Chapter
351
2005 -- S 0801 SUBSTITUTE A
Enacted 07/19/05
A N A C T
RELATING TO HEALTH CARE FOR ELDERLY AND DISABLED RESIDENTS
Introduced By: Senators Paiva-Weed, Gibbs, Alves, and Roberts
Date Introduced: February 17, 2005
It is enacted
by the General Assembly as follows:
SECTION
1. Section 40-8.5-1 of the General Laws in Chapter 40-8.5 entitled "Health
Care
for Elderly and Disabled Residents Act" is hereby amended to read as
follows:
40-8.5-1.
Categorically needy medical assistance coverage. – (a) The
department of
human
services is hereby authorized and directed to amend its Title XIX state plan to
provide for
categorically
needy medical assistance coverage as permitted pursuant to Title XIX of the
Social
Security
Act [42 U.S.C. section 1396 et seq.] as amended to individuals who are
sixty-five (65)
years or
older or are disabled (as determined under section 1614(a)(3)) of the Social
Security Act
[42
U.S.C. section 1382c(a)(3)] as amended whose income does not exceed one hundred
percent
(100%)
of the federal poverty level (as revised annually) applicable to the
individual's family
size,
and whose resources do not exceed four thousand dollars ($4,000) per
individual, or six
thousand
dollars ($6,000) per couple. The department shall provide medical assistance
coverage
to such
elderly or disabled persons in the same amount, duration and scope as provided
to other
categorically
needy persons under the state's Title XIX state plan.
(b)
In order to ensure that individuals with disabilities, have access to quality
and
affordable
health care, the department is authorized to plan and to implement a system of
health
care
delivery through a voluntary managed care health system for such individuals. “Managed care”
is
defined as a system that: integrates an efficient financing mechanism with
quality service
delivery;
provides a "medical home" to assure appropriate care and deter
unnecessary and
inappropriate
care; and places emphasis on preventive and primary care.
(c)
The department is authorized to obtain any approval and/or waivers from the
United
States
Department of Health and Human Services, necessary to
implement a voluntary managed
health
care delivery system to the extent approved by the United States department of
health and
human
services.
(d)
The department shall submit a report to the Permanent Joint Committee on Health
Care
Oversight no later than April 1, 2006 that proposes an implementation plan for
this
voluntary
program, based on beginning enrollment not sooner than July 1, 2006. The report
will
describe
projected program costs and savings, the outreach strategy to be employed to
educate the
potentially
eligible populations, the enrollment plan, and an implementation schedule.
SECTION
2. Section 40-8.7-7 of the General Laws in Chapter 40-8.7 entitled "Health
Care
Assistance for Working People With Disabilities" is hereby amended to read
as follows:
40-8.7-7.
Premiums and cost sharing. -- (a) The department of humans services is
authorized
and directed to promulgate such rules to establish the monthly premium payments
for
employed
individuals with disabilities who opt to participate directly in the Medicaid
buy-in
program.
To participate in the Medicaid buy-in program, the employed individual with
disabilities
shall be required to make payment for coverage in accordance with a monthly
payment or
payment formula to be established by the department which shall count the
individual's
monthly-unearned income in excess of the medically needy income limit [MNIL]
and
shall
count a portion of their earned income on a sliding scale basis, in accordance
with rules to
be
established by the department;
(b) The department is further authorized and directed to promulgate such rules
to
encourage
businesses, especially small businesses to hire individuals with disabilities,
and to
allow
employed individuals with disabilities who have access to employer-based health
insurance
and who
are determined eligible by the department pursuant to this chapter, to either:
determine
the
optimal health insurance coverage in consultation with the employer and the
Medicaid
agency.
(1) Enroll themselves and/or their family in the employer-based health
insurance plan as
a
condition of participation in the Medicaid buy-in program under this chapter,
provided this also
complies
with the requirements of chapters 5.1, 8.1, 8.4 and 8.5 of this title, chapters
12, 12.1,
12.2
and 12.3 of title 42 as they relate to eligibility for the medical assistance
program; and
provided,
further, that enrollment in the employer-based health insurance plan is
cost-effective
and
its benefits are comparable to the benefits provided by the Medicaid program;
or
(2) Enroll in the RI Medicaid buy-in program with employer/employee premium
payments
for coverage under the medicaid buy-in program; provided, that these premium
payments
are not greater than the employer's and employee's premiums in the existing
employer-
based
health insurance.
SECTION
3. Section 40.1-24-1 of the General Laws in Chapter 40.1-24 entitled
"Licensing
of Facilities and Programs for People who are Mentally Ill and/or
Developmentally
Disabled"
is hereby amended to read as follows:
40.1-24-1.
