Chapter 223
2009 -- S 0242 SUBSTITUTE A AS
AMENDED
Enacted 11/09/09
A N A C T
RELATING TO HUMAN SERVICES -- MEDICAL ASSISTANCE--LONG-TERM CARE AND FINANCE REFORM
Introduced
By: Senators Perry, Miller, Sheehan,
Date Introduced: February 11, 2009
It is enacted by the
General Assembly as follows:
SECTION 1. Sections 40-8.9-2, 40-8.9-4, 40-8.9-5, 40-8.9-6
and 40-8.9-9 of the General
Laws in Chapter 40-8.9
entitled "Medical Assistance - Long-Term Care Service and Finance
Reform" are hereby amended to read as follows:
40-8.9-2.
System reform goal System reform and rebalancing goal.
-- On or before
July 1, 2007, the department of human services shall
begin to implement a model system for
integrated long-term care, that expands the capacity of the
long-term care system as a whole to
support consumer choice and independence; enables consumers
to access coordinated services;
assures quality outcomes through certification standards,
performance measures and incentives
and rewards that promote service excellence and generates
the information consumers need to
make reasoned choices about their health care; and
improves the system's overall stability by
reinvesting the benefits that accrue from the more efficient
utilization of services to enhance the
capacity of each of its component parts. Attaining system-wide
reform of the magnitude set forth
herein will require rebalancing the system by making
significant changes in the organization,
financing and delivery of services that must be implemented
incrementally.
40-8.9-4. Unified
long-term care budget. -- Beginning on July 1, 2007, a unified long-
term care budget shall combine in a single line-item
appropriation within the department of
human services budget, annual department of human services
Medicaid appropriations for
nursing facility and community-based long-term care services
for elderly sixty-five (65) years and
older and younger persons at risk of nursing home
admissions (including adult day care, home
health, pace, and personal care in assisted living
settings). Beginning on July 1, 2007, the total
system savings attributable to the value of the reduction in
nursing home days including hospice
nursing home days paid for by Medicaid shall be allocated in
the budget enacted by the general
assembly for the ensuing fiscal year for the express purpose
of promoting and strengthening
community-based alternatives. Beginning on January 1, 2008, the
The allocation shall
include,
but not be limited to, funds to support an on-going
statewide community education and outreach
program to provide the public with information on home and
community services and the
establishment of presumptive eligibility criteria for the purposes
of accessing home and
community care. The home and community care service presumptive
eligibility criteria shall be
developed through rule or regulation on or before September 30,
2007. The allocation may also
be used to fund home and community services provided by
the department of elderly affairs for
persons eligible for Medicaid long-term care, and the co-pay
program administered pursuant to
section 42-66.3. Any monies in the allocation that remain
unexpended in a fiscal year shall be
carried forward to the next fiscal year for the express
purpose of strengthening community-based
alternatives.
The caseload estimating
conference pursuant to section 35-17-1 shall determine the
amount of general revenues to be added to the current
service estimate of community based long-
term care services for elderly sixty-five (65) and older
and younger persons at risk of nursing
home admissions for the ensuing budget year by multiplying
the combined cost per day of
nursing home and hospice nursing home days estimated at the
caseload conference for that year
by the reduction in nursing home and hospice nursing
home days from those in the second fiscal
year prior to the current fiscal year to those in the
first fiscal year prior to the current fiscal year.
40-8.9-5.
Administration and regulations. -- The single
state agency designated to
administer the Rhode Island Medicaid program is hereby directed
and authorized to develop and
submit any requests for waivers, demonstration projects,
grants and state plan amendments or
regulations that may be considered necessary and appropriate to
support the general purposes and
specific requirements
of this statute. Such requests shall be made in consultation with any
affected departments and, to the extent feasible, any consumer
group, advisory body, or other
entity designated for such purposes.
40-8.9-6.
Reporting. -- Annual reports showing progress
in long-term care system
reform and rebalancing shall be submitted by April 1st of each year the department to
the Joint
Legislative Committee on Health Care Oversight as well
as the finance committees of both the
senate and the house of representatives and shall include:
the number of persons aged sixty-five
(65) years and over and
adults with disabilities served in nursing facilities, the number of persons
transitioned from nursing homes to Medicaid supported home and
community based care, the
number of persons aged sixty-five (65) years and over and
adults with disabilities served in home
and community care to include home care, adult day
services, assisted living and shared living,
the dollar amounts and percent of expenditures spent on
nursing facility care and home and
community-based care, and
estimates of the continued investments necessary to provide stability
to the existing system and establish the infrastructure
and programs required to achieve system-
wide reform and the targeted goal of spending fifty
percent (50%) of Medicaid long-term care
dollars on nursing facility care and fifty percent (50%) on
home and community-based services.
40-8.9-9.
Long-term care re-balancing system reform goal. --
(a) Notwithstanding any
other provision of state law, the department of human
services is authorized and directed to apply
for and obtain any necessary waiver(s), waiver
amendment(s) and/or state plan amendments from
the secretary of the
rules necessary to adopt an affirmative plan of program
design and implementation that addresses
the goal of allocating a minimum of fifty percent (50%)
of Medicaid long-term care funding to
home and community-based care on or before December 31, 2012
2013; provided, further, the
executive office of health and human services shall report
annually as part of its budget
submission, the percentage distribution between institutional
care and home community-based
care by population and shall report current and projected
waiting lists for long-term care and
home and community-based care services. The department is further authorized and directed to
prioritize investments in home and community-based care and to
maintain the integrity and
financial viability of all current long-term care services
while pursuing this goal.
