ARTICLE 17 SUBSTITUTE A AS AMENDED
RELATING TO RHODE ISLAND MEDICAID REFORM
ACT
SECTION 1. Title 42 of
the General Laws entitled “STATE AFFAIRS AND GOVERNMENT ” is hereby amended by
adding thereto the following Chapter:
CHAPTER 42-12.4
THE RHODE ISLAND MEDICAID
REFORM ACT OF 2008
42-12.4-1. Short title. – This chapter shall be known and may be cited as “The Rhode Island Medicaid
Reform Act of 2008”.
42-12.4-2. Legislative intent. – (a) It is the
intent of the general assembly that Medicaid shall be a sustainable,
cost-effective, person-centered and opportunity-driven program utilizing
competitive and value-based purchasing to maximize available service options;
and
(b) It is the intent of the general
assembly to fundamentally redesign the Medicaid Program in order to achieve a
person-centered and opportunity-driven program; and
(c) It is the intent of the general
assembly that the Medical Assistance Program be a results oriented system of
coordinated care that focuses on independence and choice that maximizes the
available service options, promotes accountability and transparency; encourages
and rewards healthy outcomes and responsible choices; and promotes efficiencies
through interdepartmental cooperation.
(d) The executive office of health
and human services and the department of human services are authorized and
shall apply for and obtain a global waiver and/or any necessary waivers and/or
state plan amendments from the secretary of the United States Department of
Health and Human Services, including, but not limited to, a waiver of the
appropriate sections of Title XIX, 42 U.S.C. section 1396 et. seq. The application for and the provisions of
such waiver(s) and/or state plan amendments shall be implemented as follows:
(1) The federal waiver application
process shall be overseen by the respective finance committees of both chambers
of the general assembly. Ten (10) days
prior to submission to the federal government, the executive office of health
and human services and the department of human services will provide the
general assembly with the proposed submission data related to the federal
global waiver application required by the federal Center for Medicare and
Medicaid services;
(2) Prior to the final acceptance of
the federal global waiver by the state, the executive office of health and
human services and the department of human services shall allow the respective
finance committees of both chambers of the general assembly to review all
materials related to the federal global waiver, including the materials
submitted by the state and the tentative approval letter; moreover, the
executive office of health and human services and the department of human
services may accept the federal global waiver if the general assembly does not
repeal the authority to pursue the global waiver within thirty (30) days of the
receipt of the proposed federal waiver;
(3) Upon the enactment of
legislation related to the federal waiver(s), the executive office of health
and human services and the health and human services agencies, as defined in
42-7.2-2, are authorized and directed to adopt rules and regulations in order
to implement the provisions of the federal waiver(s) and/or state plan
amendments.
42-12.4-3. Legislative Enactments. – Until statutory
changes are enacted through the
legislative process, all applicable laws remain in effect. It may be necessary to propose legislative
changes in order to comply with the federal waiver(s). In order to effectuate additional
programmatic changes to the Medicaid program beyond those authorized in the
2008 legislative session, and as authorized by the federal waiver, the
executive office of health and human services and the department of human
services shall propose the additional appropriate legislative amendments. Such additional legislative changes cannot
be effectuated until the necessary statutory enactments have been passed.
42-12.4-4. Public hearings and recommendations. –
The chairpersons of the house finance committee and senate finance committee
shall hold public hearings on such additional proposed legislation, if
proposed, to determine whether or not such legislation satisfies the goals
enumerated herein and would result in substantial new opportunities for the
medical assistance program on a cost neutral
basis over a period not to exceed five (5) years.
42-12.4-5. Permanent joint committee of the Global Waiver
Compact. – Composition. – After the approval of the global
waiver by the federal center for Medicare and Medicaid services, there shall be
created a permanent joint committee on the global waiver compact to consist of
the following twelve (12) members: the chair of the house finance committee;
the chair of the senate finance committee; the chair of the house health,
education and welfare committee; the chair of the senate health and human
services committee; two (2) members of the house finance committee appointed by
the speaker of the house; two (2) members of the senate finance committee
appointed by the senate president; two (2) members of the house of
representatives appointed by the speaker of the house, one of whom shall be
from the minority party; and two (2) members of the senate appointed by the
senate president, one of whom shall be a member of the minority party.
The speaker of the house and the
senate president shall consult with the house and senate minority leaders on
the appointments of the minority members.
42-12.4-6. Powers and duties of the permanent joint committee on
the Global Waiver Compact. –
The permanent joint committee on the state Global Waiver Compact shall have the
authority to:
(a) Provide oversight on the Global
Waiver Compact;
(b) Confer as the committee deems
desirable with the directors of all departments within the executive office of
health and human services;
(c) Recommend the type of services
for the Medicaid program to be offered by the state;
(d) Issue subpoenas, subpoenas duces
tecum and orders for the production of books, accounts, papers, records and
documents; and
(e) Make recommendations to the
general assembly and propose legislation regarding the state Medicaid Program.
SECTION 2. Chapter 42-7.2 of the
General Laws entitled “Office of Health and Human Services” is hereby amended by adding thereto the following section:
42-7.2-16. Medicaid
System Reform 2008.-
(a) The executive office of health and
human services, in conjunction with the department of human services, the
department of elderly affairs, the department of children youth and families,
the department of health and the department of mental health, retardation and
hospitals, is authorized to design options that reform the Medicaid program so
that it is a person-centered,
financially sustainable, cost-effective, and opportunity driven program that: utilizes competitive and
value based purchasing to maximize the available service options, promote
accountability and transparency, and encourage and reward healthy outcomes,
independence, and responsible choices;
promotes efficiencies and the coordination of services across all health
and human services agencies; and ensures the state will have a fiscally sound
source of publicly-financed health care for Rhode Islanders in need.
