifications, resident monitoring, service | |
14 | coordination, safety risk management and disclosure, and any other related areas; | |
15 | (ii) The procedures for determining whether the certifications or contract standards have | |
16 | been met; and | |
17 | (iii) The criteria and process for granting a one time, short-term good cause exemption | |
18 | from the certification or contract standards to a licensed supportive residential care setting or | |
19 | assisted living residence that provides documented evidence indicating that meeting or failing to | |
20 | meet said standards poses an undue hardship on any person eligible under this section who is a | |
21 | prospective or current resident. | |
22 | (8) The certification or contract standards required by this section or § 40-8.13-12 or an | |
23 | alternative, successor, or substitute program, or delivery option designated by the secretary shall | |
24 | be developed in collaboration by the departments, under the direction of the executive office of | |
25 | health and human services, so as to ensure that they comply with applicable licensure regulations | |
26 | either in effect or in development. | |
27 | (b) The department is authorized and directed to provide additional assistance to | |
28 | individuals eligible for SSI benefits for: | |
29 | (1) Moving costs or other expenses as a result of an emergency of a catastrophic nature | |
30 | which is defined as a fire or natural disaster; and | |
31 | (2) Lost or stolen SSI benefit checks or proceeds of them; and | |
32 | (3) Assistance payments to SSI eligible individuals in need because of the application of | |
33 | federal SSI regulations regarding estranged spouses; and the department shall provide such | |
34 | assistance, in a form and amount, which the department shall by regulation determine. | |
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1 | 40-6-27.2. Supplementary cash assistance payment for certain Supplemental Security | |
2 | Income recipients. | |
3 | There is hereby established a $206 monthly payment for disabled and elderly individuals | |
4 | who, on or after July 1, 2012, receive the state supplementary assistance payment for an individual | |
5 | in a state-licensed assisted-living residence under § 40-6-27 and further reside in an assisted-living | |
6 | facility that is not eligible to receive funding under Title XIX of the Social Security Act, 42 U.S.C. | |
7 | § 1381 et seq., or reside in any assisted-living facility financed by the Rhode Island housing and | |
8 | mortgage finance corporation prior to January 1, 2006, and receive a payment under § 40-6-27. The | |
9 | monthly payment shall not be made on behalf of persons participating in the program authorized | |
10 | under § 40-8.13-12 or an alternative, successor, or substitute program, or delivery option designated | |
11 | for such purposes by the secretary of the executive office of health and human services. | |
12 | SECTION 2. Section 40-8-4 and 40-8-26 of the General Laws in Chapter 40-8 entitled | |
13 | “Medical Assistance” is hereby amended to read as follows: | |
14 | 40-8-4. Direct vendor payment plan. | |
15 | (a) The department shall furnish medical care benefits to eligible beneficiaries through a | |
16 | direct vendor payment plan. The plan shall include, but need not be limited to, any or all of the | |
17 | following benefits, which benefits shall be contracted for by the director: | |
18 | (1) Inpatient hospital services, other than services in a hospital, institution, or facility for | |
19 | tuberculosis or mental diseases; | |
20 | (2) Nursing services for the period of time as the director shall authorize; | |
21 | (3) Visiting nurse service; | |
22 | (4) Drugs for consumption either by inpatients or by other persons for whom they are | |
23 | prescribed by a licensed physician; | |
24 | (5) Dental services; and | |
25 | (6) Hospice care up to a maximum of two hundred and ten (210) days as a lifetime benefit. | |
26 | (b) For purposes of this chapter, the payment of federal Medicare premiums or other health | |
27 | insurance premiums by the department on behalf of eligible beneficiaries in accordance with the | |
28 | provisions of Title XIX of the federal Social Security Act, 42 U.S.C. § 1396 et seq., shall be deemed | |
29 | to be a direct vendor payment. | |
30 | (c) With respect to medical care benefits furnished to eligible individuals under this chapter | |
31 | or Title XIX of the federal Social Security Act, the department is authorized and directed to impose: | |
32 | (1) Nominal co-payments or similar charges upon eligible individuals for non-emergency | |
33 | services provided in a hospital emergency room; and | |
34 | (2) Co-payments for prescription drugs in the amount of one dollar ($1.00) for generic drug | |
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1 | prescriptions and three dollars ($3.00) for brand-name drug prescriptions in accordance with the | |
2 | provisions of 42 U.S.C. § 1396 et seq. | |
3 | (d) The department is authorized and directed to promulgate rules and regulations to | |
4 | impose co-payments or charges and to provide that, with respect to subsection (c)(2), those | |
5 | regulations shall be effective upon filing. | |
6 | (e)(c) No state agency shall pay a vendor for medical benefits provided to a recipient of | |
7 | assistance under this chapter until and unless the vendor has submitted a claim for payment to a | |
8 | commercial insurance plan, Medicare, and/or a Medicaid managed care plan, if applicable for that | |
9 | recipient, in that order. This includes payments for skilled nursing and therapy services specifically | |
10 | outlined in Chapters 7, 8, and 15 of the Medicare Benefit Policy Manual. | |
11 | 40-8-26. Community health centers. | |
12 | (a) For the purposes of this section, the term community health centers refers to federally | |
13 | qualified health centers and rural health centers. | |
14 | (b) To support the ability of community health centers to provide high-quality medical care | |
15 | to patients, the executive office of health and human services ("executive office") shall may adopt | |
16 | and implement an alternative payment methodology (APM) for determining a Medicaid per-visit | |
17 | reimbursement for community health centers that is compliant with the prospective payment system | |
18 | (PPS) provided for in the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection | |
19 | Act of 20001. The following principles are to ensure that the APM PPS prospective payment rate | |
20 | determination methodology is part of the executive office overall value purchasing approach. For | |
21 | community health centers that do not agree to the Principles of Reimbursement that reflects the | |
22 | APM PPS, EOHHS shall reimburse such community health centers at the federal PPS rate, as | |
23 | required per 1902(bb)(3) of the Social Security Act. For community health centers that are | |
24 | reimbursed at the federal PPS rate, RIGL Sections 40-8-26(d) through (f) apply. | |
25 | (c) The APM PPS rate determination methodology will (i) Fairly recognize the reasonable | |
26 | costs of providing services. Recognized reasonable costs will be those appropriate for the | |
27 | organization, management, and direct provision of services and (ii) Provide assurances to the | |
28 | executive office that services are provided in an effective and efficient manner, consistent with | |
29 | industry standards. Except for demonstrated cause and at the discretion of the executive office, the | |
30 | maximum reimbursement rate for a service (e.g., medical, dental) provided by an individual | |
31 | community health center shall not exceed one hundred twenty-five percent (125%) of the median | |
32 | rate for all community health centers within Rhode Island. | |
33 | (d) Community health centers will cooperate fully and timely with reporting requirements | |
34 | established by the executive office. | |
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1 | (e) Reimbursement rates established through this methodology shall be incorporated into | |
2 | the PPS reconciliation for services provided to Medicaid-eligible persons who are enrolled in a | |
3 | health plan on the date of service. Monthly payments by the executive office related to PPS for | |
4 | persons enrolled in a health plan shall be made directly to the community health centers. | |
5 | (f) Reimbursement rates established through this methodology shall be incorporated into | |
6 | the actuarially certified capitation rates paid to a health plan. The health plan shall be responsible | |
7 | for paying the full amount of the reimbursement rate to the community health center for each | |
8 | service eligible for reimbursement under the Medicare, Medicaid, and SCHIP Benefits | |
9 | Improvement and Protection Act of 20001. If the health plan has an alternative payment | |
10 | arrangement with the community health center the health plan may establish a PPS reconciliation | |
11 | process for eligible services and make monthly payments related to PPS for persons enrolled in the | |
12 | health plan on the date of service. The executive office will review, at least annually, the Medicaid | |
13 | reimbursement rates and reconciliation methodology used by the health plans for community health | |
14 | centers to ensure payments to each are made in compliance with the Medicare, Medicaid, and | |
15 | SCHIP Benefits Improvement and Protection Act of 20001. | |
16 | SECTION 3. Sections 40-8.3-2, 40-8.3-3 and 40-8.3-10 of the General Laws in Chapter | |
17 | 40-8.3 entitled “Uncompensated Care” are hereby amended to read as follows: | |
18 | 40-8.3-2. Definitions. | |
19 | As used in this chapter: | |
20 | (1) "Base year" means, for the purpose of calculating a disproportionate share payment for | |
21 | any fiscal year ending after September 30, 2018 2020, the period from October 1, 2016 2018, | |
22 | through September 30, 2017 2019, and for any fiscal year ending after September 30, 2019 2021, | |
23 | the period from October 1, 2016 2019, through September 30, 2017 2020. | |
24 | (2) "Medicaid inpatient utilization rate for a hospital" means a fraction (expressed as a | |
25 | percentage), the numerator of which is the hospital's number of inpatient days during the base year | |
26 | attributable to patients who were eligible for medical assistance during the base year and the | |
27 | denominator of which is the total number of the hospital's inpatient days in the base year. | |
28 | (3) "Participating hospital" means any nongovernment and nonpsychiatric hospital that: | |
29 | (i) Was licensed as a hospital in accordance with chapter 17 of title 23 during the base year | |
30 | and shall mean the actual facilities and buildings in existence in Rhode Island, licensed pursuant to | |
