=======

art.013/6/013/5/013/4/013/3/013/2/013/1

=======

     ARTICLE 13 AS AMENDED

RELATING TO MEDICAL ASSISTANCE

     SECTION 1. Sections 40-8-15 and 40-8-19 of the General Laws in Chapter 40-8 entitled

“Medical Assistance” are hereby amended to read as follows:

     40-8-15. Lien on deceased recipient's estate for assistance.

     (a)(1) Upon the death of a recipient of medical assistance Medicaid under Title XIX of the

federal Social Security Act, 42 U.S.C. § 1396 et seq., (42 U.S.C. § 1396 et seq. and referred to

hereinafter as the "Act"), the total sum of medical assistance for Medicaid benefits so paid on behalf

of a recipient beneficiary who was fifty-five (55) years of age or older at the time of receipt of the

assistance shall be and constitute a lien upon the estate, as defined in subdivision (a)(2) below, of

the recipient beneficiary in favor of the executive office of health and human services ("executive

office"). The lien shall not be effective and shall not attach as against the estate of a recipient

beneficiary who is survived by a spouse, or a child who is under the age of twenty-one (21), or a

child who is blind or permanently and totally disabled as defined in Title XVI of the federal Social

Security Act, 42 U.S.C. § 1381 et seq. The lien shall attach against property of a recipient

beneficiary, which is included or includible in the decedent's probate estate, regardless of whether

or not a probate proceeding has been commenced in the probate court by the executive office of

health and human services or by any other party. Provided, however, that such lien shall only attach

and shall only be effective against the recipient’s beneficiary's real property included or includible

in the recipient’s beneficiary's probate estate if such lien is recorded in the land evidence records

and is in accordance with subsection 40-8-15(f). Decedents who have received medical assistance

Medicaid benefits are subject to the assignment and subrogation provisions of §§ 40-6-9 and 40-6-

10.

     (2) For purposes of this section, the term “estate” with respect to a deceased individual

shall include all real and personal property and other assets included or includable within the

individual's probate estate.

      (b) The executive office of health and human services is authorized to promulgate

regulations to implement the terms, intent, and purpose of this section and to require the legal

representative(s) and/or the heirs-at-law of the decedent to provide reasonable written notice to the

executive office of health and human services of the death of a recipient beneficiary of medical

assistance Medicaid benefits who was fifty-five (55) years of age or older at the date of death, and

to provide a statement identifying the decedent's property and the names and addresses of all

persons entitled to take any share or interest of the estate as legatees or distributes thereof.

      (c) The amount of medical assistance reimbursement for Medicaid benefits imposed under

this section shall also become a debt to the state from the person or entity liable for the payment

thereof.

     (d) Upon payment of the amount of reimbursement for medical assistance Medicaid

benefits imposed by this section, the secretary of the executive office of health and human services,

or his or her designee, shall issue a written discharge of lien.

      (e) Provided, however, that no lien created under this section shall attach nor become

effective upon any real property unless and until a statement of claim is recorded naming the

debtor/owner of record of the property as of the date and time of recording of the statement of

claim, and describing the real property by a description containing all of the following: (1) tax

assessor's plat and lot; and (2) street address. The statement of claim shall be recorded in the records

of land evidence in the town or city where the real property is situated. Notice of said lien shall be

sent to the duly appointed executor or administrator, the decedent's legal representative, if known,

or to the decedent's next of kin or heirs at law as stated in the decedent's last application for medical

assistance Medicaid benefits.

      (f) The executive office of health and human services shall establish procedures, in

accordance with the standards specified by the secretary, U.S. Department of Health and Human

Services, under which the executive office of health and human services shall waive, in whole or

in part, the lien and reimbursement established by this section if such lien and reimbursement would

work cause an undue hardship, as determined by the executive office of health and human services,

on the basis of the criteria established by the secretary in accordance with 42 U.S.C. § 1396p(b)(3).

