1 | ARTICLE 12 | |
2 | RELATING TO MEDICAL ASSISTANCE | |
3 | SECTION 1. Sections 12-1.6-1 and 12-1.6-2 of the General Laws in Chapter 12-1.6 entitled | |
4 | “National Criminal Records Check System” are hereby amended to read as follows: | |
5 | 12-1.6-1. Automated fingerprint identification system database. | |
6 | The department of attorney general may establish and maintain an automated fingerprint | |
7 | identification system database that would allow the department to store and maintain all fingerprints | |
8 | submitted in accordance with the national criminal records check system. The automated | |
9 | fingerprint identification system database would provide for an automatic notification if, and when, | |
10 | a subsequent criminal arrest fingerprint card is submitted to the system that matches a set of | |
11 | fingerprints previously submitted in accordance with a national criminal records check. If the | |
12 | aforementioned arrest results in a conviction, the department shall immediately notify those | |
13 | individuals and entities with which that individual is associated and who are required to be notified | |
14 | of disqualifying information concerning national criminal records checks as provided in chapters | |
15 | 17, 17.4, 17.7.1 of title 23 or § 23-1-52 and 42-7.2 of title 42 or §§ 42-7.2-18.2 and 42-7.2-18.4. | |
16 | The information in the database established under this section is confidential and not subject to | |
17 | disclosure under chapter 38-2. | |
18 | 12-1.6-2. Long-term healthcare workers., high-risk medicaid providers, and personal | |
19 | care attendants. | |
20 | The department of attorney general shall maintain an electronic, web-based system to assist | |
21 | facilities, licensed under chapters 17, 17.4, 17.7.1 of title 23 or § 23-1-52, and the executive office | |
22 | of health and human services under §§ 42-7.2-18.1 and 42-7.2-18.3, required to check relevant | |
23 | registries and conduct national criminal records checks of routine contact patient employees., | |
24 | personal care attendants and high-risk providers. The department of attorney general shall provide | |
25 | for an automated notice, as authorized in § 12-1.6-1, to those facilities or to the executive office of | |
26 | health and human services if a routine-contact patient employee, personal care attendant or high- | |
27 | risk provider is subsequently convicted of a disqualifying offense, as described in the relevant | |
28 | licensing statute or in §§ 42-7.2-18.2 and 42-7.2-18.4. The department of attorney general may | |
29 | charge a facility a one-time, set-up fee of up to one hundred dollars ($100) for access to the | |
30 | electronic web-based system under this section. | |
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1 | SECTION 2. Section 42-7.2-18 of Chapter 42-7.2 the General Laws entitled “Office of | |
2 | Health and Human Services” is hereby amended by adding thereto the following sections: | |
3 | 42-7.2-18.1. Professional responsibility – Criminal records check for high- risk | |
4 | providers. | |
5 | (a) As a condition of enrollment and/or continued participation as a Medicaid provider, | |
6 | applicants to become and/or remain a provider shall be required to undergo criminal records checks | |
7 | including a national criminal records check supported by fingerprints by the level of screening | |
8 | based on risk of fraud, waste or abuse as determined by the executive office of health and human | |
9 | services for that category of Medicaid provider. | |
10 | (b) Establishment of Risk Categories – The executive office of health and human services | |
11 | in consultation with the department of attorney general, shall establish through regulation, risk | |
12 | categories for Medicaid providers and provider categories who pose an increased financial risk of | |
13 | fraud, waste or abuse to the Medicaid/CHIP program, in accordance with § 42 CFR §§ 455.434 and | |
14 | 455.450. | |
15 | (c) High risk categories, as determined by the executive office health and human services | |
16 | may include: | |
17 | (1) Newly enrolled home health agencies that have not been medicare certified; | |
18 | (2) Newly enrolled durable medical equipment providers; | |
19 | (3) New or revalidating providers that have been categorized by the executive office of | |
20 | health and human services as high risk; | |
21 | (4) New or revalidating providers with payment suspension histories; | |
22 | (5) New or revalidating providers with office of inspector general exclusion histories; | |
23 | (6) New or revalidating providers with qualified overpayment histories; and, | |
24 | (7) New or revalidating providers applying for enrollment post debarment or moratorium | |
25 | (Federal or State-based) | |
26 | (d) Upon the state Medicaid agency determination that a provider or an applicant to become | |
27 | a provider, or a person with a five percent (5%) or more direct or indirect ownership interest in the | |
28 | provider, meets the executive office of health and human services’ criteria for criminal records | |
29 | checks as a “high” risk to the Medicaid program, the executive office of health and human services | |
30 | shall require that each such provider or applicant to become a provider undergo a national criminal | |
31 | records check supported by fingerprints. | |
32 | (e) The executive office of health and human services shall require such a “high risk” | |
33 | Medicaid provider or applicant to become a provider, or any person with a five percent (5%) or | |
34 | more direct or indirect ownership interest in the provider, to submit to a national criminal records | |
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1 | check supported by fingerprints within thirty (30) days upon request from the Centers for Medicare | |
2 | and Medicaid or the executive office of health and human services. | |
3 | (f) The Medicaid providers requiring the national criminal records check shall apply to the | |
4 | department of attorney general, bureau of criminal dentification (BCI) to be fingerprinted. The | |
5 | fingerprints will subsequently be transmitted to the federal bureau of investigation for a national | |
6 | criminal records check. The results of the national criminal records check shall be made available | |
7 | to the applicant undergoing a record check and submitting fingerprints. | |
8 | (g) Upon the discovery of any disqualifying information, as defined in § 42-7.2-18.2 and | |
9 | as in accordance with the regulations promulgated by the executive office of health and human | |
10 | services, the bureau of criminal identification of the department of the attorney general will inform | |
11 | the applicant, in writing, of the nature of the disqualifying information; and, without disclosing the | |
12 | nature of the disqualifying information, will notify the executive office of health and human | |
13 | services, in writing, that disqualifying information has been discovered. | |
14 | (h) In those situations, in which no disqualifying information has been found, the bureau | |
15 | of criminal identification of the department of the attorney general shall inform the applicant and | |
16 | the executive office of health and human services, in writing, of this fact. | |
17 | (i) The applicant shall be responsible for the cost of conducting the national criminal | |
18 | records check through the bureau of criminal identification of the department of attorney general. | |
19 | 42-7.2-18.2. Professional responsibility – Criminal records check disqualifying | |
20 | information for high-risk providers. | |
21 | (a) Information produced by a national criminal records check pertaining to conviction, for | |
22 | the following crimes will result in a letter to the executive office of health and human services , | |
23 | disqualifying the applicant from being a medicaid provider: murder, voluntary manslaughter, | |
24 | involuntary manslaughter, first degree sexual assault, second degree sexual assault, third degree | |
25 | sexual assault, assault on persons sixty (60) years of age or older, assault with intent to commit | |
26 | specified felonies (murder, robbery, rape, burglary, or the abominable and detestable crime against | |
27 | nature) felony assault, patient abuse, neglect or mistreatment of patients, burglary, first degree | |
28 | arson, robbery, felony drug offenses, felony larceny, or felony banking law violations, felony | |
29 | obtaining money under false pretenses, felony embezzlement, abuse, neglect and/or exploitation of | |
