ARTICLE
19 AS AMENDED
RELATING TO
MEDICAL ASSISTANCE
SECTION 1. Sections 40-8-13.4, 40-8-17 and 40-8-19 of the
General Laws in Chapter
40-8 entitled "Medical
Assistance" are hereby amended to read as
follows:
40-8-13.4. Rate
methodology for payment for in state and out of state hospital
services.-- (a) The department executive office of health
and human services shall implement a
new methodology for payment for in state and out of state
hospital services in order to ensure
access to and the provision of high quality and
cost-effective hospital care to its eligible
recipients.
(b) In order to improve
efficiency and cost effectiveness, the department executive office
of health and human services shall:
(1)(A) With
respect to inpatient services for persons in fee for service Medicaid, which is
non-managed care, implement a new payment methodology for
inpatient services utilizing the
Diagnosis Related Groups (DRG) method of payment,
which is, a patient classification method
which provides a means of relating payment to the hospitals
to the type of patients cared for by
the hospitals. It is understood that a payment method
based on Diagnosis Related Groups may
include cost outlier payments and other specific exceptions.
The department executive office will
review the DRG payment method and the DRG base price
annually, making adjustments as
appropriate in consideration of such elements as trends in
hospital input costs, patterns in hospital
coding, beneficiary access to care, and the Center for
Medicare and Medicaid Services national
CMS Prospective Payment System
(IPPS) Hospital Input Price index.
(B) With respect to
inpatient services, (i) it is required as of January
1, 2011 until
December 31, 2011, that the Medicaid managed care
payment rates between each hospital and
health plan shall not exceed ninety and one tenth percent
(90.1%) of the rate in effect as of June
30, 2010. Negotiated increases in inpatient hospital payments
for each annual twelve (12) month
period beginning January 1, 2012 may not exceed the Centers
for Medicare and Medicaid
Services national CMS Prospective Payment System
(IPPS) Hospital Input Price index for the
applicable period; (ii) provided, however, for the twelve
(12) month period beginning July 1,
2013 the Medicaid managed care payment rates between
each hospital and health plan shall not
exceed the payment rates in effect as of January 1, 2013;
(iii) negotiated increases in inpatient
hospital payments for each annual twelve (12) month period
beginning July 1, 2014 may not
exceed the Centers for Medicare and Medicaid Services
national CMS Prospective Payment
System (IPPS) Hospital Input Price Index, less
Productivity Adjustment, for the applicable
period; (iv) The
Rhode Island department executive office of health and
human services will
develop an audit methodology and process to assure that
savings associated with the payment
reductions will accrue directly to the Rhode Island Medicaid
program through reduced managed
care plan payments and shall not be retained by the
managed care plans; (iii) (v) All hospitals
licensed in Rhode (iv) (vi)
for all
such hospitals, compliance with the provisions of this section
shall be a condition of participation
in the Rhode Island Medicaid program.
(2) With respect to
outpatient services and notwithstanding any provisions of the law to
the contrary, for persons enrolled in fee for service
Medicaid, the department executive office will
reimburse hospitals for outpatient services using a rate
methodology determined by the
department executive office and in accordance with
federal regulations. Fee-for-service outpatient
rates shall align with Medicare payments for similar
services. Changes Notwithstanding the
above, there shall be no increase in the Medicaid
fee-for-service outpatient rates effective July 1,
2013. Thereafter, changes to outpatient rates will be implemented on July 1
each year and shall
align with Medicare payments for similar services from the
prior federal fiscal year. With
respect
to the outpatient rate, (i)
it is required as of January 1, 2011 until December 31, 2011, that the
Medicaid managed care payment rates between each
hospital and health plan shall not exceed one
hundred percent (100%) of the rate in effect as of June 30,
2010. Negotiated increases in hospital
outpatient payments for each annual twelve (12) month period
beginning January 1, 2012 may
not exceed the Centers for Medicare and Medicaid Services
national CMS Outpatient Prospective
Payment System (OPPS) hospital price index for the
applicable period.; (ii) provided,
however,
for the twelve (12) month period beginning July 1, 2013
the Medicaid managed care outpatient
payment rates between each hospital and health plan shall not
exceed the payment rates in effect
as of January 1, 2013; (iii) negotiated increases in
outpatient hospital payments for each annual
twelve (12) month period beginning July 1, 2014 may not
exceed the Centers for Medicare and
Medicaid Services national CMS Outpatient Prospective
Payment System (OPPS) Hospital Input
Price Index, less Productivity
Adjustment, for the applicable period.