      (g) Upon the filing of a petition for admission to probate of a decedent's will or for

administration of a decedent's estate, when the decedent was fifty-five (55) years or older at the

time of death, a copy of said petition and a copy of the death certificate shall be sent to the executive

office of health and human services. Within thirty (30) days of a request by the executive office of

health and human services, an executor or administrator shall complete and send to the executive

office of health and human services a form prescribed by that office and shall provide such

additional information as the office may require. In the event a petitioner fails to send a copy of the

petition and a copy of the death certificate to the executive office of health and human services and

a decedent has received medical assistance Medicaid benefits for which the executive office of

health and human services is authorized to recover, no distribution and/or payments, including

administration fees, shall be disbursed. Any person and /or entity that receive a distribution of assets

from the decedent's estate shall be liable to the executive office of health and human services to the

extent of such distribution.

     (h) Compliance with the provisions of this section shall be consistent with the requirements

set forth in § 33-11-5 and the requirements of the affidavit of notice set forth in § 33-11-5.2. Nothing

in these sections shall limit the executive office of health and human services from recovery, to the

extent of the distribution, in accordance with all state and federal laws.

     (i) To assure the financial integrity of the Medicaid eligibility determination, benefit

renewal, and estate recovery processes in this and related sections, the secretary of health and

human services is authorized and directed to, by no later than August 1, 2018: (1), implement an

automated asset verification system, as mandated by § 1940 of the of Act that uses electronic data

sources to verify the ownership and value of countable resources held in financial institutions and

any real property for applicants and beneficiaries subject to resource and asset tests pursuant in the

Act in § 1902(e)(14)(D); (2) Apply the provisions required under §§ 1902(a)(18) and 1917(c) of

the Act pertaining to the disposition of assets for less than fair market value by applicants and

beneficiaries for Medicaid long-term services and supports and their spouses, without regard to

whether they are subject to or exempted from resources and asset tests as mandated by federal

guidance; and (3) Pursue any state plan or waiver amendments from the U.S. Centers for Medicare

and Medicaid Services and promulgate such rules, regulations, and procedures he or she deems

necessary to carry out the requirements set forth herein and ensure the state plan and Medicaid

policy conform and comply with applicable provisions Title XIX.

     40-8-19. Rates of payment to nursing facilities.

     (a) Rate reform.

     (1) The rates to be paid by the state to nursing facilities licensed pursuant to chapter 17 of

title 23, and certified to participate in the Title XIX Medicaid program for services rendered to

Medicaid-eligible residents, shall be reasonable and adequate to meet the costs which must be

incurred by efficiently and economically operated facilities in accordance with 42 U.S.C.

§1396a(a)(13). The executive office of health and human services ("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, which

may or may not result in automatic per diem revisions;

     (iv) Application of a fair rental value system;

     (v) Application of a pass-through system; and

     (vi) Adjustment of rates by the change in a recognized national nursing home inflation

index to be applied on October 1st of each year, beginning October 1, 2012. This adjustment will

not occur on October 1, 2013, 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. 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. Said inflation index shall be applied without regard for the transition factor factors

in subsection subsections (b)(1) and (b)(2) below. For purposes of October 1, 2016, adjustment

only, any rate increase that results from application of the inflation index to subparagraphs (a)(2)(i)

and (a)(2)(ii) shall be dedicated to increase compensation for direct-care workers in the following

manner: Not less than 85% of this aggregate amount shall be expended to fund an increase in wages,

benefits, or related employer costs of direct-care staff of nursing homes. For purposes of this

section, direct-care staff shall include registered nurses (RNs), licensed practical nurses (LPNs),

certified nursing assistants (CNAs), certified medical technicians, housekeeping staff, laundry staff,

dietary staff, or other similar employees providing direct care services; provided, however, that this

definition of direct-care staff shall not include: (i) RNs and LPNs who are classified as "exempt

employees" under the Federal Fair Labor Standards Act (29 U.S.C. § 201 et seq.); or (ii) CNAs,

certified medical technicians, RNs, or LPNs who are contracted, or subcontracted, through a third-

party vendor or staffing agency. By July 31, 2017, nursing facilities shall submit to the secretary,

or designee, a certification that they have complied with the provisions of this subparagraph

(a)(2)(vi) with respect to the inflation index applied on October 1, 2016. Any facility that does not

comply with terms of such certification shall be subjected to a clawback, paid by the nursing facility

to the state, in the amount of increased reimbursement subject to this provision that was not

expended in compliance with that certification.

