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ARTICLE 13 AS AMENDED |
RELATING TO HUMAN SERVICES
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SECTION 1. Section 35-17-1 of the General Laws in Chapter 35-17 entitled "Medical |
Assistance and Public Assistance Caseload Estimating Conferences" is hereby amended to read as |
follows: |
35-17-1. Purpose and membership. |
(a) In order to provide for a more stable and accurate method of financial planning and |
budgeting, it is hereby declared the intention of the legislature that there be a procedure for the |
determination of official estimates of anticipated medical assistance expenditures and public |
assistance caseloads, upon which the executive budget shall be based and for which appropriations |
by the general assembly shall be made. |
(b) The state budget officer, the house fiscal advisor, and the senate fiscal advisor shall |
meet in regularly scheduled caseload estimating conferences (C.E.C.). These conferences shall be |
open public meetings. |
(c) The chairpersonship of each regularly scheduled C.E.C. will rotate among the state |
budget officer, the house fiscal advisor, and the senate fiscal advisor, hereinafter referred to as |
principals. The schedule shall be arranged so that no chairperson shall preside over two (2) |
successive regularly scheduled conferences on the same subject. |
(d) Representatives of all state agencies are to participate in all conferences for which their |
input is germane. |
(e) The department of human services shall provide monthly data to the members of the |
caseload estimating conference by the fifteenth day of the following month. Monthly data shall |
include, but is not limited to, actual caseloads and expenditures for the following case assistance |
programs: Rhode Island Works, SSI state program, general public assistance, and child care. For |
individuals eligible to receive the payment under § 40-6-27(a)(1)(vi), the report shall include the |
number of individuals enrolled in a managed care plan receiving long-term care services and |
supports and the number receiving fee-for-service benefits. The executive office of health and |
human services shall report relevant caseload information and expenditures for the following |
medical assistance categories: hospitals, long-term care, managed care, pharmacy, and other |
medical services. In the category of managed care, caseload information and expenditures for the |
following populations shall be separately identified and reported: children with disabilities, |
children in foster care, and children receiving adoption assistance and RIte Share enrollees under § |
40-8.4-12(j). The information shall include the number of Medicaid recipients whose estate may |
be subject to a recovery and the anticipated amount to be collected from those subject to recovery, |
the total recoveries collected each month and number of estates attached to the collections and each |
month, the number of open cases and the number of cases that have been open longer than three |
months. |
SECTION 2. Section Sections 40-5-10 40-5.2-10 and 40-5.2-20 of the General Laws in |
Chapter 40-5.2 entitled "The Rhode Island Works Program" is are hereby amended to read as |
follows: |
40-5.2-10. Necessary requirements and conditions. |
The following requirements and conditions shall be necessary to establish eligibility for |
the program. |
(a) Citizenship, alienage, and residency requirements. |
(1) A person shall be a resident of the State of Rhode Island. |
(2) Effective October 1, 2008, a person shall be a United States citizen, or shall meet the |
alienage requirements established in § 402(b) of the Personal Responsibility and Work Opportunity |
Reconciliation Act of 1996, PRWORA, Public Laws No. 104-193 and as that section may hereafter |
be amended [8 U.S.C. § 1612]; a person who is not a United States citizen and does not meet the |
alienage requirements established in PRWORA, as amended, is not eligible for cash assistance in |
accordance with this chapter. |
(b) The family/assistance unit must meet any other requirements established by the |
department of human services by rules and regulations adopted pursuant to the Administrative |
Procedures Act, as necessary to promote the purpose and goals of this chapter. |
(c) Receipt of cash assistance is conditional upon compliance with all program |
requirements. |
(d) All individuals domiciled in this state shall be exempt from the application of |
subdivision 115(d)(1)(A) of Public Law 104-193, the Personal Responsibility and Work |
Opportunity Reconciliation Act of 1996, PRWORA [21 U.S.C. § 862a], which makes any |
individual ineligible for certain state and federal assistance if that individual has been convicted |
under federal or state law of any offense which that is classified as a felony by the law of the |
jurisdiction and which that has as an element the possession, use, or distribution of a controlled |
substance as defined in § 102(6) of the Controlled Substances Act (21 U.S.C. § 802(6)). |
(e) Individual employment plan as a condition of eligibility. |
(1) Following receipt of an application, the department of human services shall assess the |
financial conditions of the family, including the non-parent caretaker relative who is applying for |
cash assistance for himself or herself as well as for the minor child(ren), in the context of an |
eligibility determination. If a parent or non-parent caretaker relative is unemployed or under- |
employed, the department shall conduct an initial assessment, taking into account: (A) the The |
physical capacity, skills, education, work experience, health, safety, family responsibilities and |
place of residence of the individual; and (B) the The child care and supportive services required by |
the applicant to avail himself or herself of employment opportunities and/or work readiness |
programs. |
(2) On the basis of such this assessment, the department of human services and the |
department of labor and training, as appropriate, in consultation with the applicant, shall develop |
an individual employment plan for the family which requires the individual to participate in the |
intensive employment services. Intensive employment services shall be defined as the work |
requirement activities in subsections § 40-5.2-12(g) and (i). |
(3) The director, or his/her his or her designee, may assign a case manager to an |
applicant/participant, as appropriate. |
(4) The department of labor and training and the department of human services in |
conjunction with the participant shall develop a revised individual employment plan which that |
shall identify employment objectives, taking into consideration factors above, and shall include a |
strategy for immediate employment and for preparing for, finding, and retaining employment |
consistent, to the extent practicable, with the individual's career objectives. |
(5) The individual employment plan must include the provision for the participant to |
engage in work requirements as outlined in § 40-5.2-12 of this chapter. |
(6)(A)(i) The participant shall attend and participate immediately in intensive assessment |
and employment services as the first step in the individual employment plan, unless temporarily |
exempt from this requirement in accordance with this chapter. Intensive assessment and |
employment services shall be defined as the work requirement activities in subsections § 40-5.2- |
12(g) and (i). |
(B)(ii) Parents under age twenty (20) without a high school diploma or General |
Equivalency Diploma general equivalency diploma (GED) shall be referred to special teen parent |
programs which will provide intensive services designed to assist teen parent parents to complete |
high school education or GED, and to continue approved work plan activities in accord with Rhode |
Island Works works program requirements. |
(7) The applicant shall become a participant in accordance with this chapter at the time the |
individual employment plan is signed and entered into. |
(8) Applicants and participants of the Rhode Island Work works Program program shall |
agree to comply with the terms of the individual employment plan, and shall cooperate fully with |
the steps established in the individual employment plan, including the work requirements. |
(9) The department of human services has the authority under the chapter to require |
attendance by the applicant/participant, either at the department of human services or at the |
department of labor and training, at appointments deemed necessary for the purpose of having the |
applicant enter into and become eligible for assistance through the Rhode Island Work Program |
works program. Said The appointments include, but are not limited to, the initial interview, |
orientation and assessment; job readiness and job search. Attendance is required as a condition of |
eligibility for cash assistance in accordance with rules and regulations established by the |
department. |
(10) As a condition of eligibility for assistance pursuant to this chapter, the |
applicant/participant shall be obligated to keep appointments, attend orientation meetings at the |
department of human services and/or the Rhode Island department of labor and training, participate |
in any initial assessments or appraisals and comply with all the terms of the individual employment |
plan in accordance with department of human service services rules and regulations. |
(11) A participant, including a parent or non-parent caretaker relative included in the cash |
assistance payment, shall not voluntarily quit a job or refuse a job unless there is good cause as |
defined in this chapter or the department's rules and regulations. |
(12) A participant who voluntarily quits or refuses a job without good cause, as defined in |
subsection 40-5.2-12(l)(l), while receiving cash assistance in accordance with this chapter, shall be |
sanctioned in accordance with rules and regulations promulgated by the department. |
(f) Resources. |
(1) The Family family or assistance unit's countable resources shall be less than the |
allowable resource limit established by the department in accordance with this chapter. |
(2) No family or assistance unit shall be eligible for assistance payments if the combined |
value of its available resources (reduced by any obligations or debts with respect to such resources) |
exceeds one thousand dollars ($1,000). |
(3) For purposes of this subsection, the following shall not be counted as resources of the |
family/assistance unit in the determination of eligibility for the works program: |
(A)(i) The home owned and occupied by a child, parent, relative or other individual; |
(B)(ii) Real property owned by a husband and wife as tenants by the entirety, if the property |
is not the home of the family and if the spouse of the applicant refuses to sell his or her interest in |
the property; |
(C)(iii) Real property which that the family is making a good faith effort to dispose of, |
however, any cash assistance payable to the family for any such period shall be conditioned upon |
such disposal of the real property within six (6) months of the date of application and any payments |
of assistance for that period shall (at the time of disposal) be considered overpayments to the extent |
that they would not have occurred at the beginning of the period for which the payments were |
made. All overpayments are debts subject to recovery in accordance with the provisions of the |
chapter; |
(D)(iv) Income producing property other than real estate including, but not limited to, |
equipment such as farm tools, carpenter's tools and vehicles used in the production of goods or |
services which that the department determines are necessary for the family to earn a living; |
(E)(v) One vehicle for each adult household member, but not to exceed two (2) vehicles |
per household, and in addition, a vehicle used primarily for income producing purposes such as, |
but not limited to, a taxi, truck or fishing boat; a vehicle used as a family's home; a vehicle which |
that annually produces income consistent with its fair market value, even if only used on a seasonal |
basis; a vehicle necessary to transport a family member with a disability where the vehicle is |
specially equipped to meet the specific needs of the person with a disability or if the vehicle is a |
special type of vehicle that makes it possible to transport the person with a disability; |
(F)(vi) Household furnishings and appliances, clothing, personal effects, and keepsakes of |
limited value; |
(G)(vii) Burial plots (one for each child, relative, and other individual in the assistance |
unit), and funeral arrangements; |
(H)(viii) For the month of receipt and the following month, any refund of federal income |
taxes made to the family by reason of § 32 of the Internal Revenue Code of 1986, 26 U.S.C. § 32 |
(relating to earned income tax credit), and any payment made to the family by an employer under |
§ 3507 of the Internal Revenue Code of 1986, 26 U.S.C. § 3507 (relating to advance payment of |
such earned income credit); |
(I)(ix) The resources of any family member receiving supplementary security income |
assistance under the Social Security Act, 42 U.S.C. § 301 et seq. |
(g) Income. |
(1) Except as otherwise provided for herein, in determining eligibility for and the amount |
of cash assistance to which a family is entitled under this chapter, the income of a family includes |
all of the money, goods, and services received or actually available to any member of the family. |
(2) In determining the eligibility for and the amount of cash assistance to which a |
family/assistance unit is entitled under this chapter, income in any month shall not include the first |
one hundred seventy dollars ($170) of gross earnings plus fifty percent (50%) of the gross earnings |
of the family in excess of one hundred seventy dollars ($170) earned during the month. |
(3) The income of a family shall not include: |
(A)(i) The first fifty dollars ($50.00) in child support received in any month from each non- |
custodial parent of a child plus any arrearages in child support (to the extent of the first fifty dollars |
($50.00) per month multiplied by the number of months in which the support has been in arrears) |
which that are paid in any month by a non-custodial parent of a child; |
(B)(ii) Earned income of any child; |
(C)(iii) Income received by a family member who is receiving supplemental security |