30 | adults with severe impairments, exploitation of elders, or a crime under section 1128 (a) of the | |
31 | Social Security Act (42 U.S.C. 1320a-7(a)). An applicant against whom disqualifying information | |
32 | has been found, for purposes of appeal, may provide a copy of the national criminal records check | |
33 | to the executive office of health and human services, who shall make a judgment regarding the | |
34 | approval of or the continued status of that person as a provider. | |
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1 | (b) For purposes of this section, “conviction” means, in addition to judgments of conviction | |
2 | entered by a court subsequent to a finding of guilty or a plea of guilty, those instances where the | |
3 | defendant has entered a plea of nolo contendere and has received a sentence of probation and those | |
4 | instances where a defendant has entered into a deferred sentence agreement with the attorney | |
5 | general. | |
6 | 42-7.2-18.3. Professional responsibility – Criminal records check for personal care | |
7 | aides. | |
8 | (a) Any person seeking employment to provide care to elderly or individuals with | |
9 | disabilities who is, or may be required to be, licensed, registered, trained or certified with | |
10 | the office of medicaid if that employment involves routine contact with elderly or | |
11 | individuals with disabilities without the presence of other employees, shall undergo a | |
12 | national criminal records check supported by fingerprints. The applicant will report to the | |
13 | office of attorney general, bureau of criminal identification to submit their fingerprints. | |
14 | The fingerprints will subsequently be submitted to the federal bureau of investigation (FBI) | |
15 | by the bureau of criminal identification of the office of attorney general. The national | |
16 | criminal records check shall be initiated prior to, or within one week of, employment. | |
17 | (b) The director of the office of medicaid may, by rule, identify those positions | |
18 | requiring criminal records checks. The identified employee, through the executive office | |
19 | of health and human services, shall apply to the bureau of criminal identification of the | |
20 | department of attorney general for a national criminal records check. Upon the discovery | |
21 | of any disqualifying information, as defined in § 42-7.2-18.4 and in accordance with the | |
22 | rule promulgated by the secretary of the executive office of health and human services, the | |
23 | bureau of criminal identification of the department of the attorney general will inform the | |
24 | applicant, in writing, of the nature of the disqualifying information; and, without disclosing | |
25 | the nature of the disqualifying information, will notify the executive office of health and | |
26 | human services executive office of health and human services in writing, that disqualifying | |
27 | information has been discovered. | |
28 | (c) An applicant against whom disqualifying information has been found, for purposes of | |
29 | appeal, may provide a copy of the national criminal history check to the executive office of health | |
30 | and human services, who shall make a judgment regarding the approval of the applicant. | |
31 | (d) In those situations, in which no disqualifying information has been found, the bureau | |
32 | of criminal identification of the department of the attorney general shall inform the applicant and | |
33 | the executive office health and human services, in writing, of this fact. | |
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1 | (e) The executive office of health and human services shall maintain on file | |
2 | evidence that criminal records checks have been initiated on all applicants subsequent to | |
3 | July 1, 2022. | |
4 | (f) The applicant shall be responsible for the cost of conducting the national | |
5 | criminal records check through the bureau of criminal identification of the department of | |
6 | the attorney general. | |
7 | 42-7.2-18.4. Professional responsibility – Criminal records check disqualifying | |
8 | information for personal care aides. | |
9 | (a) Information produced by a national criminal records check pertaining to conviction, for | |
10 | the following crimes will result in a letter to the applicant and the executive office of health and | |
11 | human services , disqualifying the applicant: murder, voluntary manslaughter, involuntary | |
12 | manslaughter, first degree sexual assault, second degree sexual assault, third degree sexual assault, | |
13 | assault on persons sixty (60) years of age or older, assault with intent to commit specified felonies | |
14 | (murder, robbery, rape, burglary, or the abominable and detestable crime against nature) felony | |
15 | assault, patient abuse, neglect or mistreatment of patients, burglary, first degree arson, robbery, | |
16 | felony drug offenses, felony larceny, or felony banking law violations, felony obtaining money | |
17 | under false pretenses, felony embezzlement, abuse, neglect and/or exploitation of adults with severe | |
18 | impairments, exploitation of elders, or a crime under section 1128(a) of the Social Security Act (42 | |
19 | U.S.C. 1320a-7(a)). | |
20 | (b) For purposes of this section, “conviction” means, in addition to judgments of conviction | |
21 | entered by a court subsequent to a finding of guilty or a plea of guilty, those instances where the | |
22 | defendant has entered a plea of nolo contendere and has received a sentence of probation and those | |
23 | instances where a defendant has entered into a deferred sentence agreement with the attorney | |
24 | general. | |
25 | SECTION 3. Section 23-17-38.1 of the General Laws in Chapter 23-17 entitled “Licensing | |
26 | of Health Care Facilities” is hereby amended to read as follows: | |
27 | 23-17-38.1. Hospitals — Licensing fee. (a) There is imposed a hospital licensing fee at | |
28 | the rate of six percent (6%) upon the net patient-services revenue of every hospital for the hospital's | |
29 | first fiscal year ending on or after January 1, 2018, except that the license fee for all hospitals | |
30 | located in Washington County, Rhode Island shall be discounted by thirty-seven percent (37%). | |
31 | The discount for Washington County hospitals is subject to approval by the Secretary of the U.S. | |
32 | Department of Health and Human Services of a state plan amendment submitted by the executive | |
33 | office of health and human services for the purpose of pursuing a waiver of the uniformity | |
34 | requirement for the hospital license fee. This licensing fee shall be administered and collected by | |
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1 | the tax administrator, division of taxation within the department of revenue, and all the | |
2 | administration, collection, and other provisions of Chapter 51 of title 44 shall apply. Every hospital | |
3 | shall pay the licensing fee to the tax administrator on or before July 13, 2020, and payments shall | |
4 | be made by electronic transfer of monies to the general treasurer and deposited to the general fund. | |
5 | Every hospital shall, on or before June 15, 2020, make a return to the tax administrator containing | |
6 | the correct computation of net patient-services revenue for the hospital fiscal year ending | |
7 | September 30, 2018, and the licensing fee due upon that amount. All returns shall be signed by the | |
8 | hospital's authorized representative, subject to the pains and penalties of perjury. | |
9 | (b) (a) There is also imposed a hospital licensing fee for state fiscal year 2021 against each | |
10 | hospital in the state. The hospital licensing fee is equal to five percent (5.0%) of the net patient- | |
11 | services revenue of every hospital for the hospital's first fiscal year ending on or after January 1, | |
12 | 2019, except that the license fee for all hospitals located in Washington County, Rhode Island shall | |
13 | be discounted by thirty-seven percent (37%). The discount for Washington County hospitals is | |
14 | subject to approval by the Secretary of the U.S. Department of Health and Human Services of a | |
15 | state plan amendment submitted by the executive office of health and human services for the | |
16 | purpose of pursuing a waiver of the uniformity requirement for the hospital license fee. This | |
17 | licensing fee shall be administered and collected by the tax administrator, division of taxation | |
