2006 -- S 2628 SUBSTITUTE A

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LC01942/SUB A

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STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2006

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A N A C T

RELATING TO MEDICAL ASSISTANCE - LONG-TERM CARE SERVICE AND FINANCE

REFORM

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

     Date Introduced: February 09, 2006

     Referred To: Senate Health & Human Services

It is enacted by the General Assembly as follows:

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     SECTION 1. Title 40 of the General Laws entitled "HUMAN SERVICES" is hereby

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amended by adding thereto the following chapter:

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     CHAPTER 8.9

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MEDICAL ASSISTANCE - LONG-TERM CARE SERVICE AND FINANCE REFORM

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     40-8.9-1. Findings. -- (a) The number of Rhode Islanders in need of long-term care

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services continues to rise substantially, and the quality of life of these Rhode Islanders is

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determined by the capacity of the long-term care system to provide access to the full array of

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services and supports required to meet their health care needs and maintain their independence.

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     (b) It is in the interest of all Rhode Islanders to endorse and fund statewide efforts to

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build a fiscally sound, dynamic long-term care system that supports: consumer independence and

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choice; the delivery of high quality, coordinated services; the financial integrity of all

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participants-purchasers, payers, providers and consumers; and the responsible and efficient

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allocation of all available public and private resources.

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     (c) It is in the interest of all Rhode Islanders to assure that rates paid for community-

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based long-term care services are adequate to assure high quality as well as supportive of

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workforce recruitment and retention.

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     (d) It is in the interest of all Rhode Islanders to improve consumer's access information

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regarding community-based alternatives to institutional settings of care.

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     40-8.9-2. System reform goal. -- On or before July 1, 2007, the department of human

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services shall begin to implement a model system for integrated long-term care, that expands the

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capacity of the long-term care system as a whole to support consumer choice and independence;

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enables consumers to access coordinated services; assures quality outcomes through certification

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standards, performance measures and incentives and rewards that promote service excellence and

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generates the information consumers need to make reasoned choices about their health care; and

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improves the system's overall stability by reinvesting the benefits that accrue from the more

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efficient utilization of services to enhance the capacity of each of its component parts. Attaining

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system-wide reform of the magnitude set forth herein will require significant changes in the

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organization, financing and delivery of services that must be implemented incrementally.

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     40-8.9-3. Least restrictive setting requirement. -- Beginning on July 1, 2006, the

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department of human services is directed and authorized to allocate existing Medicaid resources

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as needed to ensure that those in need of long-term care and support services receive them in the

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setting most appropriate to their needs and preferences. The department is hereby authorized to

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utilize screening criteria, to avoid unnecessary institutionalization of persons during the full

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eligibility determination process for Medicaid community based care.

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     40-8.9-4. Unified long-term care budget. – Beginning on July 1, 2007, a unified long-

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term care budget shall combine in a single line-item within the department of human services

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budget, annual department of human services Medicaid appropriations for nursing facility and

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community-based long-term care services (including adult day care, home health, and personal

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care in assisted living settings). Beginning on July 1, 2007, the total system savings attributable to

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the value of the reduction in nursing home days paid for by Medicaid shall be allocated for the

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express purpose of promoting and strengthening community-based alternatives.

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     40-8.9-5. Administration and regulations. -- As the single state agency designated to

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administer the Rhode Island Medicaid program, the department is hereby directed and authorized

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to develop and submit any requests for waivers, demonstration projects, grants and state plan

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amendments or regulations that may be considered necessary and appropriate to support the

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general purposes of this statute. Such requests shall be made in consultation with any affected

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departments and, to the extent feasible, any consumer group, advisory body, or other entity

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designated for such purposes.

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     40-8.9-6. Reporting. -- Annual reports shall be submitted by the department to the Joint

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Legislative Committee on Health Care Oversight as well as the finance committees of both the

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senate and the house of representatives and shall include estimates of the investments necessary

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to provide stability to the existing system and establish the infrastructure and programs required

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to achieve system-wide reform.

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     40-8.9-7. Rate reform. – By January 2008 the department of human services shall design

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and require to be submitted by all service providers cost reports for all community-based long-

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term services.

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     40-8.9-8. System screening. – By January 2008 the department of human services shall

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develop and implement a screening strategy for the purpose of identifying entrants to the publicly

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financed long-term care system prior to application for eligibility as well as defining their

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potential service needs.

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     SECTION 2. Section 40-8.5-1 of the General Laws in Chapter 40-8.5 entitled "Health

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Human Services.

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

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

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

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

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

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

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automatically eligible for Medicaid by virtue of their eligibility for a social security

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

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services by the social security administration. The department of human services is authorized to

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seek any and all data sharing agreements or other agreements with the social security

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

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

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

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and regulations.

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     SECTION 3. This act shall take effect upon passage.

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LC01942/SUB A

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N A C T

RELATING TO MEDICAL ASSISTANCE - LONG-TERM CARE SERVICE AND FINANCE

REFORM

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     This act would require the department of human services to implement a model system

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for integrated long-term care that expands the capacity of the long-term care system as a whole to

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support consumer choice and independence.

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     This act would take effect upon passage.

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LC01942/SUB A

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