(b) Principles and Goals. In
developing and implementing this system of reform, the executive office of
health and human services and the five (5) health and human services
departments shall pursue the following principles and goals:
(1) Empower consumers to make reasoned and cost-effective choices about
their health by providing them with the information and array of service
options they need and offering rewards for healthy decisions;
(2) Encourage personal responsibility by assuring the information
available to beneficiaries is easy to understand and accurate, provide that a
fiscal intermediary is provided when necessary, and adequate access to needed
services;
(3) When appropriate, promote community-based care solutions by
transitioning beneficiaries from institutional settings back into the community
and by providing the needed assistance and supports to beneficiaries
requiring long-term care or residential
services who wish to remain, or are better served in the community;
(4) Enable consumers to receive individualized health care that is
outcome-oriented, focused on prevention, disease management, recovery and
maintaining independence;
(5) Promote competition between health care providers to ensure best
value purchasing, to leverage resources and to create opportunities for
improving service quality and performance;
(6) Redesign purchasing and payment methods to assure fiscal
accountability and encourage and to reward service quality and
cost-effectiveness by tying reimbursements to evidence-based performance
measures and standards, including those related to patient satisfaction; and
(7) Continually improve technology to take advantage of recent
innovations and advances that help decision makers, consumers and providers to
make informed and cost-effective decisions regarding health care.
(c) The executive office of health and human services shall
annually submit a report to the governor and the general assembly commencing on
a date no later than July 1, 2009 describing the status of the administration
and implementation of the Global Waiver Compact.
SECTION
3. Section 40-8-17 of the General Laws in Chapter 40-8 entitled
“Medical Assistance” is hereby amended to read as follows:
40-8-17. Waiver request – Formulation.-- (a) The department of human services and
the department of elderly affairs shall cooperate and collaborate in the
formulation of a 2176 waiver request to the health care financing
administration. The waiver shall be designed to bring people who have been
admitted to nursing homes back into the community. The department of human
services and the department of elderly affairs shall formulate the waiver
application forthwith. In no event shall the waiver request be submitted later
than August 1, 1987.
(b) The department of elderly
affairs shall, forthwith, formulate and effectuate a coordinated outreach and
education program to create an awareness of the alternatives to nursing home
placement. The outreach and education program shall be directed to both health
care providers and potential clients.
(a) The department of human
services, in conjunction with the executive office of health and human
services, is directed and authorized to apply for and obtain any necessary
waiver(s), waiver amendment(s) and/or state plan amendments from the secretary
of the United States department of health and human services, including, but
not limited to, a §1115a global demonstration waiver that provides program
flexibility in exchange for federal budgetary certainty and under which Rhode
Island will operate all facets of the state’s Medicaid program, except as may be
explicitly exempted under any applicable public or general laws.
SECTION 4.
Chapter 40-8.4 of the General Laws entitled “Health Care for Families”
is hereby amended by adding thereto the following section:
40-8.4-19. Managed health care delivery systems for families. --
(a) Notwithstanding any other provision of state law, the delivery and
financing of the health care services provided under this chapter shall be
provided through a system of managed care. "Managed care" is defined
as systems that: integrate an efficient financing mechanism with quality
service delivery; provide a "medical home" to assure appropriate care
and deter unnecessary services; and place emphasis on preventive and primary
care. For the purposes of Medical Assistance,
managed care systems are defined to include a primary care case
management model in which ancillary services are provided under the direction
of a physician in a practice that meets standards established by the department
of human services, including standards pertaining to certification as an
“advanced medical home”.
(b) Enrollment in managed care
health delivery systems is mandatory for individuals eligible for medical
assistance under this chapter. This
includes children in substitute care, children receiving Medical Assistance
through an adoption subsidy, and children eligible for medical assistance based
on their disability. Beneficiaries with
third-party medical coverage or insurance may be exempt from mandatory managed
care in accordance with rules and regulations promulgated by the department of
human services for such purposes.
(c) Individuals who can afford to
contribute shall share in the cost. The
department of human services is authorized and directed to apply for and obtain
any necessary waivers and/or state plan amendments from the secretary of the
U.S. department of health and human services, including, but not limited to, a
waiver of the appropriate sections of Title XIX, 42 U.S.C. § 1396 et seq., to
require that beneficiaries eligible under this chapter or chapter 12.3 of title
42, with incomes equal to or greater than one hundred thirty-three percent
(133%) of the federal poverty level, pay a share of the costs of health
coverage based on the ability to pay. The department of human services shall
implement this cost-sharing obligation by regulation, and shall consider
co-payments, premium shares, or other reasonable means to do so in accordance
with approved provisions of appropriate waivers and/or state plan amendments
approved by the secretary of the United States department of health and human
services.
(d) All children and families
receiving Medical Assistance under title 40 of the Rhode Island general
laws shall also be subject to
co-payments for certain medical services as approved in the waiver and/or the
applicable state plan amendment, and in accordance with rules and regulations
promulgated by the department.
(e) The department of human services
may provide health benefits, similar to those available through commercial
health plans, to parents or relative caretakers with an income above one
hundred percent (100%) of the federal poverty level who are not receiving cash
assistance under the Rhode Island Temporary Assistance to Needy Families (TANF
program).
(f) The department
of human services is authorized to create consumer directed health care
accounts, including but not limited to health opportunity accounts or health
savings accounts, in order to increase and encourage personal responsibility,
wellness and healthy decision-making, disease management, and to provide
tangible incentives for beneficiaries who meet designated wellness initiatives.
SECTION
5. 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. § 1396 et seq., as amended, to
individuals who are sixty-five (65) years or older or are disabled, as
determined under § 1614(a)(3) of the Social Security Act, 42 U.S.C. §
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 voluntary (opt-out) managed care health systems for such
individuals. "Managed care" is defined as systems that: integrate 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, including a primary care case management model in
which ancillary services are provided under the direction of a physician in a
practice that meets standards established by the department of human services.
Nothing in this subsection shall be interpreted to reduce the scope or duration
of services or benefits covered for any Medicaid recipient or to restrict or
remove any services or benefits from a managed care benefit plan provided by
the state Medicaid program.
