Chapter 241
2011 -- H 5618 SUBSTITUTE A
Enacted 07/09/11
A N A C T
RELATING TO
HUMAN SERVICES - HEALTH CARE ASSISTANCE FOR WORKING PEOPLE WITH DISABILITIES
Introduced
By: Representatives Naughton,
Date Introduced: March 03, 2011
It is enacted by the
General Assembly as follows:
SECTION 1. Sections 40-8.7.3, 40-8.7-4, 40-8.7-5, 40-8.7-6,
40-8.7-7 and 40-8.7-9 of
the General Laws in Chapter 40-8.7 entitled "Health
Care Assistance for Working People with
Disabilities" are
hereby amended to read as follows:
40-8.7-3.
Purpose. -- The purpose of the Medicaid buy-in
program is to:
(1) Enable individuals
with disabilities to enter and reenter the work force as soon as
possible;
(2) Provide health care
and social employment support services to individuals with
disabilities that will enable those individuals to reduce their
dependency on cash benefit
programs; and
(3) Allow
individuals with disabilities the option to purchase Medicaid coverage that is
necessary to enable such individuals to obtain and/or maintain
employment; and
(4) Authorize the
department of human services to amend the state plan for personal care
services limited to employment-related personal care services
for individuals with disabilities to
continue their employment activity.
40-8.7-4.
Definitions. -- As used in this chapter, the term:
(1) "Individual
with a disability" means a person who has been designated, but without
regard to his or her ability to engage in substantial
gainful activity, as specified in the Social
Security Act, 42 U.S.C. section 423(d)(4), as a totally and permanently disabled individual by
the
Social Security Administration or the Rhode Island
Medicaid program, pursuant to an application
for benefits under Title II, Title XVI or Title XIX of
the Social Security Act, regardless of current
receipt of cash benefits under the Social Security Act.
(2)
"Employed" means the individual with disabilities is engaged in a
work effort that
meets substantial and reasonable threshold criteria for
hours of work, wages, or other measures,
as defined by the department of human services and as
permitted by federal law.
(3) "Employment
Support Services" means activities needed to sustain paid work
including: benefits counseling; supervision; job coaching;
vocational evaluation; case
management; job development; customized employment; job
training; transportation; training;
tools; equipment; and technology, subject to Centers for
Medicare and Medicaid Services
approval.
40-8.7-5.
Authorization for the Medicaid buy-in program. –Authorization
for the
Medicaid buy-in program and
personal care services.
-- (a) The department of human
services is hereby authorized and directed to amend its title
XIX state plan to initiate a Medicaid
buy-in program for employed individuals with disabilities.
(b) The department of
human services is hereby authorized and directed to amend its title
XIX state plan to initiate community choice first for
personal care services, including through a
home health agency and/or self-directed plan.
(c) The department of
human services is hereby authorized and directed to review and/or
amend its title XIX state plan to initiate the full scope
of services authorized under 1915(i) of the
social security act, for Medicaid buy-in participants who
are eligible upon clinical assessment,
subject to Centers for Medicare and Medicaid Services
approval.
40-8.7-6.
Eligibility. -- (a) To
be eligible for benefits under the Medicaid buy-in
program:
(1) The person shall be
an individual with disabilities as defined in section 40-8.7-4, but
without regard to his or her ability to engage in substantial
gainful activity, as specified in the
Social Security Act, 42 U.S.C. section 423(d)(4);
(2) The person shall be
employed as defined in section 40-8.7-4;
(3) The person's net
accountable income shall not exceed two hundred fifty percent
(250%) of the federal poverty level, taking into
account the SSI program disregards and
impairment-related work expenses as defined in 42 U.S.C. section
1396a(r)(2);
(4) A maximum of ten
thousand dollars ($10,000) of available resources for an
individual and twenty thousand dollars ($20,000) for a couple
shall be disregarded as shall any
additional resources held in a retirement account, in a medical
savings account, or any other
account, related to enhancing the independence of the
individual and approved under rules to be
adopted by the department; and
(5) The person shall be
a current medical assistance recipient under section 40-8.5-1
[CNIL]or section
40-8-3(v)[MNIL] or shall meet income, assets, (except as modified by
subdivision (4) above) and eligibility requirements for the
medical assistance program under
section 40-8.5-1 [CNIL]or section 40-8-3(v) [MNIL] as such
requirements are modified and
extended by this chapter.
(b) Appeals Process.