     (b) Transition to full implementation of rate reform. For no less than four (4) years after

the initial application of the price-based methodology described in subdivision (a)(2) to payment

rates, the executive office of health and human services shall implement a transition plan to

moderate the impact of the rate reform on individual nursing facilities. Said transition shall include

the following components:

     (1) No nursing facility shall receive reimbursement for direct-care costs that is less than

the rate of reimbursement for direct-care costs received under the methodology in effect at the time

of passage of this act; 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. No nursing facility shall

receive reimbursement for direct care costs that is less than the rate of reimbursement for direct

care costs received under the methodology in effect at the time of passage of this act; and

     (2) No facility shall lose or gain more than five dollars ($5.00) in its total per diem rate the

first year of the transition. 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 (12) month 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 (12) month period.

     SECTION 2. Sections 40-8.3-2 and 40-8.3-3 of the General Laws in Chapter 40-8.3 entitled

"Uncompensated Care" are hereby amended to read as follows:

     40-8.3-2. Definitions.

     As used in this chapter:

     (1) "Base year" means, for the purpose of calculating a disproportionate share payment for

any fiscal year ending after September 30, 2016 2017, the period from October 1, 2014 2015,

through September 30, 2015 2016, and for any fiscal year ending after September 30, 2017 2018,

the period from October 1, 2015 2016, through September 30, 2016 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,

shall be deemed to be five and thirty hundredths percent (5.30%).

     40-8.3-3. Implementation.

     (a) For federal fiscal year 2016, commencing on October 1, 2015, and ending September

30, 2016, the executive office of health and human services shall submit to the Secretary of the

U.S. Department of Health and Human Services a state plan amendment to the Rhode Island

Medicaid DSH Plan to provide:

     (1) That the disproportionate-share hospital payments to all participating hospitals, not to

exceed an aggregate limit of $138.2 million, shall be allocated by the executive office of health and

human services to the Pool A, Pool C, and Pool D components of the DSH Plan; and,

     (2) That the Pool D allotment shall be distributed among the participating hospitals in direct

proportion to the individual, participating hospital's uncompensated-care costs for the base year,

inflated by the uncompensated-care index to the total uncompensated-care costs for the base year

inflated by uncompensated-care index for all participating hospitals. The DSH Plan shall be made

on or before July 11, 2016, and are expressly conditioned upon approval on or before July 5, 2016,

by the Secretary of the U.S. Department of Health and Human Services, or his or her authorized

representative, of all Medicaid state plan amendments necessary to secure for the state the benefit

of federal financial participation in federal fiscal year 2016 for the DSH Plan.

     (b)(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.

     (c) 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 million, shall be allocated by the executive office of health and human services to Pool D

component of the DSH Plan; and

     (2) That the Pool D allotment shall be distributed among the participating hospitals in

director 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 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)(d) 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 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.

     (d)(e) 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)(f) 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)(g) Beginning with federal FY 2016, Pool D DSH payments will be recalculated by the

state based on actual hospital experience. The final Pool D payments will be based on the data from

the final DSH audit for each federal fiscal year. Pool D DSH payments will be redistributed among

the qualifying hospitals in direct proportion to the individual, qualifying hospital's uncompensated-

care to the total uncompensated-care costs for all qualifying hospitals as determined by the DSH

audit. No hospital will receive an allocation that would incur funds received in excess of audited

uncompensated-care costs.

     SECTION 3. Section 40-8.4-12 of the General Laws in Chapter 40-8.4 entitled “Health

Care for Families” is hereby amended to read as follows:

     40-8.4-12. RIte Share Health Insurance Premium Assistance Program.