(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 6. Chapter 40-8.5
of the General Laws entitled “Health Care for Elderly and Disabled Residents
Act” is hereby amended by adding thereto the following section:
40-8.5-1.1. Managed health care delivery systems.-
(a) To ensure that all medical assistance beneficiaries, including the elderly
and all individuals with disabilities, have access to quality and affordable
health care, the department of human services is authorized to implement
mandatory managed care health systems.
(b) "Managed care" is
defined as systems that: integrate an efficient financing mechanism with
quality service delivery; provides a "medical home" to assure
appropriate care and deter unnecessary services; and place emphasis on
preventive and primary care. For
purposes of Medical Assistance, managed care systems are also defined to
include a primary care case management model in which ancillary services are
provided under the direction of a physician in a practice that meets standards
established by the department of human services. Those medical assistance
recipients who have third-party medical coverage or insurance may be exempt
from mandatory managed care in accordance with rules and regulations
promulgated by the department of human services. The department is further authorized to redesign benefit packages
for medical assistance beneficiaries subject to appropriate federal approval.
(c) The department is authorized to
obtain any approval through waiver(s) and/or state plan amendments, from the
secretary of the United States department of health and human services, that
are necessary to implement mandatory managed health care delivery systems for
all medical assistance recipients, including the primary case management model
in which ancillary services are provided under the direction of a physician in
a practice that meets standards established by the department of human
services. The waiver(s) and/or state
plan amendments shall include the authorization to exempt beneficiaries with
third-party medical coverage or insurance from mandatory managed care in
accordance with rules and regulations promulgated by the department of human
services. The department may also redesign benefit packages for medical
assistance beneficiaries in accordance with rules and regulations promulgated
by the department.
(d) To ensure the delivery of timely
and appropriate services to persons who become eligible for Medicaid by virtue
of their eligibility for a U.S. social security administration program, 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. Such information shall be used exclusively
for the purpose of service planning, and shall be held and exchanged in
accordance with all applicable state and federal medical record confidentiality
laws and regulations.
(e) The department of human services and/or the executive office of
health and human services is authorized and directed to apply for and obtain
any necessary waiver(s) and/or state plan amendments from the secretary of the
United States department of health and human services, including, but not
limited to, a waiver of the appropriate sections of law for the purpose of
administering and implementing the goals of the Medicaid Reform Act 2008 as
described in § 42-7.2-16 of the Rhode Island general laws, specifically using
competitive value-based purchasing to maximize the available service options
and to promote accountability and transparency in the delivery of services for
all Medical Assistance beneficiaries.
SECTION
7. Chapter 40-8 of the General Laws
entitled “Medical Assistance” is hereby amended by adding thereto the following
sections:
40-8-27. Cooperation by providers. – Medicaid
providers who employ individuals applying for benefits under any chapter of
title 40 shall comply in a timely manner with requests made by the department
for any documents describing employer sponsored health insurance coverage or
benefits the provider offers that are necessary to determine eligibility for
the state’s premium assistance program pursuant to section 40-8.4-12. Such documents requested by the department
may include, but are not limited to, certificates of coverage or a summary of
benefits and employee obligations. Upon
receiving notification that the department has determined that the employee is
eligible for premium assistance under section 40-8.4-12, the provider shall accept the enrollment of the employee
and his or her family in the employer based health insurance plan without
regard to any seasonal enrollment restrictions, including open enrollment
restrictions, and/or the impact on the employee’s wages. Additionally, the Medicaid provider
employing such persons shall not offer “pay in lieu of benefits.” Providers who
do not comply with the provisions set forth in this section shall be subject to
suspension as a participating Medicaid provider.
40-8-28. Vendors doing business in the state of Rhode Island.
- All vendors who do
business with the state of Rhode Island in accordance with title 37 of the
Rhode Island general laws and who are also employers of Rhode Island medical assistance
recipients shall make available in a timely manner to the department at the
department’s request, documents describing the health insurance or health
benefits offered by the vendor to the employee, including, but not limited to a
certificate of coverage or a summary of benefits and employee obligations for
the purposes of and only to the extent necessary to carry out the provisions of
this section of the general laws. The employer shall accept the enrollment of
the individual and/or the family in the employer based health insurance plan
without regard to any seasonal enrollment restrictions, including open
enrollment restrictions, without regard to the impact on the member’s
wages. This is known as “pay in lieu of
benefits.”
40-8-29. Selective Contracting. – (a)
Notwithstanding any other provision of state law, the department of human
services is authorized to utilize selective contracting to assure that all
service expenditures under this chapter have the maximum benefit of
competition, and afford Rhode Islanders the overall best value, optimal
quality, and the most cost-effective care possible.
(b) Any approved medical assistance
provider who declines to participate in contracting for benefits in any one of
the department’s medical assistance programs, including, but not limited to any
and all managed care programs, may be suspended as a participating provider and
denied participation in all state operated medical assistance programs at the
discretion of the department.
SECTION
8.
Chapter 40-8.9 of the General Laws entitled “Medical Assistance –
Long-term Care Service and Finance Reform” is hereby amended by adding thereto
the following section:
40-8.9-9. Long-term Care Re-balancing System Reform Goal.
– (a) Notwithstanding any other provision of state law, the
department of human services is authorized and directed to apply for and obtain
any necessary waiver(s), waiver amendment(s) and/or state plan amendments from
the secretary of the United States department of health and human services, and
to promulgate rules necessary to adopt an affirmative plan of program design
and implementation that addresses the goal of allocating a minimum of fifty
percent (50%) of Medicaid long-term care funding to home and community-based
care on or before December 31, 2012.
The department is further authorized and directed to prioritize
investments in home and community-based care and to maintain the integrity and
financial viability of all current long-term care services while pursuing this
goal.
(b) The long-term care re-balancing
goal is person-centered and encourages individual self-determination, family
involvement, interagency collaboration, and individual choice through the
provision of highly specialized and individually tailored home-based services.