(c) It is intended that
payment utilizing the Diagnosis Related Groups method shall
reward hospitals for providing the most efficient care, and
provide the department executive
office the opportunity to conduct value based purchasing of
inpatient care.
(d) The director secretary
of the department executive office of health and human
services and/or the secretary of executive office of health
and human services is hereby
authorized to promulgate such rules and regulations consistent
with this chapter, and to establish
fiscal procedures he or she deems necessary for the proper
implementation and administration of
this chapter in order to provide payment to hospitals
using the Diagnosis Related Group payment
methodology. Furthermore, amendment of the
(Medicaid) pursuant to Title XIX of the federal Social
Security Act is hereby authorized to
provide for payment to hospitals for services provided to
eligible recipients in accordance with
this chapter.
(e) The department
executive office shall comply with all public notice requirements
necessary to implement these rate changes.
(f) As a condition of
participation in the DRG methodology for payment of hospital
services, every hospital shall submit year-end settlement
reports to the department executive
office within one year from the close of a hospital’s fiscal
year. Should a participating hospital
fail to timely submit a year-end settlement report as
required by this section, the department
executive office
shall withhold financial cycle payments due by any state agency with respect to
this hospital by not more than ten percent (10%) until
said report is submitted. For hospital fiscal
year 2010 and all subsequent fiscal years, hospitals will
not be required to submit year-end
settlement reports on payments for outpatient services. For
hospital fiscal year 2011 and all
subsequent fiscal years, hospitals will not be required to
submit year-end settlement reports on
claims for hospital inpatient services. Further, for
hospital fiscal year 2010, hospital inpatient
claims subject to settlement shall include only those claims
received between October 1, 2009
and June 30, 2010.
(g) The provisions of
this section shall be effective upon implementation of the
amendments and new payment methodology pursuant to this section
and § 40-8-13.3, which shall
in any event be no later than March 30, 2010, at which
time the provisions of §§ 40-8-13.2, 27-
19-14, 27-19-15, and 27-19-16 shall be repealed in
their entirety.
(h) The director of
the Department of Human Services shall establish an independent
study commission comprised of representatives of the
hospital network, representatives from the
communities the hospitals serve, state and local policy makers
and any other stakeholders or
consumers interested in improving the access and affordability
of hospital care.
The study commission
shall assist the director in identifying: issues of concern and
priorities in the community hospital system, the delivery of
services and rate structures, including
graduate medical education and training programs; and
opportunities for building sustainable and
effective pubic-private partnerships that support the missions
of the department and the state’s
community hospitals.
The director of the
Department of Human Services shall report to the chairpersons of the
House and Senate Finance Committees the findings and
recommendations of the study
commission by December 31, 2010.
40-8-17.
Waiver request. -- (a)
Formation. - 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
including, but not limited to, a an extension of the
section 1115(a) 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. amended, as
appropriate, and renamed to
reflect the state's effort to coordinate all publicly
financed healthcare. The secretary of the office
shall ensure that the state's health and human services
departments and the people and
communities they serve in the Medicaid program shall have the
opportunity to contribute to and
collaborate in the formulation of any request for a new waiver,
waiver extension and/or state plan
amendment(s). Any such actions shall: (1) continue efforts to
re-balance the system of long-term
services and supports by assisting people in obtaining care in
the most appropriate and least
restrictive setting; (2) pursue further utilization of care
management models that promote
preventive care, offer a health home, and provide an integrated
system of services; (3) use smart
payments and purchasing to finance and support Medicaid
initiatives that fill gaps in the
integrated system of care; and (4) recognize and assure access
to non-medical services and
supports, such as peer navigation and employment and housing
stabilization services, that are
essential for optimizing a person's health, wellness and safety
and that reduce or delay the need
for long-term services and supports.
