Chapter 424

2007 -- S 0455 SUBSTITUTE A AS AMENDED

Enacted 07/07/07

A N A C T

RELATING TO HUMAN SERVICES - HEALTH CARE FOR FAMILIES

Introduced By: Senators Perry, Goodwin, Connors, Gallo, and Paiva-Weed

Date Introduced: February 13, 2007

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 (opt-out) managed care health system systems for such

individuals. "Managed care" is defined as a system systems that: integrates integrate 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 (opt-out)

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

Health and Human Services. , including a primary care case management model in which

ancillary services are provided under the direction of a physician in a practice that meets

standards established by the department of human services. Nothing in this subsection shall be

interpreted to reduce the scope or duration of services or benefits covered for any Medicaid

recipient or to restrict or remove any services or benefits from a managed care benefit plan

provided by the state Medicaid program.

      (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.

      (e) To ensure the delivery of timely and appropriate services to persons who become

automatically eligible for Medicaid by virtue of their eligibility for a Social Security

Administration program, data on their special needs may be reported to the department of human

services by the Social Security Administration. The department of human services is authorized

to seek any and all data sharing agreements or other agreements with the Social Security

Administration as may be necessary to receive timely and accurate diagnostic data and clinical

assessments to be used exclusively for the purpose of service planning, and to be held and

exchanged in accordance with all applicable state and federal medical record confidentiality laws

and regulations.

     SECTION 2. This act shall take effect upon passage.

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LC01562/SUB A

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