18 | within the department of revenue, and all the administration, collection, and other provisions of | |
19 | Chapter 51 of title 44 shall apply. Every hospital shall pay the licensing fee to the tax administrator | |
20 | on or before July 13, 2021, and payments shall be made by electronic transfer of monies to the | |
21 | general treasurer and deposited to the general fund. Every hospital shall, on or before June 15, | |
22 | 2020, make a return to the tax administrator containing the correct computation of net patient- | |
23 | services revenue for the hospital fiscal year ending September 30, 2019, and the licensing fee due | |
24 | upon that amount. All returns shall be signed by the hospital's authorized representative, subject to | |
25 | the pains and penalties of perjury. | |
26 | (c) (b) There is also imposed a hospital licensing fee for state fiscal year 2022 against each | |
27 | hospital in the state. The hospital licensing fee is equal to five and seven hundred twenty-five | |
28 | thousandths percent (5.725%) of the net patient-services revenue of every hospital for the hospital's | |
29 | first fiscal year ending on or after January 1, 2020, except that the license fee for all hospitals | |
30 | located in Washington County, Rhode Island shall be discounted by thirty-seven percent (37%). | |
31 | The discount for Washington County hospitals is subject to approval by the Secretary of the U.S. | |
32 | Department of Health and Human Services of a state plan amendment submitted by the executive | |
33 | office of health and human services for the purpose of pursuing a waiver of the uniformity | |
34 | requirement for the hospital license fee. This licensing fee shall be administered and collected by | |
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1 | the tax administrator, division of taxation within the department of revenue, and all the | |
2 | administration, collection, and other provisions of Chapter 51 of title 44 shall apply. Every hospital | |
3 | shall pay the licensing fee to the tax administrator on or before July 13, 2022, and payments shall | |
4 | be made by electronic transfer of monies to the general treasurer and deposited to the general fund. | |
5 | Every hospital shall, on or before June 15, 2022, make a return to the tax administrator containing | |
6 | the correct computation of net patient-services revenue for the hospital fiscal year ending | |
7 | September 30, 2020, and the licensing fee due upon that amount. All returns shall be signed by the | |
8 | hospital's authorized representative, subject to the pains and penalties of perjury. | |
9 | (c) There is also imposed a hospital licensing fee for state fiscal year 2023 against each | |
10 | hospital in the state. The hospital licensing fee is equal to five and seven hundred twenty-five | |
11 | thousandths percent (5.725%) of the net patient-services revenue of every hospital for the hospital's | |
12 | first fiscal year ending on or after January 1, 2020, except that the license fee for all hospitals | |
13 | located in Washington County, Rhode Island shall be discounted by thirty-seven percent (37%). | |
14 | The discount for Washington County hospitals is subject to approval by the Secretary of the U.S. | |
15 | Department of Health and Human Services of a state plan amendment submitted by the executive | |
16 | office of health and human services for the purpose of pursuing a waiver of the uniformity | |
17 | requirement for the hospital license fee. This licensing fee shall be administered and collected by | |
18 | the tax administrator, division of taxation within the department of revenue, and all the | |
19 | administration, collection, and other provisions of Chapter 51 of title 44 shall apply. Every hospital | |
20 | shall pay the licensing fee to the tax administrator on or before July 13, 2023, and payments shall | |
21 | be made by electronic transfer of monies to the general treasurer and deposited to the general fund. | |
22 | Every hospital shall, on or before June 15, 2023, make a return to the tax administrator containing | |
23 | the correct computation of net patient-services revenue for the hospital fiscal year ending | |
24 | September 30, 2020, and the licensing fee due upon that amount. All returns shall be signed by the | |
25 | hospital's authorized representative, subject to the pains and penalties of perjury. | |
26 | (d) For purposes of this section the following words and phrases have the following | |
27 | meanings: | |
28 | (1) "Hospital" means the actual facilities and buildings in existence in Rhode Island, | |
29 | licensed pursuant to § 23-17-1 et seq. on June 30, 2010, and thereafter any premises included on | |
30 | that license, regardless of changes in licensure status pursuant to chapter 17.14 of title 23 (hospital | |
31 | conversions) and § 23-17-6(b) (change in effective control), that provides short-term acute inpatient | |
32 | and/or outpatient care to persons who require definitive diagnosis and treatment for injury, illness, | |
33 | disabilities, or pregnancy. Notwithstanding the preceding language, the negotiated Medicaid | |
34 | managed care payment rates for a court-approved purchaser that acquires a hospital through | |
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1 | receivership, special mastership, or other similar state insolvency proceedings (which court- | |
2 | approved purchaser is issued a hospital license after January 1, 2013) shall be based upon the newly | |
3 | negotiated rates between the court-approved purchaser and the health plan, and such rates shall be | |
4 | effective as of the date that the court-approved purchaser and the health plan execute the initial | |
5 | agreement containing the newly negotiated rate. The rate-setting methodology for inpatient hospital | |
6 | payments and outpatient hospital payments set forth in §§ 40-8-13.4(b) and 40-8-13.4(b)(2), | |
7 | respectively, shall thereafter apply to negotiated increases for each annual twelve-month (12) | |
8 | period as of July 1 following the completion of the first full year of the court-approved purchaser's | |
9 | initial Medicaid managed care contract. | |
10 | (2) "Gross patient-services revenue" means the gross revenue related to patient care | |
11 | services. | |
12 | (3) "Net patient-services revenue" means the charges related to patient care services less | |
13 | (i) Charges attributable to charity care; (ii) Bad debt expenses; and (iii) Contractual allowances. | |
14 | (e) The tax administrator shall make and promulgate any rules, regulations, and procedures | |
15 | not inconsistent with state law and fiscal procedures that he or she deems necessary for the proper | |
16 | administration of this section and to carry out the provisions, policy, and purposes of this section. | |
17 | (f) The licensing fee imposed by subsection (b) (a) shall apply to hospitals as defined herein | |
18 | that are duly licensed on July 1, 2020, and shall be in addition to the inspection fee imposed by § | |
19 | 23-17-38 and to any licensing fees previously imposed in accordance with this section. | |
20 | (g) The licensing fee imposed by subsection (c) (b) shall apply to hospitals as defined | |
21 | herein that are duly licensed on July 1, 2021, and shall be in addition to the inspection fee imposed | |
22 | by § 23-17-38 and to any licensing fees previously imposed in accordance with this section. | |
23 | (e) The licensing fee imposed by subsection (c) shall apply to hospitals as defined herein | |
24 | that are duly licensed on July 1, 2022, and shall be in addition to the inspection fee imposed by § | |
25 | 23-17-38 and to any licensing fees previously imposed in accordance with this section. | |
26 | SECTION 4. Sections 40-8.3-2 and 40-8.3-3 of the General Laws in Chapter 40-8.3 entitled | |
27 | “Uncompensated Care” are hereby amended to read as follows: | |
28 | 40-8.3-2. Definitions. | |
29 | As used in this chapter: | |
30 | (1) "Base year" means, for the purpose of calculating a disproportionate share payment for | |
31 | any fiscal year ending after September 30, 2020 2021, the period from October 1, 2018 2019, | |
32 | through September 30, 2019 2020, and for any fiscal year ending after September 30, 2021 2022, | |
33 | the period from October 1, 2019, through September 30, 2020. | |
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1 | (2) "Medicaid inpatient utilization rate for a hospital" means a fraction (expressed as a | |