Definitions. -- As used in this chapter:
(1) "Adult foster home" means a private family living arrangement
which, through
financial
support from the parent deinstitutionalization subsidy aid program, provides
housing
and
supervision to two (2) or more adults who are alcoholic, drug abusers, mentally
ill or who are
persons
with developmental disabilities or otherwise eligible under section
40.1-1-10.1. Foster
homes
serving fewer than two (2) adults, foster home situations wherein the foster
parents are
natural
or adoptive parent(s) or grandparents, and any facility licensed by the
department of
children,
youth, and families shall be excluded for the purposes of this chapter.
(2) "Community residence" means any home or other living arrangement
which is
established,
offered, maintained, conducted, managed, or operated by any person for a period
of
at least
twenty-four (24) hours, where, on a twenty-four (24) hour basis, direct supervision
is
provided
for the purpose of providing rehabilitative treatment, habilitation,
psychological support,
and/or
social guidance for three (3) or more persons who are alcoholic, drug abusers,
mentally ill
or who
are persons with developmental disabilities or cognitive disabilities such
as brain injury.
The
facilities shall include but not be limited to group homes, halfway houses, and
fully
supervised
apartment programs. Semi-independent living programs, foster care, and parent
deinstitutionalization
subsidy aid programs shall not be considered community residences for the
purposes
of this chapter.
(3) "Day treatment program" means any nonresidential facility which
is established,
offered,
maintained, conducted, managed, or operated by any person for a period of less
than
twenty-four
(24) hours to provide therapeutic intervention to persons who are alcoholic,
drug
abusers,
mentally ill, or who are persons with developmental disabilities or
cognitive disabilities
such
as brain injury. These shall include
but not be limited to outpatient programs for persons
who are
alcoholic, drug abusers, mentally ill or who are persons with developmental
disabilities
or
cognitive disabilities such as brain injury.
(4) "Department" means the department of mental health, retardation
and hospitals.
(5) "Facility" means any community residence, day treatment program,
rehabilitation
program,
public or private, excluding hospitals or units within hospitals for persons
who are
alcoholic,
drug abusers, mentally ill or who are persons with developmental disabilities or
cognitive
disabilities such as brain injury
providing program services which do not constitute
medical
or custodial care, but do offer rehabilitation, habilitation, psychological
support, and
social
guidance.
(6) "Habilitation program" means any nonresidential facility which is
established,
offered,
maintained, conducted, managed, or operated by any person for a period of less
than
twenty-four
(24) hours to provide training in basic daily living skills and developmental
activities,
prevocational
skills and/or vocational training and placement, and follow up for people who
are
alcoholic,
drug abusers, mentally ill or who are persons with developmental disabilities or
cognitive
disabilities such as brain injury.
These shall include but not be limited to early
intervention,
adult development, work activities, sheltered workshops, advanced workshops,
and
job
development and training programs. Sheltered workshops not exclusively for
people who are
alcoholic,
drug abusers, mentally ill or who are persons with developmental disabilities or
cognitive
disabilities such as brain injury
shall be excluded for the purposes of this chapter.
(7) "Person" means any individual, governmental unit, corporation,
company,
association,
or joint stock association and the legal successor thereof.
(8) "Program" means a planned service delivery system structured to
provide specific
components
which are responsive to the needs of those served.
(9) "Rehabilitation program" means any facility which is established,
offered,
maintained,
conducted, managed, or operated by any person to provide restorative therapy
and/or
training
to persons who are mentally ill or who are persons with developmental
disabilities or
cognitive
disabilities such as brain injury.
These shall include but not be limited to community
mental
health centers. Sheltered workshops not exclusively for people who are
alcoholic, drug
abusers,
mentally ill or who are persons with developmental disabilities or cognitive
disabilities
such
as brain injury shall be excluded for
the purposes of this chapter.
40.1-24-2.
Purpose. – (a) The purpose of this chapter is to provide for the
development,
establishment,
and enforcement of standards:
(1) For facilities and programs providing rehabilitation, psychological
support, and
social
guidance to individuals who are alcoholic, drug abusers, mentally ill or who
are persons
with
developmental disabilities or cognitive disabilities such as brain injury;
(2) For the construction, maintenance, and operation of facilities which will
promote safe
and
adequate accommodations for individuals who are alcoholic, drug abusers,
mentally ill or
who are
persons with developmental disabilities or cognitive disabilities such as
brain injury; and
(3) For the establishment of a comprehensive licensing policy with respect to
facilities
and
programs for people who are alcoholic, drug abusers, mentally ill or who are
persons with
developmental
disabilities or cognitive disabilities such as brain injury.
(b)
The department of mental health retardation and hospitals is hereby authorized
and
directed
to be the licensing authority in Rhode Island for residential and other support
programs
designed
specifically for persons with cognitive disabilities such as brain injury.
These licensure
requirements
shall be the same standards for persons with developmental disabilities except
that
for
these purposes all references to "developmental disabilities" shall
mean "cognitive
disabilities."
SECTION 4. This act shall
take effect upon passage.
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LC01888/SUB A
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