income (SSI) assistance under Title XVI of the Social Security Act, 42 U.S.C. § 1381 et seq.; |
(D)(iv) The value of assistance provided by state or federal government or private agencies |
to meet nutritional needs, including: value of USDA donated foods; value of supplemental food |
assistance received under the Child Nutrition Act of 1966, as amended and the special food service |
program for children under Title VII, nutrition program for the elderly, of the Older Americans Act |
of 1965 as amended, and the value of food stamps; |
(E)(v) Value of certain assistance provided to undergraduate students, including any grant |
or loan for an undergraduate student for educational purposes made or insured under any loan |
program administered by the U.S. Commissioner of Education (or the Rhode Island council on |
postsecondary education or the Rhode Island division of higher education assistance); |
(F)(vi) Foster Care Payments care payments; |
(G)(vii) Home energy assistance funded by state or federal government or by a nonprofit |
organization; |
(H)(viii) Payments for supportive services or reimbursement of out-of-pocket expenses |
made to foster grandparents, senior health aides or senior companions and to persons serving in |
SCORE and ACE and any other program under Title II and Title III of the Domestic Volunteer |
Service Act of 1973, 42 U.S.C. § 5000 et seq.; |
(I)(ix) Payments to volunteers under AmeriCorps VISTA as defined in the department's |
rules and regulations; |
(J)(x) Certain payments to native Americans; payments distributed per capita to, or held in |
trust for, members of any Indian Tribe under P.L. 92-254, 25 U.S.C. § 1261 et seq., P.L. 93-134, |
25 U.S.C. § 1401 et seq., or P.L. 94-540; receipts distributed to members of certain Indian tribes |
which are referred to in § 5 of P.L. 94-114, 25 U.S.C. § 459d, that became effective October 17, |
1975; |
(K)(xi) Refund from the federal and state earned income tax credit; |
(L)(xii) The value of any state, local, or federal government rent or housing subsidy, |
provided that this exclusion shall not limit the reduction in benefits provided for in the payment |
standard section of this chapter. |
(4) The receipt of a lump sum of income shall affect participants for cash assistance in |
accordance with rules and regulations promulgated by the department. |
(h) Time limit on the receipt of cash assistance. |
(1) No On or after January 1, 2020, no cash assistance shall be provided, pursuant to this |
chapter, to a family or assistance unit which that includes an adult member who has received cash |
assistance, either for him/herself or on behalf of his/her children, for a total of twenty-four (24) |
forty-eight (48) months, (whether or not consecutive), within any sixty (60) continuous months |
after July 1, 2008 to include any time receiving any type of cash assistance in any other state or |
territory of the United States of America as defined herein. Provided further, in no circumstances |
other than provided for in section subsection (h)(3) below with respect to certain minor children, |
shall cash assistance be provided pursuant to this chapter to a family or assistance unit which |
includes an adult member who has received cash assistance for a total of a lifetime limit of forty- |
eight (48) months. |
(2) Cash benefits received by a minor dependent child shall not be counted toward their |
lifetime time limit for receiving benefits under this chapter should that minor child apply for cash |
benefits as an adult. |
(3) Certain minor children not subject to time limit. This section regarding the lifetime time |
limit for the receipt of cash assistance, shall not apply only in the instances of a minor child(ren) |
living with a parent who receives SSI benefits and a minor child(ren) living with a responsible adult |
non-parent caretaker relative who is not in the case assistance payment. |
(4) Receipt of family cash assistance in any other state or territory of the United States of |
America shall be determined by the department of human services and shall include family cash |
assistance funded in whole or in part by Temporary Assistance for Needy Families (TANF) funds |
[Title IV-A of the Federal Social Security Act 42 U.S.C. § 601 et seq.] and/or family cash assistance |
provided under a program similar to the Rhode Island Families Work and Opportunity Program |
families work and opportunity program or the federal TANF program. |
(5)(A)(i) The department of human service services shall mail a notice to each assistance |
unit when the assistance unit has six (6) months of cash assistance remaining and each month |
thereafter until the time limit has expired. The notice must be developed by the department of |
human services and must contain information about the lifetime time limit., the number of months |
the participant has remaining, the hardship extension policy, the availability of a post-employment- |
and-closure bonus, and any other information pertinent to a family or an assistance unit nearing |
either the twenty-four (24) month or nearing the forty-eight-(48) month (48) lifetime time limit. |
(B)(ii) For applicants who have less than six (6) months remaining in either the twenty- |
four (24) month or the forty-eight-(48) month (48) lifetime time limit because the family or |
assistance unit previously received cash assistance in Rhode Island or in another state, the |
department shall notify the applicant of the number of months remaining when the application is |
approved and begin the process required in paragraph (A) above subsection (h)(5)(i). |
(6) If a cash assistance recipient family closed pursuant to Rhode Island's Temporary |
Assistance for Needy Families Program, (federal TANF described in Title IV A of the Federal |
Social Security Act, 42 U.S.C. § 601 et seq.), formerly entitled the Rhode Island Family |
Independence Program family independence program, more specifically under subdivision § 40- |
5.1-9(2)(c), due to sanction because of failure to comply with the cash assistance program |
requirements; and that recipients recipient family received forty-eight (48) months of cash benefits |
in accordance with the Family Independence Program family independence program, than then |
that recipient family is not able to receive further cash assistance for his/her family, under this |
chapter, except under hardship exceptions. |
(7) The months of state or federally funded cash assistance received by a recipient family |
since May 1, 1997, under Rhode Island's Temporary Assistance for Needy Families Program, |
(federal TANF described in Title IV A of the Federal Social Security Act, 42 U.S.C. § 601 et seq.), |
formerly entitled the Rhode Island Family Independence Program family independence program, |
shall be countable toward the time limited cash assistance described in this chapter. |
(i) Time limit on the receipt of cash assistance. |
(1)(A) No cash assistance shall be provided, pursuant to this chapter, to a family assistance |
unit in which an adult member has received cash assistance for a total of sixty (60) months (whether |
or not consecutive) to include any time receiving any type of cash assistance in any other state or |
territory of the United States as defined herein effective August 1, 2008. Provided further, that no |
cash assistance shall be provided to a family in which an adult member has received assistance for |
twenty-four (24) consecutive months unless the adult member has a rehabilitation employment plan |
as provided in subsection § 40-5.2-12(g)(5). |
(B)(2) Effective August 1, 2008, no cash assistance shall be provided pursuant to this |
chapter to a family in which a child has received cash assistance for a total of sixty (60) months |
(whether or not consecutive) if the parent is ineligible for assistance under this chapter pursuant to |
subdivision 40-5.2(a) (2) to include any time received any type of cash assistance in any other state |
or territory of the United States as defined herein. |
(j) Hardship Exceptions exceptions. |
(1) The department may extend an assistance unit's or family's cash assistance beyond the |
time limit, by reason of hardship; provided, however, that the number of such families to be |
exempted by the department with respect to their time limit under this subsection shall not exceed |
twenty percent (20%) of the average monthly number of families to which assistance is provided |
for under this chapter in a fiscal year; provided, however, that to the extent now or hereafter |
permitted by federal law, any waiver granted under § 40-5.2-35, for domestic violence, shall not be |
counted in determining the twenty percent (20%) maximum under this section. |
(2) Parents who receive extensions to the time limit due to hardship must have and comply |
with employment plans designed to remove or ameliorate the conditions that warranted the |
extension. |
(k) Parents under eighteen (18) years of age. |
(1) A family consisting of a parent who is under the age of eighteen (18), and who has |
never been married, and who has a child; or a family which consists consisting of a woman under |
the age of eighteen (18) who is at least six (6) months pregnant, shall be eligible for cash assistance |
only if such the family resides in the home of an adult parent, legal guardian, or other adult relative. |
Such The assistance shall be provided to the adult parent, legal guardian, or other adult relative on |
behalf of the individual and child unless otherwise authorized by the department. |
(2) This subsection shall not apply if the minor parent or pregnant minor has no parent, |
legal guardian, or other adult relative who is living and/or whose whereabouts are unknown; or the |
department determines that the physical or emotional health or safety of the minor parent, or his or |
her child, or the pregnant minor, would be jeopardized if he or she was required to live in the same |
residence as his or her parent, legal guardian, or other adult relative (refusal of a parent, legal |
guardian or other adult relative to allow the minor parent or his or her child, or a pregnant minor, |
to live in his or her home shall constitute a presumption that the health or safety would be so |
jeopardized); or the minor parent or pregnant minor has lived apart from his or her own parent or |
legal guardian for a period of at least one year before either the birth of any child to a minor parent |
or the onset of the pregnant minor's pregnancy; or there is good cause, under departmental |
regulations, for waiving the subsection; and the individual resides in supervised a supportive living |
arrangement to the extent available. |
(3) For purposes of this section, "supervised supportive living arrangement" means an |
arrangement which that requires minor parents to enroll and make satisfactory progress in a |
program leading to a high school diploma or a general education development certificate, and |
requires minor parents to participate in the adolescent parenting program designated by the |
department, to the extent the program is available; and provides rules and regulations which that |
ensure regular adult supervision. |
(l)(l) Assignment and Cooperation cooperation. As a condition of eligibility for cash and |
medical assistance under this chapter, each adult member, parent, or caretaker relative of the |
family/assistance unit must: |
(1) Assign to the state any rights to support for children within the family from any person |
which that the family member has at the time the assignment is executed or may have while |
receiving assistance under this chapter; |
(2) Consent to and cooperate with the state in establishing the paternity and in establishing |
and/or enforcing child support and medical support orders for all children in the family or assistance |
unit in accordance with Title title 15 of the general laws, as amended, unless the parent or caretaker |
relative is found to have good cause for refusing to comply with the requirements of this subsection. |
(3) Absent good cause, as defined by the department of human services through the rule- |
making process, for refusing to comply with the requirements of (l)(1) and (l)(2) above, cash |
assistance to the family shall be reduced by twenty-five percent (25%) until the adult member of |
the family who has refused to comply with the requirements of this subsection consents to and |
cooperates with the state in accordance with the requirements of this subsection. |
(4) As a condition of eligibility for cash and medical assistance under this chapter, each |
adult member, parent, or caretaker relative of the family/assistance unit must consent to and |
cooperate with the state in identifying and providing information to assist the state in pursuing any |
third-party who may be liable to pay for care and services under Title XIX of the Social Security |
Act, 42 U.S.C. § 1396 et seq. |
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 these 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 these 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) one million |
dollars ($1,000,000), which corresponds to the amount permitted by the federal government under |
the state plan and set forth in the administrative rule-making process by the department. 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 any children in the family receiving appropriate child care under this section in |
accordance with the applicable sections of title 15 of the state's general laws, 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 the 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 the state |
agency or agencies designated to make such the determinations in accordance with the provisions |
set forth herein. |
(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 percent (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) Families who are 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 until |
their incomes exceed two hundred twenty-five percent (225%) of the applicable federal poverty |
guidelines. To be eligible, such the 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 |
§§ 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 3. Sections 40-6-27 and 40-6-27.2 of the General Laws in Chapter 40-6 entitled |
"Public Assistance Act" are hereby amended to read as follows: |
40-6-27. Supplemental security income. |
(a)(1) The director of the department is hereby authorized to enter into agreements on |