(b) Effective July 1,
2009, any provision presently in effect in the Rhode Island General
Laws where the department of human services, in
conjunction with the executive office of health
and human services, is authorized to apply for and obtain
any necessary waiver(s), waiver
amendment(s) and/or state plan amendment(s) for the purpose of
providing medical assistance to
recipients, shall authorize the department of human services,
in conjunction with the executive
office of health and human services, to proceed with
appropriate category changes in accordance
with the special terms and conditions of the Rhode Island Global
Consumer Choice Compact
section 1115(a) Demonstration Waiver, which became
effective January 16, 2009. or any
extension thereof, as amended and/or renamed under the
authority provided in this section.
40-8-19. Rates of
payment to nursing facilities. -- (a) Rate reform.
(1) The rates to be
paid by the state to nursing facilities licensed pursuant
to chapter 17 of title 23, and certified to
participate in the Title XIX Medicaid program for services
rendered to Medicaid-eligible
residents, shall be reasonable and adequate to meet the costs
which must be incurred by
efficiently and economically operated facilities in accordance
with 42 U.S.C. § 1396a(a)(13). The
executive office of health and human services shall promulgate
or modify the principles of
reimbursement for nursing facilities in effect as of July 1, 2011
to be consistent with the
provisions of this section and Title XIX, 42 U.S.C. § 1396 et
seq., of the Social Security Act.
(2) The executive office
of health and human services (“Executive Office”) shall review
the current methodology for providing Medicaid payments
to nursing facilities, including other
long-term care services providers, and is authorized to modify
the principles of reimbursement to
replace the current cost based methodology rates with rates
based on a price based methodology
to be paid to all facilities with recognition of the
acuity of patients and the relative Medicaid
occupancy, and to include the following elements to be
developed by the executive office:
(i)
A direct care rate adjusted for resident acuity;
(ii) An indirect care
rate comprised of a base per diem for all facilities;
(iii) A rearray of costs for all facilities every three (3) years
beginning October, 2015,
which may or may not result in automatic per diem
revisions;
(iv)
Application of a fair rental value system;
(v) Application of a
pass-through system; and
(vi) Adjustment of rates
by the change in a recognized national nursing home
inflation
index to be applied on October 1st of each year, beginning
October 1, 2012. This adjustment will
not occur on October 1, 2013, but will resume on October
1, 2014. Said inflation index shall
be
applied without regard for the transition factor in
subsection (b)(2) below.
(b) Transition to full
implementation of rate reform. For no less than four (4) years after
the initial application of the price-based methodology
described in subdivision (a)(2) to payment
rates, the department executive office of health and
human services shall implement a transition
plan to moderate the impact of the rate reform on
individual nursing facilities. Said transition
shall include the following components:
(1) No nursing facility
shall receive reimbursement for direct care costs that is less than
the rate of reimbursement for direct care costs received
under the methodology in effect at the
time of passage of this act; and
(2) No facility shall
lose or gain more than five dollars ($5.00) in its total per diem rate
the first year of the transition. The adjustment to the
per diem loss or gain may be phased out by
twenty-five percent (25%) each year; and
(3) The transition plan
and/or period may be modified upon full implementation of
facility per diem rate increases for quality of care related
measures. Said modifications shall be
submitted in a report to the general assembly at least six (6)
months prior to implementation.
SECTION 2. Title 40 of the General Laws entitled "HUMAN
SERVICES" is hereby
amended by adding thereto the following chapter:
CHAPTER
40-8.12
HEALTH
CARE FOR ADULTS
40-8.12-1.
Purpose. -- Pursuant to section 42-12.3-2, it
is the intent of the general
assembly to create access to comprehensive health care for
uninsured Rhode Islanders. The
income pregnant women, families with children, elders, and
persons with disabilities who might
not be able otherwise to obtain or afford health care.
