2013 -- S 0615 SUBSTITUTE A

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LC00773/SUB A

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STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2013

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A N A C T

RELATING TO HUMAN SERVICES -- LONG-TERM CARE SERVICE REFORM FOR

MEDICAID ELIGIBLE INDIVIDUALS

     Introduced By: Senator Maryellen Goodwin

     Date Introduced: March 06, 2013

     Referred To: Senate Health & Human Services

It is enacted by the General Assembly as follows:

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     SECTION 1. Section 40-8.10-4 of the General Laws in Chapter 40-8.10 entitled "Long-

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Term Care Service Reform for Medicaid Eligible Individuals" is hereby amended to read as

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follows:

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     40-8.10-4. Assessment and Coordination Unit (ACU). -- (a) The department of human

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services, in collaboration with the executive office of health and human services, shall implement

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a long-term care options counseling program to provide individuals or their representative, or

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both, with long-term care consultations that shall include, at a minimum, information about long-

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term care options, sources and methods of both public and private payment for long term care

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services, information on caregiver support services, including respite care, and an assessment of

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an individual's functional capabilities and opportunities for maximizing independence. Each

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individual admitted to or seeking admission to a long-term care facility, regardless of the payment

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source, shall be informed by the facility of the availability of the long-term care options

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counseling program and shall be provided with a long-term care options consultation, if he or she

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so requests. Each individual who applies for Medicaid long-term care services shall be provided

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with a long-term care consultation.

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      (b) Core and preventative home and community based services defined and delineated in

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section 40-8.10-2 shall be provided only to those individuals who meet one of the levels of care

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provided for in this chapter. Other long term care services authorized by the federal government,

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such as medication management, may also be provided to Medicaid eligible recipients who have

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established the requisite need as determined by the Assessment and Coordination Unit (ACU).

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Access to institutional and community based supports and services shall be through the

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Assessment and Coordination Unit (ACU). The provision of Medicaid-funded long-term care

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services and supports shall be based upon a comprehensive assessment that shall include, but not

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be limited to, an evaluation of the medical, social and environmental needs of each applicant for

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these services or programs. The assessment shall serve as the basis for the development and

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provision of an appropriate plan of care for the applicant.

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      (c) The ACU shall assess the financial eligibility of beneficiaries to receive long-term

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care services and supports in accordance with the applicable provisions of section 40-8.9-9.

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      (d) The ACU shall be responsible for conducting assessments; determining a level of

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care for applicants for medical assistance; developing service plans; pricing a service budget and

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developing a voucher when appropriate; making referrals to appropriate settings; maintaining a

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component of the unit that will provide training to and will educate consumers, discharge

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planners and providers; tracking utilization; monitoring outcomes; and reviewing service/care

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plan changes. The ACU shall provide interdisciplinary high cost case reviews and choice

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counseling for eligible recipients.

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      (e) The assessments for individuals conducted in accordance with this section shall serve

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as the basis for individual budgets for those medical assistance recipients eligible to receive

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services utilizing a self-directed delivery system.

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      (f) Nothing in this section shall prohibit the secretary of the executive office of health

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and human services, or the directors of that office's departments from utilizing community

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agencies or contractors when appropriate to perform assessment functions outlined in this

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chapter.

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     SECTION 2. 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 8.11

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FAMILY CAREGIVERS SUPPORT ACT OF 2013

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     40-8.11-1. Findings. -- (a) Family members, partners and close friends provide the vast

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majority of long-term services and supports.

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     (b) An estimated one hundred and forty-eight thousand (148,000) persons in Rhode

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Island are providing care at any one time to persons living in the community. The estimated value

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of their unpaid contributions in 2009 was one billion eight hundred eighty million dollars

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($1,880,000,000).

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     (c) Family or other caregivers who provide the majority of care in the home are

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frequently under substantial physical, psychological, and financial stress. The stress, if unrelieved

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by support for the caregiver, may lead to premature or unnecessary nursing home and institutional

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placement and health and financial burdens for the caregiver.

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     (d) Respite care and other community-based supportive services for the family caregiver

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can relive some of the stresses faced by caregivers, maintain and strengthen the family structure,

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postpone or prevent institutionalization and lead to better outcomes for both the caregiver and

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care recipient.

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     (e) The percent of Rhode Islanders age sixty-five (65) years of age and older is projected

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to grow from fourteen percent (14%) of the state population in 2010 to twenty-one percent (21%)

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by 2030. As persons age, they have greater dependency needs and an increased need for long-

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term care services and support. Younger people with disabilities also require continued

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supportive long-term care services as they age.

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     (f) As informal caregivers and families are a vital part of the long-term care services and

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support system, it is an important public purpose to recognize and respect their contributions and

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to assess and support their needs.

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     40-8.11-2. Definitions. -- (a) "Caregiver assessment" is defined and refers to a systematic

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process of gathering information about a caregiving situation to identify the specific problems,

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needs, strengths, and resources of the family caregiver, as well as the caregiver's ability to

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contribute to the needs of the care recipient.

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     (b) The term "family caregiver" is defined and refers to any relative, partner, friend, or

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neighbor who has a significant relationship with, and who provides a broad range of assistance

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for, an older adult or an adult or child with chronic or disabling conditions.

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     40-8.11-3. Caregiver assessment requirement. -- The comprehensive assessment

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required in subsection 40-8.10-4(b) as part of Medicaid long-term service reform shall also

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include a caregiver assessment whenever the plan of care depends on a family caregiver for

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providing assistance with activities of daily living needs. The assessment shall be used to develop

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a plan of care that recognizes both needs of the care recipient and the caregiver. The assessment

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shall also serve as the basis for development and provision of an appropriate plan for caregiver

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information, referral and support services. Information about available respite programs,

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caregiver training and education programs, support groups and community support services shall

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be included as part of the caregiver support plan. To implement the caregiver assessment, the

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executive office of health and human services shall adopt evidenced-based caregiver assessments

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and referral tools appropriate to the departments within the office that provide long-term care

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services and support.

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     SECTION 3. This act shall take effect upon passage.

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LC00773/SUB A

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N A C T

RELATING TO HUMAN SERVICES -- LONG-TERM CARE SERVICE REFORM FOR

MEDICAID ELIGIBLE INDIVIDUALS

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     This act would create a family caregiver support act which would require a caregiver

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assessment if the plan of care involves, a family caregiver, and a plan of care would be developed

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which would take into account the needs of the caregiver and the recipient.

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     This act would take effect upon passage.

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LC00773/SUB A

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