Additionally, individuals with severe behavioral, physical, or developmental
disabilities must have the opportunity to live safe and healthful lives through
access to a wide range of supportive services in an array of community-based
settings, regardless of the complexity of their medical condition, the severity
of their disability, or the challenges of their behavior. Delivery of services
and supports in less costly and less restrictive community settings, will
enable children, adolescents and adults to be able to curtail, delay or avoid
lengthy stays in residential treatment facilities, juvenile detention centers,
psychiatric facilities, and/or intermediate care or skilled nursing
facilities.
(c) Pursuant to federal authority
procured under section 42-7.2-16 of the general laws, the department of human
services is directed and authorized to adopt a tiered set of criteria to be
used to determine eligibility for
services. Such criteria shall be
developed in collaboration with the state’s health and human services
departments and shall encompass eligibility determinations for services in
nursing facilities, hospitals, and intermediate care facilities for the
mentally retarded as well as home and community-based alternatives, and shall
provide a common standard of income eligibility for both institutional and home
and community-based care. The
department is authorized to adopt criteria for admission to a nursing facility,
hospital, or intermediate care facility for the mentally retarded that are more
stringent than those employed for access to home and community-based
services. The department is also
authorized to promulgate rules that define the frequency of re-assessments for
services provided for under this section.
(d) The department of human services is further authorized and directed
to consolidate all home and community-based services currently provided
pursuant to section 1915(c) of title XIX of the Untied States Code into a
single program of home and community-based services that include options for consumer
direction and shared living. The
resulting single home and community-based services program shall replace and
supersede all section 1915(c) programs when fully implemented. Notwithstanding the foregoing, the resulting
single program home and community-based services program shall include the
continued funding of assisted living services at any assisted living facility
financed by the Rhode Island housing and mortgage finance corporation prior to
January 1, 2006, and shall be in
accordance with chapter 66.8 of title 42 of the general laws as long as
assisted living services are a covered Medicaid benefit.
(e) The department of human services
is authorized to promulgate rules that permit certain optional services
including, but not limited to, homemaker services, home modifications, respite,
and physical therapy evaluations to be offered subject to availability of
state-appropriated funding for these purposes.
(f) To promote the expansion of home
and community-based service capacity, the department of human services is
authorized and directed to pursue rate reform for homemaker, personal care
(home health aide) and adult day care services, as follows:
(1) A prospective base adjustment
effective, not later than July 1, 2008, across all departments and programs, of
ten percent (10%) of the existing standard or average rate, contingent upon a
demonstrated increase in the state-funded or Medicaid caseload by June 30,
2009;
(2) Development, not later than
September 30, 2008, of certification standards supporting and defining targeted
rate increments to encourage service specialization and scheduling
accommodations including, but not limited to, medication and pain management,
wound management, certified Alzheimer’s Syndrome treatment and support programs,
and shift differentials for night and week-end services; and
(3) Development and submission to
the governor and the general assembly, not later than December 31, 2008, of a
proposed rate-setting methodology for home and community-based services to
assure coverage of the base cost of service delivery as well as reasonable
coverage of changes in cost caused by wage inflation.
(h) The department of human services
is also authorized, subject to availability of appropriation of funding, to pay
for certain non-Medicaid reimbursable expenses necessary to transition
residents back to the community; provided, however, payments shall not exceed
an annual or per person amount.
(i) To assure the continued
financial viability of nursing facilities, the department of human services is
authorized and directed to develop a proposal for revisions to section 40-8-19
that reflect the changes in cost and resident acuity that result from
implementation of this re-balancing goal.
Said proposal shall be submitted to the governor and the general
assembly on or before January 1, 2010.
SECTION
9. Sections 14-1-11, 14-1-21 and
14-1-27 of the General Laws in Chapter 14-1 entitled “Proceedings in Family
Court” are hereby amended to read as follows:
14-1-11. Authorizing and filing petition. – (a) The filing of the petition constitutes assumption of jurisdiction over the child. Filing shall take place upon authorization by the intake department upon completion of its procedures pursuant to Rule 3 of the Rules of Juvenile Proceedings, upon authorization by a justice of the family court pursuant to Rule 4 of the Rules of Juvenile Proceedings, or immediately upon appearance of the child before the court following emergency detention, unless the court otherwise orders.
(b) In the event that a petition is
filed, any appropriate person having knowledge, information, or belief of the
material facts that appear to warrant a petition may be a petitioner under this
chapter and is not required to give recognizance or surety for costs. The
petition shall be directed to the family court of the state of Rhode Island,
setting forth that in the opinion of the petitioner the child is a delinquent,
wayward, dependent, or neglected child, or otherwise comes within the
provisions of this chapter, and requires the care and protection of the state,
and all petitions, with the exception of those requesting the arrest and/or
detention of any person, shall be sworn to before a licensed notary public. TheThose
exceptions, as stated in this subsection above, shall be sworn to
by either a justice or clerk of the family court.
(c) No child shall be ordered detained at the training school, unless
there is pending against the child a petition setting forth facts which would
constitute a felony or misdemeanor if committed by an adult or which alleges a
violation of a valid court order, or unless the child is adjudged in contempt
of court. In the event a child is
ordered to be detained at the training school, the family court shall conduct a
probable cause hearing within five (5) calendar days of the child’s detention
(exclusive of weekends and/or holidays).
At the conclusion of the probable cause hearing, the court shall order
the release of the child from the training school unless the court finds that
the child poses a substantial risk of harm to self or to others.
Any child detained is entitled to a probable cause hearing
within ten (10) days. Nothing in this section prohibits the temporary
commitment by the family court to the department of children, youth, and families
for placement of a child in a specific facility or program other than the
training school for youth.
(d) The department of children, youth and
families, in consultation with law enforcement agencies, the attorney general,
the office of the public defender and the family court, shall develop and
implement a detention risk assessment instrument by no later than July 1, 2009.
(e) No child shall be placed in detention at the training school
unless a determination is made by the family court that the child poses a
substantial risk of harm to self or to others.
