2022 -- H 7180

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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 -- SOCIAL AND HUMAN SERVICES PROGRAMS

RATE REVIEW AND RATE SETTING PROCESS ACT OF 2022

     

     Introduced By: Representatives Casimiro, Ruggiero, Noret, Cortvriend, McEntee, Alzate,
Kazarian, Roberts, Fenton-Fung, and Felix

     Date Introduced: January 26, 2022

     Referred To: House Finance

     It is enacted by the General Assembly as follows:

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     SECTION 1. Title 40 of the General Laws entitled "HUMAN SERVICES" is hereby

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amended by adding thereto the following chapter:

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CHAPTER 23

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SOCIAL AND HUMAN SERVICES PROGRAMS RATE REVIEW AND RATE SETTING

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ACT OF 2022

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     40-23-1. Definitions.

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     As used in this chapter:

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     (1) "Rate review" means the process of reviewing and reporting of specific trending factors

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that influence the cost of service that informs rate setting.

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     (2) "Rate setting" means the process of establishing rates for social and human service

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programs that are based on a thorough rate review process.

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     (3) "Social and human service program" means a social, mental health, developmental

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disability, child welfare, juvenile justice, prevention services, habilitative, rehabilitative, substance

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use disorder treatment, residential care, adult or adolescent day services, vocational, employment

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and training, or aging service program or accommodations purchased by the state, excluding any

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program, service, or accommodation that is reimbursable exclusively by a federal grant.

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     (4) "Social and human service provider" means a provider of social and human service

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programs pursuant to a contract with the state or any subdivision or agency to include, but not

 

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limited to, the department of children, youth and families (DCYF), the department of behavioral

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healthcare, developmental disabilities, and hospitals (BHDDH), department of human services

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(DHS), department of health (DOH) and Medicaid.

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     40-23-2. Social and human service program rate review and rate reform.

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

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comprehensive rate review of all social and human service programs pursuant to having a contract

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with or licensed by the state or any subdivision of the department of children, youth and families

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(DCYF), the department of behavioral healthcare, developmental disabilities, and hospitals

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(BHDDH), department of human services (DHS), department of health (DOH) and Medicaid for

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the purposes of:

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     (1) Establishing a baseline understanding of reimbursement rates for all social and human

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service programs;

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     (2) Ensuring accurate and adequate reimbursement to social and human service providers

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that facilitate the availability of high-quality services to individuals receiving home and

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community-based long-term services and supports provided by social and human service providers;

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and

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     (3) Ensuring the general assembly is informed and provided accurate financial projections

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on social and human service program costs, demand for services, and workforce needs to ensure

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access to entitled beneficiaries and services.

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     40-23-3. Assessment and detailed reporting of current rates -- Collaboration of

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departments and advisory committee.

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     (a) EOHHS shall work in collaboration with the department of children, youth and families

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(DCYF), the department of behavioral healthcare, developmental disabilities, and hospitals

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(BHDDH), department of human services (DHS), department of health (DOH) and Medicaid and

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the advisory committee established in § 40-23-4 to assess current rates for social and human service

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programs. This assessment shall include, but is not limited to, the following information and report

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development:

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     (1) Assessment and detailed reporting on all social and human service program rates to be

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completed by October 1, 2022;

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     (2) Assessment and detailed reporting on eligible social and human service programs to be

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completed by October 1, 2022;

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     (3) Assessment and detailed reporting on utilization trends from the period of January 1,

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2017 through December 31, 2021 for social and human service programs to be completed by

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October 31, 2022;

 

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     (4) Assessment and detailed reporting on all rate methodology and rationale for established

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rates as of January 1, 2023, for social and human service programs;

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     (5) Assessment and detailed reporting on social and human service provider reported cost

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of established rates for services and contracts by January 1, 2023 for social and human service

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programs as of December 31, 2021;

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     (6) Assessment and detailed reporting by January 1, 2023 on all professional licensed and

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unlicensed personnel requirements for established rates for social and human service programs

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pursuant to a contract or established fee schedule;

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     (7) Assessment and reporting on access to social and human service programs, to include

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any wait lists and length of time on wait lists, in each service category by January 1, 2023.

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     (8) Assessment and reporting that includes comparable rates paid regionally for similar

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social and human service providers by January 1, 2023;

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     (9) Assessment and reporting of national Medicaid rates in comparison to Rhode Island

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social and human service provider rates by January 1, 2023; and

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     (10) Assessment and reporting on usual and customary rates paid by private insurers and

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private pay for similar social and human service providers by January 1, 2023;

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     (b) Detailed reports of this assessment will be submitted to the advisory committee, the

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speaker of the house, president of the senate, governor, senate finance committee, house finance

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committee, house fiscal advisor, senate fiscal advisor, and director of the office of management and

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budget on or before March 1, 2023, and biennially thereafter.