31 | § 23-17-1 et seq. on June 30, 2010, and thereafter any premises included on that license, regardless | |
32 | of changes in licensure status pursuant to chapter 17.14 of title 23 (hospital conversions) and § 23- | |
33 | 17-6(b) (change in effective control), that provides short-term, acute inpatient and/or outpatient | |
34 | care to persons who require definitive diagnosis and treatment for injury, illness, disabilities, or | |
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1 | pregnancy. Notwithstanding the preceding language, the negotiated Medicaid managed-care | |
2 | payment rates for a court-approved purchaser that acquires a hospital through receivership, special | |
3 | mastership, or other similar state insolvency proceedings (which court-approved purchaser is issued | |
4 | a hospital license after January 1, 2013), shall be based upon the newly negotiated rates between | |
5 | the court-approved purchaser and the health plan, and the rates shall be effective as of the date that | |
6 | the court-approved purchaser and the health plan execute the initial agreement containing the newly | |
7 | negotiated rate. The rate-setting methodology for inpatient hospital payments and outpatient | |
8 | hospital payments set forth in §§ 40-8-13.4(b)(1)(ii)(C) and 40-8-13.4(b)(2), respectively, shall | |
9 | thereafter apply to negotiated increases for each annual twelve-month (12) period as of July 1 | |
10 | following the completion of the first full year of the court-approved purchaser's initial Medicaid | |
11 | managed-care contract; | |
12 | (ii) Achieved a medical assistance inpatient utilization rate of at least one percent (1%) | |
13 | during the base year; and | |
14 | (iii) Continues to be licensed as a hospital in accordance with chapter 17 of title 23 during | |
15 | the payment year. | |
16 | (4) "Uncompensated-care costs" means, as to any hospital, the sum of: (i) The cost incurred | |
17 | by such hospital during the base year for inpatient or outpatient services attributable to charity care | |
18 | (free care and bad debts) for which the patient has no health insurance or other third-party coverage | |
19 | less payments, if any, received directly from such patients; and (ii) The cost incurred by such | |
20 | hospital during the base year for inpatient or out-patient services attributable to Medicaid | |
21 | beneficiaries less any Medicaid reimbursement received therefor; multiplied by the | |
22 | uncompensated-care index. | |
23 | (5) "Uncompensated-care index" means the annual percentage increase for hospitals | |
24 | established pursuant to § 27-19-14 for each year after the base year, up to and including the payment | |
25 | year; provided, however, that the uncompensated-care index for the payment year ending | |
26 | September 30, 2007, shall be deemed to be five and thirty-eight hundredths percent (5.38%), and | |
27 | that the uncompensated-care index for the payment year ending September 30, 2008, shall be | |
28 | deemed to be five and forty-seven hundredths percent (5.47%), and that the uncompensated-care | |
29 | index for the payment year ending September 30, 2009, shall be deemed to be five and thirty-eight | |
30 | hundredths percent (5.38%), and that the uncompensated-care index for the payment years ending | |
31 | September 30, 2010, September 30, 2011, September 30, 2012, September 30, 2013, September | |
32 | 30, 2014, September 30, 2015, September 30, 2016, September 30, 2017, September 30, 2018, | |
33 | September 30, 2019, and September 30, 2020, September 30, 2021, and September 30, 2022 shall | |
34 | be deemed to be five and thirty hundredths percent (5.30%). | |
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1 | 40-8.3-3. Implementation. | |
2 | (a) For federal fiscal year 2018, commencing on October 1, 2017, and ending September | |
3 | 30, 2018, the executive office of health and human services shall submit to the Secretary of the | |
4 | United States Department of Health and Human Services a state plan amendment to the Rhode | |
5 | Island Medicaid DSH Plan to provide: | |
6 | (1) That the DSH Plan to all participating hospitals, not to exceed an aggregate limit of | |
7 | $138.6 million, shall be allocated by the executive office of health and human services to the Pool | |
8 | D component of the DSH Plan; and | |
9 | (2) That the Pool D allotment shall be distributed among the participating hospitals in direct | |
10 | proportion to the individual participating hospital's uncompensated care costs for the base year, | |
11 | inflated by the uncompensated care index to the total uncompensated care costs for the base year | |
12 | inflated by uncompensated care index for all participating hospitals. The disproportionate share | |
13 | payments shall be made on or before July 10, 2018, and are expressly conditioned upon approval | |
14 | on or before July 5, 2018, by the Secretary of the United States. Department of Health and Human | |
15 | Services, or his or her authorized representative, of all Medicaid state plan amendments necessary | |
16 | to secure for the state the benefit of federal financial participation in federal fiscal year 2018 for | |
17 | the disproportionate share payments. | |
18 | (b) For federal fiscal year 2019, commencing on October 1, 2018, and ending September | |
19 | 30, 2019, the executive office of health and human services shall submit to the Secretary of the | |
20 | United States Department of Health and Human Services a state plan amendment to the Rhode | |
21 | Island Medicaid DSH Plan to provide: | |
22 | (1) That the DSH Plan to all participating hospitals, not to exceed an aggregate limit of | |
23 | $142.4 million, shall be allocated by the executive office of health and human services to the Pool | |
24 | D component of the DSH Plan; and | |
25 | (2) That the Pool D allotment shall be distributed among the participating hospitals in direct | |
26 | proportion to the individual participating hospital's uncompensated care costs for the base year, | |
27 | inflated by the uncompensated care index to the total uncompensated care costs for the base year | |
28 | inflated by uncompensated care index for all participating hospitals. The disproportionate share | |
29 | payments shall be made on or before July 10, 2019, and are expressly conditioned upon approval | |
30 | on or before July 5, 2019, by the Secretary of the United States Department of Health and Human | |
31 | Services, or his or her authorized representative, of all Medicaid state plan amendments necessary | |
32 | to secure for the state the benefit of federal financial participation in federal fiscal year 2019 for | |
33 | the disproportionate share payments. | |
34 | (c) (a) For federal fiscal year 2020, commencing on October 1, 2019, and ending September | |
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1 | 30, 2020, the executive office of health and human services shall submit to the Secretary of the | |
2 | United States Department of Health and Human Services a state plan amendment to the Rhode | |
3 | Island Medicaid DSH Plan to provide: | |
4 | (1) That the DSH Plan to all participating hospitals, not to exceed an aggregate limit of | |
5 | $142.4 million, shall be allocated by the executive office of health and human services to the Pool | |
6 | D component of the DSH Plan; and | |
7 | (2) That the Pool D allotment shall be distributed among the participating hospitals in direct | |
8 | proportion to the individual participating hospital's uncompensated-care costs for the base year, | |
9 | inflated by the uncompensated-care index to the total uncompensated-care costs for the base year | |
10 | inflated by uncompensated-care index for all participating hospitals. The disproportionate share | |
11 | payments shall be made on or before July 13, 2020, and are expressly conditioned upon approval | |
12 | on or before July 6, 2020, by the Secretary of the United States Department of Health and Human | |
13 | Services, or his or her authorized representative, of all Medicaid state plan amendments necessary | |
14 | to secure for the state the benefit of federal financial participation in federal fiscal year 2020 for | |
15 | the disproportionate share payments. | |
16 | (b) For federal fiscal year 2021, commencing on October 1, 2020, and ending September | |
17 | 30, 2021, the executive office of health and human services shall submit to the Secretary of the | |
18 | U.S. Department of Health and Human Services a state plan amendment to the Rhode Island | |
19 | Medicaid DSH Plan to provide: | |
20 | (1) That the DSH Plan to all participating hospitals, not to exceed an aggregate limit of | |
21 | $142.5 million, shall be allocated by the executive office of health and human services to the Pool | |
22 | D component of the DSH Plan; and | |
23 | (2) That the Pool D allotment shall be distributed among the participating hospitals in direct | |
24 | proportion to the individual participating hospital's uncompensated care costs for the base year, | |
25 | inflated by the uncompensated care index to the total uncompensated care costs for the base year | |
26 | inflated by uncompensated care index for all participating hospitals. The disproportionate share | |
27 | payments shall be made on or before July 12, 2021, and are expressly conditioned upon approval | |
28 | on or before July 5, 2021, by the Secretary of the U.S. Department of Health and Human Services, | |
29 | or his or her authorized representative, of all Medicaid state plan amendments necessary to secure | |
30 | for the state the benefit of federal financial participation in federal fiscal year 2021 for the | |
31 | disproportionate share payments. | |
32 | (c) For federal fiscal year 2022, commencing on October 1, 2021, and ending September | |
33 | 30, 2022, the executive office of health and human services shall submit to the Secretary of the | |
34 | U.S. Department of Health and Human Services a state plan amendment to the Rhode Island | |
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1 | Medicaid DSH Plan to provide: | |
2 | (1) That the DSH Plan to all participating hospitals, not to exceed an aggregate limit of | |
3 | $143.8 million, shall be allocated by the executive office of health and human services to the Pool | |
4 | D component of the DSH Plan; and | |
5 | (2) That the Pool D allotment shall be distributed among the participating hospitals in direct | |
6 | proportion to the individual participating hospital's uncompensated care costs for the base year, | |
7 | inflated by the uncompensated care index to the total uncompensated care costs for the base year | |
8 | inflated by uncompensated care index for all participating hospitals. The disproportionate share | |
9 | payments shall be made on or before July 12, 2022, and are expressly conditioned upon approval | |