behalf of the state with the secretary of the Department of Health and Human Services or other |
appropriate federal officials, under the supplementary Supplementary and security Security |
income Income (SSI) program established by title XVI of the Social Security Act, 42 U.S.C. § |
1381 et seq., concerning the administration and determination of eligibility for SSI benefits for |
residents of this state, except as otherwise provided in this section. The state's monthly share of |
supplementary assistance to the supplementary Supplementary Security security Income income |
program shall be as follows: |
(i) Individual living alone: $39.92 |
(ii) Individual living with others: $51.92 |
(iii) Couple living alone: $79.38 |
(iv) Couple living with others: $97.30 |
(v) Individual living in state licensed assisted living residence: $332.00 |
(vi) Individual eligible to receive Medicaid-funded long-term services and supports and |
living in a Medicaid-certified state-licensed assisted-living residence or adult supportive-care |
residence, as defined in § 23-17.24-1, participating in the program authorized under § 40-8.13-12 |
or an alternative, successor, or substitute program or delivery option designated for such purposes |
by the secretary of the executive office of health and human services: |
(a)(A) with With countable income above one hundred and twenty (120) percent of |
poverty: up to $465.00; |
(b)(B) with With countable income at or below one hundred and twenty (120) percent of |
poverty: up to the total amount established in (v) and $465: $797 |
(vii) Individual living in state-licensed supportive residential-care settings that, depending |
on the population served, meet the standards set by the department of human services in conjunction |
with the department(s) of children, youth and families, elderly affairs and/or behavioral healthcare, |
developmental disabilities and hospitals: $300.00. |
Provided, however, that the department of human services shall by regulation reduce, |
effective January 1, 2009, the state's monthly share of supplementary assistance to the |
supplementary security income Supplementary Security Income program (SSI) for each of the |
above-listed payment levels, by the same value as the annual federal cost of living adjustment to |
be published by the federal social security administration Federal Social Security Administration |
in October 2008 and becoming effective on January 1, 2009, as determined under the provisions of |
title XVI of the federal social security act Social Security Act [42 U.S.C. § 1381 et seq.]; and |
provided further, that it is the intent of the general assembly that the January 1, 2009, reduction in |
the state's monthly share shall not cause a reduction in the combined federal and state payment |
level for each category of recipients in effect in the month of December 2008; provided further, |
that the department of human services is authorized and directed to provide for payments to |
recipients in accordance with the above directives. |
(2) As of July 1, 2010, state supplement payments shall not be federally administered and |
shall be paid directly by the department of human services to the recipient. |
(3) Individuals living in institutions shall receive a twenty dollar ($20.00) per month |
personal needs allowance from the state which that shall be in addition to the personal needs |
allowance allowed by the Social Security Act, 42 U.S.C. § 301 et seq. |
(4) Individuals living in state-licensed supportive residential-care settings and assisted- |
living residences who are receiving SSI supplemental payments under this section who are |
participating in the program under § 40-8.13-12 or an alternative, successor, or substitute program |
or delivery option, or otherwise shall be allowed to retain a minimum personal needs allowance of |
fifty-five dollars ($55.00) per month from their SSI monthly benefit prior to payment of any |
monthly fees in addition to any amounts established in an administrative rule promulgated by the |
secretary of the executive office of health and human services for persons eligible to receive |
Medicaid-funded long-term services and supports in the settings identified in subsection |
subsections (a)(1)(v) and (a)(1)(vi). |
(5) Except as authorized for the program authorized under § 40-8.13-12 or an alternative, |
successor, or substitute program, or delivery option designated by the secretary to ensure that |
supportive residential care or an assisted-living residence is a safe and appropriate service setting, |
the department is authorized and directed to make a determination of the medical need and whether |
a setting provides the appropriate services for those persons who: (i) Have applied for or are |
receiving SSI, and who apply for admission to supportive residential care setting and assisted living |
residences on or after October 1, 1998; or |
(ii) Who are residing in supportive residential care settings and assisted living residences, |
and who apply for or begin to receive SSI on or after October 1, 1998. |
(6) The process for determining medical need required by subsection (a)(5) of this section |
shall be developed by the executive office of health and human services in collaboration with the |
departments of that office and shall be implemented in a manner that furthers the goals of |
establishing a statewide coordinated long-term care entry system as required pursuant to the |
Medicaid section 1115 waiver demonstration. |
(7) To assure access to high quality coordinated services, the executive office of health and |
human services is further authorized and directed to establish certification or contract standards |
that must be met by those state-licensed supportive residential-care settings, including adult |
supportive-care homes and assisted-living residences admitting or serving any persons eligible for |
state-funded supplementary assistance under this section or the program established under § 40- |
8.13-12. Such certification or contract standards shall define: |
(i) The scope and frequency of resident assessments, the development and implementation |
of individualized service plans, staffing levels and qualifications, resident monitoring, service |
coordination, safety risk management and disclosure, and any other related areas; |
(ii) The procedures for determining whether the certifications or contract standards have |
been met; and |
(iii) The criteria and process for granting a one time, short-term good cause exemption |
from the certification or contract standards to a licensed supportive residential care setting or |
assisted living residence that provides documented evidence indicating that meeting or failing to |
meet said standards poses an undue hardship on any person eligible under this section who is a |
prospective or current resident. |
(8) The certification or contract standards required by this section or § 40-8.13-12 or an |
alternative, successor, or substitute program, or delivery option designated by the secretary shall |
be developed in collaboration by the departments, under the direction of the executive office of |
health and human services, so as to ensure that they comply with applicable licensure regulations |
either in effect or in development. |
(b) The department is authorized and directed to provide additional assistance to |
individuals eligible for SSI benefits for: |
(1) Moving costs or other expenses as a result of an emergency of a catastrophic nature |
which is defined as a fire or natural disaster; and |
(2) Lost or stolen SSI benefit checks or proceeds of them; and |
(3) Assistance payments to SSI eligible individuals in need because of the application of |
federal SSI regulations regarding estranged spouses; and the department shall provide such |
assistance, in a form and amount, which the department shall by regulation determine. |
40-6-27.2. Supplementary cash assistance payment for certain supplemental security |
income recipients. |
There is hereby established a $206 monthly payment for disabled and elderly individuals |
who, on or after July 1, 2012, receive the state supplementary assistance payment for an individual |
in state-licensed assisted-living residence under § 40-6-27 and further reside in an assisted-living |
facility that is not eligible to receive funding under Title XIX of the Social Security Act, 42 U.S.C. |
§ 1381 et seq. or reside in any assisted-living facility financed by the Rhode Island housing and |
mortgage finance corporation prior to January 1, 2006, and receive a payment under § 40-6-27. |
Such a monthly payment shall not be made on behalf of persons participating in the program |
authorized under § 40-8.13-12 or an alternative, successor, or substitute program, or delivery option |
designated for such purposes by the secretary of the executive office of health and human services. |
SECTION 4. Section 40-6.2-1.1 of the General Laws in Chapter 40-6.2 entitled "Child |
Care - State Subsidies" is hereby amended to read as follows: |
40-6.2-1.1. Rates established. |
(a) Through June 30, 2015, subject to the payment limitations in subsection (c), the |
maximum reimbursement rates to be paid by the departments of human services and children, youth |
and families for licensed childcare centers and licensed family-childcare providers shall be based |
on the following schedule of the 75th percentile of the 2002 weekly market rates adjusted for the |
average of the 75th percentile of the 2002 and the 2004 weekly market rates: |
LICENSED CHILDCARE CENTERS 75th PERCENTILE OF WEEKLY |
MARKET RATE |
INFANT $182.00 |
PRESCHOOL $150.00 |
SCHOOL-AGE $135.00 |
LICENSED FAMILY CHILDCARE 75th PERCENTILE OF WEEKLY |
PROVIDERS MARKET RATE |
INFANT $150.00 |
PRESCHOOL $150.00 |
SCHOOL-AGE $135.00 |
Effective July 1, 2015, subject to the payment limitations in subsection (c), the maximum |
reimbursement rates to be paid by the departments of human services and children, youth and |
families for licensed childcare centers and licensed family-childcare providers shall be based on |
the above schedule of the 75th percentile of the 2002 weekly market rates adjusted for the average |
of the 75th percentile of the 2002 and the 2004 weekly market rates. These rates shall be increased |
by ten dollars ($10.00) per week for infant/toddler care provided by licensed family-childcare |
providers and license-exempt providers and then the rates for all providers for all age groups shall |
be increased by three percent (3%). For the fiscal year ending June 30, 2018, licensed childcare |
centers shall be reimbursed a maximum weekly rate of one hundred ninety-three dollars and sixty- |
four cents ($193.64) for infant/toddler care and one hundred sixty-one dollars and seventy-one |
cents ($161.71) for preschool-age children. |
(b) Effective July l, 2018, subject to the payment limitations in subsection (c), the |
maximum infant/toddler and preschool-age reimbursement rates to be paid by the departments of |
human services and children, youth and families for licensed childcare centers shall be |
implemented in a tiered manner, reflective of the quality rating the provider has achieved within |
the state's quality rating system outlined in § 42-12-23.1. |
(1) For infant/toddler childcare, tier one shall be reimbursed two and one-half percent |
(2.5%) above the FY 2018 weekly amount, tier two shall be reimbursed five percent (5%) above |
the FY 2018 weekly amount, tier three shall be reimbursed thirteen percent (13%) above the FY |
2018 weekly amount, tier four shall be reimbursed twenty percent (20%) above the FY 2018 weekly |
amount, and tier five shall be reimbursed thirty-three percent (33%) above the FY 2018 weekly |
amount. |
(2) For preschool reimbursement rates, tier one shall be reimbursed two and one-half |
(2.5%) percent above the FY 2018 weekly amount, tier two shall be reimbursed five percent (5%) |
above the FY 2018 weekly amount, tier three shall be reimbursed ten percent (10%) above the FY |
2018 weekly amount, tier four shall be reimbursed thirteen percent (13%) above the FY 2018 |
weekly amount, and tier five shall be reimbursed twenty-one percent (21%) above the FY 2018 |
weekly amount. |
(c) The departments shall pay childcare providers based on the lesser of the applicable rate |
specified in subsection (a), or the lowest rate actually charged by the provider to any of its public |
or private childcare customers with respect to each of the rate categories, infant, preschool and |
school-age. |
(d)(c) (d) By June 30, 2004, and biennially through June 30, 2014, the department of labor |
and training shall conduct an independent survey or certify an independent survey of the then |
current weekly market rates for childcare in Rhode Island and shall forward such weekly market |
rate survey to the department of human services. The next survey shall be conducted by June 30, |
2016, and triennially thereafter. The departments of human services and labor and training will |
jointly determine the survey criteria including, but not limited to, rate categories and sub-categories. |
(e)(d) (e) In order to expand the accessibility and availability of quality childcare, the |
department of human services is authorized to establish by regulation alternative or incentive rates |
of reimbursement for quality enhancements, innovative or specialized childcare and alternative |
methodologies of childcare delivery, including non-traditional delivery systems and collaborations. |
(f)(e) (f) Effective January 1, 2007, all childcare providers have the option to be paid every |
two (2) weeks and have the option of automatic direct deposit and/or electronic funds transfer of |
reimbursement payments. |
(f) (g) Effective July 1, 2019, the maximum infant/toddler reimbursement rates to be paid |
by the departments of human services and children, youth and families for licensed family childcare |
providers shall be implemented in a tiered manner, reflective of the quality rating the provider has |
achieved within the state's quality rating system outlined in § 42-12-23.1. Tier one shall be |
reimbursed two percent (2%) above the prevailing base rate for step 1 and step 2 providers, three |
percent (3%) above prevailing base rate for step 3 providers, and four percent (4%) above the |
prevailing base rate for step 4 providers; tier two shall be reimbursed five percent (5%) above the |
prevailing base rate; tier three shall be reimbursed eleven percent (11%) above the prevailing base |