     (a) Basic RIte Share Health Insurance Premium Assistance Program. The office of health

and human services is authorized and directed to amend the medical assistance Title XIX state plan

to implement the provisions of section 1906 of Title XIX of the Social Security Act, 42 U.S.C.

section 1396e, and establish the Rhode Island health insurance premium assistance program for

RIte Care eligible families with incomes up to two hundred fifty percent (250%) of the federal

poverty level who have access to employer-based health insurance. The state plan amendment shall

require eligible families with access to employer-based health insurance to enroll themselves and/or

their family in the employer-based health insurance plan as a condition of participation in the RIte

Share program under this chapter and as a condition of retaining eligibility for medical assistance

under chapters 5.1 and 8.4 of this title and/or chapter 12.3 of title 42 and/or premium assistance

under this chapter, provided that doing so meets the criteria established in section 1906 of Title

XIX for obtaining federal matching funds and the department has determined that the person's

and/or the family's enrollment in the employer-based health insurance plan is cost-effective and the

department has determined that the employer-based health insurance plan meets the criteria set

forth in subsection (d). The department shall provide premium assistance by paying all or a portion

of the employee's cost for covering the eligible person or his or her family under the employer-

based health insurance plan, subject to the cost sharing provisions in subsection (b), and provided

that the premium assistance is cost-effective in accordance with Title XIX, 42 U.S.C. section 1396

et seq. Under the terms of Section 1906 of Title XIX of the U.S. Social Security Act, 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 general assembly's

direction in Rhode Island Health Reform Act of 2000, the Medicaid agency requested and obtained

federal approval under § 1916 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) Individuals who can afford it shall share in the cost. The office of health and human

services is authorized and directed to apply for and obtain any necessary waivers from the secretary

of the United States Department of Health and Human Services, including, but not limited to, a

waiver of the appropriate sections of Title XIX, 42 U.S.C. section 1396 et seq., to require that

families eligible for RIte Care under this chapter or chapter 12.3 of title 42 with incomes equal to

or greater than one hundred fifty percent (150%) of the federal poverty level pay a share of the

costs of health insurance based on the person's ability to pay, provided that the cost sharing shall

not exceed five percent (5%) of the person's annual income. The department of human services

shall implement the cost-sharing by regulation, and shall consider co-payments, premium shares or

other reasonable means to do so. Definitions. For the purposes of this subsection, 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%) 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 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) Current RIte Care enrollees with access to employer-based health insurance. The office

of health and human services shall require any family who receives RIte Care or whose family

receives RIte Care on the effective date of the applicable regulations adopted in accordance with

subsection (f) to enroll in an employer-based health insurance plan at the person's eligibility

redetermination date or at an earlier date determined by the department, provided that doing so

meets the criteria established in the applicable sections of Title XIX, 42 U.S.C. section 1396 et seq.,

for obtaining federal matching funds and the department has determined that the person's and/or

the family's enrollment in the employer-based health insurance plan is cost-effective and has

determined that the health insurance plan meets the criteria in subsection (d). The insurer shall

accept the enrollment of the person and/or the family in the employer-based health insurance plan

without regard to any enrollment season restrictions. 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 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 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%) 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 (6) month exemption from the mandatory enrollment

requirement for persons participating in the RI Works program pursuant to chapter 5.2 of title 40.

     (d) (e) Approval of health insurance plans for premium assistance. The office of health and

human services shall adopt regulations providing for the approval of employer-based health

insurance plans for premium assistance and shall approve employer-based health insurance plans

based on these regulations. In order for an employer-based health insurance plan to gain approval,

the department 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 RIte Care Medicaid-eligible persons by the RIte Care program enrolled in 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 as sto persons otherwise eligible

for RIte Care Medicaid identified in this section as supplemental benefits those benefits not

reasonably available under employer-based health insurance plans which are required for RIte Care

eligible persons 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 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 that 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. DHHS to require that person 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.

     (e) (h) Maximization of federal contribution. The office of health and human services is

authorized and directed to apply for and obtain federal approvals and waivers necessary to

maximize the federal contribution for provision of medical assistance coverage under this section,

including the authorization to amend the Title XXI state plan and to obtain any waivers necessary

to reduce barriers to provide premium assistance to recipients as provided for in Title XXI of the

Social Security Act, 42 U.S.C. section 1397 et seq.

     (f) (i) Implementation by regulation. The office of health and human services is authorized

and directed to adopt regulations to ensure the establishment and implementation of the premium

assistance program in accordance with the intent and purpose of this section, the requirements of

Title XIX, Title XXI and any approved federal waivers.

     SECTION 4. 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) 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) 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 of the general laws as long as assisted-living services are a covered Medicaid benefit.