(d)(f) No petition alleging that a child is wayward
by virtue of disobedient behavior may be filed except upon proof offered in the
petition that the child has been subjected to a needs assessment conducted at a
facility approved by the director of the department of children, youth,
and families, and that a treatment plan resulting from such an assessment has
been unsuccessful.
(e)(g)The director of the
department of children, youth, and families is authorized and directed to
promulgate any rules and regulations that it deems necessary to implement the
provisions and purposes of this section.
14-1-21. Release or detention
of child under custody of court. – In the case of any
child whose custody has been assumed by the court, the child may, pending the
final disposition of the case, be released in the custody of a parent,
guardian, or other custodian, or of a probation counselor or other person
appointed by the court, to be brought before the court at the designated time.
When not released as provided in this section, the child, pending the hearing
of the case, shall be detained in any place of detention that shall be
designated by the court, subject to further order of the court at the
training school subject to sections 14-1-11 and 14-1-27.
14-1-27. Temporary detention in public or private
institutions.–(a) Subject to section 14-1-11, Provision
provision may be made by the family court for the temporary
detention of children ordered to be detained at the training school for
youth or in the custody of the director of the department of children, youth
and families. The court may arrange
for the boarding of children temporarily authorize the temporary
placement of children in private homes licensed and approved by the
department of children, youth, and families and subject to the supervision of
the court, or may arrange with any incorporated institution or agency licensed
for child care, to receive for temporary care children ordered detained by the
court. The detention shall not exceed thirty (30) days. The court, however,
may extend this time for an additional period of not more than thirty (30) days
if it considers it is for the best interest of the child Unless good
cause is shown to delay the commencement of the adjudicatory hearing, if a
child is in detention, the family court shall commence the adjudicatory hearing
within thirty (30) calendar days from whichever of the following events occurs
latest: the date the petition is served
on the child; or the date the child is
placed in detention. In all such cases,
the family court shall conclude the adjudicatory hearing within fifteen (15)
calendar days of the commencement of the hearing unless good cause is shown to
extend an adjudicatory hearing beyond fifteen (15) calendar days.
(b) In any case wherein the attorney
general files an application to waive and/or certify a youth, the juvenile may
be detained at the training school for a period not to exceed ninety (90)
days. In such cases, the department
shall present to the family court a waiver report within forty-five (45)
calendar days. At the expiration of ninety (90) days, the attorney general’s
petition for waiver and/or certification shall be decided by the family court,
unless good cause is shown to extend the time upon which the family court may
render such a decision.
(b)(c) When DCYF makes
application to the court to take a child into temporary custody due to
allegations of abuse and/or neglect or dependency, DCYF shall have the duty to
investigate the possibility of placing the child or children with a fit and
willing relative not residing with the parents. DCYF shall conduct an
assessment into the appropriateness of placement of the child or children with
the relative within thirty (30) days of the child's placement in the temporary
custody of DCYF. If the department determines that the relative is a fit and
proper person to have placement of the child, the child shall be placed with
that relative, unless the particular needs of the child make the placement
contrary to the child's best interests. All placements with relatives shall be
subject to criminal records checks in accordance with § 14-1-34, foster care
regulations promulgated by DCYF, and interstate compact approval, if necessary.
(c)(d) If DCYF proposes to place the child with a
relative outside the state of Rhode Island, DCYF shall notify the parent who
shall have an opportunity to file an objection to the placement with the family
court within ten (10) days of receipt of the notice. A hearing shall be held
before the child is placed outside the state of Rhode Island.
(d)(e) If the request of
a relative for placement of a child or children is denied by DCYF, that
relative shall have the right to petition the court for review. The court shall
within five (5) days of the request conduct a hearing as to the suitability of
temporary placement with the relative and shall make any orders incident to placement
that it deems meet and just.
(e)(f) Whenever the court
determines that permanent placement or adoption is in the best interest of a
child, a fit and willing relative who has been awarded placement of the child
shall be given priority over a non-relative, provided that the placement or
adoption is in the best interest of the child.
SECTION
10. Chapter 14-1 of the General Laws
entitled “Delinquent and Dependent Children” is hereby amended by adding
thereto the following section:
14-1-36.2. Assignment of custody to the director of
the department of children, youth and families. – In the event the court
assigns custody of a child to the director of the department of children, youth
and families pursuant to
sections 14-1-11, 14-1-11.1, 14-1-27, 14-1-32, 14-1-34, 14-1-36, 14-1-36.1,
40-11-7.1, or 40-11-12, the court shall authorize the provision of suitable
treatment, rehabilitation and care for each child in the least restrictive
and community-based setting.
SECTION 11. Section 40.1-21-4.4 of the General Laws in Chapter 40.1-21
entitled “Division of Developmental Disabilities” is hereby repealed.
40.1-21-4.4. Medical assistance – Managed care system. – (a) In order to
ensure that adult persons who are developmentally disabled have access to an
appropriate array and level of services, the department of mental health,
retardation and hospitals, with the assistance of the department of human
services, is authorized to plan and to implement a system of service delivery
through a managed care system for developmentally disabled adults.
"Managed care" is defined as a system that: consolidates all current
state and federal funding streams for persons with developmental disabilities
to maintain and expand the broad range of primary, preventive and continuing
care community-based service options under a single funding mechanism;
integrates the single funding mechanism with quality service delivery; and
provides a "managed care home" to assure appropriate services and
deter unnecessary and inappropriate services.
(b) The department of human
services, with the assistance of the department of mental health, retardation,
and hospitals, is authorized to seek any approval and/or waivers from the U.S.
Department of Health and Human Services, Health Care Financing Administration,
necessary to implement a mandatory managed care system for persons with
developmental disabilities who are eligible for medical assistance under Title
XIX of the federal Social Security Act, 42 U.S.C. § 1396 et seq. Prior to
submitting such request for approvals and/or waivers, the department shall
submit them to the medical assistance advisory committee for comprehensive
review and comment. Subsequent applications shall be submitted to the medical
assistance advisory committee at least one month prior to submission. The
medical assistance advisory committee, to the extent not prohibited by federal
law or regulation, shall include legislative members. The department of mental
health, retardation, and hospitals, with the assistance of the department of
human services, shall identify the initial populations and geographical areas
where managed care shall begin. The department of health, in cooperation with
the departments of human services and mental health, retardation, and
hospitals, shall annually develop and implement a survey and evaluation of all
managed care programs to measure service outcomes and consumer satisfaction.