rate; tier four shall be reimbursed fourteen percent (14%) above the prevailing base rate; and tier |
five shall be reimbursed twenty-three percent (23%) above the prevailing base rate. |
SECTION 5. 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 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 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 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-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. Beginning July 1, 2019, the DRG |
base rate for Medicaid fee-for-service inpatient hospital services shall be 107.2% of the payment |
rates in effect as of July 1, 2018. Increases in the Medicaid fee-for-service DRG hospital payments |
for the twelve-month (12) period beginning July 1, 2020, shall be based on the payment rates in |
effect as of July 1 of the preceding fiscal year, and shall be the Centers for Medicare and Medicaid |
Services national Prospective Payment System (IPPS) Hospital Input Price Index. |
(ii) With respect to inpatient services, (A) 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. Increases in inpatient hospital payments for each annual twelve-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) |
Provided, however, for the twenty-four-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-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) Increases in inpatient hospital payments for each annual twelve-month (12) period |
beginning July 1, 2017, shall be the Centers for Medicare and Medicaid Services national CMS |
Prospective Payment System (IPPS) Hospital Input Price Index, less Productivity Adjustment, for |
the applicable period and shall be paid to each hospital retroactively to July 1; (D) Beginning July |
1, 2019, the Medicaid managed-care payment inpatient rates between each hospital and health plan |
shall be 107.2% of the payment rates in effect as of January 1, 2019, and shall be paid to each |
hospital retroactively to July 1; (E) Increases in inpatient hospital payments for each annual twelve- |
month (12) period beginning July 1, 2020, shall be based on the payment rates in effect as of |
January 1 of the preceding fiscal year, and shall be the Centers for Medicare and Medicaid Services |
national CMS Prospective Payment System (IPPS) Hospital Input Price Index, less Productivity |
Adjustment, for the applicable period and shall be paid to each hospital retroactively to July 1.; The |
executive office 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)(F) |
All hospitals licensed in Rhode Island shall accept such payment rates as payment in full; and |
(F)(G) 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 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-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. |
Increases in the outpatient hospital payments for the twelve-month (12) period beginning July 1, |
2016, may not exceed the CMS national Outpatient Prospective Payment System (OPPS) Hospital |
Input Price Index. Beginning July 1, 2019, the Medicaid fee-for-service outpatient rates shall be |
107.2% of the payment rates in effect as of July 1, 2018. Increases in the outpatient hospital |
payments for the twelve-month (12) period beginning July 1, 2020, shall be based on the payment |
rates in effect as of July 1 of the preceding fiscal year, and shall be the CMS national Outpatient |
Prospective Payment System (OPPS) Hospital Input Price Index. 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; (ii) Increases in hospital outpatient payments for |
each annual twelve-month (12) period beginning January 1, 2012 until July 1, 2017, may not exceed |
the Centers for Medicare and Medicaid Services national CMS Outpatient Prospective Payment |
System OPPS hospital price index for the applicable period; (iii) Provided, however, for the twenty- |
four-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-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; (iv) |
Increases in outpatient hospital payments for each annual twelve-month (12) period beginning July |
1, 2017, shall be the Centers for Medicare and Medicaid Services national CMS OPPS Hospital |
Input Price Index, less Productivity Adjustment, for the applicable period and shall be paid to each |
hospital retroactively to July 1.; (v) Beginning July 1, 2019, the Medicaid managed care outpatient |
payment rates between each hospital and health plan shall be one hundred seven and two-tenths |
percent (107.2%) of the payment rates in effect as of January 1, 2019 and shall be paid to each |
hospital retroactively to July 1; (vi) Increases in outpatient hospital payments for each annual |
twelve-month (12) period beginning July 1, 2020, shall be based on the payment rates in effect as |
of January 1 of the preceding fiscal year, and shall be the Centers for Medicare and Medicaid |
Services national CMS OPPS Hospital Input Price Index, less Productivity Adjustment, for |
the applicable period and shall be paid to each hospital retroactively to July 1. |
(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 (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 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 new |
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 new rates. The rate-setting methodology for inpatient-hospital payments and |
outpatient-hospital payments set forth in subdivisions (b)(1)(ii)(C) and (b)(2), respectively, shall |
thereafter apply to increases for each annual twelve-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 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 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 DRG-payment methodology. Furthermore, amendment of the Rhode |
Island state plan for 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 the 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 new |
payment methodology set forth in 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 Title XIX of the Social Security Act for services rendered to |
Medicaid-eligible residents, shall be reasonable and adequate to meet the costs 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 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, 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 1 of each year, beginning October 1, 2012. This adjustment will not |
occur on October 1, 2013, October 1, 2014 or October 1, 2015, but will occur on April 1, 2015. |
The adjustment of rates will also not occur on October 1, 2017, or October 1, 2018, and October 1, |
2019. Effective July 1, 2018, rates paid to nursing facilities from the rates approved by the Centers |
for Medicare and Medicaid Services and in effect on October 1, 2017, both fee-for-service and |
managed care, will be increased by one and one-half percent (1.5%) and further increased by one |
percent (1%) on October 1, 2018, and further increased by one percent (1%) on October 1, 2019. |
Said The inflation index shall be applied without regard for the transition factors in subsections |
(b)(1) and (b)(2). For purposes of October 1, 2016, adjustment only, any rate increase that results |
from application of the inflation index to subsections (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 subsections (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 subsection (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; 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; 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. An adjustment to the per diem loss or gain may be phased out by twenty- |
five percent (25%) each year; except, however, for the years 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-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. Consistent with the |
other provisions of this chapter, nothing in this provision shall require the executive office to restore |
the rates to those in effect on April 1, 2015, at the end of this twelve-month (12) period. |
SECTION 6. Sections 40-8.3-2, 40-8.3-3 and 40-8.3-10 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, 2017 2018, the period from October 1, 2015 2016, |
through September 30, 2016 2017, and for any fiscal year ending after September 30, 2018 2019, |
the period from October 1, 2016, through September 30, 2017. |
(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) Was 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 (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 §§ 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-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) Achieved a medical assistance inpatient utilization rate of at least one percent (1%) |
during the base year; and |
(iii) Continues 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) The 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) The 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, September 30, 2015, September 30, 2016, September 30, 2017, and September 30, 2018, |
September 30, 2019, and September 30, 2020, shall be deemed to be five and thirty hundredths |
percent (5.30%). |
40-8.3-3. Implementation. |
(a) 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. |
(b)(a) For federal fiscal year 2018, commencing on October 1, 2017, and ending September |
30, 2018, 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 |
$138.6 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 10, 2018, and are expressly conditioned upon approval |
on or before July 5, 2018, 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 2018 for the |
disproportionate share payments. |
(c)(b) For federal fiscal year 2019, commencing on October 1, 2018, and ending September |
30, 2019, 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 $142.4 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 10, 2019, and are expressly conditioned upon approval |
on or before July 5, 2019, 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 2018 2019 for the |
disproportionate share payments. |
(c) For federal fiscal year 2020, commencing on October 1, 2019, and ending September |
30, 2020, 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 |
$142.4 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 13, 2020, and are expressly conditioned upon approval |
on or before July 6, 2020, 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 2020 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. |
40-8.3-10. Hospital adjustment payments. |
Effective July 1, 2012, and for each subsequent year, the executive office of health and |
human services is hereby authorized and directed to amend its regulations for reimbursement to |
hospitals for inpatient and outpatient services as follows: |
(a) Each hospital in the state of Rhode Island, as defined in subdivision § 23-17-38.1(c)(1), |
shall receive a quarterly outpatient adjustment payment each state fiscal year of an amount |
determined as follows: |
(1) Determine the percent of the state's total Medicaid outpatient and emergency |
department services (exclusive of physician services) provided by each hospital during each |
hospital's prior fiscal year; |
(2) Determine the sum of all Medicaid payments to hospitals made for outpatient and |
emergency department services (exclusive of physician services) provided during each hospital's |
prior fiscal year; |
(3) Multiply the sum of all Medicaid payments as determined in subdivision subsection |
(a)(2) by a percentage defined as the total identified upper payment limit for all hospitals divided |
by the sum of all Medicaid payments as determined in subdivision subsection (a)(2); and then |
multiply that result by each hospital's percentage of the state's total Medicaid outpatient and |
emergency department services as determined in subdivision subsection (a)(1) to obtain the total |
outpatient adjustment for each hospital to be paid each year; |
(4) Pay each hospital on or before July 20, October 20, January 20, and April 20 one quarter |
(1/4) of its total outpatient adjustment as determined in subdivision subsection (a)(3) above. |
(b) Each hospital in the state of Rhode Island, as defined in subdivision 3-17-38.19(b)(1), |
shall receive a quarterly inpatient adjustment payment each state fiscal year of an amount |
determined as follows: |
(1) Determine the percent of the state's total Medicaid inpatient services (exclusive of |
physician services) provided by each hospital during each hospital's prior fiscal year; |
(2) Determine the sum of all Medicaid payments to hospitals made for inpatient services |
(exclusive of physician services) provided during each hospital's prior fiscal year; |
(3) Multiply the sum of all Medicaid payments as determined in subdivision (2) by a |
percentage defined as the total identified upper payment limit for all hospitals divided by the sum |
of all Medicaid payments as determined in subdivision (2); and then multiply that result by each |
hospital's percentage of the state's total Medicaid inpatient services as determined in subdivision |
(1) to obtain the total inpatient adjustment for each hospital to be paid each year; |
(4) Pay each hospital on or before July 20, October 20, January 20, and April 20 one quarter |
(1/4) of its total inpatient adjustment as determined in subdivision (3) above. |
(c)(b) (c) The amounts determined in subsections subsection (a) and (b) are in addition to |
Medicaid inpatient and outpatient payments and emergency services payments (exclusive of |
physician services) paid to hospitals in accordance with current state regulation and the Rhode |
Island Plan for Medicaid Assistance pursuant to Title XIX of the Social Security Act and are not |
subject to recoupment or settlement. |
SECTION 7. 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 health insurance |
premium assistance program. Under the terms of Section 1906 of Title XIX of the U.S. Social |
Security Act, 42 U.S.C. § 1396e, states are permitted to pay a Medicaid-eligible person's share of |
the costs for enrolling in employer-sponsored health insurance (ESI) coverage if it is cost effective |
to do so. Pursuant to the general assembly's direction in the Rhode Island Health Reform Act health |
reform act of 2000, the Medicaid agency requested and obtained federal approval under § 1916, |
42 U.S.C. § 1396o, to establish the RIte Share premium assistance program to subsidize the costs |
of enrolling Medicaid-eligible persons and families in employer-sponsored health insurance plans |
that have been approved as meeting certain cost and coverage requirements. The Medicaid agency |
also obtained, at the general assembly's direction, federal authority to require any such persons with |