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     40-23-4. Advisory committee

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     (a) There is hereby established the social and human services provider rate review and rate

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setting advisory committee, referred to in this section as the "advisory committee." The purpose of

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this advisory committee is to provide expert review and recommendations for the process of rate

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setting and ongoing review of rate setting. The advisory committee shall:

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     (1) Review documents, reports, assumptions, and fiscal data for annual rate review

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assessment within thirty (30) days of receipt;

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     (2) Define and establish consistent policy and methods for standardized service rate

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development, for the purposes of conducting a biennial "rate setting" in coordination with EOHHS

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by July 1, 2023 to ensure payments are consistent with efficiency, economy, and quality of care in

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order to enlist enough social and human service providers in order that care and services are

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available for beneficiaries and/or eligible persons. The biennial rate setting will be consistent with

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payment requirements established in §1902(a)(30)(A) of the Social Security Act and all federal,

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and state law, regulations and quality and safety standards. The rate setting process must include,

 

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but is not that limited to, industry standard methodology(ies); industry standard cost based

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assumptions, access to service benchmarks, relevant regional and national economic inflationary

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index, regional labor market indicators and benchmarks, Centers for Medicaid and Medicare

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Services (CMS) market basket indicators for relevant services, state mandated regulations and

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requirements of social and human service providers, triggers for adjustments according to projected

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trends, for the purposes of pricing of social and human service program rates. Proposed rates will

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be published by January 1, 2024 and effective no later than July 1, 2024;

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     (3) With the EOHHS, conduct public meetings to allow providers, recipients, and other

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interested parties an opportunity to comment on the report required by the provisions of this section;

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     (4) Review petitions or proposals for provider rates to be reviewed or adjusted that are

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received by the advisory committee from EOHHS pursuant to the provisions of subsection (a) of

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this section; and

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     (5) Prepare written recommendations to the governor, the speaker of the house, and

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president of the senate as to all changes to the process of reviewing provider rates, including

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measures to increase access to the process such as by providing for electronic comments by

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providers and the public.

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     (b) The advisory committee, may, by a majority vote, recommend to the EOHHS to include

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any rate that the EOHHS has selected to exclude or remove any rate that EOHHS has selected for

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inclusion from the schedule pursuant to this section:

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     (1) Determine whether any provider rates not scheduled for review during the next calendar

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year should be recommended for review during that calendar year; and

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     (2) Provide other assistance to the EOHHS and HHS agencies as requested.

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     (c) On or before November 1, 2022, and each November 1 thereafter, EOHHS shall submit

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a written report to the speaker of the house, the president of the senate, the governor and the

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advisory committee containing its determinations on all the provider rates reviewed pursuant to this

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section and all of the data relied upon by the EOHHS in making its determinations for rate setting.

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EOHHS shall prepare proposed projections of cost associated with biennial rate setting for social

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and human service programs.

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     (d) The advisory committee shall consist of the following twenty-four (24) members:

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     (1) The following members appointed by the senate president and the speaker of the house:

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     (i) Four (4) providers of social and human service programs, at least one of whom is a long-

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term care home care provider, with two (2) to be appointed by the senate president and two (2) to

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be appointed by the speaker of the house, two (2) recipients, or designees of the recipients of social

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and human service programs, one to be appointed by the senate president and one to be appointed

 

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by the speaker of the house, four (4) experts with relevant rate setting expertise (such as economists,

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actuarialists, billing experts, policy experts), two (2) to be appointed by the senate president and

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two (2) to be appointed by the speaker of the house, two (2) senators to be appointed by the senate

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president, one from each political party, and two (2) representatives appointed by the speaker of

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the house, one from each political party,

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     (ii) The following additional ten (10) members to be appointed by the secretary of EOHHS

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as follows:

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     (A) A representative of the developmental disability council;

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     (B) A representative of the mental health association;

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     (C) A representative of the child advocate office;

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     (D) A representative of the Rhode Island parent information network;

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     (E) A representative of the community provider network of Rhode Island;

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     (F) A representative of the substance use and mental health leadership council of RI;

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     (G) A representative of the Rhode Island coalition for children and families;

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     (H) A representative of the senior agenda coalition;

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     (I) A representative of the AARP; and

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     (J) A representative of adult day services providers.

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     (e) The appointing authorities shall make their initial appointments to the advisory

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committee no later than August 1, 2022. In making appointments to the advisory committee, to the

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greatest extent possible, the appointing authorities shall consider the diversity of Rhode Island.

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     (f) Each member of the advisory committee shall serve at the pleasure of the official who

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appointed the member. Each member of the advisory committee shall serve a four (4) year term

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and may be reappointed for no more than one additional term. Members who have served two (2)

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consecutive terms may be reappointed no sooner than one year after the end of the second term.

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     (g) The members of the advisory committee shall serve without compensation and without

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reimbursement for expenses.

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     (h) At the first meeting of the advisory committee, to be held on or before September 1,

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2022, the members shall elect a chair, vice-chair and secretary from among the members.

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     (i) The advisory committee shall meet at least once every quarter. The chair may call such

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additional meetings as may be necessary for the advisory committee to perform its duties.

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     (j) The advisory committee shall develop bylaws and procedures to govern its operations.

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     (k) The department of administration, in collaboration with the executive office of health

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and human services, shall assist the advisory committee in its work by providing resources, staff

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support and any information that may be necessary to facilitate the purposes of this chapter.

 

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     40-23-5. Funding.

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     The general assembly shall annually appropriate any sums it may deem necessary to enable

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the advisory committee to carry out its assigned purposes.

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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 -- SOCIAL AND HUMAN SERVICES PROGRAMS

RATE REVIEW AND RATE SETTING PROCESS ACT OF 2022

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     This act would require the executive office of health and human services (EOHHS) with

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the assistance of a twenty four (24) person advisory committee to provide expert review and

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recommendations for the process for rate setting and ongoing review of rate setting for all social

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and human service programs with a contract with or licensed by the state or any department of the

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state as well as Medicaid.

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     This act would take effect upon passage.

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