Chapter 286

2006 -- H 7686 SUBSTITUTE A

Enacted 07/03/06

A N A C T

RELATING TO MEDICAL ASSISTANCE -- LONG-TERM CARE SERVICE AND FINANCE REFORM

Introduced By: Representatives Sullivan, Jackson, Church, O`Neill, and Williamson

Date Introduced: February 16, 2006

It is enacted by the General Assembly as follows:

     SECTION 1. Title 40 of the General Laws entitled "HUMAN SERVICES" is hereby

amended by adding thereto the following chapter:

CHAPTER 8.9

MEDICAL ASSISTANCE - LONG-TERM CARE SERVICE AND FINANCE REFORM

40-8.9-1. Findings. -- (a) The number of Rhode Islanders in need of long-term care

services continues to rise substantially, and the quality of life of these Rhode Islanders is

determined 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.

(b) It is in the interest of all Rhode Islanders 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.

(c) It is in the interest of all Rhode Islanders to assure that rates paid for community-

based long-term care services are adequate to assure high quality as well as supportive of

workforce recruitment and retention.

(d) It is in the interest of all Rhode Islanders to improve consumer's access information

regarding community-based alternatives to institutional settings of care.

40-8.9-2. System reform goal. -- On or before July 1, 2007, the department of human

services shall begin to implement a model system for integrated long-term care, that expands the

capacity of the long-term care system as a whole to support consumer choice and independence;

enables consumers to access coordinated services; assures quality outcomes through certification

standards, performance measures and incentives and rewards that promote service excellence and

generates the information consumers need to make reasoned choices about their health care; and

improves 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. 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.

40-8.9-3. Least restrictive setting requirement. -- Beginning on July 1, 2006, the

department of human services is directed and authorized to allocate existing Medicaid resources

as needed to ensure that those in need of long-term care and support services receive them in the

least restrictive setting appropriate to their needs and preferences. The department is hereby

authorized to utilize screening criteria, to avoid unnecessary institutionalization of persons during

the full eligibility determination process for Medicaid community based care.

40-8.9-4. Unified long-term care budget. – Beginning on July 1, 2007, a unified long-

term care budget shall combine in a single line-item within the department of human services

budget, annual department of human services Medicaid appropriations for nursing facility and

community-based long-term care services (including adult day care, home health, and personal

care in assisted living settings). Beginning on July 1, 2007, the total system savings attributable to

the value of the reduction in nursing home days paid for by Medicaid shall be allocated for the

express purpose of promoting and strengthening community-based alternatives.

40-8.9-5. Administration and regulations. -- As the single state agency designated to

administer the Rhode Island Medicaid program, the department is hereby directed and authorized

to develop and submit any requests for waivers, demonstration projects, grants and state plan

amendments or regulations 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.

40-8.9-6. Reporting. -- Annual reports shall be submitted by the department to the Joint

Legislative Committee on Health Care Oversight as well as the finance committees of both the

senate and the house of representatives and 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.

40-8.9-7. Rate reform. – By January 2008 the department of human services shall design

and require to be submitted by all service providers cost reports for all community-based long-

term services.

40-8.9-8. System screening. – By January 2008 the department of human services shall

develop and implement a screening strategy for the purpose of identifying entrants to the publicly

financed long-term care system prior to application for eligibility as well as defining their

potential service needs.

     SECTION 2. 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 (opt-out) 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 (opt-out)

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.

(e) To ensure the delivery of timely and appropriate services to persons who become

automatically eligible for Medicaid by virtue of their eligibility for a Social Security

Administration program, data on their special needs may be reported to the department of human

services by the Social Security Administration. The department of human services is authorized to

seek any and all data sharing agreements or other agreements with the Social Security

Administration as may be necessary to receive timely and accurate diagnostic data and clinical

assessments to be used exclusively for the purpose of service planning, and to be held and

exchanged in accordance with all applicable state and federal medical record confidentiality laws

and regulations.

     SECTION 3. This act shall take effect upon passage.

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LC02300/SUB A

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