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art.007/5/007/4/007/3/007/2/009/1
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ARTICLE 7 AS AMENDED
RELATING TO HEALTH AND HUMAN SERVICES

     SECTION 1. Section 27-18-64 of the General Laws in Chapter 27-18 entitled “Accident
and Sickness Insurance Policies” is hereby amended to read as follows:
     27-18-64. Coverage for early intervention services. -- (a) Every individual or group
hospital or medical expense insurance policy or contract providing coverage for dependent
children, delivered or renewed in this state on or after July 1, 2004, shall include coverage of
early-intervention services which coverage shall take effect no later than January 1, 2005. Such
coverage shall not be subject to deductibles and coinsurance factors. Any amount paid by an
insurer under this section for a dependent child shall not be applied to any annual or lifetime
maximum benefit contained in the policy or contract. For the purpose of this section, "early-
intervention services" means, but is not limited to, speech and language therapy, occupational
therapy, physical therapy, evaluation, case management, nutrition, service-plan development and
review, nursing services, and assistive technology services and devices for dependents from birth
to age three (3) who are certified by the executive office of health and human services as eligible
for services under part C of the Individuals with Disabilities Education Act (20 U.S.C. § 1471 et
seq.).
     (b) Insurers shall reimburse certified, early intervention providers, who are designated as
such by the executive office of health and human services, for early intervention services as
defined in this section at rates of reimbursement equal to, or greater than, the prevailing
integrated state Medicaid rate for early intervention services as established by the executive office
of health and human services.
       (c) This section shall not apply to insurance coverage providing benefits for: (1)
hHospital confinement indemnity; (2) dDisability income; (3) aAccident only; (4) lLong-term
care; (5) Medicare supplement; (6) lLimited-benefit health; (7) sSpecified disease indemnity; (8)
sSickness or bodily injury or death by accident or both; and (9) oOther limited-benefit policies. 
     SECTION 2. Sections 40-8-13.4 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 executive office of health and human services ("executive office") 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 executive office of health
and human services shall:
     (1)(i) 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 that 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 DRG
may include cost outlier payments and other specific exceptions. The 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 Centers for Medicare and Medicaid Services national CMS
Prospective Payment System (IPPS) Hospital Input Price index. For the twelve- (12) month (12)
period beginning July 1, 2015, the DRG base rate for Medicaid fee-for-service inpatient hospital
services shall not exceed ninety-seven and one-half percent (97.5%) of the payment rates in effect
as of July 1, 2014.
     (ii) With respect to inpatient services, (A) iIt 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
(12) 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; (B) pProvided, however, for the twenty-four- (24) month (24) 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, and for the twelve-
(12) month (12) period beginning July 1, 2015, the Medicaid managed-care payment inpatient
rates between each hospital and health plan shall not exceed ninety-seven and one-half percent
(97.5%) of the payment rates in effect as of January 1, 2013; (C) nNegotiated increases in
inpatient hospital payments for each annual twelve- (12) month (12) period beginning July 1,
2016, 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; (D) The Rhode Island 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; (E) All hospitals
licensed in Rhode Island shall accept such payment rates as payment in full; and (F) fFor 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 executive office will reimburse
hospitals for outpatient services using a rate methodology determined by the executive office and
in accordance with federal regulations. Fee-for-service outpatient rates shall align with Medicare
payments for similar services. Notwithstanding the above, there shall be no increase in the
Medicaid fee-for-service outpatient rates effective on July 1, 2013, July 1, 2014, or July 1, 2015.
For the twelve- (12) month (12) period beginning July 1, 2015, Medicaid fee-for-service
outpatient rates shall not exceed ninety-seven and one-half percent (97.5%) of the rates in effect
as of July 1, 2014. 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
increases in the outpatient hospital payments for each annual twelve-month (12) period beginning
July 1, 2016, may not exceed the CMS national Outpatient Prospective Payment System (OPPS)
Hospital Input Price Index for the applicable period. With respect to the outpatient rate, (i) iIt 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.; (ii) Negotiated increases in hospital outpatient
payments for each annual twelve- (12) month (12) 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) (iii) pProvided,
however, for the twenty-four- (24) month (24) 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, and for the twelve- (12) month (12) period
beginning July 1, 2015, the Medicaid managed-care outpatient payment rates between each
hospital and health plan shall not exceed ninety-seven and one-half percent (97.5%) of the
payment rates in effect as of January 1, 2013; (iii) (iv) negotiated increases in outpatient hospital
payments for each annual twelve- (12) month (12) period beginning July 1, 2016, 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.
     (3) "Hospital", as used in this section, shall mean the actual facilities and buildings in
existence in Rhode Island, licensed pursuant to § 23-17-1 et seq. on June 30, 2010, and thereafter
any premises included on that license, regardless of changes in licensure status pursuant to
chapter 17.14 of title 23 § 23-17.14 (hospital conversions) and § 23-17-6(b) (change in effective
control), that provides short-term, acute inpatient and/or outpatient care to persons who require
definitive diagnosis and treatment for injury, illness, disabilities, or pregnancy. Notwithstanding
the preceding language, the negotiated Medicaid managed care payment rates for a court-
approved purchaser that acquires a hospital through receivership, special mastership or other
similar state insolvency proceedings (which court-approved purchaser is issued a hospital license
after January 1, 2013), shall be based upon the newly negotiated rates between the court-approved
purchaser and the health plan, and such rates shall be effective as of the date that the court-
approved purchaser and the health plan execute the initial agreement containing the newly
negotiated rate. The rate-setting methodology for inpatient-hospital payments and outpatient-
hospital payments set forth in the §§ subdivisions 40-8-13.4(b)(1)(ii)(C) and 40-8-13.4(b)(2),
respectively, shall thereafter apply to negotiated increases for each annual twelve- (12) month
(12) period as of July 1 following the completion of the first full year of the court-approved
purchaser's initial Medicaid managed care contract.
