2024 -- S 2353

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LC003993

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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 HUMAN SERVICES -- MEDICAL ASSISTANCE

     

     Introduced By: Senators LaMountain, Bissaillon, Burke, and Euer

     Date Introduced: February 12, 2024

     Referred To: Senate Finance

     It is enacted by the General Assembly as follows:

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     SECTION 1. Section 40-8-2 of the General Laws in Chapter 40-8 entitled "Medical

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Assistance" is hereby amended to read as follows:

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     40-8-2. Definitions.

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     As used in this chapter, unless the context shall otherwise require:

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     (1) “Dental service” means and includes emergency care, X-rays for diagnoses, extractions,

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palliative treatment, and the refitting and relining of existing dentures and prosthesis.

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     (2) “Department” means the department of human services.

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     (3) “Director” means the director of human services.

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     (4) “Drug” means and includes only drugs and biologicals prescribed by a licensed dentist

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or physician as are either included in the United States pharmacopoeia, national formulary, or are

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new and nonofficial drugs and remedies.

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     (5) “Inpatient” means a person admitted to and under treatment or care of a physician or

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surgeon in a hospital or nursing facility that meets standards of and complies with rules and

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regulations promulgated by the director.

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     (6) “Inpatient hospital services” means the following items and services furnished to an

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inpatient in a hospital other than a hospital, institution, or facility for tuberculosis or mental

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diseases:

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     (i) Bed and board;

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     (ii) Nursing services and other related services as are customarily furnished by the hospital

 

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for the care and treatment of inpatients and drugs, biologicals, supplies, appliances, and equipment

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for use in the hospital, as are customarily furnished by the hospital for the care and treatment of

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patients;

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     (iii)(A) Other diagnostic or therapeutic items or services, including, but not limited to,

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pathology, radiology, and anesthesiology furnished by the hospital or by others under arrangements

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made by the hospital, as are customarily furnished to inpatients either by the hospital or by others

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under such arrangements, and services as are customarily provided to inpatients in the hospital by

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an intern or resident-in-training under a teaching program having the approval of the Council on

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Medical Education and Hospitals of the American Medical Association or of any other recognized

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medical society approved by the director.

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     (B) The term “inpatient hospital services” shall be taken to include medical and surgical

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services provided by the inpatient’s physician, but shall not include the services of a private-duty

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nurse or services in a hospital, institution, or facility maintained primarily for the treatment and

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care of patients with tuberculosis or mental diseases. Provided, further, it shall be taken to include

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only the following organ transplant operations: kidney, liver, cornea, pancreas, bone marrow, lung,

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heart, and heart/lung, and other organ transplant operations as may be designated by the director

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after consultation with medical advisory staff or medical consultants; and provided that any such

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transplant operation is determined by the director or his or her designee to be medically necessary.

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Prior written approval of the director, or his or her designee, shall be required for all covered organ

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transplant operations.

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     (C) In determining medical necessity for organ transplant procedures, the state plan shall

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adopt a case-by-case approach and shall focus on the medical indications and contra-indications in

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each instance; the progressive nature of the disease; the existence of any alternative therapies; the

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life-threatening nature of the disease; the general state of health of the patient apart from the

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particular organ disease; and any other relevant facts and circumstances related to the applicant and

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the particular transplant procedure.

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     (7) “Nursing services” means the following items and services furnished to an inpatient in

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a nursing facility:

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     (i) Bed and board;

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     (ii) Nursing care and other related services as are customarily furnished to inpatients

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admitted to the nursing facility, and drugs, biologicals, supplies, appliances, and equipment for use

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in the facility, as are customarily furnished in the facility for the care and treatment of patients;

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     (iii) Other diagnostic or therapeutic items or services, legally furnished by the facility or

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by others under arrangements made by the facility, as are customarily furnished to inpatients either

 

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by the facility or by others under such arrangement;

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     (iv) Medical services provided in the facility by the inpatient’s physician, or by an intern

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or resident-in-training of a hospital with which the facility is affiliated or that is under the same

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control, under a teaching program of the hospital approved as provided in subsection (6); and

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     (v) A personal-needs allowance of seventy-five dollars ($75.00) one hundred dollars

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($100) per month.

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     (8) “Relative with whom the dependent child is living” means and includes the father,

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mother, grandfather, grandmother, brother, sister, stepfather, stepmother, stepbrother, stepsister,

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uncle, aunt, first cousin, nephew, or niece of any dependent child who maintains a home for the

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dependent child.

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     (9) “Visiting nurse service” means part-time or intermittent nursing care provided by or

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under the supervision of a registered professional nurse other than in a hospital or nursing home.

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     SECTION 2. 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 HUMAN SERVICES -- MEDICAL ASSISTANCE

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     This act would increase the personal needs allowance of nursing facility residents from

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seventy five dollars ($75.00) to one hundred dollars ($100) per month.

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     This act would take effect on July 1, 2024.

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