     (e) The executive office is authorized to promulgate rules that permit certain optional

services including, but not limited to, homemaker services, home modifications, respite, and

physical therapy evaluations to be offered to persons at risk for Medicaid-funded, long-term care

subject to availability of state-appropriated funding for these purposes.

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

executive office is authorized to pursue payment methodology reforms that increase access to

homemaker, personal care (home health aide), assisted living, adult supportive-care homes, and

adult day services, as follows:

     (1) Development of revised or new Medicaid certification standards that increase access to

service specialization and scheduling accommodations by using payment strategies designed to

achieve specific quality and health outcomes.

     (2) Development of Medicaid certification standards for state-authorized providers of

adult-day services, excluding such providers of services authorized under § 40.1-24-1(3), assisted

living, and adult supportive care (as defined under 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) 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 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;

     (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 5. Section 40.1-21-4 of the General Laws in Chapter 40.1-21 entitled "Division

of Developmental Disabilities" is hereby amended to read as follows:

     40.1-21-4. Powers and duties of director of behavioral healthcare, developmental

disabilities and hospitals.

     (a) The director of behavioral healthcare, developmental disabilities and hospitals shall be

responsible for planning and developing a complete, comprehensive, and integrated statewide

program for the developmentally disabled for the implementation of the program; and for the

coordination of the efforts of the department of behavioral healthcare, developmental disabilities

and hospitals with those of other state departments and agencies, municipal governments as well

as the federal government and private agencies concerned with and providing services for the

developmentally disabled.

     (b) The director shall be responsible for the administration and operation of all state

operated community and residential facilities established for the diagnosis, care, and training of the

developmentally disabled. The director shall be responsible for establishing standards in

conformance with generally accepted professional thought and for providing technical assistance

to all state supported and licensed habilitative, developmental, residential and other facilities for

the developmentally disabled, and exercise the requisite surveillance and inspection to insure

compliance with standards. Provided, however, that none of the foregoing shall be applicable to

any of the facilities wholly within the control of any other department of state government.

     (c) The director of behavioral healthcare, developmental disabilities and hospitals shall

stimulate research by public and private agencies, institutions of higher learning, and hospitals, in

the interest of the elimination and amelioration of developmental disabilities, and care and training

of the developmentally disabled.

     (d) The director shall be responsible for the development of criteria as to the eligibility for

admittance of any developmentally disabled person for residential care in any department supported

and licensed residential facility or agency.

     (e) The director of behavioral healthcare, developmental disabilities and hospitals may

transfer retarded persons from one state residential facility to another when deemed necessary or

desirable for their better care and welfare.

     (f) The director of behavioral healthcare, developmental disabilities and hospitals shall

make grants-in-aid and otherwise provide financial assistance to the various communities and

private nonprofit agencies, in amounts which will enable all developmentally disabled adults to

receive developmental and other services appropriate to their individual needs.

     (g) The director shall coordinate all planning for the construction of facilities for the

developmentally disabled, and the expenditure of funds appropriated or otherwise made available

to the state for this purpose.

     (h) To ensure individuals eligible for services under § 40.1-21-43 receive the appropriate

medical benefits through the Executive Office of Health and Human Services' Medicaid program,

the director, or designee, will work in coordination with the Medicaid program to determine if an

individual is eligible for long-term care services and supports and that he or she has the option to

enroll in the Medicaid program that offers these services. As part of the monthly reporting

requirements, the Department will indicate how many individuals have declined enrollment in a

managed care plan that offers these long-term care services.

     SECTION 6. Title 42 of the General Laws entitled "STATE AFFAIRS AND

GOVERNMENT" is hereby amended by adding thereto the following chapter:

CHAPTER 66.12

THE RHODE ISLAND AGING AND DISABILITY RESOURCE CENTER

     42-66.12-1. Short title.

     This chapter shall be known and may be cited as the "The Rhode Island Aging and

Disability Resource Center Act".

     42-66.12-2. Purpose.

