2025 -- H 5792

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LC001784

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2025

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J O I N T   R E S O L U T I O N

TO AMEND THE MEDICAID SECTION 1115 DEMONSTRATION WAIVER REQUESTS

AND RENEWALS – RHODE ISLAND MEDICAID REFORM ACT OF 2008

     Introduced By: Representatives Bennett, Speakman, Cortvriend, Donovan, Cruz,
Phillips, Perez, Hopkins, Noret, and Solomon

     Date Introduced: February 26, 2025

     Referred To: House Finance

     WHEREAS, The General Assembly enacted Chapter 12.4 of Title 42 entitled “The

Rhode Island Medicaid Reform Act of 2008”; and

     WHEREAS, A legislative enactment is required pursuant to Rhode Island General Laws

chapter 12.4 of title 42, et seq.; and

     WHEREAS, Rhode Island General Laws § 42-7.2-5(3)(i) provides that the secretary of

the executive office of health and human services is responsible for the review and coordination

of any Medicaid section 1115 demonstration waiver requests and renewals as well as any

initiatives and proposals requiring amendments to the Medicaid state plan or category II or III

changes as described in the demonstration, “with potential to affect the scope, amount, or

duration of publicly-funded health care services, provider payments or reimbursements, or access

to or the availability of benefits and services provided by Rhode Island general and public laws”;

and

     WHEREAS, In pursuit of a more cost-effective consumer choice system of care that is

fiscally sound and sustainable, the secretary requests legislative approval of the following

proposals to amend the demonstration; and

     WHEREAS, Implementation of adjustments may require amendments to the Rhode

Island’s Medicaid state plan and/or section 1115 waiver under the terms and conditions of the

demonstration. Further, adoption of new or amended rules, regulations and procedures may also

be required:

     (1) Nursing facility rate increase alignment with state revenue growth. The executive

office of health and human services will pursue and implement any state plan amendments

needed to limit rate increases for nursing facilities in Fiscal Year 2025-2026 to the anticipated

rate of growth of state tax revenue, estimated to be 2.3 percent.

     (2) Inpatient and outpatient hospital rate increase alignment with state revenue growth.

The executive office of health and human services will pursue and implement any state plan

amendments needed to limit rate increases for inpatient and outpatient hospital services in Fiscal

Year 2025-2026 to the anticipated rate of growth of state tax revenue, estimated to be 2.3 percent.

     (3) Home care rates. The secretary of the executive office of health and human services

will pursue and implement any state plan amendments needed to eliminate annual rate increases

for home care services.

     (4) Elimination of inpatient and outpatient hospital upper payment limit payments. The

secretary of the executive office of health and human services will pursue and implement any

state plan amendments needed to eliminate inpatient and outpatient hospital upper payment limit

payments.

     (5) Establishment of interprofessional consultation program. The secretary of the

executive office of health and human services will pursue and implement any state plan

amendments needed to establish an interprofessional consultation program in Medicaid effective

October 1, 2025.

     (6) Federal financing opportunities. The executive office health and human services

proposes that it shall review Medicaid requirements and opportunities under the U.S. Patient

Protection and Affordable Care Act of 2010 (PPACA) and various other recently enacted federal

laws and pursue any changes in the Rhode Island Medicaid program that promote, increase and

enhance service quality, access and cost-effectiveness that may require a Medicaid state plan

amendment or amendment under the terms and conditions of Rhode Island’s section 1115 waiver,

its successor, or any extension thereof. Any such actions by the executive office of health and

human services shall not have an adverse impact on beneficiaries or cause there to be an increase

in expenditures beyond the amount appropriated for Fiscal Year 2024-2025.

     (7) Hospital state directed managed care payment. The secretary of the executive office is

hereby authorized and directed to amend its regulations for reimbursement to Medicaid Managed

Care Organizations and authorized to direct MMCOs to make quarterly state directed payments to

hospitals for inpatient and outpatient services in accordance with the payment methodology

contained in the approved Centers for Medicare and Medicaid services preprint for hospital state

directed payments. The total amount of these payments for Fiscal Year 2025-2026 shall be $396

LC001784 - Page 2 of 4

million; now, therefore, be it

     RESOLVED, That the General Assembly hereby approves the above-referenced

proposals; and be it further

     RESOLVED, That the secretary of the executive office of health and human services is

authorized to pursue and implement any waiver amendments, state plan amendments, and/or

changes to the applicable department’s rules, regulations and procedures approved herein and as

authorized by Rhode Island general laws chapter 12.4 of title 42; and be it further

     RESOLVED, that this Joint Resolution shall take effect on July 1, 2025.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

J O I N T   R E S O L U T I O N

TO AMEND THE MEDICAID SECTION 1115 DEMONSTRATION WAIVER REQUESTS

AND RENEWALS – RHODE ISLAND MEDICAID REFORM ACT OF 2008

***

     This joint resolution would approve an amendment to the Medicaid section 1115

demonstration waiver requests and renewals.

     This Joint Resolution would take effect on July 1, 2025.

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