Chapter 394

2005 -- H 5734 SUBSTITUTE A

Enacted 07/19/05

A N A C T

RELATING TO HUMAN SERVICES -- HEALTH CARE FOR ELDERLY AND DISABLED

RESIDENTS ACT

Introduced By: Representatives Naughton, Ajello, McNamara, E Coderre, and Dennigan

Date Introduced: February 17, 2005

It is enacted by the General Assembly as follows:

     SECTION 1. Section 40-8.5-1 of the General Laws in Chapter 40-8.5 entitled "Health

Care for Elderly and Disabled Residents Act" is hereby amended to read as follows:

40-8.5-1. Categorically needy medical assistance coverage. – (a) The department of

human services is hereby authorized and directed to amend its Title XIX state plan to provide for

categorically needy medical assistance coverage as permitted pursuant to Title XIX of the Social

Security Act [42 U.S.C. section 1396 et seq.] as amended to individuals who are sixty-five (65)

years or older or are disabled (as determined under section 1614(a)(3)) of the Social Security Act

[42 U.S.C. section 1382c(a)(3)] as amended whose income does not exceed one hundred percent

(100%) of the federal poverty level (as revised annually) applicable to the individual's family

size, and whose resources do not exceed four thousand dollars ($4,000) per individual, or six

thousand dollars ($6,000) per couple. The department shall provide medical assistance coverage

to such elderly or disabled persons in the same amount, duration and scope as provided to other

categorically needy persons under the state's Title XIX state plan.

(b) In order to ensure that individuals with disabilities, have access to quality and

affordable health care, the department is authorized to plan and to implement a system of health

care delivery through a voluntary managed care health system for such individuals. “Managed care”

is defined as a system that: integrates an efficient financing mechanism with quality service

delivery; provides a "medical home" to assure appropriate care and deter unnecessary and

inappropriate care; and places emphasis on preventive and primary care.

(c) The department is authorized to obtain any approval and/or waivers from the United

States Department of Health and Human Services, necessary to implement a voluntary managed

health care delivery system to the extent approved by the United States Department of Health and

Human Services.

(d) The department shall submit a report to the Permanent Joint Committee on Health

Care Oversight no later than April 1, 2006 that proposes an implementation plan for this

voluntary program, based on beginning enrollment not sooner than July 1, 2006. The report will

describe projected program costs and savings, the outreach strategy to be employed to educate the

potentially eligible populations, the enrollment plan, and an implementation schedule.

     SECTION 2. Section 40-8.7-7 of the General Laws in Chapter 40-8.7 entitled "Health

Care Assistance for Working People With Disabilities" is hereby amended to read as follows:

40-8.7-7. Premiums and cost sharing. -- (a) The department of humans services is

authorized and directed to promulgate such rules to establish the monthly premium payments for

employed individuals with disabilities who opt to participate directly in the Medicaid buy-in

program. To participate in the Medicaid buy-in program, the employed individual with

disabilities shall be required to make payment for coverage in accordance with a monthly

payment or payment formula to be established by the department which shall count the

individual's monthly-unearned income in excess of the medically needy income limit [MNIL] and

shall count a portion of their earned income on a sliding scale basis, in accordance with rules to

be established by the department;

      (b) The department is further authorized and directed to promulgate such rules to

encourage businesses, especially small businesses to hire individuals with disabilities, and to

allow employed individuals with disabilities who have access to employer-based health insurance

and who are determined eligible by the department pursuant to this chapter, to either: determine

the optimal health insurance coverage in consultation with the employer and the Medicaid

agency.

(1) Enroll themselves and/or their family in the employer-based health insurance plan as

a condition of participation in the Medicaid buy-in program under this chapter, provided this also

complies with the requirements of chapters 5.1, 8.1, 8.4 and 8.5 of this title, chapters 12, 12.1,

12.2 and 12.3 of title 42 as they relate to eligibility for the medical assistance program; and

provided, further, that enrollment in the employer-based health insurance plan is cost-effective

and its benefits are comparable to the benefits provided by the Medicaid program; or

(2) Enroll in the RI Medicaid buy-in program with employer/employee premium

payments for coverage under the medicaid buy-in program; provided, that these premium

payments are not greater than the employer's and employee's premiums in the existing employer-

based health insurance.

     SECTION 3. Section 40.1-24-1 of the General Laws in Chapter 40.1-24 entitled

"Licensing of Facilities and Programs for People who are Mentally Ill and/or Developmentally

Disabled" is hereby amended to read as follows:

40.1-24-1. Definitions. -- As used in this chapter:

      (1) "Adult foster home" means a private family living arrangement which, through

financial support from the parent deinstitutionalization subsidy aid program, provides housing

and supervision to two (2) or more adults who are alcoholic, drug abusers, mentally ill or who are

persons with developmental disabilities or otherwise eligible under section 40.1-1-10.1. Foster

homes serving fewer than two (2) adults, foster home situations wherein the foster parents are

natural or adoptive parent(s) or grandparents, and any facility licensed by the department of

children, youth, and families shall be excluded for the purposes of this chapter.