     To assist Rhode Islanders and their families in making informed choices and decisions

about long-term service and support options and to streamline access to long-term supports and

services for older adults, persons with disabilities, family caregivers and providers, a statewide

aging and disability resource center shall be maintained. The Rhode Island aging and disability

resource center (ADRC) is a state multi-agency effort. It consists of a centrally operated,

coordinated system of information, referral and options counseling for all persons seeking long-

term supports and services in order to enhance individual choice, foster informed decision-making

and minimize confusion and duplication.

     42-66.12-3. Aging and disability resource center established.

     The Rhode Island aging and disability resource center (ADRC) shall be established and

operated by the department of human services, division of elderly affairs (DEA) in collaboration

with other agencies within the executive office of health and human services. The division of

elderly affairs shall build on its experience in development and implementation of the current

ADRC program. The ADRC is an integral part of the Rhode Island system of long-term supports

and services working to promote the state's long-term system rebalancing goals by diverting

persons, when appropriate, from institutional care to home and community-based services and

preventing short-term institutional stays from becoming permanent through options counseling and

screening for eligibility for home and community-based services.

     42-66.12-4. Aging and disability resource center service directives.

     (a) The aging and disability resource center (ADRC) shall provide for the following:

     (l) A statewide toll-free ADRC information number available during business hours with

a messaging system to respond to after-hours calls during the next business day and language

services to assist individuals with limited English language skills;

     (2) A comprehensive database of information, updated on a regular basis and accessible

through a dedicated website, on the full range of available public and private long-term support and

service programs, service providers and resources within the state and in specific communities,

including information on housing supports, transportation and the availability of integrated long-

term care;

     (3) Personal options counseling, including implementing provisions required in § 40-8.9-

9, to assist individuals in assessing their existing or anticipated long-term care needs, and assisting

them to develop and implement a plan designed to meet their specific needs and circumstances;

     (4) A means to link callers to the ADRC information line to interactive long-term care

screening tools and to make these tools available through the ADRC website by integrating the

tools into the website;

     (5) Development of partnerships, through memorandum agreements or other arrangements,

with other entities serving older adults and persons with disabilities, including those working on

nursing home transition and hospital discharge programs, to assist in maintaining and providing

ADRC services; and

     (6) Community education and outreach activities to inform persons about the ADRC

services, in finding information through the Internet and in planning for future long-term care needs

including housing and community service options.

     SECTION 7. 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 Medicaid section 1115 demonstration waiver requests and renewals as well

as any initiatives and proposals requiring amendments to the Medicaid state plan or category II or

III changes as described in the demonstration, “with potential to affect the scope, amount, or

duration of publicly-funded health care services, provider payments or reimbursements, or access

to or the availability of benefits and services provided by Rhode Island general and public laws”;

and

     WHEREAS, in pursuit of a more cost-effective consumer choice system of care that is

fiscally sound and sustainable, the Secretary requests legislative approval of the following

proposals to amend the demonstration:

     (a) Provider Rates -- Adjustments. The Executive Office proposes to:

     (i) Increase nursing home rates one and one-half percent (1.5%) on July 1, 2018, and one

percent (1 %) on October 1, 2018.

     (ii) Reduce the administrative component of rates for Medicaid managed care plan rates

administration.

     (iii) Reduce the medical component of Medicaid managed care plan rates.

     (iv) Increase rates paid for personal care attendants, skilled nursing and therapeutic services

and hospice care.

     Implementation of adjustments may require amendments to the Rhode Island’s Medicaid

State Plan and/or Section 1115 waiver under the terms and conditions of the demonstration. Further,

adoption of new or amended rules, regulations and procedures may also be required.

     (b) Section 1115 Demonstration Waiver – Implementation of Existing Authorities. To

achieve the objectives of the State’s demonstration waiver, the Executive Office proposes to

implement the following approved authorities:

     (i) Expanded expedited eligibility for long-term services and supports (LTSS) applicants

who are transitioning to a home or community-based setting from a health facility, including a

hospital or nursing home; and

     (ii) Institute the multi-tiered needs-based criteria for determining the level of care and scope

of services available to applicants with developmental disabilities seeking Medicaid home and

community-based services in lieu of institutional care.

