2013 -- S 0902

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LC02486

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STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2013

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A N A C T

RELATING TO HUMAN SERVICES - PUBLIC ASSISTANCE

     Introduced By: Senators DiPalma, Ottiano, Pichardo, and Goldin

     Date Introduced: May 02, 2013

     Referred To: Senate Finance

It is enacted by the General Assembly as follows:

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     SECTION 1. Section 40-6-27 of the General Laws in Chapter 40-6 entitled "Public

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Assistance Act" is hereby amended to read as follows:

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     40-6-27. Supplemental security income. -- (a) (1) The director of the department is

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hereby authorized to enter into agreements on behalf of the state with the secretary of the

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Department of Health and Human Services or other appropriate federal officials, under the

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supplementary and security income (SSI) program established by title XVI of the Social Security

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Act, 42 U.S.C. section 1381 et seq., concerning the administration and determination of eligibility

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for SSI benefits for residents of this state, except as otherwise provided in this section. The state's

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monthly share of supplementary assistance to the supplementary security income program shall

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be as follows:

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     (i) Individual living alone: $39.92

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     (ii) Individual living with others: $51.92

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     (iii) Couple living alone: $79.38

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     (iv) Couple living with others: $97.30

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     (v) Individual living in state licensed assisted living residence: $332.00 $538.00

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     (vi) Individual living in state licensed supportive residential

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     care settings that, depending on the population served, meet

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     the standards set by the department of human services in

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     conjunction with the department(s) of children, youth and

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     families, elderly affairs and/or behavioral healthcare,

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     developmental disabilities and hospitals: $300.00.

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     Provided, however, that the department of human services shall by regulation reduce,

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effective January 1, 2009, the state's monthly share of supplementary assistance to the

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supplementary security income program for each of the above listed payment levels, by the same

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value as the annual federal cost of living adjustment to be published by the federal social security

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administration in October 2008 and becoming effective on January 1, 2009, as determined under

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the provisions of title XVI of the federal social security act [42 U.S.C. section 1381 et seq.] and

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provided further, that it is the intent of the general assembly that the January 1, 2009 reduction in

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the state's monthly share shall not cause a reduction in the combined federal and state payment

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level for each category of recipients in effect in the month of December 2008; effective January

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1, 2014, and each January 1 thereafter, the department of human services shall increase the

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payment for individuals living in state licensed assisted living, subject to appropriation, by a

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percentage amount equal to the percentage rise in the United States consumer price index (CPI)

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for January 1 of that year; provided further, that the department of human services is authorized

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and directed to provide for payments to recipients in accordance with the above directives.

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     (2) As of July 1, 2010, state supplement payments shall not be federally administered and

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shall be paid directly by the department of human services to the recipient.

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     (3) Individuals living in institutions shall receive a twenty dollar ($20.00) per month

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personal needs allowance from the state which shall be in addition to the personal needs

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allowance allowed by the Social Security Act, 42 U.S.C. section 301 et seq.

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     (4) Individuals living in state licensed supportive residential care settings and assisted

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living residences who are receiving SSI shall be allowed to retain a minimum personal needs

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allowance of fifty-five dollars ($55.00) per month from their SSI monthly benefit prior to

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payment of any monthly fees.

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     (5) To ensure that supportive residential care or an assisted living residence is a safe and

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appropriate service setting, the department is authorized and directed to make a determination of

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the medical need and whether a setting provides the appropriate services for those persons who:

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     (i) Have applied for or are receiving SSI, and who apply for admission to supportive

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residential care setting and assisted living residences on or after October 1, 1998; or

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     (ii) Who are residing in supportive residential care settings and assisted living residences,

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and who apply for or begin to receive SSI on or after October 1, 1998.

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     (6) The process for determining medical need required by subsection (4) of this section

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shall be developed by the office of health and human services in collaboration with the

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departments of that office and shall be implemented in a manner that furthers the goals of

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establishing a statewide coordinated long-term care entry system as required pursuant to the

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Global Consumer Choice Compact Waiver.