     (c) It is intended that payment utilizing the Diagnosis Related Groups DRG method shall
reward hospitals for providing the most efficient care, and provide the executive office the
opportunity to conduct value-based purchasing of inpatient care.
     (d) The secretary of the 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 DRG-
payment methodology. Furthermore, amendment of the Rhode Island state plan for medical
assistance (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 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 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 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 set forth in 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. 
     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 that 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 ("executive office") 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 that 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, or October 1, 2015, but will occur on April 1, 2015. Said inflation
index shall be applied without regard for the transition factor in subsection (b)(2) below.
     For purposes of October 1, 2016, adjustment only, any rate increase that results from
application of the inflation index to subparagraphs (a)(2)(i) and (a)(2)(ii) shall be dedicated to
increase compensation for direct-care workers in the following manner: Not less than 85% of this
aggregate amount shall be expended to fund an increase in wages, benefits, or related employer
costs of direct-care staff of nursing homes. For purposes of this section, direct-care staff shall
include registered nurses (RNs), licensed practical nurses (LPNs), certified nursing assistants
(CNAs), certified medical technicians, housekeeping staff, laundry staff, dietary staff, or other
similar employees providing direct care services; provided, however, that this definition of direct-
care staff shall not include: (i) RNs and LPNs who are classified as "exempt employees" under
the Federal Fair Labor Standards Act (29 U.S.C. §201 et seq.); or (ii) CNAs, certified medical
technicians, RNs, or LPNs who are contracted, or subcontracted, through a third-party vendor or
staffing agency. By July 31, 2017, nursing facilities shall submit to the secretary, or designee, a
certification that they have complied with the provisions of this subparagraph (a)(2) (vi) with
respect to the inflation index applied on October 1, 2016. Any facility that does not comply with
terms of such certification shall be subjected to a clawback, paid by the nursing facility to the
state, in the amount of increased reimbursement subject to this provision that was not expended in
compliance with that certification.
      (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 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 for the year beginning October 1, 2017, the reimbursement for
direct-care costs under this provision will be phased out in twenty-five-percent (25%) increments
each year until October 1, 2021, when the reimbursement will no longer be in effect.
      (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. An adjustment to the per diem loss or gain may be phased out by
twenty-five percent (25%) each year; except, however, for the year beginning October 1, 2015,
there shall be no adjustment to the per diem gain or loss, but the phase out shall resume
thereafter; 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.
      (4) Notwithstanding any law to the contrary, for the twelve- (12) month (12) period
beginning July 1, 2015, Medicaid payment rates for nursing facilities established pursuant to this
section shall not exceed ninety-eight percent (98%) of the rates in effect on April 1, 2015.
     SECTION 3. Sections 40-8.3-2 and 40-8.3-3 of the General Laws in Chapter 40-8.3
entitled “Uncompensated Care” are hereby amended to read as follows:
     40-8.3-2. Definitions. -- As used in this chapter:
     (1) "Base year" means, for the purpose of calculating a disproportionate share payment
for any fiscal year ending after September 30, 2014 2015, the period from October 1, 2012 2013,
through September 30, 2013 2014, and for any fiscal year ending after September 30, 2015 2016,
the period from October 1, 2013 2014, through September 30, 2014 2015.
      (2) "Medicaid inpatient utilization rate for a hospital" means a fraction (expressed as a
percentage), the numerator of which is the hospital's number of inpatient days during the base
year attributable to patients who were eligible for medical assistance during the base year and the
denominator of which is the total number of the hospital's inpatient days in the base year.
     (3) "Participating hospital" means any nongovernment and nonpsychiatric hospital that:
     (i) wWas licensed as a hospital in accordance with chapter 17 of title 23 during the base
year; and shall mean the actual facilities and buildings in existence in Rhode Island, licensed
pursuant to § 23-17-1 et seq. on June 30, 2010, and thereafter any premises included on that
license, regardless of changes in licensure status pursuant to chapter 17.14 of title 23 § 23-17.14
(hospital conversions) and § 23-17-6(b) (change in effective control), that provides short-term
acute inpatient and/or outpatient care to persons who require definitive diagnosis and treatment
for injury, illness, disabilities, or pregnancy. Notwithstanding the preceding language, the
negotiated Medicaid managed care payment rates for a court-approved purchaser that acquires a
hospital through receivership, special mastership, or other similar state insolvency proceedings
(which court-approved purchaser is issued a hospital license after January 1, 2013) shall be based
upon the newly negotiated rates between the court-approved purchaser and the health plan, and
such rates shall be effective as of the date that the court-approved purchaser and the health plan
execute the initial agreement containing the newly negotiated rate. The rate-setting methodology
for inpatient hospital payments and outpatient hospital payments set for the §§ 40-8-13.4(b)(1)
(B)(iii) and 40-8-13.4(b)(2), respectively, shall thereafter apply to negotiated increases for each
annual twelve- (12) month (12) period as of July 1 following the completion of the first full year
of the court-approved purchaser's initial Medicaid managed care contract.
     (ii) aAchieved a medical assistance inpatient utilization rate of at least one percent (1%)
during the base year; and
     (iii) cContinues to be licensed as a hospital in accordance with chapter 17 of title 23
during the payment year.
     (4) "Uncompensated-care costs" means, as to any hospital, the sum of: (i) tThe cost
incurred by such hospital during the base year for inpatient or outpatient services attributable to
charity care (free care and bad debts) for which the patient has no health insurance or other third-
party coverage less payments, if any, received directly from such patients; and (ii) tThe cost
incurred by such hospital during the base year for inpatient or out-patient services attributable to
Medicaid beneficiaries less any Medicaid reimbursement received therefor; multiplied by the
uncompensated care index.
