2023 -- H 5238

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LC000805

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2023

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A N   A C T

RELATING TO BEHAVIORAL HEALTHCARE, DEVELOPMENTAL DISABILITIES AND

HOSPITALS -- COOPERATION WITH FEDERAL GOVERNMENT

     

     Introduced By: Representatives Fellela, Carson, Donovan, Kazarian, Cortvriend,
Sanchez, Nardone, and Noret

     Date Introduced: January 25, 2023

     Referred To: House Finance

     It is enacted by the General Assembly as follows:

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     SECTION 1. Chapter 40.1-1.1 of the General Laws entitled "Cooperation with Federal

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Government" is hereby amended by adding thereto the following section:

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     40.1-1.1-5. Home and community based services to permit payments for family

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caregivers and legally responsible individuals.

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     (a) Commencing July 1, 2023, and continuing thereafter, family caregivers and legally

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responsible individuals, including guardians appointed for an adult by a court of competent

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jurisdiction, and for children with special needs, shall be eligible to provide home and community

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based services ("HCBS"), including personal care services, to developmentally disabled adults and

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children with special needs, and be eligible to be paid for such services pursuant to the HCBS final

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rules. As used in this section, the term "family caregivers" shall include a member of the individual's

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family and a legally responsible relative. Provided, the caregiver shall be required to meet the

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provisions of subsection (b) of this section.

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     (b) The executive office of health and human services ("EOHHS") shall permit payment

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for family caregivers and legally responsible individuals to provide HCBS, including personal care

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services and all home-based services for children with special needs, and developmentally disabled

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adults. To ensure that individuals receive necessary services as authorized in the plan of care, family

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caregivers/legally responsible individuals will be required to document case notes reflecting the

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services they provide, as well as an attestation that they have reviewed the plan of care and will

 

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provide the supports in the plan to the extent possible given the public health emergency and will

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identify safe alternatives where necessary and possible. To ensure that payments are made for

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services rendered, EOHHS will utilize the self-directed plan process. Under this process,

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individuals who self-direct their services shall go through a fiscal intermediary agency, which

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reviews employment paperwork and time sheets submitted by the parent/guardian.

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     (c) The EOHHS is directed to ensure that federal financial participation is used to the

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maximum extent allowable to provide coverage pursuant to this section, and that state-only funds

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will be used only if federal financial participation is not available. To the extent the EOHHS

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determines it necessary to implement the provisions of this section, the EOHHS is authorized to

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pursue a Medicaid section 1115 demonstration waiver request and renewal to seek a waiver of the

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compliance provisions of 42 U.S.C. section 1396d(a) ("definitions").

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     SECTION 2. Rhode Island Medicaid Reform Act of 2008 Joint Resolution.

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

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Island Medicaid Reform Act of 2008"; and

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

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42-12.4-1, et seq.; and

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     WHEREAS, Rhode Island General Laws § 42-7.2-5(3)(i) provides that the secretary of the

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executive office of health and human services ("executive office") is responsible for the review and

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coordination of any Medicaid section 1115 demonstration waiver requests and renewals as well as

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any initiatives and proposals requiring amendments to the Medicaid state plan or category II or III

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changes as described in the demonstration, "with potential to affect the scope, amount, or duration

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of publicly-funded health care services, provider payments or reimbursements, or access to or the

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availability of benefits and services provided by Rhode Island general and public laws"; and

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

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fiscally sound and sustainable, the secretary requests legislative approval of the following proposals

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to amend the demonstration; and

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     WHEREAS, Implementation of adjustments may require amendments to the Rhode

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Island's Medicaid state plan and/or section 1115 waiver under the terms and conditions of the

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

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required:

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     (a) Section 1115 demonstration waiver – extension request. The executive office proposes

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to seek approval from the federal centers for Medicare and Medicaid services ("CMS") to extend

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the Medicaid section 1115 demonstration waiver as authorized in Rhode Island General Laws

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chapter 12.4 of title 42. In the Medicaid section 1115 demonstration waiver extension request due

 

LC000805 - Page 2 of 4

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to CMS by December 31, 2023, in addition to maintaining existing Medicaid section 1115

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demonstration waiver authorities, the executive office proposes to seek a Medicaid section 1115

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demonstration waiver request and renewal to a seek waiver of the compliance provisions of 42

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U.S.C. section 1396d(a) ("definitions"), as set forth in subsection (b) of this resolution.

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     (b) Home and community based services ("HBCS"). The executive office proposes to

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permit payment for family caregivers and legally responsible individuals, to provide HCBS,

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including personal care services and all home-based services for children with special needs, and

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developmentally disabled adults. To ensure that individuals receive necessary services as

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authorized in the plan of care, family caregivers/legally responsible individuals will be required to

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document case notes reflecting the services they provide, as well as an attestation that they have

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reviewed the plan of care and will provide the supports in the plan to the extent possible given the

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public health emergency and will identify safe alternatives where necessary and possible. To ensure

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that payments are made for services rendered, EOHHS will utilize the self-directed plan process.

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Under this process, individuals who self-direct their services go through a fiscal intermediary

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agency, which reviews employment paperwork and time sheets submitted by the parent/guardian.

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As used in this section, the term "family caregivers" may include a member of the individual's

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family and a legally responsible relative; now, therefore be it

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     RESOLVED, That the general assembly hereby approves the proposals stated above in the

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recitals; and be it further;

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     RESOLVED, That the secretary of the executive office of health and human services is

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authorized to pursue and implement any waiver amendments, state plan amendments, and/or

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changes to the applicable department's rules, regulations and procedures approved herein and as

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authorized by chapter 12.4 of title 42; and be it further;

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     RESOLVED, That this joint resolution shall take effect upon passage.

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     SECTION 3. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO BEHAVIORAL HEALTHCARE, DEVELOPMENTAL DISABILITIES AND

HOSPITALS -- COOPERATION WITH FEDERAL GOVERNMENT

***

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     This act would codify in state law portions of an Attachment K Emergency and

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Preparedness Response which included actions that state could take under existing section 1915(c)

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of the Social Security Act relating to home and community-based waiver authority in order to

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respond to the COVID-19 pandemic. More specifically, the act authorizes members of an

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individual's family as well as a legally responsible adult to receive payment for delivering home

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and community based services to a developmentally disabled adult and a child with special needs.

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This act would also include a Medicaid Section 1115 Demonstration Waiver to permit this payment

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to be made, notwithstanding the provisions of 42 U.S.C. section 1396d(a).

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     This act would take effect upon passage.

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