2024 -- S 2387 | |
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LC004652 | |
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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 STATE AFFAIRS AND GOVERNMENT -- OFFICE OF HEALTH AND | |
HUMAN SERVICES | |
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Introduced By: Senators Ujifusa, Miller, Valverde, Lauria, DiMario, Murray, Mack, | |
Date Introduced: February 12, 2024 | |
Referred To: Senate Health & Human Services | |
It is enacted by the General Assembly as follows: | |
1 | SECTION 1. Section 42-7.2-5 of the General Laws in Chapter 42-7.2 entitled "Office of |
2 | Health and Human Services" is hereby amended to read as follows: |
3 | 42-7.2-5. Duties of the secretary. |
4 | The secretary shall be subject to the direction and supervision of the governor for the |
5 | oversight, coordination, and cohesive direction of state-administered health and human services |
6 | and in ensuring the laws are faithfully executed, notwithstanding any law to the contrary. In this |
7 | capacity, the secretary of the executive office of health and human services (EOHHS) shall be |
8 | authorized to: |
9 | (1) Coordinate the administration and financing of healthcare benefits, human services, and |
10 | programs including those authorized by the state’s Medicaid section 1115 demonstration waiver |
11 | and, as applicable, the Medicaid state plan under Title XIX of the U.S. Social Security Act. |
12 | However, nothing in this section shall be construed as transferring to the secretary the powers, |
13 | duties, or functions conferred upon the departments by Rhode Island public and general laws for |
14 | the administration of federal/state programs financed in whole or in part with Medicaid funds or |
15 | the administrative responsibility for the preparation and submission of any state plans, state plan |
16 | amendments, or authorized federal waiver applications, once approved by the secretary. |
17 | (2) Serve as the governor’s chief advisor and liaison to federal policymakers on Medicaid |
18 | reform issues as well as the principal point of contact in the state on any such related matters. |
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1 | (3)(i) Review and ensure the coordination of the state’s Medicaid section 1115 |
2 | demonstration waiver requests and renewals as well as any initiatives and proposals requiring |
3 | amendments to the Medicaid state plan or formal amendment changes, as described in the special |
4 | terms and conditions of the state’s Medicaid section 1115 demonstration waiver with the potential |
5 | to affect the scope, amount, or duration of publicly funded healthcare services, provider payments |
6 | or reimbursements, or access to or the availability of benefits and services as provided by Rhode |
7 | Island general and public laws. The secretary shall consider whether any such changes are legally |
8 | and fiscally sound and consistent with the state’s policy and budget priorities. The secretary shall |
9 | also assess whether a proposed change is capable of obtaining the necessary approvals from federal |
10 | officials and achieving the expected positive consumer outcomes. Department directors shall, |
11 | within the timelines specified, provide any information and resources the secretary deems necessary |
12 | in order to perform the reviews authorized in this section. |
13 | (ii) Direct the development and implementation of any Medicaid policies, procedures, or |
14 | systems that may be required to assure successful operation of the state’s health and human services |
15 | integrated eligibility system and coordination with HealthSource RI, the state’s health insurance |
16 | marketplace. |
17 | (iii) Beginning in 2015, conduct on a biennial basis a comprehensive review of the |
18 | Medicaid eligibility criteria for one or more of the populations covered under the state plan or a |
19 | waiver to ensure consistency with federal and state laws and policies, coordinate and align systems, |
20 | and identify areas for improving quality assurance, fair and equitable access to services, and |
21 | opportunities for additional financial participation. |
22 | (iv) Implement service organization and delivery reforms that facilitate service integration, |
23 | increase value, and improve quality and health outcomes. |
24 | (4) Beginning in 2020, prepare and submit to the governor, the chairpersons of the house |
25 | and senate finance committees, the caseload estimating conference, and to the joint legislative |
26 | committee for health-care oversight, by no later than September 15 of each year, a comprehensive |
27 | overview of all Medicaid expenditures outcomes, administrative costs, and utilization rates. The |
28 | overview shall include, but not be limited to, the following information: |