     (5) "Uncompensated-care index" means the annual percentage increase for hospitals
established pursuant to § 27-19-14 for each year after the base year, up to and including the
payment year, provided, however, that the uncompensated care index for the payment year ending
September 30, 2007, shall be deemed to be five and thirty-eight hundredths percent (5.38%), and
that the uncompensated-care index for the payment year ending September 30, 2008, shall be
deemed to be five and forty-seven hundredths percent (5.47%), and that the uncompensated-care
index for the payment year ending September 30, 2009, shall be deemed to be five and thirty-
eight hundredths percent (5.38%), and that the uncompensated-care index for the payment years
ending September 30, 2010, September 30, 2011, September 30, 2012, September 30, 2013,
September 30, 2014, and September 30, 2015, and September 30, 2016, and September 30, 2017,
shall be deemed to be five and thirty hundredths percent (5.30%).
     40-8.3-3. Implementation. -- (a) For federal fiscal year 2014, commencing on October 1,
2013 and ending September 30, 2014, the executive office of health and human services shall
submit to the Secretary of the U.S. Department of Health and Human Services a state plan
amendment to the Rhode Island Medicaid state plan for disproportionate share hospital payments
(DSH Plan) to provide:
     (1) That the disproportionate share hospital payments to all participating hospitals, not to
exceed an aggregate limit of $136.8 million, shall be allocated by the executive office of health
and human services to the Pool A, Pool C and Pool D components of the DSH Plan; and,
     (2) That the Pool D allotment shall be distributed among the participating hospitals in
direct proportion to the individual participating hospital's uncompensated care costs for the base
year, inflated by the uncompensated care index to the total uncompensated care costs for the base
year inflated by uncompensated care index for all participating hospitals. The disproportionate
share payments shall be made on or before July 14, 2014 and are expressly conditioned upon
approval on or before July 7, 2014 by the Secretary of the U.S. Department of Health and Human
Services, or his or her authorized representative, of all Medicaid state plan amendments necessary
to secure for the state the benefit of federal financial participation in federal fiscal year 2014 for
the disproportionate share payments.
     (b)(a) For federal fiscal year 2015, commencing on October 1, 2014, and ending
September 30, 2015, the executive office of health and human services shall submit to the
Secretary of the U.S. Department of Health and Human Services a state plan amendment to the
Rhode Island Medicaid state plan for disproportionate-share hospital payments (DSH Plan) to
provide:
     (1) That the disproportionate share hospital payments DSH Plan to all participating
hospitals, not to exceed an aggregate limit of $140.0 million, shall be allocated by the executive
office of health and human services to the Pool A, Pool C, and Pool D components of the DSH
Plan; and,
     (2) That the Pool D allotment shall be distributed among the participating hospitals in
direct proportion to the individual participating hospital's uncompensated care costs for the base
year, inflated by the uncompensated care index to the total uncompensated care costs for the base
year inflated by uncompensated care index for all participating hospitals. The disproportionate
share DSH Plan payments shall be made on or before July 13, 2015, and are expressly
conditioned upon approval on or before July 6, 2015, by the Secretary of the U.S. Department of
Health and Human Services, or his or her authorized representative, of all Medicaid state-plan
amendments necessary to secure for the state the benefit of federal financial participation in
federal fiscal year 2015 for the disproportionate share payments.
     (c)(b) For federal fiscal year 2016, commencing on October 1, 2015, and ending
September 30, 2016, the executive office of health and human services shall submit to the
Secretary of the U.S. Department of Health and Human Services a state plan amendment to the
Rhode Island Medicaid state plan for disproportionate share hospital payments (DSH Plan) to
provide:
      (1) That the disproportionate-share hospital payments to all participating hospitals, not to
exceed an aggregate limit of $138.2 million, shall be allocated by the executive office of health
and human services to the Pool A, Pool C and Pool D components of the DSH Plan; and,
     (2) That the Pool D allotment shall be distributed among the participating hospitals in
direct proportion to the individual, participating hospital's uncompensated-care costs for the base
year, inflated by the uncompensated-care index to the total uncompensated-care costs for the base
year inflated by uncompensated-care index for all participating hospitals. The disproportionate
share payments DSH Plan shall be made on or before July 11, 2016, and are expressly
conditioned upon approval on or before July 5, 2016, by the Secretary of the U.S. Department of
Health and Human Services, or his or her authorized representative, of all Medicaid state plan
amendments necessary to secure for the state the benefit of federal financial participation in
federal fiscal year 2016 for the disproportionate share payments DSH Plan.
     (c) For federal fiscal year 2017, commencing on October 1, 2016, and ending September
30, 2017, the executive office of health and human services shall submit to the Secretary of the
U.S. Department of Health and Human Services a state plan amendment to the Rhode Island
Medicaid DSH Plan to provide:
     (1) That the DSH Plan to all participating hospitals, not to exceed an aggregate limit of
$139.7 million, shall be allocated by the executive office of health and human services to the Pool
D component of the DSH Plan; and,
     (2) That the Pool D allotment shall be distributed among the participating hospitals in
direct proportion to the individual, participating hospital's uncompensated-care costs for the base
year, inflated by the uncompensated-care index to the total uncompensated-care costs for the base
year inflated by uncompensated-care index for all participating hospitals. The disproportionate-
share payments shall be made on or before July 11, 2017, and are expressly conditioned upon
approval on or before July 5, 2017 by the Secretary of the U.S. Department of Health and Human
Services, or his or her authorized representative, of all Medicaid state plan amendments necessary
to secure for the state the benefit of federal financial participation in federal fiscal year 2017 for
the disproportionate share payments.
