WHEREAS, The Governor and the General Assembly find and declare that many Rhode Islanders will be consumers of long-term care services at some point in their lives. In the last twenty years, the number of those in need of long-term care services rose substantially, and is expected to increase further over the next decade. The quality of life of these Rhode Islanders is, and will continue to be, affected greatly by the capacity of the long-term care system to provide access to the full array of services and supports required to meet their health care needs and maintain their independence; and

WHEREAS, It is in the interest of all Rhode Islanders, therefore, to endorse and fund statewide efforts to build a fiscally sound, dynamic long-term care system that supports: consumer independence and choice; the delivery of high quality, coordinated services; the financial integrity of all participants-purchasers, payers, providers and consumers; and the responsible and efficient allocation of all available public and private resources; and

WHEREAS, The Governor and the General Assembly find further that any such efforts must advance the following objectives: greater coordination of services and high quality service options in order to enable consumers to access the full complement of services necessary to maintain their independence and meet their varied and complex needs in as seamless a manner as possible; more flexibility in the methods used to finance services in order to increase system capacity and stability, encourage innovation and service excellence, and reward the responsible utilization of available resources; easy access to a reliable, integrated information network in order to assist consumers in directing their own care, providers in delivering appropriate services, purchasers and payers in analyzing system inputs and to assist all participants in evaluating health care outcomes; and more varied options for assuring access and service quality in order to ensure the system has the capacity to respond effectively to the challenges posed by the growing increase in consumer demand and the rapid change in the scope and kind of available services; and

WHEREAS, The Governor and the General Assembly recognize that realizing these objectives will require a level of change that can only be achieved and sustained by participants in the system who have a stake in ensuring it is improved. It was with this mind that, in 1996, they invited the directors of the departments of human services, elderly affairs, health, and mental health, retardation, and hospitals, to join together with various stakeholders and develop strategies to expand the system's service capacity. This process yielded a set of policy reform initiatives that provide the model for a consumer-centered system of coordinated services and integrated care; and

WHEREAS, The Governor and General Assembly find and declare that establishing such a model system in Rhode Island will: provide a system of integrated care that expands the capacity of the long-term care system as a whole to support consumer choice and independence; enable consumers to access coordinated services, tailored to meet their unique health care and support services needed; assure quality outcomes will be assured by using certification standards, performance measures and incentives and rewards that promote service excellence and generate the information consumers need to make reasoned choices about their health care; and improve the system's overall stability by reinvesting the benefits that accrue from the more efficient utilization of services to enhance the capacity of each of its component parts; and

WHEREAS, The Governor and the General Assembly recognize that to fully realize the objectives of reform, affirmative actions are also necessary to change the process for financing and regulating the supply and quality of services. We recognize further that all participants in this process of change must be held accountable, and that decisions must be informed by clear measurements and data; and

WHEREAS, The Governor and General Assembly recognize that attaining system-wide reform of the magnitude set forth herein will require significant changes in the organization, financing and delivery of services that must be implemented incrementally, over time. We also recognize that immediate action is essential to ensure that certain segments, and ultimately the existing system itself, are capable of withstanding a growing list of cross pressures that threaten its stability and long-term financial viability; now, therefore be it

RESOLVED, That the General Assembly of the State of Rhode Island and Providence Plantations hereby resolves to commit a sufficient sum of general revenue each year, for a period of no less than five years, to support the initiatives that will enhance the system's capacity to achieve the objectives of reform. Each year, the minimum sum appropriated shall be no less than the savings in expenditures resulting from any charge in service utilization patterns and the implementation of system reforms. Annual reports submitted by the departments shall include estimates of the investments necessary to provide stability to the existing system and establish the infrastructure and programs required to achieve system-wide reform. This additional funding shall be allocated and apportioned between institutional and community-based services as follows: in the first year, ninety percent (90%) shall be apportioned to institutional providers and services, and ten percent (10%) to community-based services and providers. In each successive year, the percentage apportioned to institutional services and providers shall be reduced by ten percent (10%) with the institutional services and providers shall be reduced by ten percent (10%) with the remainder being apportioned to community-based services and providers; and be it further