      (2) "Community residence" means any home or other living arrangement which is

established, offered, maintained, conducted, managed, or operated by any person for a period of

at least twenty-four (24) hours, where, on a twenty-four (24) hour basis, direct supervision is

provided for the purpose of providing rehabilitative treatment, habilitation, psychological support,

and/or social guidance for three (3) or more persons who are alcoholic, drug abusers, mentally ill

or who are persons with developmental disabilities or cognitive disabilities such as brain injury.

The facilities shall include but not be limited to group homes, halfway houses, and fully

supervised apartment programs. Semi-independent living programs, foster care, and parent

deinstitutionalization subsidy aid programs shall not be considered community residences for the

purposes of this chapter.

      (3) "Day treatment program" means any nonresidential facility which is established,

offered, maintained, conducted, managed, or operated by any person for a period of less than

twenty-four (24) hours to provide therapeutic intervention to persons who are alcoholic, drug

abusers, mentally ill, or who are persons with developmental disabilities or cognitive disabilities

such as brain injury. These shall include but not be limited to outpatient programs for persons

who are alcoholic, drug abusers, mentally ill or who are persons with developmental disabilities

or cognitive disabilities such as brain injury.

      (4) "Department" means the department of mental health, retardation and hospitals.

      (5) "Facility" means any community residence, day treatment program, rehabilitation

program, public or private, excluding hospitals or units within hospitals for persons who are

alcoholic, drug abusers, mentally ill or who are persons with developmental disabilities or

cognitive disabilities such as brain injury providing program services which do not constitute

medical or custodial care, but do offer rehabilitation, habilitation, psychological support, and

social guidance.

      (6) "Habilitation program" means any nonresidential facility which is established,

offered, maintained, conducted, managed, or operated by any person for a period of less than

twenty-four (24) hours to provide training in basic daily living skills and developmental activities,

prevocational skills and/or vocational training and placement, and follow up for people who are

alcoholic, drug abusers, mentally ill or who are persons with developmental disabilities or

cognitive disabilities such as brain injury. These shall include but not be limited to early

intervention, adult development, work activities, sheltered workshops, advanced workshops, and

job development and training programs. Sheltered workshops not exclusively for people who are

alcoholic, drug abusers, mentally ill or who are persons with developmental disabilities or

cognitive disabilities such as brain injury shall be excluded for the purposes of this chapter.

      (7) "Person" means any individual, governmental unit, corporation, company,

association, or joint stock association and the legal successor thereof.

      (8) "Program" means a planned service delivery system structured to provide specific

components which are responsive to the needs of those served.

      (9) "Rehabilitation program" means any facility which is established, offered,

maintained, conducted, managed, or operated by any person to provide restorative therapy and/or

training to persons who are mentally ill or who are persons with developmental disabilities or

cognitive disabilities such as brain injury. These shall include but not be limited to community

mental health centers. Sheltered workshops not exclusively for people who are alcoholic, drug

abusers, mentally ill or who are persons with developmental disabilities or cognitive disabilities

such as brain injury shall be excluded for the purposes of this chapter.

40.1-24-2. Purpose. – (a) The purpose of this chapter is to provide for the development,

establishment, and enforcement of standards:

      (1) For facilities and programs providing rehabilitation, psychological support, and

social guidance to individuals who are alcoholic, drug abusers, mentally ill or who are persons

with developmental disabilities or cognitive disabilities such as brain injury;

      (2) For the construction, maintenance, and operation of facilities which will promote safe

and adequate accommodations for individuals who are alcoholic, drug abusers, mentally ill or

who are persons with developmental disabilities or cognitive disabilities such as brain injury; and

      (3) For the establishment of a comprehensive licensing policy with respect to facilities

and programs for people who are alcoholic, drug abusers, mentally ill or who are persons with

developmental disabilities or cognitive disabilities such as brain injury.

(b) The department of mental health retardation and hospitals is hereby authorized and

directed to be the licensing authority in Rhode Island for residential and other support programs

designed specifically for persons with cognitive disabilities such as brain injury. These licensure

requirements shall be the same standards for persons with developmental disabilities except that

for these purposes all references to "developmental disabilities" shall mean "cognitive

disabilities."

SECTION 4. This act shall take effect upon passage.     

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LC01203/SUB A

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