     (d) No provision is made pursuant to this chapter for disproportionate-share hospital
payments to participating hospitals for uncompensated-care costs related to graduate medical
education programs.
      (e) The executive office of health and human services is directed, on at least a monthly
basis, to collect patient-level uninsured information, including, but not limited to, demographics,
services rendered, and reason for uninsured status from all hospitals licensed in Rhode Island.
     (f) Beginning with federal FY 2016, Pool D DSH payments will be recalculated by the
state based on actual hospital experience. The final Pool D payments will be based on the data
from the final DSH audit for each federal fiscal year. Pool D DSH payments will be redistributed
among the qualifying hospitals in direct proportion to the individual, qualifying hospital's
uncompensated-care to the total uncompensated-care costs for all qualifying hospitals as
determined by the DSH audit. No hospital will receive an allocation that would incur funds
received in excess of audited uncompensated-care costs.
     SECTION 4. Section 40-8.5-1.1 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:
     40-8.5-1.1. 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 executive office of health
and human services ("executive office") 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 this section, managed care systems are also may also be defined to include a
primary care case-management model in which ancillary services are provided under the direction
of a physician in a practice, community health teams, and/or other such arrangements that meets
meet standards established by the department of human services executive office and serve the
purposes of this section. Managed-care systems may also include services and supports that
optimize the health and independence of recipients beneficiaries who are determined to need
Medicaid-funded long-term care under chapter 40-8.10 or to be at risk for such care under
applicable federal state plan or waiver authorities and the rules and regulations promulgated by
the department. Any medical assistance recipients executive office. Any Medicaid beneficiaries
who have third-party medical coverage or insurance may be provided such services through an
entity certified by or, in a contractual arrangement with, the department executive office or, as
deemed appropriate, exempt from mandatory managed care in accordance with rules and
regulations promulgated by the department of human services executive office.
     (c) In accordance with § 42-12.4-7, the department executive office is authorized to
obtain any approval through waiver(s), category II or III changes, and/or state-plan amendments,
from the secretary of the United States dDepartment of hHealth and hHuman sServices, 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 Medicaid beneficiaries. The waiver(s), category II or III
changes, and/or state-plan amendments shall include the authorization to extend managed care to
cover long-term-care services and supports. Such authorization shall also include, as deemed
appropriate, exempting certain 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 executive office.
     (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. sSocial sSecurity aAdministration
program, the department of human services executive office is authorized to seek any and all
data-sharing agreements or other agreements with the sSocial sSecurity aAdministration 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.
     SECTION 5. Sections 40-8.9-3, 40-8.9-4, 40-8.9-6, 40-8.9-7, 40-8.9-8 and 40-8.9-9 of
the General Laws in Chapter 40-8.9 entitled “Medical Assistance - Long-Term Care Service and
Finance Reform “ are hereby amended to read as follows:
     40-8.9-3. Least restrictive setting requirement. -- Beginning on July 1, 2007, the
department of human services The executive office of health and human services (executive
office) is directed to recommend the allocation of existing Medicaid resources as needed to
ensure that those in need of long-term care and support services receive them in the least
restrictive setting appropriate to their needs and preferences. The department executive office is
hereby authorized to utilize screening criteria, to avoid unnecessary institutionalization of persons
during the full eligibility-determination process for Medicaid community-based care.
     40-8.9-4. Unified long-term care budget. -- Beginning on July 1, 2007, a unified long-
term-care budget shall combine in a single, line-item appropriation within the department of
human services budget executive office of health and human services (executive office), annual
department of human services executive office Medicaid appropriations for nursing facility and
community-based, long-term care services for elderly sixty-five (65) years and older and younger
persons at risk of nursing home admissions (including adult day care, home health, pace, and
personal care in assisted living settings). Beginning on July 1, 2007, the total system savings
attributable to the value of the reduction in nursing home days including hospice nursing home
days paid for by Medicaid shall be allocated in the budget enacted by the general assembly for the
ensuing fiscal year for the express purpose of promoting and strengthening community-based
alternatives; provided, further, beginning July 1, 2009, said savings shall be allocated within the
budgets of the executive office and, as appropriate, the department of human services, and the
department division of elderly affairs. The allocation shall include, but not be limited to, funds to
support an on-going, statewide community education and outreach program to provide the public
with information on home and community services and the establishment of presumptive
eligibility criteria for the purposes of accessing home and community care. The home- and
community-care service presumptive eligibility criteria shall be developed through rule or
regulation on or before September 30, 2007. The allocation may also be used to fund home and
community services provided by the department division of elderly affairs for persons eligible for
Medicaid long-term care, and the co-pay program administered pursuant to section 42-chapter
66.3 of title 42. Any monies in the allocation that remain unexpended in a fiscal year shall be
carried forward to the next fiscal year for the express purpose of strengthening community-based
alternatives.
     The caseload estimating conference pursuant to § 35-17-1 shall determine the amount of
general revenues to be added to the current service estimate of community-based, long-term care
services for elderly sixty-five (65) and older and younger persons at risk of nursing home
admissions for the ensuing budget year by multiplying the combined, cost per day of nursing
home and hospice nursing home days estimated at the caseload conference for that year by the
reduction in nursing home and hospice nursing home days from those in the second fiscal year
prior to the current fiscal year to those in the first fiscal year prior to the current fiscal year.