access to ESI coverage to enroll as a condition of retaining eligibility providing that doing so meets |
the criteria established in Title XIX for obtaining federal matching funds. |
(b) Definitions. For the purposes of this section, the following definitions apply: |
(1) "Cost-effective" means that the portion of the ESI that the state would subsidize, as |
well as wrap-around costs, would on average cost less to the state than enrolling that same |
person/family in a managed-care delivery system. |
(2) "Cost sharing" means any co-payments, deductibles, or co-insurance associated with |
ESI. |
(3) "Employee premium" means the monthly premium share a person or family is required |
to pay to the employer to obtain and maintain ESI coverage. |
(4) "Employer-sponsored insurance or ESI" means health insurance or a group health plan |
offered to employees by an employer. This includes plans purchased by small employers through |
the state health insurance marketplace, healthsource, RI (HSRI). |
(5) "Policy holder" means the person in the household with access to ESI, typically the |
employee. |
(6) "RIte Share-approved employer-sponsored insurance (ESI)" means an employer- |
sponsored health insurance plan that meets the coverage and cost-effectiveness criteria for RIte |
Share. |
(7) "RIte Share buy-in" means the monthly amount an Medicaid-ineligible policy holder |
must pay toward RIte Share-approved ESI that covers the Medicaid-eligible children, young adults, |
or spouses with access to the ESI. The buy-in only applies in instances when household income is |
above one hundred fifty percent (150%) of the FPL. |
(8) "RIte Share premium assistance program" means the Rhode Island Medicaid premium |
assistance program in which the State pays the eligible Medicaid member's share of the cost of |
enrolling in a RIte Share-approved ESI plan. This allows the state to share the cost of the health |
insurance coverage with the employer. |
(9) "RIte Share Unit" means the entity within the executive office of health and human |
services (EOHHS) responsible for assessing the cost-effectiveness of ESI, contacting employers |
about ESI as appropriate, initiating the RIte Share enrollment and disenrollment process, handling |
member communications, and managing the overall operations of the RIte Share program. |
(10) "Third-Party Liability (TPL)" means other health insurance coverage. This insurance |
is in addition to Medicaid and is usually provided through an employer. Since Medicaid is always |
the payer of last resort, the TPL is always the primary coverage. |
(11) "Wrap-around services or coverage" means any health care services not included in |
the ESI plan that would have been covered had the Medicaid member been enrolled in a RIte Care |
or Rhody Health Partners plan. Coverage of deductibles and co-insurance is included in the wrap. |
Co-payments to providers are not covered as part of the wrap-around coverage. |
(c) RIte Share populations. Medicaid beneficiaries subject to RIte Share include: children, |
families, parent and caretakers eligible for Medicaid or the Children's Health Insurance Program |
children's health insurance program (CHIP) under this chapter or chapter 12.3 of title 42; and |
adults between the ages of nineteen (19) and sixty-four (64) who are eligible under chapter 8.12 of |
this title 40, not receiving or eligible to receive Medicare, and are enrolled in managed care delivery |
systems. The following conditions apply: |
(1) The income of Medicaid beneficiaries shall affect whether and in what manner they |
must participate in RIte Share as follows: |
(i) Income at or below one hundred fifty percent (150%) of FPL -- Persons and families |
determined to have household income at or below one hundred fifty percent (150%) of the Federal |
Poverty Level (FPL) guidelines based on the modified adjusted gross income (MAGI) standard or |
other standard approved by the secretary are required to participate in RIte Share if a Medicaid- |
eligible adult or parent/caretaker has access to cost-effective ESI. Enrolling in ESI through RIte |
Share shall be a condition of maintaining Medicaid health coverage for any eligible adult with |
access to such coverage. |
(ii) Income above one hundred fifty percent (150%) of FPL and policy holder is not |
Medicaid-eligible -- Premium assistance is available when the household includes Medicaid- |
eligible members, but the ESI policy holder (typically a parent/caretaker, or spouse) is not eligible |
for Medicaid. Premium assistance for parents/caretakers and other household members who are not |
Medicaid-eligible may be provided in circumstances when enrollment of the Medicaid-eligible |
family members in the approved ESI plan is contingent upon enrollment of the ineligible policy |
holder and the executive office of health and human services (executive office) determines, based |
on a methodology adopted for such purposes, that it is cost-effective to provide premium assistance |
for family or spousal coverage. |
(d) RIte Share enrollment as a condition of eligibility. For Medicaid beneficiaries over the |
age of nineteen (19) enrollment in RIte Share shall be a condition of eligibility except as exempted |
below and by regulations promulgated by the executive office. |
(1) Medicaid-eligible children and young adults up to age nineteen (19) shall not be |
required to enroll in a parent/caretaker relative's ESI as a condition of maintaining Medicaid |
eligibility if the person with access to RIte Share-approved ESI does not enroll as required. These |
Medicaid-eligible children and young adults shall remain eligible for Medicaid and shall be |
enrolled in a RIte Care plan. |
(2) There shall be a limited six-month (6) exemption from the mandatory enrollment |
requirement for persons participating in the RI Works works program pursuant to chapter 5.2 of |
this title 40. |
(e) Approval of health insurance plans for premium assistance. The executive 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 executive office 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 Medicaid-eligible persons enrolled in a Medicaid managed-care plan, when the plan is |
evaluated in conjunction with available supplemental benefits provided by the office. The office |
shall obtain and make available to persons otherwise eligible for Medicaid identified in this section |
as supplemental benefits those benefits not reasonably available under employer-based health |
insurance plans that are required for Medicaid beneficiaries by state law or federal law or |
regulation. Once it has been determined by the Medicaid agency that the ESI offered by a particular |
employer is RIte Share-approved, all Medicaid members with access to that employer's plan are |
required to participate in RIte Share. Failure to meet the mandatory enrollment requirement shall |
result in the termination of the Medicaid eligibility of the policy holder and other Medicaid |
members nineteen (19) or older in the household who could be covered under the ESI until the |
policy holder complies with the RIte Share enrollment procedures established by the executive |
office. |
(f) Premium Assistance. The executive office shall provide premium assistance by paying |
all or a portion of the employee's cost for covering the eligible person and/or his or her family under |
such a RIte Share-approved ESI plan subject to the buy-in provisions in this section. |
(g) Buy-in. Persons who can afford it shall share in the cost. -- The executive office is |
authorized and directed to apply for and obtain any necessary state plan and/or waiver amendments |
from the secretary of the U.S. U.S. Department of Health and Human Services (DHHS) to |
require that persons enrolled in a RIte Share-approved employer-based health plan who have |
income equal to or greater than one hundred fifty percent (150%) of the FPL to buy-in to pay a |
share of the costs based on the ability to pay, provided that the buy-in cost shall not exceed five |
percent (5%) of the person's annual income. The executive office shall implement the buy-in by |
regulation, and shall consider co-payments, premium shares, or other reasonable means to do so. |
(h) Maximization of federal contribution. The executive 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. § 1397 et seq. |
(i) Implementation by regulation. The executive 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. |
(j) Outreach and Reporting reporting. The executive office of health and human services |
shall develop a plan to identify Medicaid eligible individuals who have access to employer |
sponsored insurance and increase the use of RIte Share benefits. Beginning October 1, 2019, the |
executive office shall submit the plan to be included as part of the reporting requirements under § |
35-17-1. Starting January 1, 2020, the executive office of health and human services shall include |
the number of Medicaid recipients with access to employer sponsored insurance, the number of |
plans that did not meet the cost effectiveness criteria for RIte Share, and enrollment in the premium |
assistance program as part of the reporting requirements under § 35-17-1. |
SECTION 8. Section 40-8.9-9 of the General Laws in Chapter 40-8.9 entitled "Medical |
Assistance - Long-Term Care Service and Finance Reform" is hereby amended to read as follows: |
40-8.9-9. Long-term-care rebalancing 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 Department |
of Health and Human Services, and to promulgate rules necessary to adopt an affirmative plan of |
program design and implementation that addresses the goal of allocating a minimum of fifty percent |
(50%) of Medicaid long-term-care funding 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 rebalancing 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, 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)(i) The 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)(ii) The 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) Performed 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) The 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 42 U.S.C. § 1396n 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 42 |
U.S.C. § 1396n 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 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 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) As the state's Medicaid program seeks to assist more beneficiaries requiring long-term |
services and supports in home- and community-based settings, the demand for home care workers |
has increased, and wages for these workers has not kept pace with neighboring states, leading to |
high turnover and vacancy rates in the state's home-care industry, the executive office shall institute |
a one-time increase in the base-payment rates for home-care service providers to promote increased |
access to and an adequate supply of highly trained home health care professionals, in amount to be |
determined by the appropriations process, for the purpose of raising wages for personal care |
attendants and home health aides to be implemented by such providers. |
(4) A prospective base adjustment, effective not later than July 1, 2018, of ten percent |
(10%) of the current base rate for home care providers, home nursing care providers, and hospice |
providers contracted with the executive office of health and human services and its subordinate |
agencies to deliver Medicaid fee-for-service personal care attendant services. |
(5) A prospective base adjustment, effective not later than July l, 2018, of twenty percent |
(20%) of the current base rate for home care providers, home nursing care providers, and hospice |
providers contracted with the executive office of health and human services and its subordinate |
agencies to deliver Medicaid fee-for-service skilled nursing and therapeutic services and hospice |
care. |
(6) Effective upon passage of this section, hospice provider reimbursement, exclusively for |
room and board expenses for individuals residing in a skilled nursing facility, shall revert to the |
rate methodology in effect on June 30, 2018, and these room and board expenses shall be exempted |
from any and all annual rate increases to hospice providers as provided for in this section. |
(6) (7) On the first of July in each year, beginning on July l, 2019, the executive office of |
health and human services will initiate an annual inflation increase to the base rate for home care |
providers, home nursing care providers, and hospice providers contracted with the executive office |
and its subordinate agencies to deliver Medicaid fee-for-service personal care attendant services, |
skilled nursing and therapeutic services and hospice care. The base rate increase shall be by a |
percentage amount equal to the New England Consumer Price Index card as determined by the |
United States Department of Labor for medical care and for compliance with all federal and state |
laws, regulations, and rules, and all national accreditation program requirements. |
(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 § 40-8.13-12 or an |
alternative, successor, or substitute program, or delivery option designated for such these purposes |
by the secretary of the executive office of health and human services; |
(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 9. Section 40-8.13-12 of the General Laws in Chapter 40-8.13 entitled "Long- |
Term Managed Care Arrangements" is hereby amended to read as follows: |
40-8.13-12. Community-based supportive living program. |
(a) To expand the number of community-based service options, the executive office of |
health and human services shall establish a program for beneficiaries opting to participate in |
managed care long-term care arrangements under this chapter who choose to receive Medicaid- |
funded assisted living, adult supportive care home, or shared living long-term care services and |
supports. As part of the program, the executive office shall implement Medicaid certification or, as |
appropriate, managed care contract standards for state authorized providers of these services that |
establish an acuity-based, tiered service and payment system that ties reimbursements to: |
beneficiary's clinical/functional level of need; the scope of services and supports provided; and |
specific quality and outcome measures. Such standards shall set the base level of Medicaid state |
plan and waiver services that each type of provider must deliver, the range of acuity-based service |