10 | on or before July 5, 2022, by the Secretary of the U.S. Department of Health and Human Services, | |
11 | or his or her authorized representative, of all Medicaid state plan amendments necessary to secure | |
12 | for the state the benefit of federal financial participation in federal fiscal year 2022 for the | |
13 | disproportionate share payments. | |
14 | (d) No provision is made pursuant to this chapter for disproportionate-share hospital | |
15 | payments to participating hospitals for uncompensated-care costs related to graduate medical | |
16 | education programs. | |
17 | (e) The executive office of health and human services is directed, on at least a monthly | |
18 | basis, to collect patient-level uninsured information, including, but not limited to, demographics, | |
19 | services rendered, and reason for uninsured status from all hospitals licensed in Rhode Island. | |
20 | 40-8.3-10. Hospital adjustment payments. | |
21 | Effective July 1, 2012 2021, and for each subsequent year, the executive office of health | |
22 | and human services is hereby authorized and directed to amend its regulations for reimbursement | |
23 | to hospitals for inpatient and outpatient services as follows: | |
24 | (a) Each hospital in the state of Rhode Island, as defined in § 23-17-38.1, shall receive a | |
25 | quarterly outpatient adjustment payment each state fiscal year of an amount determined as follows: | |
26 | (1) Determine the percent of the state's total Medicaid outpatient and emergency | |
27 | department services (exclusive of physician services) provided by each hospital during each | |
28 | hospital's prior fiscal year; | |
29 | (2) Determine the sum of all Medicaid payments to hospitals made for outpatient and | |
30 | emergency department services (exclusive of physician services) provided during each hospital's | |
31 | prior fiscal year; | |
32 | (3) Multiply the sum of all Medicaid payments as determined in subsection (a)(2) by a | |
33 | percentage defined as the total identified upper payment limit for all hospitals divided by the sum | |
34 | of all Medicaid payments as determined in subsection (a)(2); and then multiply that result by each | |
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1 | hospital's percentage of the state's total Medicaid outpatient and emergency department services as | |
2 | determined in subsection (a)(1) to obtain the total outpatient adjustment for each hospital to be paid | |
3 | each year; | |
4 | (4) Pay each hospital on or before July 20, October 20, January 20, and April 20 one quarter | |
5 | (1/4) of its total outpatient adjustment as determined in subsection (a)(3). | |
6 | (b) [Deleted by P.L. 2019, ch. 88, art. 13, § 6.] | |
7 | (c) Each hospital in the state of Rhode Island, as defined in subdivision 3-17-38.19(b)(1), | |
8 | shall receive a quarterly inpatient adjustment payment each state fiscal year of an amount | |
9 | determined as follows: | |
10 | (1) Determine the percent of the state's total Medicaid inpatient services (exclusive of | |
11 | physician services) provided by each hospital during each hospital's prior fiscal year; | |
12 | (2) Determine the sum of all Medicaid payments to hospitals made for inpatient services | |
13 | (exclusive of physician services) provided during each hospital's prior fiscal year; | |
14 | (3) Multiply the sum of all Medicaid payments as determined in subdivision (2) by a | |
15 | percentage defined as the total identified upper payment limit for all hospitals divided by the sum | |
16 | of all Medicaid payments as determined in subdivision (2); and then multiply that result by each | |
17 | hospital's percentage of the state's total Medicaid inpatient services as determined in subdivision | |
18 | (1) to obtain the total inpatient adjustment for each hospital to be paid each year; | |
19 | (4) Pay each hospital on or before July 20, October 20, January 20, and April 20 one | |
20 | quarter (1/4) of its total inpatient adjustment as determined in subdivision (3) above. | |
21 | (c)(d) The amounts determined in subsection subsections (a) and (c) are in addition to | |
22 | Medicaid inpatient and outpatient payments and emergency services payments (exclusive of | |
23 | physician services) paid to hospitals in accordance with current state regulation and the Rhode | |
24 | Island Plan for Medicaid Assistance pursuant to Title XIX of the Social Security Act and are not | |
25 | subject to recoupment or settlement. | |
26 | SECTION 4. Section 15 of Article 5 of Chapter 141 of the Public Laws of 2015 is hereby | |
27 | repealed. | |
28 | A pool is hereby established of up to $4.0 million to support Medicaid Graduate Education | |
29 | funding for Academic Medical Centers who provide care to the state’s critically ill and indigent | |
30 | populations. The office of Health and Human Services shall utilize this pool to provide up to $5 | |
31 | million per year in additional Medicaid payments to support Graduate Medical Education programs | |
32 | to hospitals meeting all of the following criteria: | |
33 | (a) Hospital must have a minimum of 25,000 inpatient discharges per year for all patients | |
34 | regardless of coverage. | |
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| |
1 | (b) Hospital must be designated as Level I Trauma Center. | |
2 | (c) Hospital must provide graduate medical education training for at least 250 interns and | |
3 | residents per year. | |
4 | The Secretary of the Executive Office of Health and Human Services shall determine the | |
5 | appropriate Medicaid payment mechanism to implement this program and amend any state plan | |
6 | documents required to implement the payments. | |
7 | Payments for Graduate Medical Education programs shall be made annually. | |
8 | SECTION 5. Section 40-8.4-12 of the General Laws in Chapter 40-8.4 entitled "Health | |
9 | Care for Families" is hereby amended to read as follows: | |
10 | 40-8.4-12. RIte Share health insurance premium assistance program. | |
11 | (a) Basic RIte Share health insurance premium assistance program. Under the terms of | |
12 | Section 1906 of Title XIX of the U.S. Social Security Act, 42 U.S.C. § 1396e, states are permitted | |
13 | to pay a Medicaid-eligible person's share of the costs for enrolling in employer-sponsored health | |
14 | insurance (ESI) coverage if it is cost-effective to do so. Pursuant to the general assembly's direction | |
15 | in the Rhode Island health reform act of 2000, the Medicaid agency requested and obtained federal | |
16 | approval under § 1916, 42 U.S.C. § 1396o, to establish the RIte Share premium assistance program | |
17 | to subsidize the costs of enrolling Medicaid-eligible persons and families in employer-sponsored | |
18 | health insurance plans that have been approved as meeting certain cost and coverage requirements. | |
19 | The Medicaid agency also obtained, at the general assembly's direction, federal authority to require | |
20 | any such persons with access to ESI coverage to enroll as a condition of retaining eligibility | |
21 | providing that doing so meets the criteria established in Title XIX for obtaining federal matching | |
22 | funds. | |
23 | (b) Definitions. For the purposes of this section, the following definitions apply: | |
24 | (1) "Cost-effective" means that the portion of the ESI that the state would subsidize, as | |
25 | well as wrap-around costs, would on average cost less to the state than enrolling that same | |
26 | person/family in a managed-care delivery system. | |
27 | (2) "Cost sharing" means any co-payments, deductibles, or co-insurance associated with | |
28 | ESI. | |
29 | (3) "Employee premium" means the monthly premium share a person or family is required | |
30 | to pay to the employer to obtain and maintain ESI coverage. | |
31 | (4) "Employer-sponsored insurance" or "ESI" means health insurance or a group health | |
32 | plan offered to employees by an employer. This includes plans purchased by small employers | |
33 | through the state health insurance marketplace, healthsource, RI (HSRI). | |
34 | (5) "Policy holder" means the person in the household with access to ESI, typically the | |
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| |
1 | employee. | |
2 | (6) "RIte Share-approved employer-sponsored insurance (ESI)" means an employer- | |
3 | sponsored health insurance plan that meets the coverage and cost-effectiveness criteria for RIte | |
4 | Share. | |
5 | (7) "RIte Share buy-in" means the monthly amount an Medicaid-ineligible policy holder | |
6 | must pay toward RIte Share-approved ESI that covers the Medicaid-eligible children, young adults, | |
7 | or spouses with access to the ESI. The buy-in only applies in instances when household income is | |
8 | above one hundred fifty percent (150%) of the FPL. | |
9 | (8) "RIte Share premium assistance program" means the Rhode Island Medicaid premium | |
10 | assistance program in which the State pays the eligible Medicaid member's share of the cost of | |
11 | enrolling in a RIte Share-approved ESI plan. This allows the state to share the cost of the health | |
12 | insurance coverage with the employer. | |
13 | (9) "RIte Share unit" means the entity within the executive office of health and human | |
14 | services (EOHHS) responsible for assessing the cost-effectiveness of ESI, contacting employers | |
15 | about ESI as appropriate, initiating the RIte Share enrollment and disenrollment process, handling | |
16 | member communications, and managing the overall operations of the RIte Share program. | |
17 | (10) "Third-party liability (TPL)" means other health insurance coverage. This insurance | |
18 | is in addition to Medicaid and is usually provided through an employer. Since Medicaid is always | |
19 | the payer of last resort, the TPL is always the primary coverage. | |
20 | (11) "Wrap-around services or coverage" means any healthcare services not included in | |
21 | the ESI plan that would have been covered had the Medicaid member been enrolled in a RIte Care | |
22 | or Rhody Health Partners plan. Coverage of deductibles and co-insurance is included in the wrap. | |
23 | Co-payments to providers are not covered as part of the wrap-around coverage. | |
24 | (c) RIte Share populations. Medicaid beneficiaries subject to RIte Share include: children, | |
25 | families, parent and caretakers eligible for Medicaid or the children's health insurance program | |
26 | (CHIP) under this chapter or chapter 12.3 of title 42; and adults between the ages of nineteen (19) | |
27 | and sixty-four (64) who are eligible under chapter 8.12 of this title, not receiving or eligible to | |
28 | receive Medicare, and are enrolled in managed care delivery systems. The following conditions | |
29 | apply: | |
30 | (1) The income of Medicaid beneficiaries shall affect whether and in what manner they | |