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     (7) To assure access to high quality coordinated services, the department is further

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authorized and directed to establish rules specifying the payment certification standards that must

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be met by those state licensed supportive residential care settings and assisted living residences

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admitting or serving any persons eligible for state-funded supplementary assistance under this

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section. Such payment certification standards shall define:

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     (i) The scope and frequency of resident assessments, the development and

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implementation of individualized service plans, staffing levels and qualifications, resident

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monitoring, service coordination, safety risk management and disclosure, and any other related

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areas;

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     (ii) The procedures for determining whether the payment certifications standards have

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been met; and

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     (iii) The criteria and process for granting a one time, short-term good cause exemption

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from the payment certification standards to a licensed supportive residential care setting or

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assisted living residence that provides documented evidence indicating that meeting or failing to

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meet said standards poses an undue hardship on any person eligible under this section who is a

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prospective or current resident.

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     (8) The payment certification standards required by this section shall be developed in

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collaboration by the departments, under the direction of the executive office of health and human

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services, so as to ensure that they comply with applicable licensure regulations either in effect or

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in development.

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     (b) The department is authorized and directed to provide additional assistance to

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individuals eligible for SSI benefits for:

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     (1) Moving costs or other expenses as a result of an emergency of a catastrophic nature

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which is defined as a fire or natural disaster; and

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     (2) Lost or stolen SSI benefit checks or proceeds of them; and

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     (3) Assistance payments to SSI eligible individuals in need because of the application of

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federal SSI regulations regarding estranged spouses; and the department shall provide such

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assistance in a form and amount, which the department shall by regulation determine.

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     SECTION 2. Section 40-8.9-9 of the General Laws in Chapter 40-8.9 entitled "Medical

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Assistance - Long-Term Care Service and Finance Reform" is hereby amended to read as

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follows:

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     40-8.9-9. Long-term care re-balancing system reform goal. -- (a) Notwithstanding any

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other provision of state law, the department of human services is authorized and directed to apply

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for and obtain any necessary waiver(s), waiver amendment(s) and/or state plan amendments from

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the secretary of the United States department of health and human services, and to promulgate

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rules necessary to adopt an affirmative plan of program design and implementation that addresses

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the goal of allocating a minimum of fifty percent (50%) of Medicaid long-term care funding for

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persons aged sixty-five (65) and over and adults with disabilities, in addition to services for

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persons with developmental disabilities and mental disabilities, to home and community-based

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care on or before December 31, 2013; provided, further, the executive office of health and human

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services shall report annually as part of its budget submission, the percentage distribution

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between institutional care and home and community-based care by population and shall report

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current and projected waiting lists for long-term care and home and community-based care

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services. The department is further authorized and directed to prioritize investments in home and

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community-based care and to maintain the integrity and financial viability of all current long-

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term care services while pursuing this goal.

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      (b) The reformed long-term care system re-balancing goal is person-centered and

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encourages individual self-determination, family involvement, interagency collaboration, and

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individual choice through the provision of highly specialized and individually tailored home-

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based services. Additionally, individuals with severe behavioral, physical, or developmental

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disabilities must have the opportunity to live safe and healthful lives through access to a wide

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range of supportive services in an array of community-based settings, regardless of the

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complexity of their medical condition, the severity of their disability, or the challenges of their

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behavior. Delivery of services and supports in less costly and less restrictive community settings,

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will enable children, adolescents and adults to be able to curtail, delay or avoid lengthy stays in

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long-term care institutions, such as behavioral health residential treatment facilities, long-term

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care hospitals, intermediate care facilities and/or skilled nursing facilities.