enhancements that must be made available to beneficiaries with more intensive care needs, and the |
minimum state licensure and/or certification requirements a provider must meet to participate in |
the pilot at each service/payment level. The standards shall also establish any additional |
requirements, terms or conditions a provider must meet to ensure beneficiaries have access to high |
quality, cost effective care. |
(b) Room and board. The executive office shall raise the cap on the amount Medicaid |
certified assisted living and adult supportive home care providers are permitted to charge |
participating beneficiaries for room and board. In the first year of the program, the monthly charges |
for a beneficiary living in a single room who has income at or below three hundred percent (300%) |
of the Supplemental Security Income (SSI) level shall not exceed the total of both the maximum |
monthly federal SSI payment and the monthly state supplement authorized for persons requiring |
long-term services under § 40-6-27.2(a)(1)(vi) 40-6-27(a)(1)(vi), less the specified personal need |
allowance. For a beneficiary living in a double room, the room and board cap shall be set at eighty- |
five percent (85%) of the monthly charge allowed for a beneficiary living in a single room. |
(c) Program cost-effectiveness. The total cost to the state for providing the state supplement |
and Medicaid-funded services and supports to beneficiaries participating in the program in the |
initial year of implementation shall not exceed the cost for providing Medicaid-funded services to |
the same number of beneficiaries with similar acuity needs in an institutional setting in the initial |
year of the operations. The program shall be terminated if the executive office determines that the |
program has not met this target. The state shall expand access to the program to qualified |
beneficiaries who opt out of an a long term services and support (LTSS) arrangement, in |
accordance with § 40-8.13-2, or are required to enroll in an alternative, successor, or substitute |
program, or delivery option designated for such these purposes by the secretary of the executive |
office of health and human services if the enrollment in an LTSS plan is no longer an option. |
SECTION 10. Section 40.1-22-13 of the General Laws in Chapter 40.1-22 entitled |
"Developmental Disabilities" is hereby amended to read as follows: |
40.1-22-13. Visits. |
No public or private developmental disabilities facility shall restrict the visiting of a client |
by anyone at any time of the day or night; however, in special circumstances when the client is ill |
or incapacitated and a visit would not be in his or her best interest, visitation may be restricted |
temporarily during the illness or incapacity when documented in the client’s individualized |
program plan, as defined in § 40.1-21-4.3(7) of the general laws. |
SECTION 11. Section 40.1-26-3 of the General Laws in Chapter 40.1-26 entitled "Rights |
for Persons with Developmental Disabilities" is hereby amended to read as follows: |
40.1-26-3. Participants' rights. |
In addition to any other rights provided by state or federal laws, a participant as defined in |
this chapter shall be entitled to the following rights: |
(1) To be treated with dignity, respect for privacy and have the right to a safe and supportive |
environment; |
(2) To be free from verbal and physical abuse; |
(3)(i) To engage in any activity including employment, appropriate to his or her age, and |
interests in the most integrated community setting; |
(ii) No participant shall be required to perform labor, which that involves the essential |
operation and maintenance of the agency or the regular supervision or care of other participants. |
Participants may however, be requested to perform labor involving normal housekeeping and home |
maintenance functions if such these responsibilities are documented in the participant's |
individualized plan; |
(4) To participate in the development of his or her individualized plan and to provide |
informed consent to its implementation or to have an advocate provide informed consent if the |
participant is not competent to do so; |
(5) To have access to his or her individualized plan and other medical, social, financial, |
vocational, psychiatric, or other information included in the file maintained by the agency; |
(6) To give written informed consent prior to the imposition of any plan designed to modify |
behavior, including those which utilizes aversive techniques or impairs the participant's liberty or |
to have an advocate provide written informed consent if the participant is not competent to do so. |
Provided, however, that if the participant is competent to provide consent but cannot provide |
written consent, the agency shall accept an alternate form of consent and document in the |
participant's record how such consent was obtained; |
(7) To register a complaint regarding an alleged violation of rights through the grievance |
procedure delineated in § 40.1-26-5; |
(8) To be free from unnecessary restraint. Restraints shall not be employed as punishment, |
for the convenience of the staff, or as a substitute for an individualized plan. Restraints shall impose |
the least possible restrictions consistent with their purpose and shall be removed when the |
emergency ends. Restraints shall not cause physical injury to the participant and shall be designed |
to allow the greatest possible comfort. Restraints shall be subject to the following conditions: |
(i) Physical restraint shall be employed only in emergencies to protect the participant or |
others from imminent injury or when prescribed by a physician, when necessary, during the conduct |
of a specific medical or surgical procedure or if necessary for participant protection during the time |
that a medical condition exists; |
(ii) Chemical restraint shall only be used when prescribed by a physician in extreme |
emergencies in which physical restraint is not possible and the harmful effects of the emergency |
clearly outweigh the potential harmful effects of the chemical restraints; |
(iii) No participant shall be placed in seclusion; |
(iv) The agency shall have a written policy that defines the use of restraints, the staff |
members who may authorize their use, and a mechanism for monitoring and controlling their use; |
(v) All orders for restraint as well as the required frequency of staff observation of the |
participant shall be written; |
(9) To have reasonable, at any time, access to telephone communication; |
(10) To receive visitors of a participant's choosing at all reasonable hours any time; |
(11) To keep and be allowed to spend a reasonable amount of one's own money; |
(12) To be provided advance written notice explaining the reason(s) why the participant is |
no longer eligible for service from the agency; |
(13) To religious freedom and practice; |
(14) To communicate by sealed mail or otherwise with persons of one's choosing; |
(15) To select and wear one's own clothing and to keep and use one's own personal |
possessions; |
(16) To have reasonable, prompt access to current newspapers, magazines, and radio and |
television programming; |
(17) To have opportunities for physical exercise and outdoor recreation; |
(18)(i) To provide informed consent prior to the imposition of any invasive medical |
treatment including any surgical procedure or to have a legal guardian, or in the absence of a legal |
guardian, a relative as defined in this chapter, provide informed consent if the participant is not |
competent to do so. Information upon which a participant shall make necessary treatment and/or |
surgery decisions shall be presented to the participant in a manner consistent with his or her learning |
style and shall include, but not be limited to: |
(A) The nature and consequences of the procedure(s); |
(B) The risks, benefits and purpose of the procedure(s); and |
(C) Alternate procedures available; |
(ii) The informed consent of a participant or his or her legal guardian or, in the absence of |
a legal guardian, a relative as defined in this chapter, may be withdrawn at any time, with or without |
cause, prior to treatment. The absence of informed consent notwithstanding, a licensed and |
qualified physician may render emergency medical care or treatment to any participant who has |
been injured or who is suffering from an acute illness, disease, or condition if, within a reasonable |
degree of medical certainty, delay in initiation of emergency medical care or treatment would |
endanger the health of the participant; |
(19) Each participant shall have a central record. The record shall include data pertaining |
to admissions and such other information as may be required under regulations by the department; |
(20) Admissions -- As part of the procedure for the admission of a participant to an agency, |
each participant or applicant, or advocate if the participant or applicant is not competent, shall be |
fully informed, orally and in writing, of all rules, regulations, and policies governing participant |
conduct and responsibilities, including grounds for dismissal, procedures for discharge, and all |
anticipated financial charges, including all costs not covered under federal and/or state programs, |
by other third-party payors or by the agency's basic per diem rate. The written notice shall include |
information regarding the participant's or applicant's right to appeal the admission or dismissal |
decisions of the agency; |
(21) Upon termination of services to or death of a participant, a final accounting shall be |
made of all personal effects and/or money belonging to the participant held by the agency. All |
personal effects and/or money including interest shall be promptly released to the participant or his |
or her heirs; |
(22) Nothing in this chapter shall preclude intervention in the form of appropriate and |
reasonable restraint should it be necessary to protect individuals from physical injury to themselves |
or others. |
SECTION 12. Section 42-7.2-5 of the General Laws in Chapter 42-7.2 entitled "Office of |
Health and Human Services" is hereby amended to read as follows: |
42-7.2-5. Duties of the secretary. |
The secretary shall be subject to the direction and supervision of the governor for the |
oversight, coordination, and cohesive direction of state-administered health and human services |
and in ensuring the laws are faithfully executed, not withstanding any law to the contrary. In this |
capacity, the Secretary secretary of Health and Human Services the executive office of health |
and human services (EOHHS) shall be authorized to: |
(1) Coordinate the administration and financing of health-care healthcare benefits, human |
services, and programs including those authorized by the state's Medicaid section 1115 |
demonstration waiver and, as applicable, the Medicaid State Plan under Title XIX of the U.S. Social |
Security Act. However, nothing in this section shall be construed as transferring to the secretary |
the powers, duties, or functions conferred upon the departments by Rhode Island public and general |
laws for the administration of federal/state programs financed in whole or in part with Medicaid |
funds or the administrative responsibility for the preparation and submission of any state plans, |
state plan amendments, or authorized federal waiver applications, once approved by the secretary. |
(2) Serve as the governor's chief advisor and liaison to federal policymakers on Medicaid |
reform issues as well as the principal point of contact in the state on any such related matters. |
(3)(a)(i) Review and ensure the coordination of the state's Medicaid section 1115 |
demonstration waiver requests and renewals as well as any initiatives and proposals requiring |
amendments to the Medicaid state plan or category two (II) or three (III) changes formal |
amendment changes, as described in the special terms and conditions of the state's Medicaid section |
1115 demonstration waiver with the potential to affect the scope, amount or duration of publicly- |
funded health-care healthcare services, provider payments or reimbursements, or access to or the |
availability of benefits and services as provided by Rhode Island general and public laws. The |
secretary shall consider whether any such changes are legally and fiscally sound and consistent |
with the state's policy and budget priorities. The secretary shall also assess whether a proposed |
change is capable of obtaining the necessary approvals from federal officials and achieving the |
expected positive consumer outcomes. Department directors shall, within the timelines specified, |
provide any information and resources the secretary deems necessary in order to perform the |
reviews authorized in this section;. |
(b)(ii) Direct the development and implementation of any Medicaid policies, procedures, |
or systems that may be required to assure successful operation of the state's health and human |
services integrated eligibility system and coordination with HealthSource RI, the state's health |
insurance marketplace. |
(c)(iii) Beginning in 2015, conduct on a biennial basis a comprehensive review of the |
Medicaid eligibility criteria for one or more of the populations covered under the state plan or a |
waiver to ensure consistency with federal and state laws and policies, coordinate and align systems, |
and identify areas for improving quality assurance, fair and equitable access to services, and |
opportunities for additional financial participation. |
(d)(iv) Implement service organization and delivery reforms that facilitate service |
integration, increase value, and improve quality and health outcomes. |
(4) Beginning in 2006 2020, prepare and submit to the governor, the chairpersons of the |
house and senate finance committees, the caseload estimating conference, and to the joint |
legislative committee for health-care oversight, by no later than March 15 of each year, a |
comprehensive overview of all Medicaid expenditures outcomes, administrative costs, and |
utilization rates. The overview shall include, but not be limited to, the following information: |
(i) Expenditures under Titles XIX and XXI of the Social Security Act, as amended; |
(ii) Expenditures, outcomes and utilization rates by population and sub-population served |
(e.g. families with children, persons with disabilities, children in foster care, children receiving |