     (c) Section 1115 Demonstration Waiver – Extension Request – The Executive Office

proposes to seek approval from our federal partners to extend the Section 1115 demonstration as

authorized in §42-12.4. In addition to maintaining existing waiver authorities, the Executive Office

proposes to seek additional federal authorities to:

     (i) Further the goals of LTSS rebalancing set forth in §40-8.9, by expanding the array of

health care stabilization and maintenance services eligible for federal financial participation which

are available to beneficiaries residing in home and community-based settings. Such services include

adaptive and home-based monitoring technologies, transition help, and peer and personal supports

that assist beneficiaries in better managing and optimizing their own care. The Executive Office

proposes to pursue alternative payment strategies financed through the Health System

Transformation Project (HSTP) to cover the state’s share of the cost for such services and to expand

on-going efforts to identify and provide cost-effective preventive services to persons at-risk for

LTSS and other high cost interventions.

     (ii) Leverage existing resources and the flexibility of alternative payment methodologies

to provide integrated medical and behavioral services to children and youth at risk and in transition,

including targeted family visiting nurses, peer supports, and specialized networks of care.

     (iii) Establish authority to provide Medicaid coverage to children who require residential

care who by themselves would meet the Supplemental Security Income Disability standards but

could not receive the cash benefit due to family income and resource limits and who would

otherwise be placed in state custody.

     (d) Financial Integrity – Asset Verification and Transfers. To comply with federal

mandates pertaining to the integrity of the determination of eligibility and estate recoveries, the

Executive Office plans to adopt an automated asset verification system which uses electronic data

sources to verify ownership and the value of the financial resources and real property of applicants

and beneficiaries and their spouses who are subject to asset and resource limits under Title XIX. In

addition, the Executive Office proposes to adopt new or amended rules, policies and procedures for

LTSS applicants and beneficiaries, inclusive of those eligible pursuant to §40-8.12, that conform

to federal guidelines related to the transfer of assets for less than fair market value established in

Title XIX and applicable federal guidelines. State plan amendments are required to comply fully

with these mandates.

     (e) Service Delivery. To better leverage all available health care dollars and promote access

and service quality, the Executive Office proposes to:

     (i) Restructure delivery systems for dual Medicare and Medicaid eligible LTSS

beneficiaries who have chronic or disabling conditions to provide the foundation for implementing

more cost-effective and sustainable managed care LTSS arrangements. Additional state plan

authorities may be required.

     (ii) Expand the reach of the RIte Share premium assistance program through amendments

to the Medicaid state plan to cover non-disabled adults, ages 19 and older, who have access to a

cost-effective Executive Office approved employer-sponsored health insurance program.

     (f) Non-Emergency Transportation Program (NEMT). To implement cost effective

delivery of services and to enhance consumer satisfaction with transportation services by:

     (i) Expanding reimbursement methodologies; and

     (ii) Removing transportation restrictions to align with Title XIX of Federal law.

     (g) Community First Choice (CFC). To seek Medicaid state plan and any additional waiver

authority necessary to implement the CFC option.

     (h) Alternative Payment Methodology. To develop, in collaboration with the Department

of Behavioral Healthcare, Development Disabilities and Hospitals (BHDDH), a health home for

providing conflict free person-centered planning and a quality and value based alternative payment

system that advances the goal of improving service access, quality and value.

     (i) Opioid and Behavioral Health Crisis Management. To implement in collaboration

with the Department of Behavioral Healthcare, Development Disabilities and Hospitals (BHDDH),

a community based alternative to emergency departments for addiction and mental

health emergencies.

     (j) Federal Financing Opportunities. The Executive Office proposes to review Medicaid

requirements and opportunities under the U.S. Patient Protection and Affordable Care Act of 2010

(PPACA) 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 or cause there to be an increase

in expenditures beyond the amount appropriated for state fiscal year 2019. Now, therefore, be it

     RESOLVED, the General Assembly hereby approves proposals and be it further;

     RESOLVED, the Secretary of the Executive Office is authorized to pursue and implement

any waiver amendments, State Plan amendments, and/or changes to the applicable department’s

rules, regulations and procedures approved herein and as authorized by 42-12.4; and be it further

     RESOLVED, that this Joint Resolution shall take effect upon passage.

     SECTION 8. This Article shall take effect upon passage.