These results shall be published and made available to the public.
SECTION
12. Section 42-66-4 of the General Laws
in Chapter 42-66 entitled “Elderly Affairs Department” is hereby amended to
read as follows:
42-66-4. Duties of the department. – (a) The department shall be the principal agency of the state to mobilize the human, physical, and financial resources available to plan, develop, and implement innovative programs to insure the dignity and independence of elderly persons, including the planning, development, and implementation of a home and long-term care program for the elderly in the communities of the state.
(b) The department shall serve as an advocate for the needs of the adult with a disability as these needs and services overlap the needs and services of elderly persons.
(2) The department shall serve as the state's central agency for the administration and coordination of a long-term care entry system, using community-based access points, that will provide the following services related to long-term care: information and referral, initial screening for service and benefits eligibility, and a uniform assessment program for state supported long-term care.
(3) The department shall investigate
reports of elder abuse, and neglect, exploitation, or self-neglect
and shall provide and/or coordinate protective services.
(c) To accomplish these objectives, the director is authorized:
(1) To provide assistance to communities in solving local problems with regard to elderly persons including, but not limited to, problems in identifying and coordinating local resources to serve the needs of elderly persons;
(2) To facilitate communications and the free flow of information between communities and the offices, agencies and employees of the state;
(3) To encourage and assist communities, agencies, and state departments to plan, develop, and implement home and long-term care programs;
(4) To provide and act as a clearinghouse for information, data, and other materials relative to elderly persons;
(5) To initiate and carry out studies and analyses which will aid in solving local, regional, and statewide problems concerning elderly persons;
(6) To coordinate those programs of other state agencies designed to assist in the solution of local, regional, and statewide problems concerning elderly persons;
(7) To advise and inform the governor on the affairs and problems of elderly persons in the state;
(8) To exercise the powers and discharge the duties assigned to the director in the fields of health care, nutrition, homemaker services, geriatric day care, economic opportunity, local and regional planning, transportation, and education and pre-retirement programs;
(9) To further the cooperation of local, state, federal and private agencies and institutions providing for services or having responsibility for elderly persons;
(10) To represent and act on behalf of the state in connection with federal grant programs applicable to programs for elderly persons in the functional areas described in this chapter;
(11) To seek, accept, and otherwise take advantage of all federal aid available to the department, and to assist other agencies of the state, local agencies, and community groups in taking advantage of all federal grants and subventions available for elderly persons and to accept other sources of funds with the approval of the director of administration which shall be deposited as general revenues;
(12) To render advice and assistance to communities and other groups in the preparation and submission of grant applications to state and federal agencies relative to programs for elderly persons;
(13) To review and coordinate those activities of agencies of the state and of any political subdivision of the state at the request of the subdivision, which affect the full and fair utilization of community resources for programs for elderly persons, and initiate programs that will help assure such utilization;
(14) To encourage the formation of councils on aging and to assist local communities in the development of the councils;
(15) To promote, and coordinate day care facilities for the frail elderly who are in need of supportive care and supervision during the daytime;
(16) To provide and coordinate the
delivery of in-home services to the elderly, as defined under the rules and
regulations proposed by the in-home services commission and adopted by
the department of elderly affairs;
(17) To advise and inform the public of the risks of accidental hypothermia;
(18) To establish a clearinghouse for information and education of the elderly citizens of the state;
(19) To establish and operate in collaboration with community and aging service agencies a statewide family-caregiver resource network to provide and coordinate family-caregiver training and support services to include counseling and respite services;
(20) To provide and coordinate the "elderly/disabled transportation" program including a passenger cost sharing program as defined and provided for under rules and regulations promulgated by the department; and
(21) To supervise the citizens' commission for the safety and care of the elderly created pursuant to the provisions of chapter 1.4 of title 12.
(d) In order to assist in the discharge of the duties of the department, the director may request from any agency of the state information pertinent to the affairs and problems of elderly persons.
SECTION
13. Sections 42-66.3-1, 42-66.3-3 and 42-66.3-4 of the General Laws in Chapter
42-66.3 entitled “Home and Community
Services to the Elderly” is hereby amended to read as follows:
42-66.3-1. Definitions. – As used in this
chapter: (1) "Adult day
services program" is an agency licensed through the department of elderly
affairs health that provides a comprehensive supervised program on a
regular basis to physically and/or mentally handicapped adults for a
substantial part of a day in a single physical location for a specified number
of participants daily. Adult day services may include, medical supervision,
social and educational activities, snacks and/or hot lunch.
(2) "Case management
agency" means a community-based agency designated by the department of elderly
affairs to provide case management service care coordination for
home and community care clients.
(3) "Director" means the director of the department of elderly affairs.
(4) "Home and
community care services" means arranging for, or providing directly
to the client, or providing through contract arrangement adult
day services - such as home health aid/homemaker services and
such other services that may be required for a client to remain in the
community and as may be promulgated by department regulations.
(5) "Home care agency" means an agency licensed by the department of health as a "home nursing provider" and/or "home care provider" under the provisions of chapter 17 of title 23.
(6) "Long-term care ombudsperson" means the person or persons designated by the director of the department of elderly affairs for the purpose of advocating on behalf of recipients of long-term care services and of receiving, investigating and resolving through mediation, negotiation and administrative action complaints filed by recipients of long-term care services; individuals acting on their behalf or any individual organization or government agency that has reason to believe that a long-term care agency has engaged in activities, practices or omissions that constitute a violation of applicable statutes or regulations or that may have an adverse effect upon the health, safety, welfare, rights or the quality of life of recipients of long-term care services.