Under the
Affordable Care Act (ACA) of 2010, all Americans will
be required to have health insurance, with
some exceptions, beginning in 2014. Federal funding is
available with ACA implementation to
help pay for health insurance for low income adults, ages
nineteen (19) to sixty-four (64), who do
not qualify for Medicaid eligibility under
the general assembly, therefore, to implement the
Medicaid expansion for adults without
dependent children authorized by the ACA, to extend health
insurance coverage to these Rhode
Islanders and further the goal established in section
42-12.3-2 in1993.
40-8.12-2.
Eligibility.-- (a) Medicaid coverage for non-pregnant
adults without children.
There is hereby established, effective January 1,
2014, a category of Medicaid eligibility pursuant
to Title XIX of the Social Security Act, as amended by
the
Affordable Care Act (ACA) of 2010, 42 U.S.C. section
1396u-1, for adults ages nineteen (19) to
sixty-four (64) who do not have dependent children and do
not qualify for Medicaid under Rhode
Island general laws applying to families with children
and adults who are blind, aged or living
with a disability. The executive office of health and
human services is directed to make any
amendments to the Medicaid state plan and waiver authorities
established under title XIX
necessary to implement this expansion in eligibility and assure
the maximum federal contribution
for health insurance coverage provided pursuant to this
chapter.
(b) Income. The
secretary of the executive office of health and human services is
authorized and directed to amend the Medicaid Title XIX state
plan and, as deemed necessary,
any waiver authority to effectuate this expansion of
coverage to any Rhode Islander who qualifies
for Medicaid eligibility under this chapter with income
at or below one hundred and thirty-three
percent (133%) the federal poverty level, based on modified
adjusted gross income.
(c) Delivery system.
The executive office of health and human services is authorized and
directed to apply for and obtain any waiver authorities
necessary to provide persons eligible under
this chapter with managed, coordinated health care
coverage consistent with the principles set
forth in section 42-12.4, pertaining to a health care home.
40-8.12-3.
Premium assistance program. – (a) The office of health and human services
is directed to amend its rules and regulations to
implement a premium assistance program for
adults with dependent children, enrolled in the state's
health benefits exchange, whose annual
income and resources meet the guidelines established in
section 40-8.4-4 in effect on December
1, 2013. The premium assistance will pay one-half of the cost
of a commercial plan that a parent
may incur after subtracting the cost-sharing requirement
under section 40-8.4-4 as of December
31, 2013 and any applicable
federal tax credits available.
The office is also directed to amend the
1115 waiver demonstration extension and the medical
assistance title XIX state plan for this
program if it is determined that it is eligible for funding
pursuant to title XIX of the social
security act.
(b) The office of
health and human services shall require any individual receiving
benefits under a state funded healthcare assistance program to
apply for any health insurance for
which he or she is eligible, including health insurance
available through the health benefits
exchange. Nothing shall preclude the state from using funds
appropriated for affordable care act
transition expenses to reduce the impact on an individual who
has been transitioned from a state
program to a health insurance plan available through the
health benefits exchange. It shall not be
deemed cost effective for the state if it would result in a
loss of benefits or an increase in the cost
of health care services for the person above an amount
deemed de minimus as determined by state
regulation.
SECTION 3. Section 42-12.4-8 of the General Laws in Chapter
42-12.4 entitled "The
Rhode Island Medicaid
Reform Act of 2008" is hereby amended to read as follows:
42-12.4-8.
Demonstration termination. -- Demonstration
expiration or termination.-
In the event the demonstration is suspended or
terminated for any reason, or in the event that the
demonstration expires, 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 all waivers an
extension or renewal of the section 1115 research and
demonstration waiver or any new waiver(s)
that, at a minimum, ensure continuation of the waiver
authorities in existence prior to the
acceptance of the demonstration. The office shall ensure that
any such actions are conducted in
accordance with applicable federal guidelines pertaining to
section 1115 demonstration waiver
renewals, extensions, suspensions or terminations. The department of human services and the
executive office of health and human services to the extent
possible shall ensure that said waivers
waiver authorities
are reinstated prior to any suspension, termination, or expiration of the
demonstration.
