2022 -- H 7180

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2022

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A N   A C T

RELATING TO HUMAN SERVICES -- SOCIAL AND HUMAN SERVICES PROGRAMS

RATE REVIEW AND RATE SETTING PROCESS ACT OF 2022

     Introduced By: Representatives Casimiro, Ruggiero, Noret, Cortvriend, McEntee, Alzate,
Kazarian, Roberts, Fenton-Fung, and Felix

     Date Introduced: January 26, 2022

     Referred To: House Finance

     It is enacted by the General Assembly as follows:

     SECTION 1. Title 40 of the General Laws entitled "HUMAN SERVICES" is hereby

amended by adding thereto the following chapter:

CHAPTER 23

SOCIAL AND HUMAN SERVICES PROGRAMS RATE REVIEW AND RATE SETTING

ACT OF 2022

     40-23-1. Definitions.

     As used in this chapter:

     (1) "Rate review" means the process of reviewing and reporting of specific trending factors

that influence the cost of service that informs rate setting.

     (2) "Rate setting" means the process of establishing rates for social and human service

programs that are based on a thorough rate review process.

     (3) "Social and human service program" means a social, mental health, developmental

disability, child welfare, juvenile justice, prevention services, habilitative, rehabilitative, substance

use disorder treatment, residential care, adult or adolescent day services, vocational, employment

and training, or aging service program or accommodations purchased by the state, excluding any

program, service, or accommodation that is reimbursable exclusively by a federal grant.

     (4) "Social and human service provider" means a provider of social and human service

programs pursuant to a contract with the state or any subdivision or agency to include, but not

limited to, the department of children, youth and families (DCYF), the department of behavioral

healthcare, developmental disabilities, and hospitals (BHDDH), department of human services

(DHS), department of health (DOH) and Medicaid.

     40-23-2. Social and human service program rate review and rate reform.

     The executive office of health and human services (EOHHS) shall conduct a

comprehensive rate review of all social and human service programs pursuant to having a contract

with or licensed by the state or any subdivision of the department of children, youth and families

(DCYF), the department of behavioral healthcare, developmental disabilities, and hospitals

(BHDDH), department of human services (DHS), department of health (DOH) and Medicaid for

the purposes of:

     (1) Establishing a baseline understanding of reimbursement rates for all social and human

service programs;

     (2) Ensuring accurate and adequate reimbursement to social and human service providers

that facilitate the availability of high-quality services to individuals receiving home and

community-based long-term services and supports provided by social and human service providers;

and

     (3) Ensuring the general assembly is informed and provided accurate financial projections

on social and human service program costs, demand for services, and workforce needs to ensure

access to entitled beneficiaries and services.

     40-23-3. Assessment and detailed reporting of current rates -- Collaboration of

departments and advisory committee.

     (a) EOHHS shall work in collaboration with the department of children, youth and families

(DCYF), the department of behavioral healthcare, developmental disabilities, and hospitals

(BHDDH), department of human services (DHS), department of health (DOH) and Medicaid and

the advisory committee established in § 40-23-4 to assess current rates for social and human service

programs. This assessment shall include, but is not limited to, the following information and report

development:

     (1) Assessment and detailed reporting on all social and human service program rates to be

completed by October 1, 2022;

     (2) Assessment and detailed reporting on eligible social and human service programs to be

completed by October 1, 2022;

     (3) Assessment and detailed reporting on utilization trends from the period of January 1,

2017 through December 31, 2021 for social and human service programs to be completed by

October 31, 2022;

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     (4) Assessment and detailed reporting on all rate methodology and rationale for established

rates as of January 1, 2023, for social and human service programs;

     (5) Assessment and detailed reporting on social and human service provider reported cost

of established rates for services and contracts by January 1, 2023 for social and human service

programs as of December 31, 2021;

     (6) Assessment and detailed reporting by January 1, 2023 on all professional licensed and

unlicensed personnel requirements for established rates for social and human service programs

pursuant to a contract or established fee schedule;

     (7) Assessment and reporting on access to social and human service programs, to include

any wait lists and length of time on wait lists, in each service category by January 1, 2023.

     (8) Assessment and reporting that includes comparable rates paid regionally for similar

social and human service providers by January 1, 2023;

     (9) Assessment and reporting of national Medicaid rates in comparison to Rhode Island

social and human service provider rates by January 1, 2023; and

     (10) Assessment and reporting on usual and customary rates paid by private insurers and

private pay for similar social and human service providers by January 1, 2023;

     (b) Detailed reports of this assessment will be submitted to the advisory committee, the

speaker of the house, president of the senate, governor, senate finance committee, house finance

committee, house fiscal advisor, senate fiscal advisor, and director of the office of management and

budget on or before March 1, 2023, and biennially thereafter.