     40-8.9-6. Reporting. -- Annual reports showing progress in long-term-care system
reform and rebalancing shall be submitted by April 1st of each year by the department executive
office of health and human services to the Jjoint Llegislative Ccommittee on Hhealth Ccare
Oversight as well as the finance committees of both the senate and the house of representatives
and shall include: the number of persons aged sixty-five (65) years and over and adults with
disabilities served in nursing facilities,; the number of persons transitioned from nursing homes to
Medicaid supported home- and community-based care,; the number of persons aged sixty-five
(65) years and over and adults with disabilities served in home and community care, to include
home care, adult day services, assisted living and shared living,; the dollar amounts and percent
of expenditures spent on nursing facility care and home- and community-based care,; and
estimates of the continued investments necessary to provide stability to the existing system and
establish the infrastructure and programs required to achieve system-wide systemwide reform
and the targeted goal of spending fifty percent (50%) of Medicaid long-term care dollars on
nursing facility care and fifty percent (50%) on home and community-based services.
     40-8.9-7. Rate reform. -- By January 2008 the department of human services The
executive office of health and human services shall design, and require to be submitted by all
service providers, cost reports for all community-based, long-term services, including patient
liability owed and collected.
     40-8.9-8. System screening. -- By January 2008 the department of human services The
executive office of health and human services shall develop and implement a screening strategy
for the purpose of identifying entrants to the publicly financed, long-term-care system prior to
application for eligibility as well as defining their potential service needs.
     40-8.9-9. Long-term care re-balancing system reform goal. -- (a) Notwithstanding any
other provision of state law, the executive office of health and 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 Ddepartment of Hhealth and Hhuman
Sservices, 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 for persons aged sixty-five (65) and over and adults with
disabilities, in addition to services for persons with developmental disabilities , to home- and
community-based care ; provided, further, the executive office shall report annually as part of its
budget submission, the percentage distribution between institutional care and home- and
community-based care by population and shall report current and projected waiting lists for long-
term care and home- and community-based care services. The executive office 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 reformed long-term-care system 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
long-term care institutions, such as behavioral health residential-treatment facilities, long- term
care hospitals, intermediate-care facilities and/or skilled nursing facilities.
     (c) Pursuant to federal authority procured under § 42-7.2-16 of the general laws, the
executive office of health and 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, to the extent feasible,
any consumer group, advisory board, or other entity designated for such purposes, and shall
encompass eligibility determinations for long-term care services in nursing facilities, hospitals,
and intermediate-care facilities for persons with intellectual disabilities, 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 executive office is authorized to
adopt clinical and/or functional criteria for admission to a nursing facility, hospital, or
intermediate- care facility for persons with intellectual disabilities that are more stringent than
those employed for access to home- and community-based services. The executive office is also
authorized to promulgate rules that define the frequency of re-assessments for services provided
for under this section. Levels of care may be applied in accordance with the following:
     (1) The executive office shall continue to apply the level of care criteria in effect on June
30, 2015, for any recipient determined eligible for and receiving Medicaid-funded, long-term
services in supports in a nursing facility, hospital, or intermediate-care facility for persons with
intellectual disabilities on or before that date, unless:
     (a) tThe recipient transitions to home- and community-based services because he or she
would no longer meet the level of care criteria in effect on June 30, 2015; or
     (b) tThe recipient chooses home- and community-based services over the nursing facility,
hospital, or intermediate-care facility for persons with intellectual disabilities. For the purposes of
this section, a failed community placement, as defined in regulations promulgated by the
executive office, shall be considered a condition of clinical eligibility for the highest level of care.
The executive office shall confer with the long-term care ombudsperson with respect to the
determination of a failed placement under the ombudsperson's jurisdiction. Should any Medicaid
recipient eligible for a nursing facility, hospital, or intermediate-care facility for persons with
intellectual disabilities as of June 30, 2015, receive a determination of a failed community
placement, the recipient shall have access to the highest level of care; furthermore, a recipient
who has experienced a failed community placement shall be transitioned back into his or her
former nursing home, hospital, or intermediate-care facility for persons with intellectual
disabilities whenever possible. Additionally, residents shall only be moved from a nursing home,
hospital, or intermediate-care facility for persons with intellectual disabilities in a manner
consistent with applicable state and federal laws.
     (2) Any Medicaid recipient eligible for the highest level of care who voluntarily leaves a
nursing home, hospital, or intermediate-care facility for persons with intellectual disabilities shall
not be subject to any wait list for home and community-based services.
     (3) No nursing home, hospital, or intermediate-care facility for persons with intellectual
disabilities shall be denied payment for services rendered to a Medicaid recipient on the grounds
that the recipient does not meet level of care criteria unless and until the executive office has:
     (i) pPerformed an individual assessment of the recipient at issue and provided written
notice to the nursing home, hospital, or intermediate-care facility for persons with intellectual
disabilities that the recipient does not meet level of care criteria; and
     (ii) tThe recipient has either appealed that level of care determination and been
unsuccessful, or any appeal period available to the recipient regarding that level of care
determination has expired.
     (d) The executive office is further authorized to consolidate all home and community-
based services currently provided pursuant to § 1915( c) of title XIX of the United States Code
into a single system of home- and community-based services that include options for consumer
direction and shared living. The resulting single-home and community-based services system
shall replace and supersede all §1915(c) programs when fully implemented. Notwithstanding the
foregoing, the resulting single-program home and community-based services system 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 executive office 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 to persons at risk for Medicaid-funded, long-term care
subject to availability of state-appropriated funding for these purposes.
     (f) To promote the expansion of home- and community-based service capacity, the
executive office is authorized to pursue payment methodology reforms that increase access to
homemaker, personal care (home health aide), assisted living, adult, supportive-care homes, and
adult day services, as follows:
     (1) Development, of revised or new Medicaid certification standards that increase access
to service specialization and scheduling accommodations by using payment strategies designed to
achieve specific quality and health outcomes.