SECTION 4. Section 40-8.4-4 of the General Laws in Chapter
40-8.4 entitled "Health
Care For
Families" is hereby amended to read as follows:
40-8.4-4.
Eligibility. -- (a) Medical assistance for
families. - There is hereby established
a category of medical assistance eligibility pursuant
to section 1931 of Title XIX of the Social
Security Act, 42 U.S.C. section
1396u-1, for families whose income and resources are no greater
than the standards in effect in the aid to families with
dependent children program on July 16,
1996 or such increased standards as the department may
determine. The department office of
health and human
services is directed to amend the medical assistance Title XIX state plan and
to
submit to the U.S. Department of Health and Human Services
an amendment to the RIte Care
waiver project to provide for medical assistance coverage to
families under this chapter in the
same amount, scope and duration as coverage provided to
comparable groups under the waiver.
The department is further authorized and directed to
submit such amendments and/or requests for
waivers to the Title XXI state plan as may be necessary to
maximize federal contribution for
provision of medical assistance coverage provided pursuant to
this chapter, including providing
medical coverage as a "qualified state" in
accordance with Title XXI of the Social Security Act,
42 U.S.C. section 1397 et seq. Implementation of
expanded coverage under this chapter shall not
be delayed pending federal review of any Title XXI
amendment or waiver.
(b) Income. - The director
secretary of the department office of health and
human
services is authorized and directed to amend the medical
assistance Title XIX state plan or RIte
Care waiver to provide medical assistance coverage
through expanded income disregards or other
methodology for parents or relative caretakers whose income
levels are below one hundred
seventy-five percent (175%) one hundred thirty-three percent (133%) of the federal poverty
level.
(c) Waiver. - The
department of human services is authorized and directed to apply for
and obtain appropriate waivers from the Secretary of the
U.S. Department of Health and Human
Services, including, but not limited to, a waiver of
the appropriate provisions of Title XIX, to
require that individuals with incomes equal to or greater
than one hundred fifty percent (150%) of
the federal poverty level pay a share of the costs of
their medical assistance coverage provided
through enrollment in either the RIte
Care Program or under the premium assistance program
under section 40-8.4-12, in a manner and at an amount
consistent with comparable cost-sharing
provisions under section 40-8.4-12, provided that such cost
sharing shall not exceed five percent
(5%) of annual income for those with annual income in
excess of one hundred fifty percent
(150%); and provided, further, that cost-sharing shall
not be required for pregnant women or
children under age one.
SECTION 5. Section 40-8.4-12 of the General Laws in Chapter
40-8.4 entitled "Health
Care For
Families" is hereby amended to read as follows:
40-8.4-12.
RIte Share Health Insurance Premium Assistance
Program. -- (a) Basic
RIte Share Health Insurance Premium Assistance
Program. - The department office
of health and
human services is authorized and directed to amend the
medical assistance Title XIX state plan to
implement the provisions of section 1906 of Title XIX of the
Social Security Act, 42 U.S.C.
section 1396e, and establish the
RIte Care eligible parents families with
incomes up to one hundred seventy-five percent (175%)
two hundred fifty percent (250%) of the federal poverty level who have access to
employer-based
health insurance. The state plan amendment shall require
eligible individuals families with
access
to employer-based health insurance to enroll themselves
and/or their family in the employer-
based health insurance plan as a condition of participation
in the RIte Share program under this
chapter and as a condition of retaining eligibility for
medical assistance under chapters 5.1 and
8.4 of this title and/or chapter
12.3 of title 42 and/or premium assistance under this chapter,
provided that doing so meets the criteria established in
section 1906 of Title XIX for obtaining
federal matching funds and the department has determined that
the individual's and/or the family's
enrollment in the employer-based health insurance plan is
cost-effective and the department has
determined that the employer-based health insurance plan meets
the criteria set forth in
subsection (d). The department shall provide premium assistance
by paying all or a portion of the
employee's cost for covering the eligible individual or his or
her family under the employer-based
health insurance plan, subject to the cost sharing
provisions in subsection (b), and provided that
the premium assistance is cost-effective in accordance
with Title XIX, 42 U.S.C. section 1396 et
seq.