(b) The reformed
long-term care system re-balancing goal is person-centered and
encourages individual self-determination, family involvement,
interagency collaboration, and
individual choice through the provision of highly specialized
and individually tailored home-
based services. Additionally, individuals with severe
behavioral, physical, or developmental
disabilities must have the opportunity to live safe and healthful
lives through access to a wide
range of supportive services in an array of community-based
settings, regardless of the
complexity of their medical condition, the severity of their
disability, or the challenges of their
behavior. Delivery of services and supports in less costly and
less restrictive community settings,
will enable children, adolescents and adults to be able to
curtail, delay or avoid lengthy stays in
residential treatment facilities, juvenile detention centers,
psychiatric facilities, and/or
intermediate care or skilled nursing facilities.
(c)
Pursuant to federal authority procured under section 42-7.2-16 of the general
laws,
the department of human services is directed and
authorized to adopt a tiered set of criteria to be
used to determine eligibility for long-term care
services. Such criteria shall be developed in
collaboration with the state's health and human services
departments and, to the extent feasible,
any consumer group, advisory board, or other entity
designated for such purposes, and
shall
encompass eligibility determinations for services in nursing
facilities, hospitals, and intermediate
care facilities for the mentally retarded as well as home
and community-based alternatives, and
shall provide a common standard of income eligibility for
both institutional and home and
community-based care. The department is, subject to prior approval
of the general assembly,
authorized to adopt criteria for admission to a nursing
facility, hospital, or intermediate care
facility for the mentally retarded that are more stringent
than those employed for access to home
and community-based services. The department is also
authorized to promulgate rules that define
the frequency of re-assessments for services provided for
under this section.
(d) The department of
human services is further authorized and directed to consolidate
all home and community-based services currently provided
pursuant to section 1915(c) of title
XIX of the Untied States Code into a single program
system of home and community-based
services that include options for consumer direction and
shared living. The resulting single home
and community-based services program system
shall replace and supersede all section 1915(c)
programs when fully implemented. Notwithstanding the
foregoing, the resulting single program
home and community-based services program system
shall include the continued funding of
assisted living services at any assisted living facility
financed by the
mortgage finance corporation prior to January 1, 2006, and
shall be in accordance with chapter
66.8 of title 42 of the general laws as long as
assisted living services are a covered Medicaid
benefit.
(e) The department of
human services is authorized to promulgate rules that permit
certain optional services including, but not limited to,
homemaker services, home modifications,
respite, and physical therapy evaluations to be offered
subject to availability of state-appropriated
funding for these purposes.
(f) To promote the expansion
of home and community-based service capacity, the
department of human services is authorized and directed to
pursue rate reform for homemaker,
personal care (home health aide) and adult day care services,
as follows:
(1) A prospective base
adjustment effective, not later than July 1, 2008, across all
departments and programs, of ten percent (10%) of the existing
standard or average rate,
contingent upon a demonstrated increase in the state-funded or
Medicaid caseload by June 30,
2009;
(2) Development, not
later than September 30, 2008, of certification standards
supporting and defining targeted rate increments to encourage
service specialization and
scheduling accommodations including, but not limited to,
medication and pain management,
wound management, certified Alzheimer's Syndrome treatment
and support programs, and shift
differentials for night and week-end services; and
(3) Development and
submission to the governor and the general assembly, not later than
December 31, 2008, of a proposed rate-setting
methodology for home and community-based
services to assure coverage of the base cost of service
delivery as well as reasonable coverage of
changes in cost caused by wage inflation.
(g) The department,
in collaboration with the executive office of human services, shall
implement a long-term care options counseling program to
provide individuals or their
representatives, or both, with long-term care consultations that
shall include, at a minimum,
information about: long-term care options, sources and methods of
both public and private
payment for long-term care services and an assessment of an
individual’s functional capabilities
and opportunities for maximizing independence. Each
individual admitted to or seeking
admission to a long-term care facility regardless of the
payment source shall be informed by the
facility of the availability of the long-term care options
counseling program and shall be provided
with long-term care options consultation if they so request.
Each individual who applies for
Medicaid long-term care services shall be provided
with a long-term care consultation.
(h) The department of
human services is also authorized, subject to availability of
appropriation of funding, to pay for certain non-Medicaid
reimbursable expenses necessary to
transition residents back to the community; provided, however,
payments shall not exceed an
annual or per person amount.
(i)
To assure the continued financial viability of nursing facilities, the
department of
human services is authorized and directed to develop a
proposal for revisions to section 40-8-19
that reflect the changes in cost and resident acuity that
result from implementation of this re-
balancing goal. Said proposal shall be submitted to the
governor and the general assembly on or
before January 1, 2010.
(j) To ensure persons
with long-term care needs who remain living at home have
adequate resources to deal with housing maintenance and
unanticipated housing related costs, the
department of human services is authorized to develop higher
resource eligibility limits for
persons on home and community waiver services who are living
in their own homes or rental
units.
SECTION 2. This act shall take effect upon passage.
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LC01087/SUB A
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