31 | must participate in RIte Share as follows: | |
32 | (i) Income at or below one hundred fifty percent (150%) of FPL -- Persons and families | |
33 | determined to have household income at or below one hundred fifty percent (150%) of the federal | |
34 | poverty level (FPL) guidelines based on the modified adjusted gross income (MAGI) standard or | |
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| |
1 | other standard approved by the secretary are required to participate in RIte Share if a Medicaid- | |
2 | eligible adult or parent/caretaker has access to cost-effective ESI. Enrolling in ESI through RIte | |
3 | Share shall be a condition of maintaining Medicaid health coverage for any eligible adult with | |
4 | access to such coverage. | |
5 | (ii) Income above one hundred fifty percent (150%) of FPL and policy holder is not | |
6 | Medicaid-eligible -- Premium assistance is available when the household includes Medicaid- | |
7 | eligible members, but the ESI policy holder (typically a parent/caretaker, or spouse) is not eligible | |
8 | for Medicaid. Premium assistance for parents/caretakers and other household members who are not | |
9 | Medicaid-eligible may be provided in circumstances when enrollment of the Medicaid-eligible | |
10 | family members in the approved ESI plan is contingent upon enrollment of the ineligible policy | |
11 | holder and the executive office of health and human services (executive office) determines, based | |
12 | on a methodology adopted for such purposes, that it is cost-effective to provide premium assistance | |
13 | for family or spousal coverage. | |
14 | (d) RIte Share enrollment as a condition of eligibility. For Medicaid beneficiaries over the | |
15 | age of nineteen (19), enrollment in RIte Share shall be a condition of eligibility except as exempted | |
16 | below and by regulations promulgated by the executive office. | |
17 | (1) Medicaid-eligible children and young adults up to age nineteen (19) shall not be | |
18 | required to enroll in a parent/caretaker relative's ESI as a condition of maintaining Medicaid | |
19 | eligibility if the person with access to RIte Share-approved ESI does not enroll as required. These | |
20 | Medicaid-eligible children and young adults shall remain eligible for Medicaid and shall be | |
21 | enrolled in a RIte Care plan. | |
22 | (2) There shall be a limited six-month (6) exemption from the mandatory enrollment | |
23 | requirement for persons participating in the RI works program pursuant to chapter 5.2 of this title. | |
24 | (e) Approval of health insurance plans for premium assistance. The executive office of | |
25 | health and human services shall adopt regulations providing for the approval of employer-based | |
26 | health insurance plans for premium assistance and shall approve employer-based health insurance | |
27 | plans based on these regulations. In order for an employer-based health insurance plan to gain | |
28 | approval, the executive office must determine that the benefits offered by the employer-based | |
29 | health insurance plan are substantially similar in amount, scope, and duration to the benefits | |
30 | provided to Medicaid-eligible persons enrolled in a Medicaid managed care plan, when the plan is | |
31 | evaluated in conjunction with available supplemental benefits provided by the office. The office | |
32 | shall obtain and make available to persons otherwise eligible for Medicaid identified in this section | |
33 | as supplemental benefits those benefits not reasonably available under employer-based health | |
34 | insurance plans that are required for Medicaid beneficiaries by state law or federal law or | |
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| |
1 | regulation. Once it has been determined by the Medicaid agency that the ESI offered by a particular | |
2 | employer is RIte Share-approved, all Medicaid members with access to that employer's plan are | |
3 | required to participate in RIte Share. Failure to meet the mandatory enrollment requirement shall | |
4 | result in the termination of the Medicaid eligibility of the policy holder and other Medicaid | |
5 | members nineteen (19) or older in the household who could be covered under the ESI until the | |
6 | policy holder complies with the RIte Share enrollment procedures established by the executive | |
7 | office. | |
8 | (f) Premium assistance. The executive office shall provide premium assistance by paying | |
9 | all or a portion of the employee's cost for covering the eligible person and/or his or her family under | |
10 | such a RIte Share-approved ESI plan subject to the buy-in provisions in this section. | |
11 | (g) Buy-in. Persons who can afford it shall share in the cost. -- The executive office is | |
12 | authorized and directed to apply for and obtain any necessary state plan and/or waiver amendments | |
13 | from the Secretary of the United States Department of Health and Human Services (DHHS) to | |
14 | require that persons enrolled in a RIte Share-approved employer-based health plan who have | |
15 | income equal to or greater than one hundred fifty percent (150%) of the FPL to buy-in to pay a | |
16 | share of the costs based on the ability to pay, provided that the buy-in cost shall not exceed five | |
17 | percent (5%) of the person's annual income. The executive office shall implement the buy-in by | |
18 | regulation, and shall consider co-payments, premium shares, or other reasonable means to do so. | |
19 | (h) Maximization of federal contribution. The executive office of health and human | |
20 | services is authorized and directed to apply for and obtain federal approvals and waivers necessary | |
21 | to maximize the federal contribution for provision of medical assistance coverage under this | |
22 | section, including the authorization to amend the Title XXI state plan and to obtain any waivers | |
23 | necessary to reduce barriers to provide premium assistance to recipients as provided for in Title | |
24 | XXI of the Social Security Act, 42 U.S.C. § 1397aa et seq. | |
25 | (i) Implementation by regulation. The executive office of health and human services is | |
26 | authorized and directed to adopt regulations to ensure the establishment and implementation of the | |
27 | premium assistance program in accordance with the intent and purpose of this section, the | |
28 | requirements of Title XIX, Title XXI, and any approved federal waivers. | |
29 | (j) Outreach and reporting. The executive office of health and human services shall develop | |
30 | a plan to identify Medicaid-eligible individuals who have access to employer-sponsored insurance | |
31 | and increase the use of RIte Share benefits. Beginning October 1, 2019, the executive office shall | |
32 | submit the plan to be included as part of the reporting requirements under § 35-17-1. Starting | |
33 | January 1, 2020, the executive office of health and human services shall include the number of | |
34 | Medicaid recipients with access to employer-sponsored insurance, the number of plans that did not | |
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| |
1 | meet the cost-effectiveness criteria for RIte Share, and enrollment in the premium assistance | |
2 | program as part of the reporting requirements under § 35-17-1. | |
3 | (k) Employer Sponsored Insurance. The Executive Office of Health and Human Services | |
4 | shall dedicate staff and resources to reporting monthly as part of the requirements under § 35-17-1 | |
5 | which employer sponsored insurance plans meet the cost effectiveness criteria for RIte Share. | |
6 | Information in the report shall be used for screening for Medicaid enrollment to encourage Rite | |
7 | Share participation. By October 1, 2021, the report shall include any employers with 300 or more | |
8 | employees. By January 1, 2022, the report shall include employers with 100 or more employees. | |
9 | The January report shall also be provided to the chairperson of the house finance committee; the | |
10 | chairperson of the senate finance committee; the house fiscal advisor; the senate fiscal advisor; and | |
11 | the state budget officer.. | |
12 | SECTION 6. Section 40-8.9-9 of the General Laws in Chapter 40-8.9 entitled “Medical | |
13 | Assistance – Long-Term Care Service and Finance Reform” is hereby amended to read as follows: | |
14 | 40-8.9-9. Long-term-care rebalancing system reform goal. | |
15 | (a) Notwithstanding any other provision of state law, the executive office of health and | |
16 | human services is authorized and directed to apply for, and obtain, any necessary waiver(s), waiver | |
17 | amendment(s), and/or state-plan amendments from the Secretary of the United States Department | |
18 | of Health and Human Services, and to promulgate rules necessary to adopt an affirmative plan of | |
19 | program design and implementation that addresses the goal of allocating a minimum of fifty percent | |
20 | (50%) of Medicaid long-term-care funding for persons aged sixty-five (65) and over and adults | |
21 | with disabilities, in addition to services for persons with developmental disabilities, to home- and | |
22 | community-based care; provided, further, the executive office shall report annually as part of its | |
23 | budget submission, the percentage distribution between institutional care and home- and | |
24 | community-based care by population and shall report current and projected waiting lists for long- | |
25 | term-care and home- and community-based care services. The executive office is further authorized | |
26 | and directed to prioritize investments in home- and community-based care and to maintain the | |
27 | integrity and financial viability of all current long-term-care services while pursuing this goal. | |
28 | (b) The reformed long-term-care system rebalancing goal is person-centered and | |
29 | encourages individual self-determination, family involvement, interagency collaboration, and | |
30 | individual choice through the provision of highly specialized and individually tailored home-based | |
31 | services. Additionally, individuals with severe behavioral, physical, or developmental disabilities | |
32 | must have the opportunity to live safe and healthful lives through access to a wide range of | |
33 | supportive services in an array of community-based settings, regardless of the complexity of their | |
34 | medical condition, the severity of their disability, or the challenges of their behavior. Delivery of | |
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| |
1 | services and supports in less-costly and less-restrictive community settings will enable children, | |
2 | adolescents, and adults to be able to curtail, delay, or avoid lengthy stays in long-term-care | |
3 | institutions, such as behavioral health residential-treatment facilities, long-term-care hospitals, | |