(b) Individuals who can
afford it shall share in the cost. - The department office of health
and human services is authorized and directed to apply
for and obtain any necessary waivers 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., to
require that individuals families eligible for RIte Care under this chapter or chapter 12.3 of title
42 with incomes equal to or greater than one hundred
fifty percent (150%) of the federal poverty
level pay a share of the costs of health insurance based on
the individual's ability to pay, provided
that the cost sharing shall not exceed five percent (5%)
of the individual's annual income. The
department of human services shall implement the cost-sharing by
regulation, and shall consider
co-payments, premium shares or other reasonable means to do so.
(c) Current RIte Care enrollees with access to employer-based health
insurance. - The
department office of health and human services
shall require any individual family who receives
RIte Care or whose family receives RIte
Care on the effective date of the applicable regulations
adopted in accordance with subsection (f) to enroll in an
employer-based health insurance plan at
the individual's eligibility redetermination date or at
an earlier date determined by the department,
provided that doing so meets the criteria established in the
applicable sections of Title XIX, 42
U.S.C. section 1396 et seq., for obtaining federal
matching funds and the department has
determined that the individual's and/or the family's enrollment
in the employer-based health
insurance plan is cost-effective and has determined that the
health insurance plan meets the
criteria in subsection (d). The insurer shall accept the
enrollment of the individual and/or the
family in the employer-based health insurance plan without
regard to any enrollment season
restrictions.
(d) Approval of health
insurance plans for premium assistance. - The department office
of health and human services shall adopt
regulations providing for the approval of employer-
based health insurance plans for premium assistance and
shall approve employer-based health
insurance plans based on these regulations. In order for an
employer-based health insurance plan
to gain approval, the department must determine that the
benefits offered by the employer-based
health insurance plan are substantially similar in amount,
scope, and duration to the benefits
provided to RIte Care eligible
persons by the RIte Care program, when the plan is
evaluated in
conjunction with available supplemental benefits provided by the department
office. The
department office shall obtain and make available to
persons otherwise eligible for RIte Care as
supplemental benefits those benefits not reasonably available
under employer-based health
insurance plans which are required for RIte
Care eligible persons by state law or federal law or
regulation.
(e) Maximization of
federal contribution. - The department office of health and
human
services is authorized and directed to apply for and obtain
federal approvals and waivers
necessary to maximize the federal contribution for provision of
medical assistance coverage
under this section, including the authorization to amend
the Title XXI state plan and to obtain any
waivers necessary to reduce barriers to provide premium
assistance to recipients as provided for
in Title XXI of the Social Security Act, 42 U.S.C.
section 1397 et seq.
(f) Implementation by
regulation. - The department office of health and human
services
is authorized and directed to adopt regulations to
ensure the establishment and implementation of
the premium assistance program in accordance with the
intent and purpose of this section, the
requirements of Title XIX, Title XXI and any approved federal
waivers.
SECTION
86.
WHEREAS, The General
Assembly enacted Chapter 12.4 of Title 42 entitled “The
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 II or III 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 as provided by
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) Nursing Facility
Payment Rates - Eliminate Rate Increase. The Medicaid agency
proposes to eliminate the projected nursing facility rate
increase and associated hospice rate
increase that would otherwise become effective during state
fiscal year 2014. A Category II
change is required to implement this proposal under the
terms and conditions of the Global
Consumer Choice Compact Waiver. Further, this change may also require the adoption of
new or
amended rules, regulations and procedures.
(b)
agency proposes to reduce hospital payments by eliminating
the projected inpatient and outpatient
hospital rate increase for state fiscal year 2014. A Category
II change is required to implement
this proposal under the terms and conditions of the Global
Consumer Choice Compact Waiver.
Further, this change may also require the adoption of
new or amended rules, regulations and
procedures.
(c) Integrated Care initiative
- Implementation Phase-in. The Medicaid single state
agency proposes to continue implementation of the Medicaid
Integrated Care Initiative for Adults
authorized under the Rhode Island Medicaid Reform Act of 2008,
as amended in 2011. Moving
the initiative forward may require Category II changes
under the terms and conditions of the
Global Consumer Choice Compact Waiver and the adoption
of new or amended rules, regulations
and procedures.