     (2) Development of Medicaid certification standards for state-authorized providers of
adult-day services, excluding such providers of services authorized under § 40.1-24-1(3), assisted
living, and adult supportive care (as defined under § 23-17.24 chapter 17.24 of title 23) that
establish for each, an acuity-based, tiered service and payment methodology tied to: licensure
authority,; level of beneficiary needs; the scope of services and supports provided; and specific
quality and outcome measures.
     The standards for adult-day services for persons eligible for Medicaid-funded, long-term
services may differ from those who do not meet the clinical/functional criteria set forth in § 40-
8.10-3.
     (3) By October 1, 2016, institute an increase in the base-payment rates for home-care
service providers, in an amount to be determined through the appropriations process, for the
purpose of implementing a wage pass-through program for personal-care attendants and home
health aides assisting long-term-care beneficiaries. On or before September 1, 2016, Medicaid-
funded home health providers seeking to participate in the program shall submit to the secretary,
for his or her approval, a written plan describing and attesting to the manner in which the
increased payment rates shall be passed through to personal-care attendants and home health
aides in their salaries or wages less any attendant costs incurred by the provider for additional
payroll taxes, insurance contributions, and other costs required by federal or state law, regulation,
or policy and directly attributable to the wage pass-through program established in this section.
Any such providers contracting with a Medicaid managed-care organization shall develop the
plan for the wage pass-through program in conjunction with the managed-care entity and shall
include an assurance by the provider that the base-rate increase is implemented in accordance
with the goal of raising the wages of the health workers targeted in this subsection. Participating
providers who do not comply with the terms of their wage pass-through plan shall be subject to a
clawback, paid by the provider to the state, for any portion of the rate increase administered under
this section that the secretary deems appropriate.
      (g) The executive office shall implement a long-term-care-options counseling program to
provide individuals, or their representatives, or both, with long-term-care consultations that shall
include, at a minimum, information about: long-term-care options, sources, and methods of both
public and private payment for long-term-care services and an assessment of an individual's
functional capabilities and opportunities for maximizing independence. Each individual admitted
to, or seeking admission to, a long-term-care facility, regardless of the payment source, shall be
informed by the facility of the availability of the long-term-care options counseling program and
shall be provided with long-term-care options consultation if they so request. Each individual
who applies for Medicaid long-term-care services shall be provided with a long-term care
consultation.
     (h) The executive office is also authorized, subject to availability of appropriation of
funding, and federal, Medicaid-matching funds, to pay for certain services and supports necessary
to transition or divert beneficiaries from institutional or restrictive settings and optimize their
health and safety when receiving care in a home or the community . The secretary is authorized to
obtain any state plan or waiver authorities required to maximize the federal funds available to
support expanded access to such home- and community-transition and stabilization services;
provided, however, payments shall not exceed an annual or per person amount.
     (i) To ensure persons with long-term-care needs who remain living at home have
adequate resources to deal with housing maintenance and unanticipated housing-related costs, the
secretary is authorized to develop higher resource eligibility limits for persons or obtain any state
plan or waiver authorities necessary to change the financial eligibility criteria for long-term
services and supports to enable beneficiaries receiving home and community waiver services to
have the resources to continue living in their own homes or rental units or other home-based
settings.
     (j) The executive office shall implement, no later than January 1, 2016, the following
home- and community-based service and payment reforms:
     (1) Community-based, supportive-living program established in § 40-8.13-2.1;
     (2) Adult day services level of need criteria and acuity-based, tiered-payment
methodology; and
     (3) Payment reforms that encourage home- and community-based providers to provide
the specialized services and accommodations beneficiaries need to avoid or delay institutional
care.
     (k) The secretary is authorized to seek any Medicaid section 1115 waiver or state-plan
amendments and take any administrative actions necessary to ensure timely adoption of any new
or amended rules, regulations, policies, or procedures and any system enhancements or changes,
for which appropriations have been authorized, that are necessary to facilitate implementation of
the requirements of this section by the dates established. The secretary shall reserve the discretion
to exercise the authority established under §§ 42-7.2-5(6)(v) and 42-7.2-6.1, in consultation with
the governor, to meet the legislative directives established herein.
     SECTION 6. Section 40-8.13-5 of the General Laws in Chapter 40-8.13 entitled "Long-
Term Managed Care Arrangements" is hereby amended to read as follows:
     40-8.13-5. Financial principles under managed care. -- (a) To the extent that financial
savings are a goal under any managed long-term-care arrangement, it is the intent of the
legislature to achieve such savings through administrative efficiencies, care coordination,
improvements in care outcomes and in a way that encourages the highest quality care for patients
and maximizes value for the managed-care organization and the state. Therefore, any managed-
long-term-care arrangement shall include a requirement that the managed-care organization
reimburse providers for services in accordance with these principles. Notwithstanding any law to
the contrary, for the twelve- (12) month (12) period beginning July 1, 2015, Medicaid managed
long-term-care payment rates to nursing facilities established pursuant to this section shall not
exceed ninety-eight percent (98.0%) of the rates in effect on April 1, 2015.
      (1) For a duals demonstration project, the managed-care organization:
      (i) Shall not combine the rates of payment for post-acute skilled and rehabilitation care
provided by a nursing facility and long-term and chronic care provided by a nursing facility in
order to establish a single-payment rate for dual eligible beneficiaries requiring skilled nursing
services;
      (ii) Shall pay nursing facilities providing post-acute skilled and rehabilitation care or
long-term and chronic care rates that reflect the different level of services and intensity required
to provide these services; and
      (iii) For purposes of determining the appropriate rate for the type of care identified in
subsection (a)(1)(ii) of this section, the managed-care organization shall pay no less than the rates
which that would be paid for that care under traditional Medicare and Rhode Island Medicaid for
these service types. The managed-care organization shall not, however, be required to use the
same payment methodology as EOHHS.
