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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2024

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A N   A C T

RELATING TO HEALTH AND SAFETY -- LICENSING OF HEALTHCARE FACILITIES

     Introduced By: Representatives Speakman, Donovan, McGaw, Henries, Fogarty, Handy,
Shallcross Smith, Bennett, Stewart, and Giraldo

     Date Introduced: February 23, 2024

     Referred To: House Finance

     It is enacted by the General Assembly as follows:

     SECTION 1. Chapter 23-17 of the General Laws entitled "Licensing of Healthcare

Facilities" is hereby amended by adding thereto the following section:

     23-17-67. Hospital determinations for Medicare and Medicaid for uninsured patients.

     (a) All hospitals shall screen each uninsured patient, upon the uninsured patient's

agreement, at the earliest reasonable moment for potential eligibility for both:

     (1) Public health insurance programs; and

     (2) Any financial assistance offered by the hospital.

     (b) All screening activities, including initial screenings and all follow-up assistance, shall

be provided in compliance with § 23-17-54.

     (c) If a patient declines or fails to respond to the screening described in subsection (a) of

this section, the hospital shall document in the patient's record the patient's decision to decline or

failure to respond to the screening, confirming the date and method by which the patient declined

or failed to respond.

     (d) If a patient does not decline the screening described in subsection (a) of this section, a

hospital should screen an uninsured patient during registration unless it would cause a delay of care

to the patient; otherwise, a hospital shall screen an uninsured patient at the earliest reasonable

moment.

     (e) If a patient does not submit to screening, financial assistance application, or reasonable

payment plan documentation within thirty (30) days after a request, the hospital shall document the

lack of received documentation, confirming the date that the screening took place and that the thirty

(30) day timeline for responding to the hospital's request has lapsed; provided, however, that it may

be reopened within ninety (90) days after the date of discharge, date of service, or completion of

the screening.

     (f) If the screening indicates that the patient may be eligible for a public health insurance

program, the hospital shall provide information to the patient about how the patient can apply for

the public health insurance program, including, but not limited to, referral to healthcare navigators

who provide free and unbiased eligibility and enrollment assistance, including healthcare

navigators at federally qualified health centers; local, state, or federal government agencies; or any

other resources that the state recognizes as designed to assist uninsured individuals in obtaining

health coverage.

     (g) If the uninsured patient's application for a public health insurance program is approved,

the hospital shall bill the insuring entity and shall not pursue the patient for any aspect of the bill,

except for any required copayment, coinsurance, or other similar payment for which the patient is

responsible under the insurance. If the uninsured patient's application for public health insurance is

denied, the hospital shall again offer to screen the uninsured patient for hospital financial assistance,

and the timeline for applying for financial assistance under this section shall begin again.

     (h) A hospital shall offer to screen an insured patient for hospital financial assistance under

this section if the patient requests financial assistance screening, if the hospital is contacted in

response to a bill, if the hospital learns information that suggests an inability to pay, or if the

circumstances otherwise suggest the patient's inability to pay.

     (i)(1) Each hospital shall post a sign with the following notice: "You may be eligible for

financial assistance under the terms and conditions the hospital offers to qualified patients. For

more information contact [hospital financial assistance representative]".

     (2) The sign under subsection (i)(1) of this subsection shall be posted, either by physical

or electronic means, conspicuously in the admission and registration areas of the hospital.

     (3) The sign shall be in English, and in any other language that is the primary language of

at least five percent (5%) of the patients served by the hospital annually.

     (4) Each hospital that has a website shall post a notice in a prominent place on its website

that financial assistance is available at the hospital, a description of the financial assistance

application process, and a copy of the financial assistance application.

     (5) Within one hundred eighty (180) days after the effective date of this section, each

hospital shall make available information regarding financial assistance from the hospital in the

form of either a brochure, an application for financial assistance, or other written or electronic

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material in the emergency room, hospital admission, and registration area.

     (j)(1) The executive office of health and human services is responsible for administering

and ensuring compliance with this section, including the development of any rules and regulations

necessary for the implementation and enforcement of this section.

     (2) The executive office of health and human services shall develop and implement a

process for receiving and handling complaints from individuals or hospitals regarding possible

violations of this section.

     (3) The attorney general may conduct any investigation deemed necessary regarding

possible violations of this section by any hospital including, without limitation, the issuance of

subpoenas to:

     (i) Require the hospital to file a statement or report or answer interrogatories in writing as

to all information relevant to the alleged violations;

     (ii) Examine under oath any person who possesses knowledge or information directly

related to the alleged violations; and

     (iii) Examine any record, book, document, account, or paper necessary to investigate the

alleged violation.