2 | percentage), the numerator of which is the hospital's number of inpatient days during the base year | |
3 | attributable to patients who were eligible for medical assistance during the base year and the | |
4 | denominator of which is the total number of the hospital's inpatient days in the base year. | |
5 | (3) "Participating hospital" means any nongovernment and nonpsychiatric hospital that: | |
6 | (i) Was licensed as a hospital in accordance with chapter 17 of title 23 during the base year | |
7 | and shall mean the actual facilities and buildings in existence in Rhode Island, licensed pursuant to | |
8 | § 23-17-1 et seq. on June 30, 2010, and thereafter any premises included on that license, regardless | |
9 | of changes in licensure status pursuant to chapter 17.14 of title 23 (hospital conversions) and § 23- | |
10 | 17-6(b) (change in effective control), that provides short-term, acute inpatient and/or outpatient | |
11 | care to persons who require definitive diagnosis and treatment for injury, illness, disabilities, or | |
12 | pregnancy. Notwithstanding the preceding language, the negotiated Medicaid managed care | |
13 | payment rates for a court-approved purchaser that acquires a hospital through receivership, special | |
14 | mastership, or other similar state insolvency proceedings (which court-approved purchaser is issued | |
15 | a hospital license after January 1, 2013), shall be based upon the newly negotiated rates between | |
16 | the court-approved purchaser and the health plan, and the rates shall be effective as of the date that | |
17 | the court-approved purchaser and the health plan execute the initial agreement containing the newly | |
18 | negotiated rate. The rate-setting methodology for inpatient hospital payments and outpatient | |
19 | hospital payments set forth in §§ 40-8-13.4(b)(1)(ii)(C) and 40-8-13.4(b)(2), respectively, shall | |
20 | thereafter apply to negotiated increases for each annual twelve-month (12) period as of July 1 | |
21 | following the completion of the first full year of the court-approved purchaser's initial Medicaid | |
22 | managed care contract; | |
23 | (ii) Achieved a medical assistance inpatient utilization rate of at least one percent (1%) | |
24 | during the base year; and | |
25 | (iii) Continues to be licensed as a hospital in accordance with chapter 17 of title 23 during | |
26 | the payment year. | |
27 | (4) "Uncompensated-care costs" means, as to any hospital, the sum of: (i) The cost incurred | |
28 | by the hospital during the base year for inpatient or outpatient services attributable to charity care | |
29 | (free care and bad debts) for which the patient has no health insurance or other third-party coverage | |
30 | less payments, if any, received directly from such patients; and (ii) The cost incurred by the hospital | |
31 | during the base year for inpatient or outpatient services attributable to Medicaid beneficiaries less | |
32 | any Medicaid reimbursement received therefor; multiplied by the uncompensated-care index. | |
33 | (5) "Uncompensated-care index" means the annual percentage increase for hospitals | |
34 | established pursuant to § 27-19-14 [repealed] for each year after the base year, up to and including | |
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1 | the payment year; provided, however, that the uncompensated-care index for the payment year | |
2 | ending September 30, 2007, shall be deemed to be five and thirty-eight hundredths percent (5.38%), | |
3 | and that the uncompensated-care index for the payment year ending September 30, 2008, shall be | |
4 | deemed to be five and forty-seven hundredths percent (5.47%), and that the uncompensated-care | |
5 | index for the payment year ending September 30, 2009, shall be deemed to be five and thirty-eight | |
6 | hundredths percent (5.38%), and that the uncompensated-care index for the payment years ending | |
7 | September 30, 2010, September 30, 2011, September 30, 2012, September 30, 2013, September | |
8 | 30, 2014, September 30, 2015, September 30, 2016, September 30, 2017, September 30, 2018, | |
9 | September 30, 2019, September 30, 2020, September 30, 2021, and September 30, 2022, and | |
10 | September 30, 2023 shall be deemed to be five and thirty hundredths percent (5.30%). | |
11 | 40-8.3-3. Implementation. | |
12 | (a) For federal fiscal year 2020, commencing on October 1, 2019, and ending September | |
13 | 30, 2020, the executive office of health and human services shall submit to the Secretary of the | |
14 | United States Department of Health and Human Services a state plan amendment to the Rhode | |
15 | Island Medicaid DSH Plan to provide: | |
16 | (1) That the DSH Plan to all participating hospitals, not to exceed an aggregate limit of | |
17 | $142.4 million, shall be allocated by the executive office of health and human services to the Pool | |
18 | D component of the DSH Plan; and | |
19 | (2) That the Pool D allotment shall be distributed among the participating hospitals in direct | |
20 | proportion to the individual participating hospital's uncompensated-care costs for the base year, | |
21 | inflated by the uncompensated-care index to the total uncompensated-care costs for the base year | |
22 | inflated by the uncompensated-care index for all participating hospitals. The disproportionate share | |
23 | payments shall be made on or before July 13, 2020, and are expressly conditioned upon approval | |
24 | on or before July 6, 2020, by the Secretary of the United States Department of Health and Human | |
25 | Services, or his or her authorized representative, of all Medicaid state plan amendments necessary | |
26 | to secure for the state the benefit of federal financial participation in federal fiscal year 2020 for | |
27 | the disproportionate share payments. | |
28 | (b) (a) For federal fiscal year 2021, commencing on October 1, 2020, and ending | |
29 | September 30, 2021, the executive office of health and human services shall submit to the Secretary | |
30 | of the United States Department of Health and Human Services a state plan amendment to the | |
31 | Rhode Island Medicaid DSH Plan to provide: | |
32 | (1) That the DSH Plan to all participating hospitals, not to exceed an aggregate limit of | |
33 | $142.5 million, shall be allocated by the executive office of health and human services to the Pool | |
34 | D component of the DSH Plan; and | |
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1 | (2) That the Pool D allotment shall be distributed among the participating hospitals in direct | |
2 | proportion to the individual participating hospital's uncompensated-care costs for the base year, | |
3 | inflated by the uncompensated-care index to the total uncompensated-care costs for the base year | |
4 | inflated by the uncompensated-care index for all participating hospitals. The disproportionate share | |
5 | payments shall be made on or before July 12, 2021, and are expressly conditioned upon approval | |
6 | on or before July 5, 2021, by the Secretary of the United States department of health and human | |
7 | services, or his or her authorized representative, of all Medicaid state plan amendments necessary | |
8 | to secure for the state the benefit of federal financial participation in federal fiscal year 2021 for | |
9 | the disproportionate share payments. | |
10 | (c) (b) For federal fiscal year 2022, commencing on October 1, 2021, and ending | |
11 | September 30, 2022, the executive office of health and human services shall submit to the Secretary | |
12 | of the United States Department of Health and Human Services a state plan amendment to the | |
13 | Rhode Island Medicaid DSH Plan to provide: | |
14 | (1) That the DSH Plan to all participating hospitals, not to exceed an aggregate limit of | |
15 | $143.8 $142.5 million, shall be allocated by the executive office of health and human services to | |
16 | the Pool D component of the DSH Plan; and | |
17 | (2) That the Pool D allotment shall be distributed among the participating hospitals in direct | |
18 | proportion to the individual participating hospital's uncompensated-care costs for the base year, | |
19 | inflated by the uncompensated-care index to the total uncompensated-care costs for the base year | |
20 | inflated by the uncompensated-care index for all participating hospitals. The disproportionate share | |
21 | payments shall be made on or before July 12, 2022, and are expressly conditioned upon approval | |
