2020 -- H 7662

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LC004978

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2020

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A N   A C T

RELATING TO THE STATE AFFAIRS AND GOVERNMENT - DEPARTMENT OF

HUMAN SERVICES

     Introduced By: Representative Joseph M. McNamara

     Date Introduced: February 26, 2020

     Referred To: House Finance

     It is enacted by the General Assembly as follows:

     SECTION 1. Chapter 42-12 of the General Laws entitled "Department of Human Services"

is hereby amended by adding thereto the following section:

     42-12-31. Medicaid primary care parity.

     (a) This section is intended to ensure Rhode Island's children enrolled in Medicaid have

access to high-quality and coordinated medical care. In the face of a growing number of Rhode

Island children enrolled in Medicaid, this section shall address the many challenges related to

meeting the population health management targets required by the state of Rhode Island's

accountable entity program and the state's long-term vision of addressing Rhode Island's public

health challenges; which include, but are not limited to, high achievement in quality metric targets,

providing timely access to medical care, and reducing the overall costs of Rhode Island's Medicaid

program. To meet these objectives, the general assembly will encourage private community-based

pediatric primary care physicians to participate in Medicaid.

     (b) To achieve the aforementioned objectives, private community-based pediatric primary

care physicians must be willing, and able, to open their practices (panels) to Medicaid beneficiaries.

     (c) As a result of the 113th Congress, in which federal lawmakers failed to reauthorize the

Medicaid fee bump outlined in the Affordable Care Act, the federal government ended the two (2)

year Medicare fee parity program. In states that participated in Medicaid expansion, the Medicare

fee parity program incentivized private community-based pediatric primary care physicians to open

their practices to Medicaid beneficiaries. The end of this program, and fee-for­services cuts of up

to fifty-five percent (55%), put significant financial pressure on Rhode Island's private community-

based pediatric primary care physicians.

     Providers were forced to either close their practices to Medicaid beneficiaries, or to stop

caring for Medicaid patients. As the volume of Medicaid patients seeking care increases, getting

access to primary care is difficult for Rhode Island's Medicaid beneficiaries. As Medicaid

enrollment continues to increase, when currently more than one-in-four (4) Rhode Island residents

is a Medicaid beneficiary, the state is faced with an access crisis to primary care medicine.

     (d) To ensure that Rhode Island's Medicaid beneficiaries are able to get access to high

quality and coordinated health care, effective July 1, 2021, the general assembly shall raise

Medicaid primary care payment rates to federal Medicare levels, paying private community-based

pediatric primary care providers one hundred percent (100%) of the federal Medicare fee-for-

service rates. Often referred to as "Medicaid primary care parity", this provision shall:

     (1) Incentivize private community-based pediatric primary care physicians to participate

in the state's Medicaid program;

     (2) Support the goals and objectives of the executive office of health and human services'

accountable entity program:

     (3) Support Rhode Island's private community-based pediatric primary care providers;

     (4) Support the ten (10) year public health vision shared by the Rhode Island department

of health in partnership with the Rhode Island Foundation;

     (5) Support the office of the health insurance commissioner's affordability standards; and

     (6) Ensure Medicaid beneficiaries get access to high quality and coordinated primary care.

     SECTION 2. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO THE STATE AFFAIRS AND GOVERNMENT - DEPARTMENT OF

HUMAN SERVICES

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     This act would, on July 1, 2021, raise Medicaid primary care payment rates to federal

Medicare levels, which would result in paying private community-based pediatric primary care

providers one hundred percent (100%) of the federal Medicare fee-for-service rates.

     This act would take effect upon passage.

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