4 | intermediate-care facilities, and/or skilled nursing facilities. | |
5 | (c) Pursuant to federal authority procured under § 42-7.2-16, the executive office of health | |
6 | and human services is directed and authorized to adopt a tiered set of criteria to be used to determine | |
7 | eligibility for services. The criteria shall be developed in collaboration with the state's health and | |
8 | human services departments and, to the extent feasible, any consumer group, advisory board, or | |
9 | other entity designated for these purposes, and shall encompass eligibility determinations for long- | |
10 | term-care services in nursing facilities, hospitals, and intermediate-care facilities for persons with | |
11 | intellectual disabilities, as well as home- and community-based alternatives, and shall provide a | |
12 | common standard of income eligibility for both institutional and home- and community-based care. | |
13 | The executive office is authorized to adopt clinical and/or functional criteria for admission to a | |
14 | nursing facility, hospital, or intermediate-care facility for persons with intellectual disabilities that | |
15 | are more stringent than those employed for access to home- and community-based services. The | |
16 | executive office is also authorized to promulgate rules that define the frequency of re-assessments | |
17 | for services provided for under this section. Levels of care may be applied in accordance with the | |
18 | following: | |
19 | (1) The executive office shall continue to apply the level-of-care criteria in effect on June | |
20 | 30, 2015, for any recipient determined eligible for and receiving Medicaid-funded long-term | |
21 | services in supports in a nursing facility, hospital, or intermediate-care facility for persons with | |
22 | intellectual disabilities on or before that date, unless: | |
23 | (i) The recipient transitions to home- and community-based services because he or she | |
24 | would no longer meet the level-of-care criteria in effect on June 30, 2015; or | |
25 | (ii) The recipient chooses home- and community-based services over the nursing facility, | |
26 | hospital, or intermediate-care facility for persons with intellectual disabilities. For the purposes of | |
27 | this section, a failed community placement, as defined in regulations promulgated by the executive | |
28 | office, shall be considered a condition of clinical eligibility for the highest level of care. The | |
29 | executive office shall confer with the long-term-care ombudsperson with respect to the | |
30 | determination of a failed placement under the ombudsperson's jurisdiction. Should any Medicaid | |
31 | recipient eligible for a nursing facility, hospital, or intermediate-care facility for persons with | |
32 | intellectual disabilities as of June 30, 2015, receive a determination of a failed community | |
33 | placement, the recipient shall have access to the highest level of care; furthermore, a recipient who | |
34 | has experienced a failed community placement shall be transitioned back into his or her former | |
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| |
1 | nursing home, hospital, or intermediate-care facility for persons with intellectual disabilities | |
2 | whenever possible. Additionally, residents shall only be moved from a nursing home, hospital, or | |
3 | intermediate-care facility for persons with intellectual disabilities in a manner consistent with | |
4 | applicable state and federal laws. | |
5 | (2) Any Medicaid recipient eligible for the highest level of care who voluntarily leaves a | |
6 | nursing home, hospital, or intermediate-care facility for persons with intellectual disabilities shall | |
7 | not be subject to any wait list for home- and community-based services. | |
8 | (3) No nursing home, hospital, or intermediate-care facility for persons with intellectual | |
9 | disabilities shall be denied payment for services rendered to a Medicaid recipient on the grounds | |
10 | that the recipient does not meet level-of-care criteria unless and until the executive office has: | |
11 | (i) Performed an individual assessment of the recipient at issue and provided written notice | |
12 | to the nursing home, hospital, or intermediate-care facility for persons with intellectual disabilities | |
13 | that the recipient does not meet level-of-care criteria; and | |
14 | (ii) The recipient has either appealed that level-of-care determination and been | |
15 | unsuccessful, or any appeal period available to the recipient regarding that level-of-care | |
16 | determination has expired. | |
17 | (d) The executive office is further authorized to consolidate all home- and community- | |
18 | based services currently provided pursuant to 42 U.S.C. § 1396n into a single system of home- and | |
19 | community-based services that include options for consumer direction and shared living. The | |
20 | resulting single home- and community-based services system shall replace and supersede all 42 | |
21 | U.S.C. § 1396n programs when fully implemented. Notwithstanding the foregoing, the resulting | |
22 | single program home- and community-based services system shall include the continued funding | |
23 | of assisted-living services at any assisted-living facility financed by the Rhode Island housing and | |
24 | mortgage finance corporation prior to January 1, 2006, and shall be in accordance with chapter 66.8 | |
25 | of title 42 as long as assisted-living services are a covered Medicaid benefit. | |
26 | (e) The executive office is authorized to promulgate rules that permit certain optional | |
27 | services including, but not limited to, homemaker services, home modifications, respite, and | |
28 | physical therapy evaluations to be offered to persons at risk for Medicaid-funded long-term care | |
29 | subject to availability of state-appropriated funding for these purposes. | |
30 | (f) To promote the expansion of home- and community-based service capacity, the | |
31 | executive office is authorized to pursue payment methodology reforms that increase access to | |
32 | homemaker, personal care (home health aide), assisted living, adult supportive-care homes, and | |
33 | adult day services, as follows: | |
34 | (1) Development of revised or new Medicaid certification standards that increase access to | |
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| |
1 | service specialization and scheduling accommodations by using payment strategies designed to | |
2 | achieve specific quality and health outcomes. | |
3 | (2) Development of Medicaid certification standards for state-authorized providers of adult | |
4 | day services, excluding providers of services authorized under § 40.1-24-1(3), assisted living, and | |
5 | adult supportive care (as defined under chapter 17.24 of title 23) that establish for each, an acuity- | |
6 | based, tiered service and payment methodology tied to: licensure authority; level of beneficiary | |
7 | needs; the scope of services and supports provided; and specific quality and outcome measures. | |
8 | The standards for adult day services for persons eligible for Medicaid-funded long-term | |
9 | services may differ from those who do not meet the clinical/functional criteria set forth in § 40- | |
10 | 8.10-3. | |
11 | (3) As the state's Medicaid program seeks to assist more beneficiaries requiring long-term | |
12 | services and supports in home- and community-based settings, the demand for home-care workers | |
13 | has increased, and wages for these workers has not kept pace with neighboring states, leading to | |
14 | high turnover and vacancy rates in the state's home-care industry, the executive office shall institute | |
15 | a one-time increase in the base-payment rates for FY 2019, as described below, for home-care | |
16 | service providers to promote increased access to and an adequate supply of highly trained home- | |
17 | healthcare professionals, in amount to be determined by the appropriations process, for the purpose | |
18 | of raising wages for personal care attendants and home health aides to be implemented by such | |
19 | providers. | |
20 | (4)(i) A prospective base adjustment, effective not later than July 1, 2018, of ten percent | |
21 | (10%) of the current base rate for home-care providers, home nursing care providers, and hospice | |
22 | providers contracted with the executive office of health and human services and its subordinate | |
23 | agencies to deliver Medicaid fee-for-service personal care attendant services. | |
24 | (5)(ii) A prospective base adjustment, effective not later than July 1, 2018, of twenty | |
25 | percent (20%) of the current base rate for home-care providers, home nursing care providers, and | |
26 | hospice providers contracted with the executive office of health and human services and its | |
27 | subordinate agencies to deliver Medicaid fee-for-service skilled nursing and therapeutic services | |
28 | and hospice care. | |
29 | (6)(iii) Effective upon passage of this section, hospice provider reimbursement, exclusively | |
30 | for room and board expenses for individuals residing in a skilled nursing facility, shall revert to the | |
31 | rate methodology in effect on June 30, 2018, and these room and board expenses shall be exempted | |
32 | from any and all annual rate increases to hospice providers as provided for in this section. | |
33 | (7)(iv) On the first of July in each year, beginning on July 1, 2019, the executive office of | |
34 | health and human services will initiate an annual inflation increase to the base rate for home-care | |
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| |
1 | providers, home nursing care providers, and hospice providers contracted with the executive office | |
2 | and its subordinate agencies to deliver Medicaid fee-for-service personal care attendant services, | |
3 | skilled nursing and therapeutic services and hospice care. The base rate increase shall be a | |
4 | percentage amount equal to the New England Consumer Price Index card as determined by the | |
5 | United States Department of Labor for medical care and for compliance with all federal and state | |
6 | laws, regulations, and rules, and all national accreditation program requirements. | |
7 | (g) As the state's Medicaid program seeks to assist more beneficiaries requiring long-term | |
8 | services and supports in home- and community-based settings, the demand for home-care workers | |
9 | has increased, and wages for these workers has not kept pace with neighboring states, leading to | |
10 | high turnover and vacancy rates in the state's home-care industry, to promote increased access to | |
11 | and an adequate supply of direct care workers the executive office shall institute a payment | |
12 | methodology change, in Medicaid fee-for-service and managed care, for FY 2022, which shall be | |