22 | on or before July 5, 2022, by the Secretary of the United States Department of Health and Human | |
23 | Services, or his or her authorized representative, of all Medicaid state plan amendments necessary | |
24 | to secure for the state the benefit of federal financial participation in federal fiscal year 2022 for | |
25 | the disproportionate share payments. | |
26 | (c) For federal fiscal year 2023, commencing on October 1, 2022, and ending September | |
27 | 30, 2023, the executive office of health and human services shall submit to the Secretary of the | |
28 | United States Department of Health and Human Services a state plan amendment to the Rhode | |
29 | Island Medicaid DSH Plan to provide: | |
30 | (1) That the DSH Plan to all participating hospitals, not to exceed an aggregate limit of | |
31 | $142.5 million, shall be allocated by the executive office of health and human services to the Pool | |
32 | D component of the DSH Plan; and | |
33 | (2) That the Pool D allotment shall be distributed among the participating hospitals in direct | |
34 | proportion to the individual participating hospital's uncompensated-care costs for the base year, | |
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| |
1 | inflated by the uncompensated-care index to the total uncompensated-care costs for the base year | |
2 | inflated by the uncompensated-care index for all participating hospitals. The disproportionate share | |
3 | payments shall be made on or before July 12, 2023, and are expressly conditioned upon approval | |
4 | on or before July 5, 2023, by the Secretary of the United States Department of Health and Human | |
5 | Services, or his or her authorized representative, of all Medicaid state plan amendments necessary | |
6 | to secure for the state the benefit of federal financial participation in federal fiscal year 2023 for | |
7 | the disproportionate share payments. | |
8 | (d) No provision is made pursuant to this chapter for disproportionate-share hospital | |
9 | payments to participating hospitals for uncompensated-care costs related to graduate medical | |
10 | education programs. | |
11 | (e) The executive office of health and human services is directed, on at least a monthly | |
12 | basis, to collect patient-level uninsured information, including, but not limited to, demographics, | |
13 | services rendered, and reason for uninsured status from all hospitals licensed in Rhode Island. | |
14 | (f) [Deleted by P.L. 2019, ch. 88, art. 13, § 6.] | |
15 | SECTION 5. Section 40-8.19 of the General Laws in Chapter 40-8 entitled “Medical | |
16 | Assistance” is hereby amended to read as follows: | |
17 | 40-8-19. Rates of payment to nursing facilities. | |
18 | (a) Rate reform. | |
19 | (1) The rates to be paid by the state to nursing facilities licensed pursuant to chapter 17 of | |
20 | title 23, and certified to participate in Title XIX of the Social Security Act for services rendered to | |
21 | Medicaid-eligible residents, shall be reasonable and adequate to meet the costs that must be | |
22 | incurred by efficiently and economically operated facilities in accordance with 42 U.S.C. § | |
23 | 1396a(a)(13). The executive office of health and human services ("executive office") shall | |
24 | promulgate or modify the principles of reimbursement for nursing facilities in effect as of July 1, | |
25 | 2011, to be consistent with the provisions of this section and Title XIX, 42 U.S.C. § 1396 et seq., | |
26 | of the Social Security Act. | |
27 | (2) The executive office shall review the current methodology for providing Medicaid | |
28 | payments to nursing facilities, including other long-term-care services providers, and is authorized | |
29 | to modify the principles of reimbursement to replace the current cost-based methodology rates with | |
30 | rates based on a price-based methodology to be paid to all facilities with recognition of the acuity | |
31 | of patients and the relative Medicaid occupancy, and to include the following elements to be | |
32 | developed by the executive office: | |
33 | (i) A direct-care rate adjusted for resident acuity; | |
34 | (ii) An indirect-care rate comprised of a base per diem for all facilities; | |
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1 | (iii) A rearray of costs for all facilities every three (3) years beginning October, 2015, that | |
2 | may or may not result in automatic per diem revisions; | |
3 | (iv) Application of a fair-rental value system; | |
4 | (v) Application of a pass-through system; and | |
5 | (vi) Adjustment of rates by the change in a recognized national nursing home inflation | |
6 | index to be applied on October 1 of each year, beginning October 1, 2012. This adjustment will not | |
7 | occur on October 1, 2013, October 1, 2014, or October 1, 2015, but will occur on April 1, 2015. | |
8 | The adjustment of rates will also not occur on October 1, 2017, October 1, 2018, and October 1, | |
9 | 2019., and October 2022. Effective July 1, 2018, rates paid to nursing facilities from the rates | |
10 | approved by the Centers for Medicare and Medicaid Services and in effect on October 1, 2017, | |
11 | both fee-for-service and managed care, will be increased by one and one-half percent (1.5%) and | |
12 | further increased by one percent (1%) on October 1, 2018, and further increased by one percent | |
13 | (1%) on October 1, 2019. Effective October 1, 2022, rates paid to nursing facilities from the rates | |
14 | approved by the Centers for Medicare and Medicaid Services and in effect on October 1, 2021, | |
15 | both fee-for-service and managed care, will be increased by three percent (3%). In addition to the | |
16 | annual nursing home inflation index adjustment, there shall be a base rate staffing adjustment of | |
17 | one-half percent (0.5%) on October 1, 2021, one percent (1.0%) on October 1, 2022, and one and | |
18 | one-half percent (1.5%) on October 1, 2023. The inflation index shall be applied without regard for | |
19 | the transition factors in subsections (b)(1) and (b)(2). For purposes of October 1, 2016, adjustment | |
20 | only, any rate increase that results from application of the inflation index to subsections (a)(2)(i) | |
21 | and (a)(2)(ii) shall be dedicated to increase compensation for direct-care workers in the following | |
22 | manner: Not less than 85% of this aggregate amount shall be expended to fund an increase in wages, | |
23 | benefits, or related employer costs of direct-care staff of nursing homes. For purposes of this | |
24 | section, direct-care staff shall include registered nurses (RNs), licensed practical nurses (LPNs), | |
25 | certified nursing assistants (CNAs), certified medical technicians, housekeeping staff, laundry staff, | |
26 | dietary staff, or other similar employees providing direct-care services; provided, however, that this | |
27 | definition of direct-care staff shall not include: (i) RNs and LPNs who are classified as "exempt | |
28 | employees" under the federal Fair Labor Standards Act (29 U.S.C. § 201 et seq.); or (ii) CNAs, | |
29 | certified medical technicians, RNs, or LPNs who are contracted, or subcontracted, through a third- | |
30 | party vendor or staffing agency. By July 31, 2017, nursing facilities shall submit to the secretary, | |
31 | or designee, a certification that they have complied with the provisions of this subsection (a)(2)(vi) | |
32 | with respect to the inflation index applied on October 1, 2016. Any facility that does not comply | |
33 | with terms of such certification shall be subjected to a clawback, paid by the nursing facility to the | |
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1 | state, in the amount of increased reimbursement subject to this provision that was not expended in | |
2 | compliance with that certification. | |
3 | (3) Commencing on October 1, 2021, eighty percent (80%) of any rate increase that results | |
4 | from application of the inflation index to subsections (a)(2)(i) and (a)(2)(ii) of this section shall be | |
5 | dedicated to increase compensation for all eligible direct-care workers in the following manner on | |
6 | October 1, of each year. | |
7 | (i) For purposes of this subsection, compensation increases shall include base salary or | |
8 | hourly wage increases, benefits, other compensation, and associated payroll tax increases for | |
9 | eligible direct-care workers. This application of the inflation index shall apply for Medicaid | |
10 | reimbursement in nursing facilities for both managed care and fee-for-service. For purposes of this | |