(7) "Home health aide services" means simple health care tasks, personal hygiene services, housekeeping tasks essential to the patient's health, and other related supportive services. These services shall be in accordance with a plan of treatment for the patient and shall be under the supervision of the appropriate health care professional. These services shall be provided by a person who meets the standards established by the department of health.
(8) "Homebound" means the condition of the client is such that the client does not have the normal ability to leave home, consequently leaving the home requires a considerable and taxing effort by the client. A client does not have to be confined to bed to be homebound.
(9) "Homemaker services" means assistance and instruction in managing and maintaining a household and incidental household tasks for persons at home because of illness, incapacity, or the absence of a caretaker relative. These services shall be provided by a person who meets the standards established by the department of health.
(10) "Assisted living
residences" means a publicly or privately operated residence that is provides directly or indirectly by means
of contracts or arrangements personal assistance to meet the resident's
changing needs and preferences, lodging, and meals to two (2) or more adults
who are unrelated to the licensee or administrator, excluding however, any
privately operated establishment or facility licensed pursuant to section
23-17-4 of the general laws as amended.
17 of title 23, as amended, and those facilities licensed by or under
the jurisdiction of the department of mental health, retardation, and
hospitals, the department of children, youth and families, or any other state
agency. Assisted living residences include sheltered care homes, and board and
care residences or any other entity by any other name providing the above
services which meet the definition of assisted living facilities.
(11) "Respite care
services" means temporary care given inside or outside the home of a
client who cannot entirely care for themselves and thereby offers relief to
caregivers. For the purposes of this chapter, these services are provided by
an agency funded by the department of elderly affairs to provide respite care
services.
(12) “Shared living” program means a privately owned residence in
which the family provides for or arranges for the needs of the client so that
the client can remain in the community,
a program that is designed to respect the unique character of each
individual, promotes self-reliance and the freedom to make choices, and fosters
dignity, autonomy and personal safety.
Services may be provided in-home or a host home residence in which the
family provides for or arranges for the needs of the client so that the client
can remain in the community including but not limited to lodging and
meals. This program is designed to
provide the opportunity for the provision of an inter-generational
multidisciplinary supports to preserve and strengthen families.
42-66.3-3. Services available.– Home and community care services shall consist of: (1) Medicaid waiver services for Medicaid eligible clients; or
(2) For the state funded
co-payment program, case management care coordination, a
combination of homemaker/personal care services and other support services
deemed necessary by the director.
42-66.3-4. Persons eligible. – (a) To be eligible for this
program the client must be determined, through a functional assessment, to be
in need of assistance with activities of daily living or meets an institutional
level of care; and/or must meet a required level of care as defined in
rules and regulations promulgated by the department;
(b) Medicaid eligible
individuals age sixty-five (65) or older of the state who meet the financial
guidelines of the Rhode Island medical assistance program except that they
may retain cash and/or liquid resources not exceeding four
thousand dollars ($4,000) for an individual and six thousand dollars ($6,000)
for a married couple, as defined in rules and regulations promulgated by
the department, shall be provided the services without charge; or
(c) Persons eligible for
assistance under the provisions of this section, subject to the annual
appropriations deemed necessary by the general assembly to carry out the
provisions of this chapter, include: (1) any homebound unmarried resident or
homebound married resident of the state living separate and apart, who is at
least sixty-five (65) years of age, ineligible for Medicaid, and whose income
does not exceed the income eligibility for persons eligible under §
42-66.2-5(a)(1)(i) and (a)(2)(i) for the Rhode Island pharmaceutical assistance
to the elderly program; limits as defined by rules and regulations
promulgated by the department and (2) any married resident of the state who
is at least sixty-five (65) years of age, ineligible for Medicaid, and whose
income when combined with any income of that person's spouse does not exceed
the income eligibility for persons eligible under § 42-66.2-5(a)(1)(i) and
(a)(2)(i) for the Rhode Island pharmaceutical assistance to the elderly
program. limits as defined in rules and regulations promulgated by the
department. Persons who meet the
eligibility requirement of this subsection shall be eligible for the co-payment
portion as set forth in § 42-66.3-5.
SECTION 14. Section 40-21-1 of the
General Laws entitled “Medical
Assistance- Prescription Drugs” is hereby amended to read as follows:
40-21-1 Prescription drug program. – The department of human services is hereby authorized and directed to amend its practices, procedures, regulations and the Rhode Island state plan for medical assistance (Medicaid) pursuant to title XIX of the Federal Social Security Act [42 U.S.C. § 1396 et seq.] to modify the prescription drug program:
(1) To establish a preferred drug list (PDL);
(2) To enter into supplemental rebate, discount or other agreements with pharmaceutical companies; and
(3) To negotiate either state-specific supplemental rebates or to participate in a multi-state pooling supplemental rebate program.
Determinations of
drugs included on the PDL will be made by the State Department of Human
Services, and a listing of such drugs shall be maintained on a public website.
In making these determinations, the department shall consider the
recommendations of the Medicaid Pharmaceutical and Therapeutics Committee,
whose membership shall include practicing pharmacists and physicians, faculty
members of the University of Rhode Island's College of Pharmacy, and consumers
or consumer representatives. Drugs exempt from the PDL shall include: (1)
antipsychotics; (2) (1) anti-retrovirals; and (3) (2)
organ transplant medications. Physicians will be informed about prior
authorization procedures for medications not on the PDL, and seventy-two (72)
hour emergency supplies may be dispensed if authorizations cannot be obtained.
SECTION
15. Section 40-6-9.1 of
General Laws in Chapter 40-6 entitled
“Public Assistance Act” is hereby amended to read as follows:
40-6-9.1 Data matching – Health care coverages. – (a) For purposes of this section, the term "medical assistance program" shall mean medical assistance provided in whole or in part by the department of human services pursuant to chapters 5.1, 8, 8.4 of title 40, 12.3 of title 42 and/or title XIX or XXI of the federal Social Security Act, as amended, 42 U.S.C. § 1396 et seq. and 42 U.S.C. § 1397aa et seq., respectively. Any references to the department shall be to the department of human services.
