ARTICLE 21 SUBSTITUTE A

RELATING TO MEDICAID REFORM ACT

SECTION 1. This article shall serve as a Joint Resolution required pursuant to Rhode

Island General Laws § 42-12.4-1, et seq.

     WHEREAS, the General Assembly enacted Chapter 12.4 of Title 42 entitled “The Rhode

Island Medicaid Reform Act of 2008”; and

     WHEREAS, Rhode Island General Law § 42-12.4-7 provides that any change that

requires the implementation of a rule or regulation or modification of a rule or regulation in

existence prior to the implementation of the global consumer choice section 1115 demonstration

(“the demonstration”) shall require prior approval of the general assembly; and further provides

that any category II change or category III change as defined in the demonstration shall also

require prior approval to the general assembly; and

     WHEREAS, Rhode Island General Law § 42-7.2-5 states that the Secretary of the Office

of Health and Human Services is responsible for the “review and coordination of any Global

Consumer Choice Compact Waiver requests and renewals as well as any initiatives and proposals

requiring amendments to the Medicaid state plan or category I or II changes” as described in the

demonstration, with “the potential to affect the scope, amount, or duration of publicly-funded

health care services, provider payments or reimbursements, or access to or the availability of

benefits and services provided by Rhode Island general and public laws”; and

     WHEREAS, in pursuit of a more cost-effective consumer choice system of care that is

fiscally sound and sustainable, the Secretary requests that the following proposals to amend the

demonstration be approved by the general assembly:

     (a) Expansion and integration of care management strategies. The department of human

services proposes to establish a contractual agreement between the Medicaid agency and a

contractor (e.g., managed care entity) to manage primary, acute and long-term care services for

Medicaid-only beneficiaries and managed long-term care benefits for individuals dually eligible

for Medicaid and Medicare. The changes in service delivery will require changes to the rules,

regulations and procedures governing this area for Medicaid-only and dually eligible

beneficiaries, as well as Category II changes to the Global Consumer Choice Compact Waiver

authorizing the expansion of managed care to new service areas and populations.

     (b) Re-procure Medicaid managed care. The department of human services proposes to

seek a new managed care procurement for RIte Care children and families; children with special

health care needs; and adults enrolled in Rhody Health Partners living in the community with no

other form of coverage for the purposes of achieving cost-effective program modifications

including implementation of communities of care, rate reform, pharmacy efficiencies, selective

contracting and enhanced benefit management. The re-procurement will follow purchasing rules

pursuant to Chapter 37-2 of the Rhode Island General Laws. Implementation of these

modifications may require changes to the rules, regulations and procedures related to managed

care for the populations affected and Category II changes to the Global Consumer Choice

Compact Waiver in those areas where additional authority under the terms and conditions of the

demonstration agreement are warranted.

      (c) Refine payment system for multi-disciplinary treatment planning. The department of

mental health, retardation, and hospitals proposes to modify the current payment strategy for a

multi-disciplinary treatment plan to ensure program integrity and accuracy. The changes in the

payment structure for Medicaid funded services will require a Category II change under the terms

and conditions established for the Global Consumer Choice Compact Waiver.

     (d) Establish behavioral health community safety net. The department of mental health,

retardation, and hospitals proposes that the division of behavioral health services use contracting

to provide community mental health centers a consistent and predictable payment system that

provides performance and financial incentives. The contracting strategy proposed may result in

payment restructuring requiring a Category II change under the Global Waiver and amendments

to the department’s rules, regulations and procedures.

     (e) Restructuring of the network of providers serving persons with developmental

disabilities. The department of mental health, retardation, and hospitals amendment intends to

establish through a competitive bidding process one or more networks of service providers, each

headed by a lead agency, for the purposes of maximizing services and operational efficiencies

and assuring beneficiaries’ needs are met with the most appropriate services in the most

appropriate setting. The changes in payment structures and service delivery will require a

Category II change to the Global Consumer Choice Compact Waiver and certain modifications to

department rules, regulations and procedures.

     (f) Transfer of state funded methadone maintenance and treatment to costs not otherwise

matchable. The department of mental health, retardation, and hospitals proposes to obtain federal

matching funds for certain state-only funded methadone maintenance and treatment costs under

the terms and conditions of the Global Consumer Choice Compact Waiver. Although such

matching funds are authorized, the department may need to request certain Category II changes to

the waiver demonstration prior to implementation.

     (g) Pharmacy – SMAC Program for fee for service. The department of human services

proposes to establish a state maximum allowable cost (SMAC) program for multi-source generic

prescription drugs dispensed to Medicaid beneficiaries through fee for service delivery that

furthers ongoing efforts to leverage the state's purchasing power to obtain the best health

outcomes at the best price. The implementation of this program requires a Category II change to

the demonstration under the terms and conditions established under the Global Consumer Choice

Compact Waiver.

     (h) Personal Choice and Habilitation Services Reform. The department of human

services is proposing changes to the personal choice and habilitation services programs, which

will ensure that appropriate, cost effective care is provided in the in the least restrictive setting

with improved oversight and monitoring and a broader array of service alternatives. The reforms

will require changes to the department of human services rules, regulations and procedures for

these programs. Now, therefore, be it

     RESOLVED, that the general assembly hereby approves the changes set forth in

proposals (a) through (i) listed above to amend the demonstration; and be it further

     RESOLVED, that the secretary of the office of health and human services is authorized

to pursue and implement any such necessary waiver amendments, category II or category III

changes, state plan amendments and/or changes to the applicable department’s rules, regulations

and procedures approved herein and as authorized by § 42-12.4-7.

SECTION 2. This article shall take effect upon passage.