Chapter 241

2011 -- H 5618 SUBSTITUTE A

Enacted 07/09/11

 

A N A C T

RELATING TO HUMAN SERVICES - HEALTH CARE ASSISTANCE FOR WORKING PEOPLE WITH DISABILITIES

          

     Introduced By: Representatives Naughton, E Coderre, Ferri, and Kennedy

     Date Introduced: March 03, 2011

 

It is enacted by the General Assembly as follows:

 

     SECTION 1. Sections 40-8.7.3, 40-8.7-4, 40-8.7-5, 40-8.7-6, 40-8.7-7 and 40-8.7-9 of

the General Laws in Chapter 40-8.7 entitled "Health Care Assistance for Working People with

Disabilities" are hereby amended to read as follows:

 

     40-8.7-3. Purpose. -- The purpose of the Medicaid buy-in program is to:

      (1) Enable individuals with disabilities to enter and reenter the work force as soon as

possible;

      (2) Provide health care and social employment support services to individuals with

disabilities that will enable those individuals to reduce their dependency on cash benefit

programs; and

      (3) Allow individuals with disabilities the option to purchase Medicaid coverage that is

necessary to enable such individuals to obtain and/or maintain employment; and

      (4) Authorize the department of human services to amend the state plan for personal care

services limited to employment-related personal care services for individuals with disabilities to

continue their employment activity.

 

     40-8.7-4. Definitions. -- As used in this chapter, the term:

      (1) "Individual with a disability" means a person who has been designated, but without

regard to his or her ability to engage in substantial gainful activity, as specified in the Social

Security Act, 42 U.S.C. section 423(d)(4), as a totally and permanently disabled individual by the

Social Security Administration or the Rhode Island Medicaid program, pursuant to an application

for benefits under Title II, Title XVI or Title XIX of the Social Security Act, regardless of current

receipt of cash benefits under the Social Security Act.

      (2) "Employed" means the individual with disabilities is engaged in a work effort that

meets substantial and reasonable threshold criteria for hours of work, wages, or other measures,

as defined by the department of human services and as permitted by federal law.

     (3) "Employment Support Services" means activities needed to sustain paid work

including: benefits counseling; supervision; job coaching; vocational evaluation; case

management; job development; customized employment; job training; transportation; training;

tools; equipment; and technology, subject to Centers for Medicare and Medicaid Services

approval.

 

     40-8.7-5. Authorization for the Medicaid buy-in program. Authorization for the

Medicaid buy-in program and personal care services. -- (a) The department of human

services is hereby authorized and directed to amend its title XIX state plan to initiate a Medicaid

buy-in program for employed individuals with disabilities.

     (b) The department of human services is hereby authorized and directed to amend its title

XIX state plan to initiate community choice first for personal care services, including through a

home health agency and/or self-directed plan.

     (c) The department of human services is hereby authorized and directed to review and/or

amend its title XIX state plan to initiate the full scope of services authorized under 1915(i) of the

social security act, for Medicaid buy-in participants who are eligible upon clinical assessment,

subject to Centers for Medicare and Medicaid Services approval.

 

     40-8.7-6. Eligibility. -- (a) To be eligible for benefits under the Medicaid buy-in

program:

      (1) The person shall be an individual with disabilities as defined in section 40-8.7-4, but

without regard to his or her ability to engage in substantial gainful activity, as specified in the

Social Security Act, 42 U.S.C. section 423(d)(4);

      (2) The person shall be employed as defined in section 40-8.7-4;

      (3) The person's net accountable income shall not exceed two hundred fifty percent

(250%) of the federal poverty level, taking into account the SSI program disregards and

impairment-related work expenses as defined in 42 U.S.C. section 1396a(r)(2);

      (4) A maximum of ten thousand dollars ($10,000) of available resources for an

individual and twenty thousand dollars ($20,000) for a couple shall be disregarded as shall any

additional resources held in a retirement account, in a medical savings account, or any other

account, related to enhancing the independence of the individual and approved under rules to be

adopted by the department; and

      (5) The person shall be a current medical assistance recipient under section 40-8.5-1

[CNIL]or section 40-8-3(v)[MNIL] or shall meet income, assets, (except as modified by

subdivision (4) above) and eligibility requirements for the medical assistance program under

section 40-8.5-1 [CNIL]or section 40-8-3(v) [MNIL] as such requirements are modified and

extended by this chapter.

     (b) Appeals Process. The director or designee shall review each application filed in

accordance with regulations, and shall make a determination of whether the application will be

approved and the extent of the benefits to be made available to the applicant, and shall within

thirty (30) days after the filing notify the applicant, in writing, of the determination. If the

application is rejected, the applicant shall be notified the reason for the denial. The director may

at any time reconsider any determination. Any applicant for or recipient of benefits aggrieved

because of a decision, or delay in making a decision, shall be entitled to an appeal and shall be

afforded reasonable notice and opportunity for a fair hearing conducted by the director, pursuant

to chapter 40-8.

 

     40-8.7-7. Premiums and cost sharing. -- Premiums. -- (a) The department of human

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 the individual's or couple's 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 determine the

optimal health insurance coverage in consultation with the employer and the Medicaid agency to

coordinate health insurance coverage options.