(d) BHDDH System Reforms
- implementation of Employment First Initiative. As part of
ongoing reforms promoting rehabilitation services that
enhance a person’s dignity, self-worth and
connection to the community, the Department of Behavioral
Healthcare, Developmental
Disabilities, and Hospitals proposes to change
Medicaid financing to support the Employment
First initiative. The initiative uses reductions in Medicaid payments
to provide incentives for
service alternatives that optimize health and independence.
The resulting changes in payment
rates may require Category II changes under the terms and
conditions of the Global Consumer
Choice Compact Waiver and the
adoption of new or amended rules, regulations and procedures.
(e) Costs Not Otherwise Matchable (CNOM) Federal Funding. Implementation of the
U.S. Patient Protection and Affordable Care Act of
2010 will render it unnecessary for the
Medicaid agency to continue to pursue federal CNOM
funding for services to certain newly
Medicaid eligible populations served by the Executive
Office of Health and Human Services, the
Department of Human Services and the Department of
Behavioral Healthcare, Developmental
Disabilities and Hospitals. Category II changes may be necessary under the terms
and conditions
of the Global Consumer Choice Compact Waiver to
facilitate the transition of the affected people
and services to full Medicaid coverage.
(f) Approved
Authorities: Section 1115 Waiver Demonstration Extension. The Medicaid
agency proposes to implement authorities approved under the
Section 1115 waiver demonstration
extension request - formerly known as the Global Consumer
Choice Waiver - that (1) continue
efforts to re-balance the system of long term services and
supports by assisting people in
obtaining care in the most appropriate and least restrictive
setting; (2) pursue further utilization of
care management models that offer a health home, promote
access to preventive care, and provide
an integrated system of services; (3) use smart payments
and purchasing to finance and support
Medicaid initiatives that fill gaps in the integrated
system of care; and (4) recognize and assure
access to non-medical services and supports, such as peer
navigation and employment and
housing stabilization services, that are essential for
optimizing a person’s health, wellness and
safety and that reduce or delay the need for long term
services and supports.
(g) Medicaid
Requirements and Opportunities under the
Affordable Care Act of 2010. The Medicaid agency proposes to pursue any
requirements and/or
opportunities established under the U.S. Patient Protection and
Affordable Care Act of 2010 that
may warrant a Medicaid State Plan Amendment and/or a
Category II or III change under the
terms and conditions of the Global Consumer Choice Compact
Waiver or its successor or any
extension thereof. Such opportunities and requirements include,
but are not limited to: (1) the
continuation of coverage for youths who had been in substitute
care who are at least eighteen (18)
years old but are not yet twenty-six (26) years of age, and
who are eligible for Medicaid coverage
under the Foster Care Independence Act of 1999 (2) the
maximizing of Medicaid federal
matching funds for any services currently administered by the
health and human services
agencies that are authorized under
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 2014. Now,
therefore, be it
(h) RIte
Care Parents Eligibility. The Medicaid single state agency proposes to reduce
the RIte Care coverage income
eligibility threshold for parents to one hundred thirty-three percent
(133%) of the federal poverty level. A Category III change is required to implement this
proposal
under the terms and conditions of the Global Consumer
Choice Compact Waiver. Further this
change requires the adoption of amended rules, regulations
and procedures.
(i)
Cortical Integrative Therapy. The Medicaid single state agency shall seek to
create a
new service entitled Cortical Integrative Therapy. This
service is designed to effectuate either
neuronal excitation or inhibition through temporal and spatial
summation to strengthen synaptic
connections. Creating this new service may require Category II
changes under the terms and
conditions of the Global Consumer Choice Waiver and the adoption
of new or amended rules,
regulations, and procedures;
Now, therefore, be it
RESOLVED, that the
general assembly hereby approves proposals (a) through (f)(i)
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.
SECTION 7. Section 4 of this article shall take effect on January 1, 2014. The
remainder
of this Article shall take
effect upon passage.