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      (c) Pursuant to federal authority procured under section 42-7.2-16 of the general laws,

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the department of human services is directed and authorized to adopt a tiered set of criteria to be

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used to determine eligibility for services. Such criteria shall be developed in collaboration with

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the state's health and human services departments and, to the extent feasible, any consumer

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group, advisory board, or other entity designated for such purposes, and shall encompass

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eligibility determinations for long-term care services in nursing facilities, hospitals, and

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intermediate care facilities for the mentally retarded as well as home and community-based

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alternatives, and shall provide a common standard of income eligibility for both institutional and

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home and community-based care. The department is, subject to prior approval of the general

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assembly, authorized to adopt criteria for admission to a nursing facility, hospital, or

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intermediate care facility for the mentally retarded that are more stringent than those employed

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for access to home and community-based services. The department is also authorized to

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promulgate rules that define the frequency of re-assessments for services provided for under this

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section. Legislatively approved levels of care may be applied in accordance with the following:

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      (1) The department shall apply pre-waiver level of care criteria for any Medicaid

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recipient eligible for a nursing facility, hospital, or intermediate care facility for the mentally

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retarded as of June 30, 2009, unless the recipient transitions to home and community based

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services because he or she: (a) Improves to a level where he/she would no longer meet the pre-

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waiver level of care criteria; or (b) The individual chooses home and community based services

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over the nursing facility, hospital, or intermediate care facility for the mentally retarded. For the

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purposes of this section, a failed community placement, as defined in regulations promulgated by

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the department, shall be considered a condition of clinical eligibility for the highest level of care.

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The department shall confer with the long-term care ombudsperson with respect to the

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determination of a failed placement under the ombudsperson's jurisdiction. Should any Medicaid

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recipient eligible for a nursing facility, hospital, or intermediate care facility for the mentally

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retarded as of June 30, 2009 receive a determination of a failed community placement, the

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recipient shall have access to the highest level of care; furthermore, a recipient who has

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experienced a failed community placement shall be transitioned back into his or her former

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nursing home, hospital, or intermediate care facility for the mentally retarded whenever possible.

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Additionally, residents shall only be moved from a nursing home, hospital, or intermediate care

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facility for the mentally retarded in a manner consistent with applicable state and federal laws.

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      (2) Any Medicaid recipient eligible for the highest level of care who voluntarily leaves a

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nursing home, hospital, or intermediate care facility for the mentally retarded shall not be subject

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to any wait list for home and community based services.

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      (3) No nursing home, hospital, or intermediate care facility for the mentally retarded

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shall be denied payment for services rendered to a Medicaid recipient on the grounds that the

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recipient does not meet level of care criteria unless and until the department of human services

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has: (i) performed an individual assessment of the recipient at issue and provided written notice to

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the nursing home, hospital, or intermediate care facility for the mentally retarded that the

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recipient does not meet level of care criteria; and (ii) the recipient has either appealed that level of

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care determination and been unsuccessful, or any appeal period available to the recipient

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regarding that level of care determination has expired.

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      (d) The department of human services is further authorized and directed to consolidate

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all home and community-based services currently provided pursuant to section 1915(c) of title

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XIX of the United States Code into a single system of home and community-based services that

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include options for consumer direction and shared living. The resulting single home and

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community-based services system shall replace and supersede all section 1915(c) programs when

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fully implemented. Notwithstanding the foregoing, the resulting single program home and

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community-based services system shall include the continued funding of assisted living services

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at any assisted living facility financed by the Rhode Island housing and mortgage finance

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corporation prior to January 1, 2006, and shall be in accordance with chapter 66.8 of title 42 of

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the general laws as long as assisted living services are a covered Medicaid benefit.

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      (e) The department of human services is authorized to promulgate rules that permit

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certain optional services including, but not limited to, homemaker services, home modifications,

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respite, and physical therapy evaluations to be offered subject to availability of state-appropriated

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funding for these purposes.