      The state shall not enter into any agreement with a managed-care organization in
connection with a duals demonstration project unless that agreement conforms to this section, and
any existing such agreement shall be amended as necessary to conform to this subsection.
      (2) For a managed long-term-care arrangement that is not a duals demonstration project,
the managed-care organization shall reimburse providers in an amount not less than the amount
that would be paid for the same care by the executive office of health and human services
EOHHS under the Medicaid program. The managed-care organization shall not, however, be
required to use the same payment methodology as the executive office of health and human
services EOHHS.
      (3) Notwithstanding any provisions of the general or public laws to the contrary, the
protections of subsections subdivisions (1) and (2) of this section may be waived by a nursing
facility in the event it elects to accept a payment model developed jointly by the managed-care
organization and skilled nursing facilities, that is intended to promote quality of care and cost
effectiveness, including, but not limited to, bundled-payment initiatives, value-based purchasing
arrangements, gainsharing, and similar models.
      (b) Notwithstanding any law to the contrary, for the twelve- (12) month (12) period
beginning July 1, 2015, Medicaid managed long-term-care payment rates to nursing facilities
established pursuant to this section shall not exceed ninety-eight percent (98.0%) of the rates in
effect on April 1, 2015.
     SECTION 7. Section 40-5.2-20 of the General Laws in Chapter 40-5.2 entitled "The
Rhode Island Works Program" is hereby amended to read as follows:
     40-5.2-20. Child-care assistance. -- Families or assistance units eligible for child-care
assistance.
      (a) The department shall provide appropriate child care to every participant who is
eligible for cash assistance and who requires child care in order to meet the work requirements in
accordance with this chapter.
      (b) Low-Income child care. - The department shall provide child care to all other
working families with incomes at or below one hundred eighty percent (180%) of the federal
poverty level if, and to the extent, such other families require child care in order to work at paid
employment as defined in the department's rules and regulations. Beginning October 1, 2013, the
department shall also provide child care to families with incomes below one hundred eighty
percent (180%) of the federal poverty level if, and to the extent, such families require child care
to participate on a short-term basis, as defined in the department's rules and regulations, in
training, apprenticeship, internship, on-the-job training, work experience, work immersion, or
other job-readiness/job-attachment program sponsored or funded by the human resource
investment council (governor's workforce board) or state agencies that are part of the coordinated
program system pursuant to § 42-102-11.
      (c) No family/assistance unit shall be eligible for child-care assistance under this chapter
if the combined value of its liquid resources exceeds ten thousand dollars ($10,000). Liquid
resources are defined as any interest(s) in property in the form of cash or other financial
instruments or accounts that are readily convertible to cash or cash equivalents. These include,
but are not limited to, cash, bank, credit union, or other financial institution savings, checking,
and money market accounts; certificates of deposit or other time deposits; stocks; bonds; mutual
funds; and other similar financial instruments or accounts. These do not include educational
savings accounts, plans, or programs; retirement accounts, plans, or programs; or accounts held
jointly with another adult, not including a spouse. The department is authorized to promulgate
rules and regulations to determine the ownership and source of the funds in the joint account.
      (d) As a condition of eligibility for child-care assistance under this chapter, the parent or
caretaker relative of the family must consent to, and must cooperate with, the department in
establishing paternity, and in establishing and/or enforcing child support and medical support
orders for all children in the family in accordance with title 15, as amended, unless the parent or
caretaker relative is found to have good cause for refusing to comply with the requirements of this
subsection.
      (e) For purposes of this section, "appropriate child care" means child care, including
infant, toddler, pre-school, nursery school, school-age, that is provided by a person or
organization qualified, approved, and authorized to provide such care by the department of
children, youth, and families, or by the department of elementary and secondary education, or
such other lawful providers as determined by the department of human services, in cooperation
with the department of children, youth and families and the department of elementary and
secondary education.
      (f)(1) Families with incomes below one hundred percent (100%) of the applicable
federal poverty level guidelines shall be provided with free child care. Families with incomes
greater than one hundred percent (100%) and less than one hundred eighty (180%) of the
applicable federal poverty guideline shall be required to pay for some portion of the child care
they receive, according to a sliding-fee scale adopted by the department in the department's rules.
      (2) For a thirty-six (36) month period beginning October 1, 2013, the child care subsidy
transition program shall function within the department of human services. Under this program,
families Families who are already receiving child-care assistance and who become ineligible for
child-care assistance as a result of their incomes exceeding one hundred eighty percent (180%) of
the applicable federal poverty guidelines shall continue to be eligible for child-care assistance
from October 1, 2013, to September 30, 2016 2017, or until their incomes exceed two hundred
twenty-five percent (225%) of the applicable federal poverty guidelines, whichever occurs first.
To be eligible, such families must continue to pay for some portion of the child care they receive,
as indicated in a sliding-fee scale adopted in the department's rules and in accordance with all
other eligibility standards.
      (g) In determining the type of child care to be provided to a family, the department shall
take into account the cost of available child-care options; the suitability of the type of care
available for the child; and the parent's preference as to the type of child care.
      (h) For purposes of this section, "income" for families receiving cash assistance under §
40-5.2-11 means gross, earned income and unearned income, subject to the income exclusions in
subdivisions §§ 40-5.2-10(g)(2) and 40-5.2-10(g)(3), and income for other families shall mean
gross, earned and unearned income as determined by departmental regulations.
      (i) The caseload estimating conference established by chapter 17 of title 35 shall forecast
the expenditures for child-care in accordance with the provisions of § 35-17-1.