11 | subsection, direct-care staff shall include registered nurses (RNs), licensed practical nurses (LPNs), | |
12 | certified nursing assistants (CNAs), certified medication technicians, licensed physical therapists, | |
13 | licensed occupational therapists, licensed speech-language pathologists, mental health workers | |
14 | who are also certified nurse assistants, physical therapist assistants, housekeeping staff, laundry | |
15 | staff, dietary staff or other similar employees providing direct-care services; provided, however | |
16 | that this definition of direct-care staff shall not include: | |
17 | (A) RNs and LPNs who are classified as "exempt employees" under the federal Fair Labor | |
18 | Standards Act (29 U.S.C. § 201 et seq.); or | |
19 | (B) CNAs, certified medication technicians, RNs or LPNs who are contracted or | |
20 | subcontracted through a third-party vendor or staffing agency. | |
21 | (4) (i) By July 31, 2021, and July 31 of each year thereafter, nursing facilities shall submit | |
22 | to the secretary or designee a certification that they have complied with the provisions of subsection | |
23 | (a)(3) of this section with respect to the inflation index applied on October 1. The executive office | |
24 | of health and human services (EOHHS) shall create the certification form nursing facilities must | |
25 | complete with information on how each individual eligible employee's compensation increased, | |
26 | including information regarding hourly wages prior to the increase and after the compensation | |
27 | increase, hours paid after the compensation increase, and associated increased payroll taxes. A | |
28 | collective bargaining agreement can be used in lieu of the certification form for represented | |
29 | employees. All data reported on the compliance form is subject to review and audit by EOHHS. | |
30 | The audits may include field or desk audits, and facilities may be required to provide additional | |
31 | supporting documents including, but not limited to, payroll records. | |
32 | (ii) Any facility that does not comply with the terms of certification shall be subjected to a | |
33 | clawback and twenty-five percent (25%) penalty of the unspent or impermissibly spent funds, paid | |
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| |
1 | by the nursing facility to the state, in the amount of increased reimbursement subject to this | |
2 | provision that was not expended in compliance with that certification. | |
3 | (iii) In any calendar year where no inflationary index is applied, eighty percent (80%) of | |
4 | the base rate staffing adjustment in that calendar year pursuant to subsection (a)(2)(vi) of this | |
5 | section shall be dedicated to increase compensation for all eligible direct-care workers in the | |
6 | manner referenced in subsections (a)(3)(i), (a)(3)(i)(A), and (a)(3)(i)(B) of this section. | |
7 | (b) Transition to full implementation of rate reform. For no less than four (4) years after | |
8 | the initial application of the price-based methodology described in subsection (a)(2) to payment | |
9 | rates, the executive office of health and human services shall implement a transition plan to | |
10 | moderate the impact of the rate reform on individual nursing facilities. The transition shall include | |
11 | the following components: | |
12 | (1) No nursing facility shall receive reimbursement for direct-care costs that is less than | |
13 | the rate of reimbursement for direct-care costs received under the methodology in effect at the time | |
14 | of passage of this act; for the year beginning October 1, 2017, the reimbursement for direct-care | |
15 | costs under this provision will be phased out in twenty-five-percent (25%) increments each year | |
16 | until October 1, 2021, when the reimbursement will no longer be in effect; and | |
17 | (2) No facility shall lose or gain more than five dollars ($5.00) in its total, per diem rate the | |
18 | first year of the transition. An adjustment to the per diem loss or gain may be phased out by twenty- | |
19 | five percent (25%) each year; except, however, for the years beginning October 1, 2015, there shall | |
20 | be no adjustment to the per diem gain or loss, but the phase out shall resume thereafter; and | |
21 | (3) The transition plan and/or period may be modified upon full implementation of facility | |
22 | per diem rate increases for quality of care-related measures. Said modifications shall be submitted | |
23 | in a report to the general assembly at least six (6) months prior to implementation. | |
24 | (4) Notwithstanding any law to the contrary, for the twelve-month (12) period beginning | |
25 | July 1, 2015, Medicaid payment rates for nursing facilities established pursuant to this section shall | |
26 | not exceed ninety-eight percent (98%) of the rates in effect on April 1, 2015. Consistent with the | |
27 | other provisions of this chapter, nothing in this provision shall require the executive office to restore | |
28 | the rates to those in effect on April 1, 2015, at the end of this twelve-month (12) period. | |
29 | SECTION 6. Section 40-8.9-4 of the General Laws in Chapter 40-8.9 entitled “Medical | |
30 | Assistance — Long-Term Care Service and Finance Reform” is hereby amended to read as follows: | |
31 | 40-8.9-4. Unified long-term care budget. | |
32 | Beginning on July 1, 2007, but not including state fiscal year 2023, a unified long-term-care | |
33 | budget shall combine in a single, line-item appropriation within the executive office of health and | |
34 | human services (executive office), annual executive office Medicaid appropriations for nursing | |
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1 | facility and community-based, long-term-care services for elderly sixty-five (65) years and older | |
2 | and younger persons at risk of nursing home admissions (including adult day care, home health, | |
3 | PACE, and personal care in assisted-living settings). Beginning on July 1, 2007, but not including | |
4 | state fiscal year 2023, the total system savings attributable to the value of the reduction in nursing | |
5 | home days including hospice nursing home days paid for by Medicaid shall be allocated in the | |
6 | budget enacted by the general assembly for the ensuing fiscal year for the express purpose of | |
7 | promoting and strengthening community-based alternatives; provided, further, beginning July 1, | |
8 | 2009, but not including state fiscal year 2023, said savings shall be allocated within the budgets | |
9 | of the executive office and, as appropriate, the department of human services, office of healthy | |
10 | aging. The allocation shall include, but not be limited to, funds to support an ongoing, statewide | |
11 | community education and outreach program to provide the public with information on home and | |
12 | community services and the establishment of presumptive eligibility criteria for the purposes of | |
13 | accessing home and community care. Notwithstanding the foregoing, for state fiscal year 2023, | |
14 | enhanced federal medical assistance percentage funding provided through the American Rescue | |
15 | Plan Act (ARPA) specifically for enhancement and expansion of home and community-based | |
16 | (HCBS) services, may be used to satisfy the total system savings reallocation to strengthening | |
17 | community-based alternatives and funding requirements of this section. The home- and | |
18 | community-care service presumptive eligibility criteria shall be developed through rule or | |
19 | regulation on or before September 30, 2007. The allocation may also be used to fund home and | |
20 | community services provided by the office of healthy aging for persons eligible for Medicaid | |
21 | long-term care, and the co-pay program administered pursuant to chapter 66.3 of title 42. Any | |
22 | monies in the allocation that remain unexpended in a fiscal year shall be carried forward to the | |
23 | next fiscal year for the express purpose of strengthening community-based alternatives. | |
24 | The caseload estimating conference pursuant to § 35-17-1 shall determine the amount of | |
25 | general revenues to be added to the current service estimate of community-based, long-term-care | |
26 | services for elderly sixty-five (65) and older and younger persons at risk of nursing home | |
27 | admissions for the ensuing budget year by multiplying the combined, cost per day of nursing home | |