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      (f) To promote the expansion of home and community-based service capacity, the

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department of human services is authorized and directed to pursue rate reform for homemaker,

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personal care (home health aide) and adult day care services, as follows:

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      (1) A prospective base adjustment effective, not later than July 1, 2008, across all

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departments and programs, of ten percent (10%) of the existing standard or average rate,

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contingent upon a demonstrated increase in the state-funded or Medicaid caseload by June 30,

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2009;

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      (2) Development, not later than September 30, 2008, of certification standards

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supporting and defining targeted rate increments to encourage service specialization and

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scheduling accommodations including, but not limited to, medication and pain management,

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wound management, certified Alzheimer's Syndrome treatment and support programs, and shift

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differentials for night and week-end services; and

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      (3) Development and submission to the governor and the general assembly, not later than

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December 31, 2008, of a proposed rate-setting methodology for home and community-based

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services to assure coverage of the base cost of service delivery as well as reasonable coverage of

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changes in cost caused by wage inflation.

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      (g) The department, in collaboration with the executive office of human services, shall

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implement a long-term care options counseling program to provide individuals or their

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representatives, or both, with long-term care consultations that shall include, at a minimum,

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information about: long-term care options, sources and methods of both public and private

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payment for long-term care services and an assessment of an individual's functional capabilities

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and opportunities for maximizing independence. Each individual admitted to or seeking

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admission to a long-term care facility regardless of the payment source shall be informed by the

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facility of the availability of the long-term care options counseling program and shall be provided

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with long-term care options consultation if they so request. Each individual who applies for

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Medicaid long-term care services shall be provided with a long-term care consultation.

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      (h) The department of human services is also authorized, subject to availability of

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appropriation of funding, to pay for certain expenses necessary to transition residents back to the

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community; provided, however, payments shall not exceed an annual or per person amount.

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      (i) To assure the continued financial viability of nursing facilities, the department of

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human services is authorized and directed to develop a proposal for revisions to section 40-8-19

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that reflect the changes in cost and resident acuity that result from implementation of this re-

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balancing goal. Said proposal shall be submitted to the governor and the general assembly on or

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before January 1, 2010.

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      (j) To ensure persons with long-term care needs who remain living at home have

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adequate resources to deal with housing maintenance and unanticipated housing related costs, the

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department of human services is authorized to develop higher resource eligibility limits for

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persons on home and community waiver services who are living in their own homes or rental

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units.

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     (k) To promote increased access to assisted living services for Medicaid beneficiaries and

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to accelerate the rebalancing of the long-term care system, the executive office of health and

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human services ("executive office") shall pursue reimbursement rate reform for assisted living. In

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pursuing assisted living reimbursement rate reform, the executive office shall:

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     (1) Solicit input and consult regularly with representatives from relevant stakeholder

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groups, including, but not limited to, the Rhode assisted living association and leading age RI;

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     (2) Include in the assisted living reimbursement rate reform plan, at a minimum, the

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following elements:

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     (i) A tiered, acuity based reimbursement system for Medicaid assisted living services to

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replace the existing per diem flat rate. In pursuing a tiered reimbursement system, the office shall

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ensure that the lowest payment tier is no lower than the flat rate in existence on January 1, 2013;

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     (ii) Annual adjustments to the Medicaid assisted living services reimbursement rates by a

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percentage amount equal to the percentage rise in the United States consumer price index (CPI)

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for January 1 of that year.

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     (3) Explore options for an enhanced Medicaid services reimbursement rate for assisted

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living residences that are required by regulation to offer single-occupant apartments.

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     (4) Provide the speaker of the house of representatives, president of the senate,

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chairperson of the house committee on health education and welfare and chairperson of the senate

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committee on health and human services with an assisted living rate reform progress report no

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later than October 1, 2013;

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     (5) The executive office is hereby authorized and directed to file a state plan amendment

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with the U.S. department of health and human services in order to implement assisted living

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reimbursement rate reform no later than January 1, 2014.

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     SECTION 3. This act shall take effect upon passage.

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LC02486

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N A C T

RELATING TO HUMAN SERVICES - PUBLIC ASSISTANCE

***

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     This act would increase the state's monthly share of supplementary assistance to the

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supplementary security income program from $332.00 to $538.00. This act would also provide

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guidelines to promote reimbursement rate reform for assisted living.

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     This act would take effect upon passage.

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LC02486

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