(b) In furtherance of the assignment of rights to medical support to the department of human services under § 40-6-9(b), (c), (d), and (e) and in order to determine the availability of other sources of health care insurance or coverage for beneficiaries of the medical assistance program, and to determine potential third party liability for medical assistance paid out by the department, all health insurers, health maintenance organizations, including managed care organizations, and third party administrators, self insured plans, pharmacy benefit managers (PBM), and other parties that are by statute, contract, or agreement, legally responsible for payment of a claim for a health care item of service doing business in the state of Rhode Island shall permit and participate in data matching with the department of human services, as provided in this section, to assist the Department to identify medical assistance program applicants, beneficiaries and/or persons responsible for providing medical support for such applicants and beneficiaries who may also have health care insurance or coverage in addition to that provided or to be provided by the medical assistance program and to determine any third party liability in accordance with this section.
The department shall take all reasonable measures to determine the legal liability of all third parties (including health insurers, self-insured plans, group health plans (as defined in § 607(1) of the Employee Retirement Income Security Act of 1974 [29 U.S.C. § 1167(1)]), service benefit plans, health maintenance organizations, managed care organizations, pharmacy benefit managers, or other parties that are, by statute, contract, or agreement, legally responsible for payment of a claim for a health care item or service), to pay for care and services on behalf of a medical assistance recipient, including collecting sufficient information to enable the department to pursue claims against such third parties.
In any case where such a legal liability is found to exist and medical assistance has been made available on behalf of the individual (beneficiary), the department shall seek reimbursement for such assistance to the extent of such legal liability and in accordance with the assignment described in § 40-6-9.
To the extent that payment has been made by the department for medical assistance to a beneficiary in any case where a third party has a legal liability to make payment for such assistance, and to the extent that payment has been made by the department for medical assistance for health care items or services furnished to an individual, the department (state) is considered to have acquired the rights of such individual to payment by any other party for such health care items or services in accordance with § 40-6-9.
Any health insurer (including a group health plan, as defined in § 607(1) of the employee retirement income security act of 1974 [29 U.S.C. § 1167(1)], a self-insured plan, a service benefit plan, a managed care organization, a pharmacy benefit manager, or other party that is, by statute, contract, or agreement, legally responsible for payment of a claim for a health care item or service), in enrolling an individual or in making any payments for benefits to the individual or on the individual's behalf, is prohibited from taking into account that the individual is eligible for or is provided medical assistance under a plan under 42 U.S.C. § 1396 et seq. for such state, or any other state.
(c) All health insurers, including, but not limited to, health maintenance organizations, third party administrators, nonprofit medical service corporations, nonprofit hospital service corporations, subject to the provisions of chapters 18, 19, 20 and 41 of title 27, as well as, self-insured plans, group health plans (as defined in § 607(1) of the Employee Retirement Income Security Act of 1974 [29 U.S.C. § 1167(1)]), service benefit plans, managed care organizations, pharmacy benefit managers, or other parties that are, by statute, contract, or agreement, legally responsible for payment of a claim for a health care item or service) doing business in this state shall: (i) Provide member information within fourteen (14) calendar days of the request to the department to enable the medical assistance program to identify medical assistance program recipients, applicants and/or persons responsible for providing medical support for those recipients and applicants who are or could be enrollees or beneficiaries under any individual or group health insurance contract, plan or policy available or in force and effect in the state;
(ii) With respect to individuals who are eligible for, or are provided, medical assistance by the department, upon the request of the department, provide member information within fourteen (14) calendar days of the request member information to determine during what period the individual or their spouses or their dependents may be (or may have been) covered by a health insurer and the nature of the coverage that is or was provided by the health insurer (including the name, address, and identifying number of the plan);
(iii) Accept the state's right of recovery and the assignment to the state of any right of an individual or other entity to payment from the party for an item or service for which payment has been made by the department;
(iv) Respond to any inquiry by the department regarding a claim for payment for any health care item or service that is submitted not later than three (3) years after the date of the provision of such health care item or service; and
(v) Agree not to deny a claim submitted by the state based solely on procedural reasons such as on the basis of the date of submission of the claim, the type or format of the claim form, or a failure to present proper documentation at the point-of-sale that is the basis of the claim, if–
(I) The claim is submitted by the state within the three (3) year period beginning on the date on which the item or service was furnished; and
(II) Any action by the state to enforce its rights with respect to such claim is commenced within six (6) years of the state's submission of such claim.
(d) This information shall be made available by these insurers and health maintenance organizations and used by the department of human services only for the purposes of and to the extent necessary for identifying these persons determining the scope and terms of coverage, and ascertaining third party liability. The department of human services shall provide information to the health insurers, including health insurers, self-insured plans, group health plans (as defined in § 607(1) of the employee retirement income security act of 1974 [29 U.S.C. § 1167(1)]), service benefit plans, managed care organizations, pharmacy benefit managers, or other parties that are, by statute, contract, or agreement, legally responsible for payment of a claim for a health care item or service) only for the purposes described herein.
(e) No health insurer, health maintenance organization, or third party administrator which provides or makes arrangements to provide information pursuant to this section shall be liable in any civil or criminal action or proceeding brought by beneficiaries or members on account of this action for the purposes of violating confidentiality obligations under the law.
(f) The department
shall submit any appropriate and necessary state plan provisions.
SECTION 16. This article shall take effect upon passage. Any rules or regulations necessary or advisable to implement the provisions of SECTION 6 and SECTION 14 of this article shall be effective immediately as an emergency rule upon the department’s filing thereof with the secretary of state as it is hereby found that the current fiscal crisis in this state has caused an imminent peril to public health, safety and welfare, and the department is hereby exempted from the requirements of sections 42-35-3(b) and 42-35-4(b)(2) relating to agency findings of imminent peril to public health, safety and welfare and the filing of statements of the agency’s reasons thereof.