2022 -- H 7179

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LC003814

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2022

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A N   A C T

RELATING TO HUMAN SERVICES -- MEDICAL ASSISTANCE

     

     Introduced By: Representatives Place, Filippi, Fenton-Fung, and Nardone

     Date Introduced: January 26, 2022

     Referred To: House Finance

     It is enacted by the General Assembly as follows:

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     SECTION 1. Chapter 40-8 of the General Laws entitled "Medical Assistance" is hereby

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amended by adding thereto the following section:

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     40-8-33. Community medical services.

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     (a) The executive office of health and human services (EOHHS) shall adopt and implement

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a methodology for medical assistance reimbursement for services provided by licensed medical

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service providers acting in their capacity as community medical service providers, to include

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physicians, nurses, physician assistants, paramedics, and emergency medical technicians when

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services are provided in accordance with this section to eligible recipients pursuant to the provisions

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of ยง 40-8-3.

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     (b) An eligible recipient shall be qualified for coverage pursuant to this section, if as an

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individual they have received hospital emergency department services three (3) or more times in a

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period of four (4) consecutive months in the past twelve (12) months or have been identified by the

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individual's primary health care provider for whom community medical services, as provided in

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subsection (c) of this section, would likely prevent admission to or would allow discharge from a

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nursing facility; or would likely prevent readmission to a hospital or nursing facility.

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     (c) Payment for services provided by a community medical service provider pursuant to

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this section shall be a part of a care plan ordered by a primary health care provider and must be

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billed by an eligible provider enrolled in medical assistance that employs or contracts with the

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community medical service provider. The care plan must ensure that the services provided by a

 

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community medical service provider are coordinated with other community health providers and

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local public health agencies, and that the community medical services do not duplicate services

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already provided to the patient, including existing home health care or waiver services. Community

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medical services shall include health assessment, chronic disease monitoring and education,

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medication compliance, immunizations and vaccinations, laboratory specimen collection, hospital

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discharge follow-up care, and minor medical procedures approved by the director of the department

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of health.

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     (d) Services provided by a community medical service provider to an eligible recipient who

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is also receiving care coordination services must be in consultation with the providers of the

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recipient's care coordination services.

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     (e) Nothing in this section shall be construed to authorize any medical service provider to

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provide services beyond or outside the scope of their training or license authorization.

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     (f) The director of the department of health may promulgate rules and regulations to

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implement the method and manner of health care services to be provided pursuant to the provisions

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of this section.

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     (g) The department of human services or EOHHS shall seek federal approval to implement

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the provision of this section.

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     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 HUMAN SERVICES -- MEDICAL ASSISTANCE

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     This act would provide medical assistance coverage for medical services provided to

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qualifying eligible recipients for community-based care. The department of human services or

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EOHHS would seek federal approval to implement the provisions of the act.

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     This act would take effect upon passage.

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