13 | passed through directly to the direct care workers’ wages that are employed by home nursing care | |
14 | and home care providers licensed by Rhode Island Department of Health, as described below: | |
15 | (1) Effective July 1, 2021, increase the existing shift differential modifier by $0.19 per | |
16 | fifteen (15) minutes for Personal Care and Combined Personal Care/Homemaker. | |
17 | (i) Employers must pass on one-hundred percent (100%) of the shift differential modifier | |
18 | increase per fifteen (15) minute unit of service to the CNAs that rendered such services. This | |
19 | compensation shall be provided in addition to the rate of compensation that the employee was | |
20 | receiving as of June 30, 2021. For an employee hired after June 30, 2021, the agency shall use not | |
21 | less than the lowest compensation paid to an employee of similar functions and duties as of June | |
22 | 30, 2021 as the base compensation to which the increase is applied. | |
23 | (ii) Employers must provide to EOHHS an annual compliance statement showing wages | |
24 | as of June 30, 2021, amounts received from the increases outlined herein, and compliance with this | |
25 | section by July 1, 2022. EOHHS may adopt any additional necessary regulations and processes to | |
26 | oversee this section. | |
27 | (2) Effective January 1, 2022, establish a new behavioral healthcare enhancement of $0.39 | |
28 | per fifteen (15) minutes for Personal Care, Combined Personal Care/Homemaker, and Homemaker | |
29 | only for providers who have at least thirty percent (30%) of their direct care workers (which | |
30 | includes Certified Nursing Assistants (CNA) and Homemakers) certified in behavioral healthcare | |
31 | training. | |
32 | (i) Employers must pass on one-hundred percent (100%) of the behavioral healthcare | |
33 | enhancement per fifteen (15) minute unit of service rendered by only those CNAs and Homemakers | |
34 | who have completed the thirty (30) hour behavioral health certificate training program offered by | |
|
| |
1 | Rhode Island College, or a training program that is prospectively determined to be compliant per | |
2 | EOHHS, to those CNAs and Homemakers. This compensation shall be provided in addition to the | |
3 | rate of compensation that the employee was receiving as of December 31, 2021. For an employee | |
4 | hired after December 31, 2021, the agency shall use not less than the lowest compensation paid to | |
5 | an employee of similar functions and duties as of December 31, 2021 as the base compensation to | |
6 | which the increase is applied. | |
7 | (ii) By January 1, 2023, employers must provide to EOHHS an annual compliance | |
8 | statement showing wages as of December 31, 2021, amounts received from the increases outlined | |
9 | herein, and compliance with this section, including which behavioral healthcare training programs | |
10 | were utilized. EOHHS may adopt any additional necessary regulations and processes to oversee | |
11 | this section. | |
12 | (g)(h) The executive office shall implement a long-term-care-options counseling program | |
13 | to provide individuals, or their representatives, or both, with long-term-care consultations that shall | |
14 | include, at a minimum, information about: long-term-care options, sources, and methods of both | |
15 | public and private payment for long-term-care services and an assessment of an individual's | |
16 | functional capabilities and opportunities for maximizing independence. Each individual admitted | |
17 | to, or seeking admission to, a long-term-care facility, regardless of the payment source, shall be | |
18 | informed by the facility of the availability of the long-term-care-options counseling program and | |
19 | shall be provided with long-term-care-options consultation if they so request. Each individual who | |
20 | applies for Medicaid long-term-care services shall be provided with a long-term-care consultation. | |
21 | (h)(i) The executive office is also authorized, subject to availability of appropriation of | |
22 | funding, and federal, Medicaid-matching funds, to pay for certain services and supports necessary | |
23 | to transition or divert beneficiaries from institutional or restrictive settings and optimize their health | |
24 | and safety when receiving care in a home or the community. The secretary is authorized to obtain | |
25 | any state plan or waiver authorities required to maximize the federal funds available to support | |
26 | expanded access to home- and community-transition and stabilization services; provided, however, | |
27 | payments shall not exceed an annual or per-person amount. | |
28 | (i)(j) To ensure persons with long-term-care needs who remain living at home have | |
29 | adequate resources to deal with housing maintenance and unanticipated housing-related costs, the | |
30 | secretary is authorized to develop higher resource eligibility limits for persons or obtain any state | |
31 | plan or waiver authorities necessary to change the financial eligibility criteria for long-term services | |
32 | and supports to enable beneficiaries receiving home and community waiver services to have the | |
33 | resources to continue living in their own homes or rental units or other home-based settings. | |
34 | (j)(k) The executive office shall implement, no later than January 1, 2016, the following | |
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1 | home- and community-based service and payment reforms: | |
2 | (1) Community-based, supportive-living program established in § 40-8.13-12 or an | |
3 | alternative, successor, or substitute program, or delivery option designated for these purposes by | |
4 | the secretary of the executive office of health and human services; | |
5 | (2) (1) Adult day services level of need criteria and acuity-based, tiered-payment | |
6 | methodology; and | |
7 | (3) (2) Payment reforms that encourage home- and community-based providers to provide | |
8 | the specialized services and accommodations beneficiaries need to avoid or delay institutional care. | |
9 | (k)(l) The secretary is authorized to seek any Medicaid section 1115 waiver or state-plan | |
10 | amendments and take any administrative actions necessary to ensure timely adoption of any new | |
11 | or amended rules, regulations, policies, or procedures and any system enhancements or changes, | |
12 | for which appropriations have been authorized, that are necessary to facilitate implementation of | |
13 | the requirements of this section by the dates established. The secretary shall reserve the discretion | |
14 | to exercise the authority established under §§ 42-7.2-5(6)(v) and 42-7.2-6.1, in consultation with | |
15 | the governor, to meet the legislative directives established herein. | |
16 | SECTION 7. Section 40-8.13-12 of the General Laws in Chapter 40-8.13 entitled “Long- | |
17 | Term Managed Care Arrangements” is hereby repealed in its entirety. | |
18 | 40-8.13-12. Community-based supportive living program. | |
19 | (a) To expand the number of community-based service options, the executive office of | |
20 | health and human services shall establish a program for beneficiaries opting to participate in | |
21 | managed care long-term-care arrangements under this chapter who choose to receive Medicaid- | |
22 | funded assisted living, adult supportive-care home, or shared living long-term-care services and | |
23 | supports. As part of the program, the executive office shall implement Medicaid certification or, as | |
24 | appropriate, managed care contract standards for state-authorized providers of these services that | |
25 | establish an acuity-based, tiered service and payment system that ties reimbursements to: a | |
26 | beneficiary's clinical/functional level of need; the scope of services and supports provided; and | |
27 | specific quality and outcome measures. These standards shall set the base level of Medicaid state- | |
28 | plan and waiver services that each type of provider must deliver, the range of acuity-based service | |
29 | enhancements that must be made available to beneficiaries with more intensive care needs, and the | |
30 | minimum state licensure and/or certification requirements a provider must meet to participate in | |
31 | the pilot at each service/payment level. The standards shall also establish any additional | |
32 | requirements, terms, or conditions a provider must meet to ensure beneficiaries have access to high- | |
33 | quality, cost-effective care. | |
34 | (b) Room and board. The executive office shall raise the cap on the amount Medicaid- | |
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1 | certified assisted-living and adult supportive home-care providers are permitted to charge | |
2 | participating beneficiaries for room and board. In the first year of the program, the monthly charges | |
3 | for a beneficiary living in a single room who has income at or below three hundred percent (300%) | |
4 | of the Supplemental Security Income (SSI) level shall not exceed the total of both the maximum | |
5 | monthly federal SSI payment and the monthly state supplement authorized for persons requiring | |
6 | long-term services under § 40-6-27(a)(1)(vi), less the specified personal-needs allowance. For a | |
7 | beneficiary living in a double room, the room and board cap shall be set at eighty-five percent | |
8 | (85%) of the monthly charge allowed for a beneficiary living in a single room. | |
9 | (c) Program cost-effectiveness. The total cost to the state for providing the state supplement | |
10 | and Medicaid-funded services and supports to beneficiaries participating in the program in the | |
11 | initial year of implementation shall not exceed the cost for providing Medicaid-funded services to | |
12 | the same number of beneficiaries with similar acuity needs in an institutional setting in the initial | |
13 | year of the operations. The program shall be terminated if the executive office determines that the | |
14 | program has not met this target. The state shall expand access to the program to qualified | |
15 | beneficiaries who opt out of a long-term services and support (LTSS) arrangement, in accordance | |
16 | with § 40-8.13-2, or are required to enroll in an alternative, successor, or substitute program, or | |
17 | delivery option designated for these purposes by the secretary of the executive office of health and | |
18 | human services if the enrollment in an LTSS plan is no longer an option. | |
19 | SECTION 8. Section 42-7.2-5 of the General Laws in Chapter 42-7.2 entitled “Office of | |
20 | Health and Human Services” is hereby amended to read as follows: | |
21 | 42-7.2-5. Duties of the secretary. | |
22 | The secretary shall be subject to the direction and supervision of the governor for the | |