28 | and hospice nursing home days estimated at the caseload conference for that year by the reduction | |
29 | in nursing home and hospice nursing home days from those in the second fiscal year prior to the | |
30 | current fiscal year to those in the first fiscal year prior to the current fiscal year. | |
31 | SECTION 7. Sections 42-12.3-3, 42-12.3-4 and 42-12.3-15 of the General Laws in Chapter | |
32 | 42-12.3 “Health Care for Children and Pregnant Women” are hereby amended to read as follows: | |
33 | 42-12.3-3. Medical assistance expansion for pregnant women/RIte Start. | |
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| |
1 | (a) The director of the department of human services secretary of the executive office of | |
2 | health and human services is authorized to amend its Title XIX state plan pursuant to Title XIX of | |
3 | the Social Security Act to provide Medicaid coverage and to amend its Title XXI state plan pursuant | |
4 | to Title XXI of the Social Security Act to provide medical assistance coverage through expanded | |
5 | family income disregards for pregnant women whose family income levels are between one | |
6 | hundred eighty-five percent (185%) and two hundred fifty percent (250%) of the federal poverty | |
7 | level. The department is further authorized to promulgate any regulations necessary and in accord | |
8 | with Title XIX [42 U.S.C. § 1396 et seq.] and Title XXI [ 42 U.S.C. § 1397aa et seq.] of the Social | |
9 | Security Act necessary in order to implement said state plan amendment. The services provided | |
10 | shall be in accord with Title XIX [ 42 U.S.C. § 1396 et seq.] and Title XXI [ 42 U.S.C. § 1397aa | |
11 | et seq.] of the Social Security Act. | |
12 | (b) The director of the department of human services secretary of health and human | |
13 | services is authorized and directed to establish a payor of last resort program to cover prenatal, | |
14 | delivery and postpartum care. The program shall cover the cost of maternity care for any woman | |
15 | who lacks health insurance coverage for maternity care and who is not eligible for medical | |
16 | assistance under Title XIX [42 U.S.C. § 1396 et seq.] and Title XXI [ 42 U.S.C. § 1397aa et seq.] | |
17 | of the Social Security Act including, but not limited to, a noncitizen pregnant woman lawfully | |
18 | admitted for permanent residence on or after August 22, 1996, without regard to the availability of | |
19 | federal financial participation, provided such pregnant woman satisfies all other eligibility | |
20 | requirements. The director secretary shall promulgate regulations to implement this program. Such | |
21 | regulations shall include specific eligibility criteria; the scope of services to be covered; procedures | |
22 | for administration and service delivery; referrals for non-covered services; outreach; and public | |
23 | education. Excluded services under this subsection will include, but not be limited to, induced | |
24 | abortion except in cases of rape or incest or to save the life of the pregnant individual. | |
25 | (c) The department of human services secretary of health and human services may enter | |
26 | into cooperative agreements with the department of health and/or other state agencies to provide | |
27 | services to individuals eligible for services under subsections (a) and (b) above. | |
28 | (d) The following services shall be provided through the program: | |
29 | (1) Ante-partum and postpartum care; | |
30 | (2) Delivery; | |
31 | (3) Cesarean section; | |
32 | (4) Newborn hospital care; | |
33 | (5) Inpatient transportation from one hospital to another when authorized by a medical | |
34 | provider; and | |
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1 | (6) Prescription medications and laboratory tests. | |
2 | (e) The department of human services secretary of health and human services shall provide | |
3 | enhanced services, as appropriate, to pregnant women as defined in subsections (a) and (b), as well | |
4 | as to other pregnant women eligible for medical assistance. These services shall include: care | |
5 | coordination, nutrition and social service counseling, high risk obstetrical care, childbirth and | |
6 | parenting preparation programs, smoking cessation programs, outpatient counseling for drug- | |
7 | alcohol use, interpreter services, mental health services, and home visitation. The provision of | |
8 | enhanced services is subject to available appropriations. In the event that appropriations are not | |
9 | adequate for the provision of these services, the department executive office has the authority to | |
10 | limit the amount, scope and duration of these enhanced services. | |
11 | (f) The department of human services executive office of health and human services shall | |
12 | provide for extended family planning services for up to twenty-four (24) months postpartum. These | |
13 | services shall be available to women who have been determined eligible for RIte Start or for | |
14 | medical assistance under Title XIX [42 U.S.C. § 1396 et seq.] or Title XXI [ 42 U.S.C. § 1397aa | |
15 | et seq.] of the Social Security Act. | |
16 | (g) Effective October 1, 2022, individuals eligible for RIte Start pursuant to this section or | |
17 | for medical assistance under Title XIX or Title XXI of the Social Security Act while pregnant | |
18 | (including during a period of retroactive eligibility), are eligible for full Medicaid benefits through | |
19 | the last day of the month in which their twelve (12) month postpartum period ends. This benefit | |
20 | will be provided to eligible Rhode Island residents without regard to the availability of federal | |
21 | financial participation. The executive office of health and human services is directed to ensure that | |
22 | federal financial participation is used to the maximum extent allowable to provide coverage | |
23 | pursuant to this section, and that state-only funds will be used only if federal financial participation | |
24 | is not available. | |
25 | 42-12.3-4. "RIte track" program. | |
26 | (a) There is hereby established a payor of last resort program for comprehensive health | |
27 | care for children until they reach nineteen (19) years of age, to be known as "RIte track." The | |
28 | department of human services executive office of health and human services is hereby authorized | |
29 | to amend its Title XIX state plan pursuant to Title XIX [42 U.S.C. § 1396 et seq.] and Title XXI [ | |
30 | 42 U.S.C. § 1397aa et seq.] of the Social Security Act as necessary to provide for expanded | |
31 | Medicaid coverage through expanded family income disregards for children, until they reach | |
32 | nineteen (19) years of age, whose family income levels are up to two hundred fifty percent (250%) | |
33 | of the federal poverty level. Provided, however, that healthcare coverage provided under this | |
34 | section shall also be provided without regard to the availability of federal financial participation in | |
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| |
1 | accordance to Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq., to a noncitizen child | |
2 | who is a resident of Rhode Island lawfully residing in the United States, and who is otherwise | |
3 | eligible for such assistance. The department is further authorized to promulgate any regulations | |
4 | necessary, and in accord with Title XIX [42 U.S.C. § 1396 et seq.] and Title XXI [ 42 U.S.C. § | |
5 | 1397aa et seq.] of the Social Security Act as necessary in order to implement the state plan | |
6 | amendment. For those children who lack health insurance, and whose family incomes are in excess | |
7 | of two hundred fifty percent (250%) of the federal poverty level, the department of human services | |
8 | shall promulgate necessary regulations to implement the program. The department of human | |
9 | services is further directed to ascertain and promulgate the scope of services that will be available | |
10 | to those children whose family income exceeds the maximum family income specified in the | |
11 | approved Title XIX [42 U.S.C. § 1396 et seq.] and Title XXI [ 42 U.S.C. § 1397aa et seq.] state | |
12 | plan amendment. | |
13 | (b) The executive office of health and human services is directed to ensure that federal | |
14 | financial participation is used to the maximum extent allowable to provide coverage pursuant to | |
15 | this section, and that state-only funds will be used only if federal financial participation is not | |
16 | available. | |
17 | 42-12.3-15. Expansion of RIte track program. | |
