2023 -- H 5315

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LC000480

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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 HUMAN SERVICES -- MEDICAL ASSISTANCE

     Introduced By: Representatives Place, Rea, and Nardone

     Date Introduced: February 01, 2023

     Referred To: House Finance

     It is enacted by the General Assembly as follows:

     SECTION 1. Chapter 40-8 of the General Laws entitled "Medical Assistance" is hereby

amended by adding thereto the following section:

     40-8-33. Community medical services.

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

a methodology for medical assistance reimbursement for services provided by licensed medical

service providers acting in their capacity as community medical service providers, to include

physicians, nurses, physician assistants, paramedics, and emergency medical technicians when

services are provided in accordance with this section to eligible recipients pursuant to the provisions

of § 40-8-3.

     (b) An eligible recipient shall be qualified for coverage pursuant to this section, if as an

individual they have received hospital emergency department services three (3) or more times in a

period of four (4) consecutive months in the past twelve (12) months or have been identified by the

individual's primary health care provider for whom community medical services, as provided in

subsection (c) of this section, would likely prevent admission to or would allow discharge from a

nursing facility; or would likely prevent readmission to a hospital or nursing facility.

     (c) Payment for services provided by a community medical service provider pursuant to

this section shall be a part of a care plan ordered by a primary health care provider and must be

billed by an eligible provider enrolled in medical assistance that employs or contracts with the

community medical service provider. The care plan must ensure that the services provided by a

community medical service provider are coordinated with other community health providers and

local public health agencies, and that the community medical services do not duplicate services

already provided to the patient, including existing home health care or waiver services. Community

medical services shall include health assessment, chronic disease monitoring and education,

medication compliance, immunizations and vaccinations, laboratory specimen collection, hospital

discharge follow-up care, and minor medical procedures approved by the director of the department

of health.

     (d) Services provided by a community medical service provider to an eligible recipient who

is also receiving care coordination services must be in consultation with the providers of the

recipient's care coordination services.

     (e) Nothing in this section shall be construed to authorize any medical service provider to

provide services beyond or outside the scope of their training or license authorization.

     (f) The director of the department of health may promulgate rules and regulations to

implement the method and manner of health care services to be provided pursuant to the provisions

of this section.

     (g) The department of human services or EOHHS shall seek federal approval to implement

the provision of this section.

     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 -- MEDICAL ASSISTANCE

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     This act would provide medical assistance coverage for medical services provided to

qualifying eligible recipients for community-based care. The department of human services or

EOHHS would seek federal approval to implement the provisions of the act.

     This act would take effect upon passage.

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