2023 -- H 5238

========

LC000805

========

     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2023

____________

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:

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

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

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

caregivers and legally responsible individuals.

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

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

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

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

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

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

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

provisions of subsection (b) of this section.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Island Medicaid Reform Act of 2008"; and

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

42-12.4-1, et seq.; and

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

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

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

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

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

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

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

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

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

to amend the demonstration; and

     WHEREAS, Implementation of adjustments may require amendments to the Rhode

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

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

required:

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

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

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

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

LC000805 - Page 2 of 4

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

recitals; and be it further;

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

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

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

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

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

     SECTION 3. This act shall take effect upon passage.

========

LC000805

========

LC000805 - Page 3 of 4

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO BEHAVIORAL HEALTHCARE, DEVELOPMENTAL DISABILITIES AND

HOSPITALS -- COOPERATION WITH FEDERAL GOVERNMENT

***

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

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

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

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

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

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

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

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

     This act would take effect upon passage.

========

LC000805

========

LC000805 - Page 4 of 4