     (c) The department of human services, in consultation with the health insurance

commissioner, employer and disability advocacy organizations, shall, by June 30, 2012,

investigate, develop and promulgate rules that may:

     (1) Require enrollment in the employer-based health insurance plan as a condition of

participation in the Medicaid buy-in program under this chapter, provided 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. Enrollment of the individual and/or the family in the

employer-based health insurance plan without regard to any enrollment season restrictions,

subject to Centers for Medicare and Medicaid Services approval; or

     (2) Provide opportunities for employers to buy into the Medicaid Buy-in program, at the

employer's expense, where the employer's premium contribution shall be no greater than the

employer's premiums in the existing employer-based health insurance or before September 30,

2012.

 

     40-8.7-9. Regulations and commencement of program. -- (a) The department of human

services shall promulgate the rules or regulations necessary to implement the provisions of this

act by January 1, 2005 September 30, 2011, and enrollment of individuals with disabilities in the

Medicaid buy-in program shall commence under the new rules on January 1, 2006 or before

January 1, 2012.

     (b) The department of human services shall provide quarterly progress reports to the

chairpersons of the house and senate finance committees by the fifteenth (15th) day of the

following month of each quarter, from date of passage until March 2013.

     (c) By March 31, 2013, the department shall report annually to the governor and the

chairpersons of the house and senate finance committees on data included, but not limited to, the

following:

     (1) The number of applications, the number of approved applications, the number of

applicants who are currently eligible for other forms of medical coverage;

     (2) Demographics including: age, sex, employment supports provided; and primary

disabling condition, as permissible under the health insurance portability and accountability act of

1996 (HIPAA) privacy and security rules;

     (3) Prior and current participation in other public assistance programs including

Medicare, Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI),

including the 1619(b) provision;

     (4) The number of beneficiaries employed, and the average wage of those beneficiaries

prior to and post Medicaid buy-in plan eligibility;

     (5) The amounts of premiums collected;

     (6) Medicaid claims data including pre-buy-in, while on the buy-in, and if disenrolled,

after buy-in to perform an analysis of costs/per member, per month, of buy-in enrollees shall also

be provided by the Medicaid agency to the Medicaid Infrastructure Grant recipient, as provided

for in the data use agreement;

     (7) Findings and recommendations with regard to "best practices" used by other states in

the New England region and nationwide that should be considered to increase employment

among Medicaid beneficiaries with disabilities and how to best support Medicaid beneficiaries

with disabilities who are working; and

     (8) Identification and strategies that the finance committees should consider regarding

challenges or opportunities for workers with disabilities in Rhode Island as the Affordable Care

Act is implemented; including, but not limited to, ensuring that employment supportive policies

and supports are integrated into the state's design and implementation of the following long-term

care Affordable Care Act provisions: Section 10202-Balancing Incentive Payments Plan (BIPP);

1915(i) State Plan Amendment; Section 2401-Community First Choice (CFC); Section 2703-

Health Homes for Individuals with chronic conditions; Money Follows the Person; 2014

Medicaid Expansion; and the dual eligible integrated care plan models.

 

     SECTION 2. This act shall serve as a Joint Resolution required pursuant to Rhode Island

General Laws section 42-12.4-1, et seq.

 

     WHEREAS, The General Assembly enacted Chapter 12.4 of Title 42 entitled "The

Rhode Island Medicaid Reform Act of 2008"; and

     WHEREAS, Rhode Island General Laws section 42-12.4-7 provides that any change that

requires implementation of a rule or regulation or modification of a rule or regulation in existence

prior to the implementation of the global consumer choice section 1115 demonstration ("the

demonstration") shall require prior approval of the general assembly; and further provides that

any category II change or category III change as defined in the demonstration shall also require

prior approval to the general assembly; and

     WHEREAS, Rhode Island General Law section 42-7.2-5 states that the secretary of the

office of health and human services is responsible for the "review and coordination of any Global

Consumer Choice and Human Services is responsible for the "review and coordination of any

Global Consumer Choice Compact Waiver requests and renewals as well as any initiatives and

proposals requiring amendments to the Medicaid state plan or category I or II changes" as

described in the demonstration with "the potential to affect the scope, amount, or duration of

publicly-funded health care services, provider payments or reimbursements, or access to or the

availability of benefits and services provided by Rhode Island general and public laws"; and

     WHEREAS, In pursuit of a more cost-effective consumer choice system of care that is

fiscally sound and sustainable, the Secretary requests that the following proposal to amend the

demonstration be approved by the general assembly:

     Modify the Sherlock Act. The department of human services proposes refining the

determination of eligibility, and premiums of workers with disabilities enrolled in the Medicaid

Buy-In program; now, therefore be it

     RESOLVED, That the general assembly hereby approves the changes set forth in the

proposal listed above to amend the demonstration; and be it further

     RESOLVED, That the secretary of the office of health and human services is authorized

to pursue and implement any such necessary waiver amendments, category II or category III

changes, state plan amendments and/or changes to the applicable department's rules, regulations

and procedures approved herein and as authorized by section 42-12.4-7.

 

     SECTION 3. This act shall take effect on July 1, 2011.

     

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LC01572/SUB A/3

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