23 | oversight, coordination, and cohesive direction of state-administered health and human services | |
24 | and in ensuring the laws are faithfully executed, not withstanding any law to the contrary. In this | |
25 | capacity, the secretary of the executive office of health and human services (EOHHS) shall be | |
26 | authorized to: | |
27 | (1) Coordinate the administration and financing of healthcare benefits, human services, and | |
28 | programs including those authorized by the state's Medicaid section 1115 demonstration waiver | |
29 | and, as applicable, the Medicaid State Plan under Title XIX of the U.S. Social Security Act. | |
30 | However, nothing in this section shall be construed as transferring to the secretary the powers, | |
31 | duties, or functions conferred upon the departments by Rhode Island public and general laws for | |
32 | the administration of federal/state programs financed in whole or in part with Medicaid funds or | |
33 | the administrative responsibility for the preparation and submission of any state plans, state plan | |
34 | amendments, or authorized federal waiver applications, once approved by the secretary. | |
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1 | (2) Serve as the governor's chief advisor and liaison to federal policymakers on Medicaid | |
2 | reform issues as well as the principal point of contact in the state on any such related matters. | |
3 | (3)(i) Review and ensure the coordination of the state's Medicaid section 1115 | |
4 | demonstration waiver requests and renewals as well as any initiatives and proposals requiring | |
5 | amendments to the Medicaid state plan or formal amendment changes, as described in the special | |
6 | terms and conditions of the state's Medicaid section 1115 demonstration waiver with the potential | |
7 | to affect the scope, amount or duration of publicly funded healthcare services, provider payments | |
8 | or reimbursements, or access to or the availability of benefits and services as provided by Rhode | |
9 | Island general and public laws. The secretary shall consider whether any such changes are legally | |
10 | and fiscally sound and consistent with the state's policy and budget priorities. The secretary shall | |
11 | also assess whether a proposed change is capable of obtaining the necessary approvals from federal | |
12 | officials and achieving the expected positive consumer outcomes. Department directors shall, | |
13 | within the timelines specified, provide any information and resources the secretary deems necessary | |
14 | in order to perform the reviews authorized in this section. | |
15 | (ii) Direct the development and implementation of any Medicaid policies, procedures, or | |
16 | systems that may be required to assure successful operation of the state's health and human services | |
17 | integrated eligibility system and coordination with HealthSource RI, the state's health insurance | |
18 | marketplace. | |
19 | (iii) Beginning in 2015, conduct on a biennial basis a comprehensive review of the | |
20 | Medicaid eligibility criteria for one or more of the populations covered under the state plan or a | |
21 | waiver to ensure consistency with federal and state laws and policies, coordinate and align systems, | |
22 | and identify areas for improving quality assurance, fair and equitable access to services, and | |
23 | opportunities for additional financial participation. | |
24 | (iv) Implement service organization and delivery reforms that facilitate service integration, | |
25 | increase value, and improve quality and health outcomes. | |
26 | (4) Beginning in 2020, prepare and submit to the governor, the chairpersons of the house | |
27 | and senate finance committees, the caseload estimating conference, and to the joint legislative | |
28 | committee for health-care oversight, by no later than March September 15 of each year, a | |
29 | comprehensive overview of all Medicaid expenditures outcomes, administrative costs, and | |
30 | utilization rates. The overview shall include, but not be limited to, the following information: | |
31 | (i) Expenditures under Titles XIX and XXI of the Social Security Act, as amended; | |
32 | (ii) Expenditures, outcomes and utilization rates by population and sub-population served | |
33 | (e.g. families with children, persons with disabilities, children in foster care, children receiving | |
34 | adoption assistance, adults ages nineteen (19) to sixty-four (64), and elders); | |
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1 | (iii) Expenditures, outcomes and utilization rates by each state department or other | |
2 | municipal or public entity receiving federal reimbursement under Titles XIX and XXI of the Social | |
3 | Security Act, as amended; | |
4 | (iv) Expenditures, outcomes and utilization rates by type of service and/or service provider; | |
5 | and | |
6 | (v) Expenditures by mandatory population receiving mandatory services and, reported | |
7 | separately, optional services, as well as optional populations receiving mandatory services and, | |
8 | reported separately, optional services for each state agency receiving Title XIX and XXI funds. | |
9 | The directors of the departments, as well as local governments and school departments, | |
10 | shall assist and cooperate with the secretary in fulfilling this responsibility by providing whatever | |
11 | resources, information and support shall be necessary. | |
12 | (5) Resolve administrative, jurisdictional, operational, program, or policy conflicts among | |
13 | departments and their executive staffs and make necessary recommendations to the governor. | |
14 | (6) Ensure continued progress toward improving the quality, the economy, the | |
15 | accountability and the efficiency of state-administered health and human services. In this capacity, | |
16 | the secretary shall: | |
17 | (i) Direct implementation of reforms in the human resources practices of the executive | |
18 | office and the departments that streamline and upgrade services, achieve greater economies of scale | |
19 | and establish the coordinated system of the staff education, cross-training, and career development | |
20 | services necessary to recruit and retain a highly-skilled, responsive, and engaged health and human | |
21 | services workforce; | |
22 | (ii) Encourage EOHHS-wide consumer-centered approaches to service design and delivery | |
23 | that expand their capacity to respond efficiently and responsibly to the diverse and changing needs | |
24 | of the people and communities they serve; | |
25 | (iii) Develop all opportunities to maximize resources by leveraging the state's purchasing | |
26 | power, centralizing fiscal service functions related to budget, finance, and procurement, | |
27 | centralizing communication, policy analysis and planning, and information systems and data | |
28 | management, pursuing alternative funding sources through grants, awards and partnerships and | |
29 | securing all available federal financial participation for programs and services provided EOHHS- | |
30 | wide; | |
31 | (iv) Improve the coordination and efficiency of health and human services legal functions | |
32 | by centralizing adjudicative and legal services and overseeing their timely and judicious | |
33 | administration; | |
34 | (v) Facilitate the rebalancing of the long term system by creating an assessment and | |
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1 | coordination organization or unit for the expressed purpose of developing and implementing | |
2 | procedures EOHHS-wide that ensure that the appropriate publicly funded health services are | |
3 | provided at the right time and in the most appropriate and least restrictive setting; | |
4 | (vi) Strengthen health and human services program integrity, quality control and | |
5 | collections, and recovery activities by consolidating functions within the office in a single unit that | |
6 | ensures all affected parties pay their fair share of the cost of services and are aware of alternative | |
7 | financing; | |
8 | (vii) Assure protective services are available to vulnerable elders and adults with | |
9 | developmental and other disabilities by reorganizing existing services, establishing new services | |
10 | where gaps exist and centralizing administrative responsibility for oversight of all related initiatives | |
11 | and programs. | |
12 | (7) Prepare and integrate comprehensive budgets for the health and human services | |
13 | departments and any other functions and duties assigned to the office. The budgets shall be | |
14 | submitted to the state budget office by the secretary, for consideration by the governor, on behalf | |
15 | of the state's health and human services agencies in accordance with the provisions set forth in § | |
16 | 35-3-4. | |
17 | (8) Utilize objective data to evaluate health and human services policy goals, resource use | |
18 | and outcome evaluation and to perform short and long-term policy planning and development. | |
19 | (9) Establishment of an integrated approach to interdepartmental information and data | |
20 | management that complements and furthers the goals of the unified health infrastructure project | |
21 | initiative and that will facilitate the transition to a consumer-centered integrated system of state | |
22 | administered health and human services. | |
23 | (10) At the direction of the governor or the general assembly, conduct independent reviews | |
24 | of state-administered health and human services programs, policies and related agency actions and | |
25 | activities and assist the department directors in identifying strategies to address any issues or areas | |
26 | of concern that may emerge thereof. The department directors shall provide any information and | |
27 | assistance deemed necessary by the secretary when undertaking such independent reviews. | |
28 | (11) Provide regular and timely reports to the governor and make recommendations with | |
29 | respect to the state's health and human services agenda. | |
30 | (12) Employ such personnel and contract for such consulting services as may be required | |
31 | to perform the powers and duties lawfully conferred upon the secretary. | |
32 | (13) Assume responsibility for complying with the provisions of any general or public law | |
33 | or regulation related to the disclosure, confidentiality and privacy of any information or records, in | |
34 | the possession or under the control of the executive office or the departments assigned to the | |
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1 | executive office, that may be developed or acquired or transferred at the direction of the governor | |
2 | or the secretary for purposes directly connected with the secretary's duties set forth herein. | |
3 | (14) Hold the director of each health and human services department accountable for their | |