     40-23-4. Advisory committee

     (a) There is hereby established the social and human services provider rate review and rate

setting advisory committee, referred to in this section as the "advisory committee." The purpose of

this advisory committee is to provide expert review and recommendations for the process of rate

setting and ongoing review of rate setting. The advisory committee shall:

     (1) Review documents, reports, assumptions, and fiscal data for annual rate review

assessment within thirty (30) days of receipt;

     (2) Define and establish consistent policy and methods for standardized service rate

development, for the purposes of conducting a biennial "rate setting" in coordination with EOHHS

by July 1, 2023 to ensure payments are consistent with efficiency, economy, and quality of care in

order to enlist enough social and human service providers in order that care and services are

available for beneficiaries and/or eligible persons. The biennial rate setting will be consistent with

payment requirements established in §1902(a)(30)(A) of the Social Security Act and all federal,

and state law, regulations and quality and safety standards. The rate setting process must include,

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but is not that limited to, industry standard methodology(ies); industry standard cost based

assumptions, access to service benchmarks, relevant regional and national economic inflationary

index, regional labor market indicators and benchmarks, Centers for Medicaid and Medicare

Services (CMS) market basket indicators for relevant services, state mandated regulations and

requirements of social and human service providers, triggers for adjustments according to projected

trends, for the purposes of pricing of social and human service program rates. Proposed rates will

be published by January 1, 2024 and effective no later than July 1, 2024;

     (3) With the EOHHS, conduct public meetings to allow providers, recipients, and other

interested parties an opportunity to comment on the report required by the provisions of this section;

     (4) Review petitions or proposals for provider rates to be reviewed or adjusted that are

received by the advisory committee from EOHHS pursuant to the provisions of subsection (a) of

this section; and

     (5) Prepare written recommendations to the governor, the speaker of the house, and

president of the senate as to all changes to the process of reviewing provider rates, including

measures to increase access to the process such as by providing for electronic comments by

providers and the public.

     (b) The advisory committee, may, by a majority vote, recommend to the EOHHS to include

any rate that the EOHHS has selected to exclude or remove any rate that EOHHS has selected for

inclusion from the schedule pursuant to this section:

     (1) Determine whether any provider rates not scheduled for review during the next calendar

year should be recommended for review during that calendar year; and

     (2) Provide other assistance to the EOHHS and HHS agencies as requested.

     (c) On or before November 1, 2022, and each November 1 thereafter, EOHHS shall submit

a written report to the speaker of the house, the president of the senate, the governor and the

advisory committee containing its determinations on all the provider rates reviewed pursuant to this

section and all of the data relied upon by the EOHHS in making its determinations for rate setting.

EOHHS shall prepare proposed projections of cost associated with biennial rate setting for social

and human service programs.

     (d) The advisory committee shall consist of the following twenty-four (24) members:

     (1) The following members appointed by the senate president and the speaker of the house:

     (i) Four (4) providers of social and human service programs, at least one of whom is a long-

term care home care provider, with two (2) to be appointed by the senate president and two (2) to

be appointed by the speaker of the house, two (2) recipients, or designees of the recipients of social

and human service programs, one to be appointed by the senate president and one to be appointed

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by the speaker of the house, four (4) experts with relevant rate setting expertise (such as economists,

actuarialists, billing experts, policy experts), two (2) to be appointed by the senate president and

two (2) to be appointed by the speaker of the house, two (2) senators to be appointed by the senate

president, one from each political party, and two (2) representatives appointed by the speaker of

the house, one from each political party,

     (ii) The following additional ten (10) members to be appointed by the secretary of EOHHS

as follows:

     (A) A representative of the developmental disability council;

     (B) A representative of the mental health association;

     (C) A representative of the child advocate office;

     (D) A representative of the Rhode Island parent information network;

     (E) A representative of the community provider network of Rhode Island;

     (F) A representative of the substance use and mental health leadership council of RI;

     (G) A representative of the Rhode Island coalition for children and families;

     (H) A representative of the senior agenda coalition;

     (I) A representative of the AARP; and

     (J) A representative of adult day services providers.

     (e) The appointing authorities shall make their initial appointments to the advisory

committee no later than August 1, 2022. In making appointments to the advisory committee, to the

greatest extent possible, the appointing authorities shall consider the diversity of Rhode Island.

     (f) Each member of the advisory committee shall serve at the pleasure of the official who

appointed the member. Each member of the advisory committee shall serve a four (4) year term

and may be reappointed for no more than one additional term. Members who have served two (2)

consecutive terms may be reappointed no sooner than one year after the end of the second term.

     (g) The members of the advisory committee shall serve without compensation and without

reimbursement for expenses.

     (h) At the first meeting of the advisory committee, to be held on or before September 1,

2022, the members shall elect a chair, vice-chair and secretary from among the members.

     (i) The advisory committee shall meet at least once every quarter. The chair may call such

additional meetings as may be necessary for the advisory committee to perform its duties.

     (j) The advisory committee shall develop bylaws and procedures to govern its operations.

     (k) The department of administration, in collaboration with the executive office of health

and human services, shall assist the advisory committee in its work by providing resources, staff

support and any information that may be necessary to facilitate the purposes of this chapter.

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     40-23-5. Funding.

     The general assembly shall annually appropriate any sums it may deem necessary to enable

the advisory committee to carry out its assigned purposes.

     SECTION 2. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO HUMAN SERVICES -- SOCIAL AND HUMAN SERVICES PROGRAMS

RATE REVIEW AND RATE SETTING PROCESS ACT OF 2022

***

     This act would require the executive office of health and human services (EOHHS) with

the assistance of a twenty four (24) person advisory committee to provide expert review and

recommendations for the process for rate setting and ongoing review of rate setting for all social

and human service programs with a contract with or licensed by the state or any department of the

state as well as Medicaid.

     This act would take effect upon passage.

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