The director or designee shall review each application filed in
accordance with regulations, and shall make a determination of
whether the application will be
approved and the extent of the benefits to be made available
to the applicant, and shall within
thirty (30) days after the filing notify the applicant, in
writing, of the determination. If the
application is rejected, the applicant shall be notified the
reason for the denial. The director may
at any time reconsider any determination. Any applicant
for or recipient of benefits aggrieved
because of a decision, or delay in making a decision, shall
be entitled to an appeal and shall be
afforded reasonable notice and opportunity for a fair hearing
conducted by the director, pursuant
to chapter 40-8.
40-8.7-7.
Premiums and cost sharing. -- Premiums.
-- (a) The department of human
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 the individual's
or couple's 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 determine the
optimal health insurance coverage in consultation with the
employer and the Medicaid agency to
coordinate health insurance coverage options.
(c) The department of
human services, in consultation with the health insurance
commissioner, employer and disability advocacy organizations,
shall, by June 30, 2012,
investigate, develop and promulgate rules that may:
(1) Require
enrollment in the employer-based health insurance plan as a condition of
participation in the Medicaid buy-in program under this chapter,
provided 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. Enrollment of the
individual and/or the family in the
employer-based health insurance plan without regard to any
enrollment season restrictions,
subject to Centers for Medicare and Medicaid Services
approval; or
(2) Provide
opportunities for employers to buy into the Medicaid Buy-in program, at the
employer's expense, where the employer's premium contribution
shall be no greater than the
employer's premiums in the existing employer-based health
insurance or before September 30,
2012.
40-8.7-9.
Regulations and commencement of program. -- (a)
The department of human
services shall promulgate the rules or regulations necessary
to implement the provisions of this
act by January 1, 2005 September 30, 2011, and
enrollment of individuals with disabilities in the
Medicaid buy-in program shall commence under the
new rules on January 1, 2006 or before
January 1, 2012.
(b) The department of
human services shall provide quarterly progress reports to the
chairpersons of the house and senate finance committees by the
fifteenth (15th) day of the
following month of each quarter, from date of passage until
March 2013.
(c) By March 31,
2013, the department shall report annually to the governor and the
chairpersons of the house and senate finance committees on data
included, but not limited to, the
following:
(1) The number of
applications, the number of approved applications, the number of
applicants who are currently eligible for other forms of medical
coverage;
(2) Demographics
including: age, sex, employment supports provided; and primary
disabling condition, as permissible under the health insurance
portability and accountability act of
1996 (HIPAA) privacy and security rules;
(3) Prior and current
participation in other public assistance programs including
Medicare, Social Security Disability Insurance (SSDI),
Supplemental Security Income (SSI),
including the 1619(b) provision;
(4) The number of
beneficiaries employed, and the average wage of those beneficiaries
prior to and post Medicaid buy-in plan eligibility;
(5) The amounts of
premiums collected;
(6) Medicaid claims
data including pre-buy-in, while on the buy-in, and if disenrolled,
after buy-in to perform an analysis of costs/per member,
per month, of buy-in enrollees shall also
be provided by the Medicaid agency to the Medicaid
Infrastructure Grant recipient, as provided
for in the data use agreement;
(7) Findings and
recommendations with regard to "best practices" used by other states
in
the
among Medicaid beneficiaries with disabilities and how to
best support Medicaid beneficiaries
with disabilities who are working; and
(8) Identification
and strategies that the finance committees should consider regarding
challenges or opportunities for workers with disabilities in
Act is implemented; including, but not limited to,
ensuring that employment supportive policies
and supports are integrated into the state's design and
implementation of the following long-term
care Affordable Care Act provisions: Section
10202-Balancing Incentive Payments Plan (BIPP);
1915(i) State Plan
Amendment; Section 2401-Community First Choice (CFC); Section 2703-
Health Homes for Individuals with chronic conditions;
Money Follows the Person; 2014
Medicaid Expansion; and the dual eligible integrated
care plan models.
SECTION 2. This act shall serve as a Joint Resolution
required pursuant to
General Laws section
42-12.4-1, et seq.
WHEREAS, The General
Assembly enacted Chapter 12.4 of Title 42 entitled "The
WHEREAS, Rhode Island
General Laws section 42-12.4-7 provides that any change that
requires 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 section 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 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
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 proposal to amend the
demonstration be approved by the general assembly:
Modify the Sherlock Act.
The department of human services proposes refining the
determination of eligibility, and premiums of workers with
disabilities enrolled in the Medicaid
Buy-In program; now, therefore be it
RESOLVED,
That the general assembly hereby approves the changes
set forth in the
proposal 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
section 42-12.4-7.
SECTION 3. This act shall take effect on July 1, 2011.
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LC01572/SUB A/3
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