      (j) In determining eligibility for child-care assistance for children of members of reserve
components called to active duty during a time of conflict, the department shall freeze the family
composition and the family income of the reserve component member as it was in the month prior
to the month of leaving for active duty. This shall continue until the individual is officially
discharged from active duty.
     SECTION 8. Section 40.1-22-39 of the General Laws in Chapter 40.1-22 entitled
"Developmental Disabilities" is hereby amended to read as follows:
     40.1-22-39. Monthly reports to the general assembly. -- On or before the fifteenth
(15th) day of each month, the department shall provide a monthly report of monthly caseload and
expenditure data, pertaining to eligible, developmentally disabled adults, to the chairperson of the
house finance committee,; the chairperson of the senate finance committee,; the house fiscal
advisor,; the senate fiscal advisor,; and the state budget officer. The monthly report shall be in
such form, and in such number of copies, and with such explanation as the house and senate fiscal
advisors may require. It shall include, but is not limited to, the number of cases and expenditures
from the beginning of the fiscal year at the beginning of the prior month,; cases added and denied
during the prior month,; expenditures made,; and the number of cases and expenditures at the end
of the month. The information concerning cases added and denied shall include summary
information and profiles of the service-demand request for eligible adults meeting the state
statutory definition for services from the division of developmental disabilities as determined by
the division, including age, Medicaid eligibility and agency selection placement with a list of the
services provided, and the reasons for the determinations of ineligibility for those cases denied.
     The department shall also provide, monthly, the number of individuals in a shared-living
arrangement and how many may have returned to a 24-hour residential placement in that month.
The department shall also report, monthly, any and all information for the consent decree that has
been submitted to the federal court as well as the number of unduplicated individuals employed;
the place of employment; and the number of hours working.
     The department shall also provide the amount of funding allocated to individuals above
the assigned resource levels; the number of individuals and the assigned resource level; and the
reasons for the approved additional resources.
     The department shall also provide the amount of patient liability to be collected and the
amount collected as well as the number of individuals who have a financial obligation.
     SECTION 9. Rhode Island Medicaid Reform Act of 2008 Resolution.
     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 Law § 42-
12.4-1, et seq. for federal waiver requests and/or state plan amendments; and
     WHEREAS, Rhode Island General Law § 42-7.2-5 provides that the Secretary of the
Executive Office of Health and Human Services (EOHHS) (hereafter “the Secretary’) is
responsible for the review and coordination of any Medicaid section 1115 demonstration 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 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) Beneficiary Liability Collection Enhancements – Federal laws and regulations require
beneficiaries who are receiving Medicaid-funded, long-term services and supports (LTSS) to pay
a portion of any excess income they may have once eligibility has been determined toward in the
cost of care. The amount the beneficiary is obligated to pay is referred to as a liability or cost-
share and must be used solely for the purpose of offsetting the agency’s payment for the LTSS
provided. The EOHHS is seeking to implement new methodologies that will make it easier for
beneficiaries to make these payments and enhance the agency’s capacity to collect them in a
timely and equitable manner. The EOHHS may require federal state plan and/or waiver authority
to implement these new methodologies. Amended rules, regulations, and procedures may also be
required.
     (b) Increase in LTSS Home-Care Provider Wages. To further the goal of rebalancing the
long-term-care system to promote home- and community-based alternatives, the EOHHS
proposes to establish a wage-pass-through program targeting certain home-health-care
professionals. Implementation of the program may require amendments to the Medicaid Sstate
Pplan and/or section 1115 demonstration waiver due to changes in payment methodologies.
     (c) Alternative Payment Arrangements – The EOHHS proposes to leverage all available
resources by repurposing funds derived from various savings initiatives and obtaining federal
financial participation for costs not otherwise matchable to expand the reach and enhance the
effectiveness of alternative payment arrangements that maximize value and cost-effectiveness,
and tie payments to improvements in service quality and health outcomes. Amendments to the
section 1115 waiver and/or the Medicaid state plan may be required to implement any alternative
payment arrangements the EOHHS is authorized to pursue. EOHHS proposes to fund the R.I.
Health System Transformation Program by seeking federal authority for federal financial
participation (FFP) in financing both Costs Not Otherwise Matchable (CNOMS) and Designated
State Health Programs (DSHPs) that either not previously utilized although authorized or were
not authorized for federal financial participation prior to June 1, 2016, and for which authority is
obtained after June 1, 2016. Utilizing the funds made available by this new authority for federal
financial participation, the R.I. Health System Transformation Program will make payments to
health-care providers to reward and encourage improvements in clinical quality, patient
experience, and health system integration. Eligibility for these Health System Transformation
Program payments will be made to health-care providers participating in Aalternative Ppayment
Aarrangements, including, but not limited to, accountable entities and to those engaged in
electronic exchange of clinical information necessary for optimal management of patient care.
      (d) Federal Financing Opportunities. The EOHHS proposes to review Medicaid
requirements and opportunities under the U.S. Patient Protection and Affordable Care Act of
2010, and various other recently enacted federal laws, and pursue any changes in the Rhode
Island Medicaid program that promote service quality, access, and cost-effectiveness that may
warrant a Medicaid Sstate Pplan Aamendment or amendment under the terms and conditions of
Rhode Island’s section 1115 Waiver, its successor, or any extension thereof. Any such actions the
EOHHS takes shall not have an adverse impact on beneficiaries or cause an increase in
expenditures beyond the amount appropriated for state fiscal year 2017; now, therefore, be it
     RESOLVED, that the general assembly hereby approves proposals (a) through (d) listed
above to amend the demonstration; and be it further
     RESOLVED, that the Secretary is authorized to pursue and implement any waiver
amendments, 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 10. This article shall take effect upon passage, except as otherwise provided
herein.