RESOLVED, That the department of human services is the single state agency designated, in compliance with federal law, to administer the Rhode Island Medicaid program. In this capacity, the department is the entity responsible for, and is hereby directed and authorized to, develop and submit any requests for waivers, demonstration projects, and state plan amendments that may be considered necessary and appropriate to support the general purposes of this statute. Such requests shall be made in consultation with any affected departments and, to the extent feasible, any consumer group, advisory body, or other entity designated for such purposes; and be it further

RESOLVED, That the departments of human services, elderly affairs, health, and mental health, retardation, and hospitals are authorized to promulgate any regulations necessary to implement the provisions of this statute; and be it further

RESOLVED, That by no later than March 1, 2003, the departments of human services, elderly affairs, health, and mental health, retardation, and hospitals shall continue their partnership with consumers and stakeholders in the community and submit a joint Strategic Plan of Action for Long-Term Care System Reform for the review and approval of the Governor and General Assembly, or an entity designated for such purposes. The Strategic Plan shall be developed in an open and accountable process that provides the opportunity for public input and shall include a proposal for the continued financing and implementation of the reform initiatives deemed necessary to further enhance the scope, quality and availability of the long-term care services and supports consumers' needs; and be it further

RESOLVED, The following additional steps shall be taken to continue the process of long-term care system reform:

(1) The department of human services shall lead a system-wide effort to ensure that the long-term care financing and reimbursement process supports the development and maintenance of an adequate supply of quality services based on acuity, quality incentives, outcomes, and consumer satisfaction with innovative use of all funding. As the first part of this multi-year effort, a proposal shall be submitted as part of the Strategic Plan of Action that seeks to pay providers of non-institutional state-financed services, including, but not limited to, those paid for through Medicare, at rates not less than a market-based benchmark, and reviewed on a biennial basis by the Legislative Commission on Health Care Oversight.

(2) The department of health shall lead a comprehensive review of the process now in place, which regulate the supply and quality of services including, but not limited to, any procedures and performance standards designed to promote healthy outcomes. Said review shall evaluate whether the existing regulatory processes are adequate and equitable, supportive of the proposed changes in service financing and reimbursement methods, and complementary to reform objectives and initiatives more generally. The findings and recommendations from this review shall be used as the basis for a proposal, to be developed by all interested parties, as part of the Strategic Plan of Action. The proposal shall identify the changes in existing regulatory process, and any alternative strategies necessary to promote access to high quality services and supports in a consumer-centered integrated care system.

(3) The departments of human services, elderly affairs, health, and mental health, retardation, and hospitals shall also develop a joint proposal to establish a readily accessible integrated information network, and a strategy thereof, for the management, collection and dissemination of accurate information, from multiple sources, that encompasses quality indices, service, delivery, demographic and financial data, as well as measures of provider performance, consumer satisfaction and health care outcomes. Said proposal shall also be developed in consultation with various stakeholders as a part of the Strategic Plan of Action; and be it further

RESOLVED, That the Governor and the General Assembly direct that the proposals developed heretofore as part of a Strategic Plan of Action for Long-Term Care System Reform shall be submitted to the Governor and the General Assembly for review and approval, or entity designated for such purposes, by no later than March 1, 2003; and be it further

RESOLVED, That except as provided expressly herein, no provision of this resolution shall be construed to limit or otherwise restrict the departments of human services, elderly affairs, health, and mental health, retardation, and hospitals from fulfilling any statutory requirement or complying with any regulation deemed otherwise valid; and be it further

RESOLVED, That the Secretary of State be and he is hereby authorized and directed to transmit a duly certified copy of this resolution to Governor Lincoln Almond, the Department of Human Services, the Department of Elderly Affairs, the Department of Health, the Department of Mental Health, Retardation and Hospitals, and the Legislative Commission on Health Care Oversight.