4 | administrative, fiscal and program actions in the conduct of the respective powers and duties of | |
5 | their agencies. | |
6 | SECTION 9. Rhode Island Medicaid Reform Act of 2008 Resolution. | |
7 | WHEREAS, the General Assembly enacted Chapter 12.4 of Title 42 entitled “The Rhode | |
8 | Island Medicaid Reform Act of 2008”; and | |
9 | WHEREAS, a legislative enactment is required pursuant to Rhode Island General Laws | |
10 | 42-12.4-1, et seq.; and | |
11 | WHEREAS, Rhode Island General Law Section 42-7.2-5(3)(a) provides that the Secretary | |
12 | of Health and Human Services (“Secretary”), of the Executive Office of Health and Human | |
13 | Services (“Executive Office”), is responsible for the review and coordination of any Medicaid | |
14 | section 1115 demonstration waiver requests and renewals as well as any initiatives and proposals | |
15 | requiring amendments to the Medicaid state plan or changes as described in the demonstration, | |
16 | “with potential to affect the scope, amount, or duration of publicly-funded health care services, | |
17 | provider payments or reimbursements, or access to or the availability of benefits and services | |
18 | provided by Rhode Island general and public laws”; and | |
19 | WHEREAS, in pursuit of a more cost-effective consumer choice system of care that is | |
20 | fiscally sound and sustainable, the Secretary requests legislative approval of the following | |
21 | proposals to amend the demonstration: | |
22 | (a) Update dental benefits for children. The Executive Office proposes to allow coverage | |
23 | for dental caries arresting treatments using Silver Diamine Fluoride when necessary. | |
24 | Implementation of this initiative requires amendments to the Medicaid State Plan. | |
25 | (b) Perinatal Doula Services. The Executive Office proposes to establish medical | |
26 | assistance coverage and reimbursement rates for perinatal doula services, a practice to provide non- | |
27 | clinical emotional, physical and informational support before, during and after birth for expectant | |
28 | mothers, in order to reduce maternal health disparities, reduce the likelihood of costly interventions | |
29 | during births, such as cesarean birth and epidural pain relief, while increasing the likelihood of a | |
30 | shorter labor, a spontaneous vaginal birth, and a positive childbirth experience. | |
31 | (c) Community Health Workers. To improve health outcomes, increase access to care, and | |
32 | reduce healthcare costs, the Executive Office proposes to provide medical assistance coverage and | |
33 | reimbursement to community health workers. | |
34 | (d) HCBS Maintenance of Need Allowance Increase. The Executive Office proposes to | |
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1 | increase the Home and Community Based Services (HCBS) Maintenance of Need Allowance from | |
2 | 100% of the Federal Poverty Limit (FPL) plus twenty dollars to 300% of the Federal Social Security | |
3 | Income (SSI) standard to enable the Executive Office to provide sufficient support for individuals | |
4 | who are able to, and wish to, receive services in their homes. | |
5 | (e) Change to Rates for Nursing Facility Services. To more effectively compensate the | |
6 | nursing facilities for the costs of providing care to members who require behavioral healthcare or | |
7 | ventilators, the Executive Office proposes to revise the fee-for-service Medicaid payment rate for | |
8 | nursing facility residents in the following ways: | |
9 | (i) Re-weighting towards behavioral health care, such that the average Resource Utilization | |
10 | Group (RUG) weight is not increased as follows: | |
11 | 1. Increase the RUG weights related to behavioral healthcare; and | |
12 | 2. Decrease all other RUG weights | |
13 | (ii) Increase the RUG weight related to ventilators; and | |
14 | (iii) Implement a behavioral health per-diem add-on for particularly complex patients, who | |
15 | have been hospitalized for six months or more, are clinically appropriate for discharge to a nursing | |
16 | facility, and where the nursing facility is Medicaid certified to provide or facilitate enhanced levels | |
17 | of behavioral healthcare. | |
18 | (f) Increase Shared Living Rates. In order to better incentivize the utilization of home- and | |
19 | community-based care for individuals that wish to receive their care in the community, the | |
20 | Executive Office proposes a ten percent (10%) increase to shared living caregiver stipend rates that | |
21 | are paid to providers through Medicaid fee-for-service and managed care. | |
22 | (g) Increase rates for home nursing care and home care providers licensed by Rhode Island | |
23 | Department of Health. To ensure better access to home- and community-based services, the | |
24 | Executive Office proposes, for both fee-for-service and managed care, to increase the existing shift | |
25 | differential modifier by $0.19 per fifteen (15) minutes for Personal Care and Combined Personal | |
26 | Care/Homemaker effective July 1, 2021, and to establish a new behavioral healthcare enhancement | |
27 | of $0.39 per fifteen (15) minutes for Personal Care, Combined Personal Care/Homemaker, and | |
28 | Homemaker only for providers who have at least thirty percent (30%) of their direct care workers | |
29 | (which includes Certified Nursing Assistants (CNA) and Homemakers) certified in behavioral | |
30 | healthcare training effective January 1, 2022. | |
31 | (h) Expansion of First Connections Program. In collaboration with the Rhode Island | |
32 | Department of Health (RIDOH), the Executive Office proposes to seek federal matching funds for | |
33 | the expansion of the First Connections Program, a risk assessment and response home visiting | |
34 | program designed to ensure that families are connected to appropriate services such as food | |
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1 | assistance, mental health, child care, long term family home visiting, Early Intervention (EI) and | |
2 | other programs, to prenatal women. The Executive Office would establish medical assistance | |
3 | coverage and reimbursement rates for such First Connection services provided to prenatal women. | |
4 | (i) Parents as Teachers Program. In collaboration with RIDOH, the Executive Office | |
5 | proposes to seek federal matching funds for the coverage of the Parents as Teachers Program, to | |
6 | ensure that parents of young children are connected with the medical and social supports necessary | |
7 | to support their families. | |
8 | (j) Increase Assisted Living rates. To ensure better access to home- and community-based | |
9 | services, the Executive Office proposes to increase the rates for Assisted Living providers in both | |
10 | fee-for-service and managed care. | |
11 | (k) Elimination of Category F State Supplemental Payments. To ensure better access to | |
12 | home- and community-based services, the Executive Office proposes to eliminate the State | |
13 | Supplemental Payment for Category F individuals. | |
14 | (l) Establish an intensive, expanded Mental Health Psychiatric Rehabilitative Residential | |
15 | (“MHPRR”). In collaboration with BHDDH, the Executive Office proposes to establish a MHPRR | |
16 | to provide discharge planning, medical and/or psychiatric treatment, and identification and | |
17 | amelioration of barriers to transition to less restrictive settings. | |
18 | (m) Hospice and Home Care Annual Rate Increase Language. The Executive Office | |
19 | proposes amending the language in the Medicaid State Plan detailing the annual inflationary | |
20 | adjustments to hospice rates to utilize the New England Consumer Price Index card as determined | |
21 | by the United States Department of Labor for medical care data that is released in March, containing | |
22 | the February data. Additionally, the Executive Office proposes to add language to the Medicaid | |
23 | State Plan regarding the annual inflationary adjustments to home care rates to clarify that the | |
24 | Executive Office will utilize the New England Consumer Price Index card as determined by the | |
25 | United States Department of Labor for medical care data that is released in March, containing the | |
26 | February data. | |
27 | (n) Non-Emergency Transportation Services. The Executive Office of Health and Human | |
28 | Services shall, as part of its payments through the transportation broker model, reimburse for basic | |
29 | life-support services at a rate no less than $147.67 and for advanced life-support services at no less | |
30 | than $177.20. | |
31 | (o) Expansion of Home and Community Co-Pay Programs. The Executive Office, in | |
32 | conjunction with the Office of Healthy Aging, proposes to implement the authorities approved | |
33 | under the section 1115 demonstration waiver to increase the maximum income limit for all co-pay | |
34 | program eligibility from two hundred percent (200%) to two hundred fifty percent (250%) of the | |
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1 | federal poverty level. This includes implementing programs for adults, age 19 through 64, | |
2 | diagnosed with Alzheimer's or a related dementia. Implementation of these waiver authorities | |
3 | requires adoption of new or amended rules, regulations and procedures.. | |
4 | (p) Federal Financing Opportunities. The Executive Office proposes to review Medicaid | |
5 | requirements and opportunities under the U.S. Patient Protection and Affordable Care Act of 2010 | |
6 | (PPACA) and various other recently enacted federal laws and pursue any changes in the Rhode | |
7 | Island Medicaid program that promote service quality, access and cost-effectiveness that may | |
8 | warrant a Medicaid state plan amendment or amendment under the terms and conditions of Rhode | |
9 | Island’s section 1115 waiver, its successor, or any extension thereof. Any such actions by the | |
10 | Executive Office shall not have an adverse impact on beneficiaries or cause there to be an increase | |
11 | in expenditures beyond the amount appropriated for state fiscal year 2022. | |
12 | Now, therefore, be it | |
13 | RESOLVED, the General Assembly hereby approves the proposals stated in (a) through | |
14 | (p) above; and be it further; | |
15 | RESOLVED, the Secretary of the Executive Office is authorized to pursue and implement | |
16 | any 1115 demonstration waiver amendments, Medicaid state plan amendments, and/or changes to | |
17 | the applicable department’s rules, regulations and procedures approved herein and as authorized | |
18 | by Chapter 42-12.4; and be it further; | |
19 | RESOLVED, that this Joint Resolution shall take effect upon passage. | |
20 | SECTION 10. This article shall take effect as of July 1, 2021. | |
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