18 | (a) The Department of Human Services executive office of health and human services is | |
19 | hereby authorized and directed to submit to the United States Department of Health and Human | |
20 | Services an amendment to the "RIte Care" waiver project number 11-W-0004/1-01 to provide for | |
21 | expanded Medicaid coverage for children until they reach eight (8) years of age, whose family | |
22 | income levels are to two hundred fifty percent (250%) of the federal poverty level. Expansion of | |
23 | the RIte track program from the age of six (6) until they reach eighteen (18) years of age in | |
24 | accordance with this chapter shall be subject to the approval of the amended waiver by the United | |
25 | States Department of Health and Human Services. Healthcare coverage under this section shall also | |
26 | be provided to a noncitizen child lawfully residing in the United States who is a resident of Rhode | |
27 | Island, and who is otherwise eligible for such assistance under Title XIX [42 U.S.C. § 1396 et seq.] | |
28 | or Title XXI [ 42 U.S.C. § 1397aa et seq.] | |
29 | (b) The executive office of health and human services is directed to ensure that federal | |
30 | financial participation is used to the maximum extent allowable to provide coverage pursuant to | |
31 | this section, and that state-only funds will be used only if federal financial participation is not | |
32 | available. | |
33 | SECTION 8. Rhode Island Medicaid Reform Act of 2008 Resolution. | |
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| |
1 | WHEREAS, the General Assembly enacted Chapter 12.4 of Title 42 entitled “The Rhode | |
2 | Island Medicaid Reform Act of 2008”; and | |
3 | WHEREAS, a legislative enactment is required pursuant to Rhode Island General Laws | |
4 | 42-12.4-1, et seq.; and | |
5 | WHEREAS, Rhode Island General Laws section 42-7.2-5(3)(i) provides that the Secretary | |
6 | of the Executive Office of Health and Human Services (“Executive Office”) is responsible for the | |
7 | review and coordination of any Medicaid section 1115 demonstration waiver requests and renewals | |
8 | as well as any initiatives and proposals requiring amendments to the Medicaid state plan or category | |
9 | II or III changes as described in the demonstration, “with potential to affect the scope, amount, or | |
10 | duration of publicly-funded health care services, provider payments or reimbursements, or access | |
11 | to or the availability of benefits and services provided by Rhode Island general and public laws”; | |
12 | and | |
13 | WHEREAS, in pursuit of a more cost-effective consumer choice system of care that is | |
14 | fiscally sound and sustainable, the Secretary requests legislative approval of the following | |
15 | proposals to amend the demonstration; and | |
16 | WHEREAS, implementation of adjustments may require amendments to the Rhode | |
17 | Island’s Medicaid state plan and/or section 1115 waiver under the terms and conditions of the | |
18 | demonstration. Further, adoption of new or amended rules, regulations and procedures may also | |
19 | be required: | |
20 | (a) Section 1115 Demonstration Waiver – Extension Request. The Executive Office | |
21 | proposes to seek approval from the federal centers for Medicare and Medicaid services (“CMS”) | |
22 | to extend the Medicaid section 1115 demonstration waiver as authorized in Rhode Island General | |
23 | Laws § 42-12.4. In the Medicaid section 1115 demonstration waiver extension request due to CMS | |
24 | by December 31, 2022, in addition to maintaining existing Medicaid section 1115 demonstration | |
25 | waiver authorities, the Executive Office proposes to seek additional federal authorities including | |
26 | but not limited to promoting choice and community integration. | |
27 | (b) Meals on Wheels. The Executive Office proposes an increase to existing fee-for-service | |
28 | and managed care rates to account for growing utilization and rising food and delivery costs. | |
29 | Additionally, the Executive Office of Health and Human Services will offer new Medicaid | |
30 | reimbursement for therapeutic and cultural meals that are specifically tailored to improve health | |
31 | through nutrition, provide post discharge support, and bolster complex care management for those | |
32 | with chronic health conditions. To ensure the continued adequacy of rates, effective July 1, 2022, | |
33 | and annually thereafter, the Executive Office proposes an annual rate increase based on the CPI-U | |
34 | for New England: Food at Home, March release (containing the February data). | |
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| |
1 | (c) American Rescue Act. The Executive Office proposes to seek approval from CMS for | |
2 | any necessary amendments to the Rhode Island State Plan or the 1115 Demonstration Waiver to | |
3 | implement the spending plan approved by CMS under section 9817 of the American Rescue Plan | |
4 | Act of 2021. | |
5 | (d) HealthSource RI automatic enrollment: The Executive Office shall work with | |
6 | HealthSource RI to establish a program for automatically enrolling qualified individuals who lose | |
7 | Medicaid coverage at the end of the COVID-19 Public Health Emergency into Qualified Health | |
8 | Plans (“QHP”). HealthSource RI may use funds available through the American Rescue Plan Act | |
9 | to pay the first month’s premium for individuals who qualify for this program. HealthSource RI | |
10 | may promulgate regulations establishing the scope and parameters of this program. | |
11 | (e) Increase Nursing Facility Rates. The Executive Office proposes to increase rates, both | |
12 | fee-for-service and managed care, paid to nursing facilities by three percent (3.0%) on October 1, | |
13 | 2022, in lieu of the adjustment of rates by the change in a recognized national home inflation index | |
14 | as defined in § 40-8-19 (2)(vi) and in addition to the one percent (1.0%) increase required for the | |
15 | minimum wage pass through as defined in § 40-8-19 (2)(vi). | |
16 | (f) Extend Post-Partum Medicaid Coverage. The Executive Office proposes extending the | |
17 | continuous coverage of full benefit medical assistance from sixty (60) days to twelve (12) months | |
18 | postpartum to women who are (1) not eligible for Medicaid under another Medicaid eligibility | |
19 | category, or (2) do not have qualified immigrant status for Medicaid whose births are financed by | |
20 | Medicaid through coverage of the child and currently only receive state-only extended family | |
21 | planning benefits postpartum. | |
22 | (g) Extending Medical Coverage to Children Previously Ineligible. The executive office of | |
23 | health and human services will maximize federal financial participation if and when available, | |
24 | though state-only funds will be used if federal financial participation is not available. | |
25 | (h) Federal Financing Opportunities. The Executive Office proposes to review Medicaid | |
26 | requirements and opportunities under the U.S. Patient Protection and Affordable Care Act of 2010 | |
27 | (PPACA) and various other recently enacted federal laws and pursue any changes in the Rhode | |
28 | Island Medicaid program that promote service quality, access and cost-effectiveness that may | |
29 | warrant a Medicaid state plan amendment or amendment under the terms and conditions of Rhode | |
30 | Island’s section 1115 waiver, its successor, or any extension thereof. Any such actions by the | |
31 | Executive Office shall not have an adverse impact on beneficiaries or cause there to be an increase | |
32 | in expenditures beyond the amount appropriated for state fiscal year 2021. | |
33 | Now, therefore, be it: | |
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1 | RESOLVED, that the General Assembly hereby approves the proposals stated above in the | |
2 | recitals; and be it further; | |
3 | RESOLVED, that the Secretary of the Executive Office of Health and Human Services is | |
4 | authorized to pursue and implement any waiver amendments, state plan amendments, and/or | |
5 | changes to the applicable department’s rules, regulations and procedures approved herein and as | |
6 | authorized by 42-12.4; and be it further; | |
7 | RESOLVED, that this Joint Resolution shall take effect upon passage. | |
8 | SECTION 9. Sections 1 – 7 of this Article shall take effect as of July 1, 2022. Section 8 | |
9 | shall take effect upon passage. | |
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