adoption assistance, adults ages nineteen (19) to sixty-four (64), and elders); |
(iii) Expenditures, outcomes and utilization rates by each state department or other |
municipal or public entity receiving federal reimbursement under Titles XIX and XXI of the Social |
Security Act, as amended; and |
(iv) Expenditures, outcomes and utilization rates by type of service and/or service provider; |
and |
(v) Expenditures by mandatory population receiving mandatory services and, reported |
separately, optional services, as well as optional populations receiving mandatory services and, |
reported separately, optional services for each state agency receiving Title XIX and XXI funds . |
The directors of the departments, as well as local governments and school departments, |
shall assist and cooperate with the secretary in fulfilling this responsibility by providing whatever |
resources, information and support shall be necessary. |
(5) Resolve administrative, jurisdictional, operational, program, or policy conflicts among |
departments and their executive staffs and make necessary recommendations to the governor. |
(6) Assure Ensure continued progress toward improving the quality, the economy, the |
accountability and the efficiency of state-administered health and human services. In this capacity, |
the secretary shall: |
(i) Direct implementation of reforms in the human resources practices of the executive |
office and the departments that streamline and upgrade services, achieve greater economies of scale |
and establish the coordinated system of the staff education, cross-training, and career development |
services necessary to recruit and retain a highly-skilled, responsive, and engaged health and human |
services workforce; |
(ii) Encourage EOHHS-wide consumer-centered approaches to service design and delivery |
that expand their capacity to respond efficiently and responsibly to the diverse and changing needs |
of the people and communities they serve; |
(iii) Develop all opportunities to maximize resources by leveraging the state's purchasing |
power, centralizing fiscal service functions related to budget, finance, and procurement, |
centralizing communication, policy analysis and planning, and information systems and data |
management, pursuing alternative funding sources through grants, awards and partnerships and |
securing all available federal financial participation for programs and services provided EOHHS- |
wide; |
(iv) Improve the coordination and efficiency of health and human services legal functions |
by centralizing adjudicative and legal services and overseeing their timely and judicious |
administration; |
(v) Facilitate the rebalancing of the long term system by creating an assessment and |
coordination organization or unit for the expressed purpose of developing and implementing |
procedures EOHHS-wide that ensure that the appropriate publicly-funded health services are |
provided at the right time and in the most appropriate and least restrictive setting;. |
(vi) Strengthen health and human services program integrity, quality control and |
collections, and recovery activities by consolidating functions within the office in a single unit that |
ensures all affected parties pay their fair share of the cost of services and are aware of alternative |
financing. |
(vii) Assure protective services are available to vulnerable elders and adults with |
developmental and other disabilities by reorganizing existing services, establishing new services |
where gaps exist and centralizing administrative responsibility for oversight of all related initiatives |
and programs. |
(7) Prepare and integrate comprehensive budgets for the health and human services |
departments and any other functions and duties assigned to the office. The budgets shall be |
submitted to the state budget office by the secretary, for consideration by the governor, on behalf |
of the state's health and human services agencies in accordance with the provisions set forth in § |
35-3-4 of the Rhode Island general laws. |
(8) Utilize objective data to evaluate health and human services policy goals, resource use |
and outcome evaluation and to perform short and long-term policy planning and development. |
(9) Establishment of an integrated approach to interdepartmental information and data |
management that complements and furthers the goals of the unified health infrastructure project |
initiative and that will facilitate the transition to a consumer-centered integrated system of state |
administered health and human services. |
(10) At the direction of the governor or the general assembly, conduct independent reviews |
of state-administered health and human services programs, policies and related agency actions and |
activities and assist the department directors in identifying strategies to address any issues or areas |
of concern that may emerge thereof. The department directors shall provide any information and |
assistance deemed necessary by the secretary when undertaking such independent reviews. |
(11) Provide regular and timely reports to the governor and make recommendations with |
respect to the state's health and human services agenda. |
(12) Employ such personnel and contract for such consulting services as may be required |
to perform the powers and duties lawfully conferred upon the secretary. |
(13) Assume responsibility for complying with the provisions of any general or public law |
or regulation related to the disclosure, confidentiality and privacy of any information or records, in |
the possession or under the control of the executive office or the departments assigned to the |
executive office, that may be developed or acquired or transferred at the direction of the governor |
or the secretary for purposes directly connected with the secretary's duties set forth herein. |
(14) Hold the director of each health and human services department accountable for their |
administrative, fiscal and program actions in the conduct of the respective powers and duties of |
their agencies. |
SECTION 13. Section 42-12.4-7 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: |
42-12.4-7. Demonstration implementation -- Restrictions. |
The executive office of health and human services and the department of human services |
may implement the global consumer choice section 1115 demonstration ("the demonstration"), |
project number 11W-00242/1, subject to the following restrictions: |
(1) Notwithstanding the provisions of the demonstration, any change that requires the |
implementation of a rule or regulation or modification of a rule or regulation in existence prior to |
the demonstration shall require prior approval of the general assembly; |
(2) Notwithstanding the provisions of the demonstration, any Category II change or |
Category III change formal waiver amendments, as defined in the demonstration, or state plan |
amendments shall require the prior approval of the general assembly. |
SECTION 14. Section 42-14.6-4 of the General Laws in Chapter 42-14.6 entitled "Rhode |
Island All-Payer Patient-Centered Medical Home Act" is hereby amended to read as follows: |
42-14.6-4. Promotion of the patient-centered medical home. |
(a) Care coordination payments. |
(1) The commissioner and the secretary shall convene a patient-centered medical home |
collaborative consisting of the entities described in subdivision § 42-14.6-3(7). The commissioner |
shall require participation in the collaborative by all of the health insurers described above. The |
collaborative shall propose, by January 1, 2012, a payment system, to be adopted in whole or in |
part by the commissioner and the secretary, that requires all health insurers to make per-person care |
coordination payments to patient-centered medical homes, for providing care coordination services |
and directly managing on-site or employing care coordinators as part of all health insurance plans |
offered in Rhode Island. The collaborative shall provide guidance to the state health-care |
healthcare program as to the appropriate payment system for the state health-care healthcare |
program to the same patient-centered medical homes; the state health-care program must justify |
the reasons for any departure from this guidance to the collaborative. |
(2) The care coordination payments under this shall be consistent across insurers and |
patient-centered medical homes and shall be in addition to any other incentive payments such as |
quality incentive payments. In developing the criteria for care coordination payments, the |
commissioner shall consider the feasibility of including the additional time and resources needed |
by patients with limited English-language skills, cultural differences, or other barriers to health |
care. The commissioner may direct the collaborative to determine a schedule for phasing in care |
coordination fees. |
(3) The care coordination payment system shall be in place through July 1, 2016. Its |
continuation beyond that point shall depend on results of the evaluation reports filed pursuant to § |
42-14.6-6. |
(4)(3) (4) Examination of other payment reforms. By January 1, 2013, the The |
commissioner and the secretary shall direct the collaborative to consider additional payment |
reforms to be implemented to support patient-centered medical homes including, but not limited |
to, payment structures (to medical home or other providers) that: |
(i) Reward high-quality, low-cost providers; |
(ii) Create enrollee incentives to receive care from high-quality, low-cost providers; |
(iii) Foster collaboration among providers to reduce cost shifting from one part of the health |
continuum to another; and |
(iv) Create incentives that health care be provided in the least restrictive, most appropriate |
setting.; and |
(v) Constitute alternatives to fee for service payment, such as partial and full capitation. |
(5)(4) (5) The patient-centered medical home collaborative shall examine and make |
recommendations to the secretary regarding the designation of patient-centered medical homes, in |
order to promote diversity in the size of practices designated, geographic locations of practices |
designated and accessibility of the population throughout the state to patient-centered medical |
homes. |
(b) The patient-centered medical home collaborative shall propose to the secretary for |
adoption, standards for the patient-centered medical home to be used in the payment system. In |
developing these standards, the existing standards by the national committee for quality assurance, |
or other independent accrediting organizations may be considered where feasible. |
SECTION 15. Section 42-72-5.3 of the General Laws in Chapter 42-72 entitled |
"Department of Children, Youth and Families" is hereby amended to read as follows: |
42-72-5.3. Accreditation. |
(a) The standards set by the Council on Accreditation (COA) are nationally recognized as |
best practices for protecting and providing services to abused and neglected children.; |
(b) Achieving and maintaining these standards requires a solid commitment from the |
legislative, executive and judicial branches of government; |
(c) It is the intent of the general assembly to provide the resources for the department of |
children, youth and families to meet, achieve and sustain accreditation by the Council on |
Accreditation; |
(d) Upon the appropriation of sufficient funds and resources by the general assembly, the |
The department of children, youth and families shall initiate the process for seeking COA |
accreditation no later than July 1, 2011 September 1, 2019, and shall submit an accreditation plan |
to the governor, the speaker of the house of representatives, the president of the senate, the |
chairperson of the house committee on health, education and welfare, the chairperson of the senate |
committee on health and human services, the chairpersons of the finance committees of the house |
and senate, and to the chairpersons of the judiciary committees of the house and senate no later |
than July 1, 2012 October 1, 2020. Said plan shall include, at a minimum, the following: |
(1) Inputs, including updated staffing requirements, a timetable for achieving those |
requirements, and any additional costs associated with achieving accreditation; |
(2) Outcomes, including an assessment based on statistical and other evidence, of the |
impact of accreditation on the number of abused and neglected children, the nature of their abuse, |
and the relationships between such children and their families. |
(e) The general assembly shall appropriate sufficient funds for expenses associated with |
achieving initial COA accreditation and subsequent re-accreditation with said funds being placed |
in a restricted receipt account to be used solely for this purpose." |
SECTION 16. 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 legislative enactment is required pursuant to Rhode Island General Laws |
42-12.4-1, et seq.; and |
WHEREAS, Rhode Island General Law 42-7.2-5(3)(a) provides that the Secretary of the |
Executive Office of Health and Human Services (“Executive Office”) is responsible for the review |
and coordination of any Rhode Island’s Medicaid section 1115 demonstration waiver requests and |
renewals as well as any initiatives and proposals requiring amendments to the Medicaid state plan |
or changes as described in the demonstration, “with potential to affect the scope, amount, or |
duration of publicly-funded health care services, provider payments or reimbursements, or access |
to or the availability of benefits and services provided by Rhode Island general and public laws”; |
and |
WHEREAS, In pursuit of a more cost-effective consumer choice system of care that is |
fiscally sound and sustainable, the Secretary of the Executive Office requests legislative approval |
of the following proposals to amend the Rhode Island’s Medicaid section 1115 demonstration: |
(a) Provider rates – Adjustments. The Executive Office proposes to: |
(i) Increase in-patient and out-patient hospital payment rates by seven and two tenths |
percent (7.2%) on July 1, 2019; |
(ii) Increase nursing home rates by one percent (1%) on October 1, 2019; |
(iii) Establish, effective July 1, 2019, hospice provider reimbursement, exclusively for |
room and board expenses for individuals residing in a skilled nursing facility, shall revert to the |
rate methodology in effect on June 30, 2018 and these room and board expenses shall be exempted |
