2023 -- H 6205

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LC002649

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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 Solomon, Spears, Cotter, Fellela, Boylan, and Slater

     Date Introduced: March 24, 2023

     Referred To: House Finance

     It is enacted by the General Assembly as follows:

     SECTION 1. Section 40-8-2 of the General Laws in Chapter 40-8 entitled "Medical

Assistance" is hereby amended to read as follows:

     40-8-2. Definitions.

     As used in this chapter, unless the context shall otherwise require:

     (1) “Dental service” means and includes emergency care, X-rays for diagnoses, extractions,

palliative treatment, and the refitting and relining of existing dentures and prosthesis.

     (2) “Department” means the department of human services.

     (3) “Director” means the director of human services.

     (4) “Drug” means and includes only drugs and biologicals prescribed by a licensed dentist

or physician as are either included in the United States pharmacopoeia, national formulary, or are

new and nonofficial drugs and remedies.

     (5) “Inpatient” means a person admitted to and under treatment or care of a physician or

surgeon in a hospital or nursing facility that meets standards of and complies with rules and

regulations promulgated by the director.

     (6) “Inpatient hospital services” means the following items and services furnished to an

inpatient in a hospital other than a hospital, institution, or facility for tuberculosis or mental

diseases:

     (i) Bed and board;

     (ii) Nursing services and other related services as are customarily furnished by the hospital

for the care and treatment of inpatients and drugs, biologicals, supplies, appliances, and equipment

for use in the hospital, as are customarily furnished by the hospital for the care and treatment of

patients;

     (iii)(A) Other diagnostic or therapeutic items or services, including, but not limited to,

pathology, radiology, and anesthesiology furnished by the hospital or by others under arrangements

made by the hospital, as are customarily furnished to inpatients either by the hospital or by others

under such arrangements, and services as are customarily provided to inpatients in the hospital by

an intern or resident-in-training under a teaching program having the approval of the Council on

Medical Education and Hospitals of the American Medical Association or of any other recognized

medical society approved by the director.

     (B) The term “inpatient hospital services” shall be taken to include medical and surgical

services provided by the inpatient’s physician, but shall not include the services of a private-duty

nurse or services in a hospital, institution, or facility maintained primarily for the treatment and

care of patients with tuberculosis or mental diseases. Provided, further, it shall be taken to include

only the following organ transplant operations: kidney, liver, cornea, pancreas, bone marrow, lung,

heart, and heart/lung, and other organ transplant operations as may be designated by the director

after consultation with medical advisory staff or medical consultants; and provided that any such

transplant operation is determined by the director or his or her designee to be medically necessary.

Prior written approval of the director, or his or her designee, shall be required for all covered organ

transplant operations.

     (C) In determining medical necessity for organ transplant procedures, the state plan shall

adopt a case-by-case approach and shall focus on the medical indications and contra-indications in

each instance; the progressive nature of the disease; the existence of any alternative therapies; the

life-threatening nature of the disease; the general state of health of the patient apart from the

particular organ disease; and any other relevant facts and circumstances related to the applicant and

the particular transplant procedure.

     (7) “Nursing services” means the following items and services furnished to an inpatient in

a nursing facility:

     (i) Bed and board;

     (ii) Nursing care and other related services as are customarily furnished to inpatients

admitted to the nursing facility, and drugs, biologicals, supplies, appliances, and equipment for use

in the facility, as are customarily furnished in the facility for the care and treatment of patients;

     (iii) Other diagnostic or therapeutic items or services, legally furnished by the facility or

by others under arrangements made by the facility, as are customarily furnished to inpatients either

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by the facility or by others under such arrangement;

     (iv) Medical services provided in the facility by the inpatient’s physician, or by an intern

or resident-in-training of a hospital with which the facility is affiliated or that is under the same

control, under a teaching program of the hospital approved as provided in subsection (6); and

     (v) A personal-needs allowance of fifty dollars ($50.00) one hundred dollars ($100) per

month.

     (8) “Relative with whom the dependent child is living” means and includes the father,

mother, grandfather, grandmother, brother, sister, stepfather, stepmother, stepbrother, stepsister,

uncle, aunt, first cousin, nephew, or niece of any dependent child who maintains a home for the

dependent child.

     (9) “Visiting nurse service” means part-time or intermittent nursing care provided by or

under the supervision of a registered professional nurse other than in a hospital or nursing home.

     SECTION 2. This act shall take effect upon passage.

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LC002649

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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 increase the personal needs allowances of nursing facility residents from

fifty dollars ($50.00) to one hundred dollars ($100) per month.

     This act would take effect upon passage.

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LC002649

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