ARTICLE 19 AS AMENDED

RELATING TO MEDICAID REFORM ACT OF 2008

SECTION 1. Rhode Island Medicaid Reform Act of 2008.

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

Rhode Island Medicaid Reform Act of 2008”; and

     WHEREAS, A Joint Resolution is required pursuant to Rhode Island General Laws § 42-

12.4-1, et seq.; and

     WHEREAS, Rhode Island General Law § 42-12.4-7 provides that any change that

requires the 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 by the general assembly; and

     WHEREAS, Rhode Island General Law § 42-7.2-5 provides that the Secretary of the

Office of Health 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 general assembly approval of the following

proposals to amend the demonstration:

      (a) Medicaid Managed Care Plan Refinements – New Components. The Medicaid single

state agency proposes to reduce hospital readmissions, promote better health and nutrition and

encourage non-invasive approaches to address obesity by incorporating a nutritional education

and exercise component into the benefit package offered to certain Medicaid beneficiaries.

Establishing a targeted benefit requires amendments to or new rules, regulations and procedures

pertaining to coverage for the Medicaid populations affected as well as a Category II change to

the Global Consumer Choice Compact Waiver in those areas where additional authority is

warranted under the terms and conditions of the demonstration agreement;

     (b) Medicaid Rate Change – Durable Medical Equipment. The Medicaid single state

agency proposes to reduce the payment for durable medical equipment provided to beneficiaries

to 85 percent of the Medicare payment rate. Implementation of this change requires a Category II

change under the terms and conditions of the Global Consumer Choice Waiver. The Medicaid

single state agency is instructed to review the appropriateness and relevance of its current

package of approved durable medical equipment (DME) to ensure the equipment is accessible

and reliable. The Medicaid single state agency is to consider the purchase of any additional or

alternative equipment and is to explore group purchasing opportunities to access DME. The

Medicaid single state agency is to review agreements with DME providers to ensure standards

governing the maintenance and durability of DME are established and monitored; and

     (c) Medicaid Requirements and Opportunities under U.S. Patient Protection and

Affordable Care Act (ACA) of 2010. The Medicaid agency proposes to pursue any requirements

and/or opportunities established under the ACA that may warrant a Category II or III change

under the terms and conditions of the Global Consumer Choice Waiver. Any such actions the

Medicaid agency takes shall not have an adverse impact on beneficiaries or cause there to be an

increase in expenditures beyond the amount appropriated for state fiscal year 2013; now

therefore, be it

     RESOLVED, That the general assembly hereby approves proposals (a) through (c) 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 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 § 42-12.4-7; and be it further

     RESOLVED, That this joint resolution shall take effect upon passage.

SECTION 2. The executive office of health and human services shall provide a report to

the chairpersons of the house and senate finance committees by January 1, 2013 that analyzes and

evaluates the current dental benefits program for Medicaid eligible individuals and includes the

number of recipients, types of services provided, reimbursement rates and the settings. The report

shall also examine the opportunities for improved quality, access and value of potential

partnerships with private entities and shall propose a five (5) year plan for dental services for

Medicaid-eligible adults.

SECTION 3. This article shall take effect upon passage.