29 | (i) Expenditures under Titles XIX and XXI of the Social Security Act, as amended; |
30 | (ii) Expenditures, outcomes, and utilization rates by population and sub-population served |
31 | (e.g., families with children, persons with disabilities, children in foster care, children receiving |
32 | adoption assistance, adults ages nineteen (19) to sixty-four (64), and elders); |
33 | (iii) Expenditures, outcomes, and utilization rates by each state department or other |
34 | municipal or public entity receiving federal reimbursement under Titles XIX and XXI of the Social |
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1 | Security Act, as amended; |
2 | (iv) Expenditures, outcomes, and utilization rates by type of service and/or service |
3 | provider; |
4 | (v) Expenditures by mandatory population receiving mandatory services and, reported |
5 | separately, optional services, as well as optional populations receiving mandatory services and, |
6 | reported separately, optional services for each state agency receiving Title XIX and XXI funds; and |
7 | (vi) Information submitted to the Centers for Medicare & Medicaid Services for the |
8 | mandatory annual state reporting of the Core Set of Children’s Health Care Quality Measures for |
9 | Medicaid and Children’s Health Insurance Program, behavioral health measures on the Core Set of |
10 | Adult Health Care Quality Measures for Medicaid and the Core Sets of Health Home Quality |
11 | Measures for Medicaid to ensure compliance with the Bipartisan Budget Act of 2018, Pub. L. No. |
12 | 115-123. |
13 | The directors of the departments, as well as local governments and school departments, |
14 | shall assist and cooperate with the secretary in fulfilling this responsibility by providing whatever |
15 | resources, information and support shall be necessary. |
16 | (5) Resolve administrative, jurisdictional, operational, program, or policy conflicts among |
17 | departments and their executive staffs and make necessary recommendations to the governor. |
18 | (6) Ensure continued progress toward improving the quality, the economy, the |
19 | accountability, and the efficiency of state-administered health and human services. In this capacity, |
20 | the secretary shall: |
21 | (i) Direct implementation of reforms in the human resources practices of the executive |
22 | office and the departments that streamline and upgrade services, achieve greater economies of scale |
23 | and establish the coordinated system of the staff education, cross-training, and career development |
24 | services necessary to recruit and retain a highly-skilled, responsive, and engaged health and human |
25 | services workforce; |
26 | (ii) Encourage EOHHS-wide consumer-centered approaches to service design and delivery |
27 | that expand their capacity to respond efficiently and responsibly to the diverse and changing needs |
28 | of the people and communities they serve; |
29 | (iii) Develop all opportunities to maximize resources by leveraging the state’s purchasing |
30 | power, centralizing fiscal service functions related to budget, finance, and procurement, |
31 | centralizing communication, policy analysis and planning, and information systems and data |
32 | management, pursuing alternative funding sources through grants, awards, and partnerships and |
33 | securing all available federal financial participation for programs and services provided EOHHS- |
34 | wide; |
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1 | (iv) Improve the coordination and efficiency of health and human services legal functions |
2 | by centralizing adjudicative and legal services and overseeing their timely and judicious |
3 | administration; |
4 | (v) Facilitate the rebalancing of the long-term system by creating an assessment and |
5 | coordination organization or unit for the expressed purpose of developing and implementing |
6 | procedures EOHHS-wide that ensure that the appropriate publicly funded health services are |
7 | provided at the right time and in the most appropriate and least restrictive setting; |
8 | (vi) Strengthen health and human services program integrity, quality control and |
9 | collections, and recovery activities by consolidating functions within the office in a single unit that |
10 | ensures all affected parties pay their fair share of the cost of services and are aware of alternative |
11 | financing; |
12 | (vii) Assure protective services are available to vulnerable elders and adults with |
13 | developmental and other disabilities by reorganizing existing services, establishing new services |
14 | where gaps exist, and centralizing administrative responsibility for oversight of all related |
15 | initiatives and programs. |
16 | (7) Prepare and integrate comprehensive budgets for the health and human services |