     (4) If the attorney general determines that there is a reason to believe that any hospital has

violated this section, the attorney general may bring an action against the hospital to obtain

temporary, preliminary, or permanent injunctive relief for any act, policy, or practice by the hospital

that violates this section. Before bringing such an action, the attorney general may permit the

hospital to submit a correction plan for the attorney general's approval.

     SECTION 2. Joint Resolution. – AUTHORIZING THE SECRETARY OF THE

EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES TO DEVELOP A PILOT PLAN

FOR ESTABLISHING AN ACUTE HOSPITAL CARE AT HOME PROGRAM

     WHEREAS, During the COVID-19 pandemic, federal and state governments issued

waiver flexibilities that allowed hospitals to provide advanced level services to patients at home

under certain circumstances; and

     WHEREAS, The waiver flexibility is built on the success of previous acute care at home

models that have been tested over decades, showing that advanced care at home can be a safe,

effective way to provide care to patients that is associated with lower costs and better patient

outcome and satisfaction compared with inpatient hospitalization; and

     WHEREAS, As part of the omnibus spending bill that became law December 29, 2022,

the Centers for Medicare and Medicaid services extended, through December 31, 2024, the acute

hospital care at home initiative whereby individual hospitals may seek waivers to operate acute

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care at home programs; and

     WHEREAS, The hospital at home model is an important component of the shift away from

institutionalized care and has been successful in allowing patients with particular conditions to

remain in their homes and avoid risks associated with inpatient admission and care.

     NOW THEREFORE BE IT RESOLVED,

     l. Notwithstanding any provision of law to the contrary, the Executive Office of Health and

Human Services shall establish a pilot program to permit a hospital to provide acute care services

to a covered person outside of the hospital's licensed facility and within a private residence

designated by the covered person. The pilot program shall be established in a manner that is

consistent with the provisions of the Acute Hospital Care at Home Program, as authorized by the

federal Centers for Medicare and Medicaid Services.

     2. Any hospital previously in receipt of a waiver to operate, or otherwise approved to

participate in the Centers for Medicare and Medicaid Services' Acute Hospital Care at Home

Program prior to the effective date of this resolution, shall be permitted to operate or to continue to

operate the program in the same manner as previously permitted under federal law, and shall be

integrated into the pilot program established pursuant to this resolution.

     3. The Medicaid program shall provide coverage and payment for acute hospital care

services delivered to a covered person through the program established pursuant to this resolution,

on the same basis as when services are delivered within the facilities of a hospital. Reimbursement

payments under this section shall be provided to the hospital, facility, or organization providing the

services or the individual practitioner who delivered the reimbursable services, or to the agency,

facility, or organization that employs or contracts with the individual practitioner who delivered

the reimbursable services, as appropriate, for a period of ninety (90) days following the expiration

of the program, at a rate no higher than current reimbursement rates to ensure the pilot program is

budget neutral.

     4. The pilot program shall be limited to any person participating in the program at the time

of the expiration of the program and shall continue for not more than ninety (90) days, provided

that the person is eligible for Medicaid. The pilot program shall not utilize more stringent utilization

management criteria than apply when those services are provided within the facilities of a hospital.

     5. The Secretary of the Executive Office of Health and Human Services shall apply for any

State plan amendments or waivers as may be necessary to implement the provisions of this

resolution and to secure federal financial participation for State Medicaid expenditures under the

federal Medicaid program.

     6. The Secretary of the Executive Office of Health and Human Services shall adopt rules

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and regulations, in accordance with the "Administrative Procedure Act," if necessary to effectuate

the provisions of this resolution.

     7. The Secretary of the Executive Office of Health and Human Services may waive any

state rules or regulations if necessary to implement the provisions of this resolution.

     AND BE IT FURTHER RESOLVED, The pilot program shall become ineffective upon

the expiration of the federal program, and The Secretary of the Executive Office of Health and

Human Services shall provide a report to the Governor and the General Assembly regarding the

cost of the pilot program.

     SECTION 3. Section 1 of this act shall take effect on January 1, 2025 and Section 2 of this

act shall take effect on July 1, 2024.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO HEALTH AND SAFETY -- LICENSING OF HEALTHCARE FACILITIES

***

     This act would require all hospitals to screen uninsured patients for eligibility for public

health programs and financial assistance under Medicare and Medicaid.

     This act would also, by joint resolution, provide for establishment of a pilot program to

permit a hospital to provide acute care services for a covered person outside the hospital's licensed

facility. The pilot program would become effective upon expiration of the federal program

providing for the acute hospital care at home initiative.

     Section 1 of this act would take effect on January 1, 2025 and Section 2 of this act would

take effect on July 1, 2024.

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