from any and all annual rate increases to hospice providers; and |
(iv) Reduce the rates for Medicaid managed care plan. |
Implementation of adjustments may require amendments to the Rhode Island’s Medicaid |
state plan and/or section 1115 demonstration waiver under applicable terms and conditions. |
Further, adoption of new or amended rules, regulations and procedures may also be required. |
(b) Increase in the Department of Behavioral Healthcare, Developmental Disabilities and |
Hospitals department of behavioral healthcare, developmental disabilities and hospitals |
(BHDDH) Direct Care Service Workers Wages direct care service workers wages. To further the |
long-term care system rebalancing goal of improving access to high quality services in the least |
restrictive setting, the Executive Office executive office proposes to establish a targeted wage |
increase for certain community-based BHDDH developmental disability private providers and self- |
directed consumer direct care service workers. Implementation of the program may require |
amendments to the Medicaid State Plan state plan and/or Section 1115 demonstration waiver due |
to changes in payment methodologies. |
(c) Federal Financing Opportunities. The Executive Office executive office proposes to |
review Medicaid requirements and opportunities under the U.S. Patient Protection and Affordable |
Care Act of 2010, as amended, 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 state plan amendment or amendment under the terms |
and conditions of Rhode Island’s section 1115 waiver, its successor, or any extension thereof. Any |
such actions by the Executive Office shall not have an adverse impact on beneficiaries and shall |
not cause an increase in expenditures beyond the amount appropriated for state fiscal year 2020. |
Now, therefore, be it |
RESOLVED, the General Assembly hereby approves the proposals under paragraphs (a) |
through (c) above; and be it further; |
RESOLVED, the Secretary of the Executive Office is authorized to pursue and implement |
any Rhode Island’s Medicaid section 1115 demonstration waiver amendments, Medicaid state plan |
amendments, and/or changes to the applicable department’s rules, regulations and procedures |
approved herein and as authorized by 42-12.4; and be it further |
RESOLVED, that this Joint Resolution shall take effect upon passage. |
SECTION 17. Title 21 of the General Laws entitled "FOOD AND DRUGS" is hereby |
amended by adding thereto the following chapter: |
CHAPTER 28.10 |
OPIOID STEWARDSHIP ACT |
21-28.10-1. Definitions. |
21-28.10-1. Definitions. |
Unless the context otherwise requires, the following terms shall be construed in this chapter |
to have the following meanings: |
(1) "Department" means the Rhode Island department of health. |
(2) "Director” means the director of the Rhode Island department of health. |
(3) "Distribute" means distribute as defined in § 21-28-1.02. |
(4) "Distributor" means distributor as defined in § 21-28-1.02. |
(5) "Manufacture" means manufacture as defined in § 21-28-1.02. |
(6) "Manufacturer" means manufacturer as defined in § 21-28-1.02. |
(7) "Market share" means the total opioid stewardship fund amount measured as a |
percentage of each manufacturer's, distributor's and wholesaler's gross, in-state, opioid sales in |
dollars from the previous calendar year as reported to the U.S. Drug Enforcement Administration |
(DEA) on its Automation of Reports and Consolidated Orders System (ARCOS) report. |
(8) "Wholesaler" means wholesaler as defined in § 21-28-1.02. |
21-28.10-2. Opioid registration fee imposed on manufacturers, distributors, and |
wholesalers. |
All manufacturers, distributors, and wholesalers licensed or registered under this title or |
chapter 19.1 of title 5 (hereinafter referred to as "licensees"), that manufacture or distribute opioids |
shall be required to pay an opioid registration fee. On an annual basis, the director shall certify the |
amount of all revenues collected from opioid registration fees and any penalties imposed, to the |
general treasurer. The amount of revenues so certified shall be deposited annually into the opioid |
stewardship fund restricted receipt account established pursuant to § 21-28.10-10. |
21-28.10-3. Determination of market share and registration fee. |
(1) The total opioid stewardship fund amount shall be five million dollars ($5,000,000) |
annually, subject to downward adjustments pursuant to § 21-28.10-7. |
(2) Each manufacturer's, distributor's, and wholesaler's annual opioid registration fee shall |
be based on that licensee's in-state market share. |
(3) The following sales will not be included when determining a manufacturer's, |
distributor's, or wholesaler's market share: |
(i) The gross, in-state opioid sales attributed to the sale of buprenorphine or methadone; |
(ii) The gross, in-state opioid sales sold or distributed directly to opioid treatment programs, |
data-waivered practitioners, or hospice providers licensed pursuant to chapter 17 of title 23; |
(iii) Any sales from those opioids manufactured in Rhode Island, but whose final point of |
delivery or sale is outside of Rhode Island; and |
(iv) Any sales of anesthesia or epidurals as defined in regulation by the department.; and |
(v) Any in-state intracompany transfers of opioids between any division, affiliate, |
subsidiary, parent, or other entity under complete and common ownership and control. |
(4) The department shall provide to the licensee, in writing, on or before October 15, 2019, |
the licensee's market share for the 2018 calendar year. Thereafter, the department shall notify the |
licensee, in writing, on or before October 15 of each year, of its market share for the prior calendar |
year based on the opioids sold or distributed for the prior calendar year. |
21-28.10-4. Reports and records. |
(a) Each manufacturer, distributor, and wholesaler licensed to manufacture or distribute |
opioids in the state of Rhode Island shall provide to the director a report detailing all opioids sold |
or distributed by such that manufacturer or distributor in the state of Rhode Island. Such report |
shall include: |
(1) The manufacturer's, distributor's, or wholesaler's name, address, phone number, DEA |
registration number, and controlled substance license number issued by the department; |
(2) The name, address, and DEA registration number of the entity to whom the opioid was |
sold or distributed; |
(3) The date of the sale or distribution of the opioids; |
(4) The gross receipt total, in dollars, of all opioids sold or distributed; |
(5) The name and National Drug Code of the opioids sold or distributed; |
(6) The number of containers and the strength and metric quantity of controlled substance |
in each container of the opioids sold or distributed; and |
(7) Any other elements as deemed necessary or advisable by the director. |
(b) Initial and future reports. |
Such This information shall be reported annually to the department via ARCOS or in such |
other form as defined or approved by the director; provided, however, that the initial report |
provided pursuant to subsection (a) of this section shall consist of all opioids sold or distributed in |
the state of Rhode Island for the 2018 calendar year, and shall be submitted by September 1, 2019. |
Subsequent annual reports shall be submitted by April 15 of each year based on the actual opioid |
sales and distributions of the prior calendar year. |
21-28.10-5. Payment of market share. |
The licensee shall make payments annually to the department with the first payment of its |
market share due on December 31, 2019; provided, that the amount due on December 31, 2019 |
shall be for the full amount of the payment for the 2018 calendar year, with subsequent payments |
to be due and owing on the last day of every year thereafter. |
21-28.10-6. Rebate of market share. |
In any year for which the director determines that a licensee failed to report information |
required by this chapter, those licensees complying with this chapter shall receive a reduced |
assessment of their market share in the following year equal to the amount in excess of any |
overpayment in the prior payment period. |
21-28.10-7. Licensee opportunity to appeal. |
(a) A licensee shall be afforded an opportunity to submit information to the department |
documenting or evidencing that the market share provided to the licensee (or amounts paid |
thereunder), pursuant to § 21-28.10-3(4), is in error or otherwise not warranted. The department |
may consider and examine such additional information that it determines to be reasonably related |
to resolving the calculation of a licensee's market share, which may require the licensee to provide |
additional materials to the department. If the department determines thereafter that all or a portion |
of such market share, as determined by the director pursuant to § 21-28.10-3(4), is not warranted, |
the department may: |
(1) Adjust the market share; |
(2) Adjust the assessment of the market share in the following year equal to the amount in |
excess of any overpayment in the prior payment period; or |
(3) Refund amounts paid in error. |
(b) Any person aggrieved by a decision of the department relating to the calculation of |
market share may appeal that decision to the superior court, which shall have power to review such |
decision, and the process by which such decision was made, as prescribed in chapter 35 of title 42. |
(c) A licensee shall also have the ability to appeal its assessed opioid registration fee if the |
assessed fee amount exceeds the amount of profit the licensee obtains through sales in the state of |
products described in § 21-28.10-3. The department may, exercising discretion as it deems |
appropriate, waive or decrease fees as assessed pursuant to § 21-28.10-3 if a licensee can |
demonstrate that the correctly assessed payment will pose undue hardship to the licensee's |
continued activities in state. The department shall be allowed to request, and the licensee shall |
furnish to the department, any information or supporting documentation validating the licensee's |
request for waiver or reduction under this subsection. Fees waived under this section shall not be |
reapportioned to other licensees which have payments due under this chapter. |
21-28.10-8. Departmental annual reporting. |
By January of each calendar year, the department of behavioral healthcare, developmental |
disabilities and hospitals (BHDDH), the executive office of health and human services (EOHHS), |
the department of children, youth and families (DCYF), the Rhode Island department of education |
(RIDE), the Rhode Island office of veterans' affairs services (RIOVA), the department of |
corrections (DOC), and the department of labor and training (DLT) shall report annually to the |
governor, the speaker of the house, and the senate president which programs in their respective |
departments were funded using monies from the opioid stewardship fund and the total amount of |
funds spent on each program. |
21-28.10-9. Penalties. |
(a) The department may assess a civil penalty in an amount not to exceed one thousand |
dollars ($1,000) per day against any licensee that fails to comply with this chapter. |
(b)(1) In addition to any other civil penalty provided by law, where a licensee has failed to |
pay its market share in accordance with § 21-28.10-5, the department may also assess a penalty of |
no less than ten percent (10%) and no greater than three hundred percent (300%) of the market |
share due from such licensee. |
(2) In addition to any other criminal penalty provided by law, where a licensee has failed |
to pay its market share in accordance with § 21-28.10-5, the department may also assess a penalty |
of no less than ten percent (10%) and no greater than fifty percent (50%) of the market share due |
from such licensee. |
21-28.10-10. Creation of opioid stewardship fund. |
(a) There is hereby established, in the custody of the department, a restricted-receipt |
account to be known as the "opioid stewardship fund." |
(b) Monies in the opioid stewardship fund shall be kept separate and shall not be |
commingled with any other monies in the custody of the department. |
(c) The opioid stewardship fund shall consist of monies appropriated for the purpose of |
such account, monies transferred to such account pursuant to law, contributions consisting of |
promises or grants of any money or property of any kind or value, or any other thing of value, |
including grants or other financial assistance from any agency of government and monies required |
by the provisions of this chapter or any other law to be paid into or credited to this account. |
(d) Monies of the opioid stewardship fund shall be available to provide opioid treatment, |
recovery, prevention, education services, and other related programs, subject to appropriation by |
the general assembly. |
21-28.10-11. Allocation. |
The monies, when allocated, shall be paid out of the opioid stewardship fund and subject |
to the approval of the director and the approval of the director of the department of behavioral |
healthcare, developmental disabilities and hospitals (BHDDH), pursuant to the provisions of this |
chapter. |
21-28.10-12. Severability. |
If any clause, sentence, paragraph, subdivision, or section of this act shall be adjudged by |
any court of competent jurisdiction to be invalid, such judgment shall not affect, impair, or |
invalidate the remainder thereof, but shall be confined in its operation to the clause, sentence, |
paragraph, subdivision, or section directly involved in the controversy in which such judgment shall |
have been rendered. It is hereby declared to be the intent of the legislature that this act would have |
been enacted even if such invalid provisions had not been included herein. |
21-28.10-13. Rules and regulations. |
The director may prescribe rules and regulations, not inconsistent with law, to carry into |
effect the provisions of this chapter 28.10 of title 21, which rules and regulations, when reasonably |
designed to carry out the intent and purpose of this chapter, are prima facie evidence of its proper |
interpretation. Such rules and regulations may be amended, suspended, or revoked, from time to |
time and in whole or in part, by the director. The director may prescribe, and may furnish, any |
forms necessary or advisable for the administration of this chapter. |
SECTION 18. This article shall take effect upon passage. |