17 | departments and any other functions and duties assigned to the office. The budgets shall be |
18 | submitted to the state budget office by the secretary, for consideration by the governor, on behalf |
19 | of the state’s health and human services agencies in accordance with the provisions set forth in § |
20 | 35-3-4. |
21 | (8) Utilize objective data to evaluate health and human services policy goals, resource use |
22 | and outcome evaluation and to perform short and long-term policy planning and development. |
23 | (9) Establishment of an integrated approach to interdepartmental information and data |
24 | management that complements and furthers the goals of the unified health infrastructure project |
25 | initiative and that will facilitate the transition to a consumer-centered integrated system of state- |
26 | administered health and human services. |
27 | (10) At the direction of the governor or the general assembly, conduct independent reviews |
28 | of state-administered health and human services programs, policies and related agency actions and |
29 | activities and assist the department directors in identifying strategies to address any issues or areas |
30 | of concern that may emerge thereof. The department directors shall provide any information and |
31 | assistance deemed necessary by the secretary when undertaking such independent reviews. |
32 | (11) Provide regular and timely reports to the governor and make recommendations with |
33 | respect to the state’s health and human services agenda. |
34 | (12) Employ such personnel and contract for such consulting services as may be required |
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1 | to perform the powers and duties lawfully conferred upon the secretary. |
2 | (13) Assume responsibility for complying with the provisions of any general or public law |
3 | or regulation related to the disclosure, confidentiality, and privacy of any information or records, |
4 | in the possession or under the control of the executive office or the departments assigned to the |
5 | executive office, that may be developed or acquired or transferred at the direction of the governor |
6 | or the secretary for purposes directly connected with the secretary’s duties set forth herein. |
7 | (14) Hold the director of each health and human services department accountable for their |
8 | administrative, fiscal, and program actions in the conduct of the respective powers and duties of |
9 | their agencies. |
10 | (15) Identify opportunities for inclusion with the EOHHS’ October 1, 2023 budget |
11 | submission, to remove fixed eligibility thresholds for programs under its purview by establishing |
12 | sliding scale decreases in benefits commensurate with income increases up to four hundred fifty |
13 | percent (450%) of the federal poverty level. These shall include but not be limited to, medical |
14 | assistance, childcare assistance, and food assistance. |
15 | (16) Ensure managed care organizations (MCOs) and pharmacy benefit managers (PBMs) |
16 | working for the Rhode Island Medicaid program are transparent, do not increase unnecessary costs |
17 | for the Rhode Island Medicaid program and patients, and demonstrate that they improve patient |
18 | health outcomes, by taking actions and promulgating regulations that achieve these goals, including |
19 | but not limited to: |
20 | (i) Requiring MCO contracts with PBMs to: |
21 | (A) Prohibit spread pricing or other practices that are similar to spread pricing; |
22 | (B) Require PBMs to use pass-through pricing; |
23 | (C) Prohibit discriminatory treatment of non-affiliated pharmacies and pharmacists by |
24 | PBMs; |
25 | (D) Prohibit PBMs from using “utilization management” that delays or prevents timely |
26 | medically necessary care; and |
27 | (E) Require information be provided that permits effective oversight of PBMs and |
28 | enforcement of this subsection. |
29 | (ii) Developing and implementing a plan for a single PBM to be used by MCOs within |
30 | twelve (12) months of the effective date of this subsection. |
31 | SECTION 2. This act shall take effect upon passage. |
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LC004652 | |
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EXPLANATION | |
BY THE LEGISLATIVE COUNCIL | |
OF | |
A N A C T | |
RELATING TO STATE AFFAIRS AND GOVERNMENT -- OFFICE OF HEALTH AND | |
HUMAN SERVICES | |
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1 | This act would impose requirements on a managed care organization (MCO) and pharmacy |
2 | benefit manger (PBM) in order to control Medicaid prescription drug prices. |
3 | This act would take effect upon passage. |
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LC004652 | |
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