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art.008/4/008/3/008/2/008/1

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     ARTICLE 8 AS AMENDED

RELATING TO MEDICAL ASSISTANCE

     SECTION 1. Section 23-17-38.1 of the General Laws in Chapter 23-17 entitled "Licensing

of Healthcare Facilities" is hereby amended to read as follows:

     (a) There is imposed a hospital licensing fee described in subsections (c) through (f) for

state fiscal years 2024 and 2025 against net patient-services revenue of every non-government

owned hospital as defined herein for the hospital's first fiscal year ending on or after January 1,

2022. The hospital licensing fee shall have three (3) tiers with differing fees based on inpatient and

outpatient net patient-services revenue. The executive office of health and human services, in

consultation with the tax administrator, shall identify the hospitals in each tier, subject to the

definitions in this section, by July 15, 2023, and shall notify each hospital of its tier by August 1,

2023.

     (b) There is also imposed a hospital licensing fee described in subsections (c) through (f)

for state fiscal year years 2026 and 2027 against net patient-services revenue of every non-

government owned hospital as defined herein for the hospital's first fiscal year ending on or after

January 1, 2023. The hospital licensing fee shall have three (3) tiers with differing fees based on

inpatient and outpatient net patient-services revenue. The executive office of health and human

services, in consultation with the tax administrator, shall identify the hospitals in each tier, subject

to the definitions in this section, annually by July 15, 2025, and shall notify each hospital of its

assigned tier by August 1, 2025.

     (c) Tier 1 is composed of hospitals that do not meet the description of either Tier 2 or Tier

3.

     (1) The inpatient hospital licensing fee for Tier 1 is equal to thirteen and twelve hundredths

percent (13.12%) of the inpatient net patient-services revenue derived from inpatient net patient-

services revenue of every Tier 1 hospital.

     (2) The outpatient hospital licensing fee for Tier 1 is equal to thirteen and thirty hundredths

percent (13.30%) of the net patient-services revenue derived from outpatient net patient-services

revenue of every Tier 1 hospital.

     (d) Tier 2 is composed of high Medicaid/uninsured cost hospitals and independent

hospitals.

     (1) The inpatient hospital licensing fee for Tier 2 is equal to two and sixty-three hundredths

percent (2.63%) of the inpatient net patient-services revenue derived from inpatient net patient-

services revenue of every Tier 2 hospital.

     (2) The outpatient hospital licensing fee for Tier 2 is equal to two and sixty-six hundredths

percent (2.66%) of the outpatient net patient-services revenue derived from outpatient net patient-

services revenue of every Tier 2 hospital.

     (e) Tier 3 is composed of hospitals that are Medicare-designated low-volume hospitals and

rehabilitative hospitals.

     (1) The inpatient hospital licensing fee for Tier 3 is equal to one and thirty-one hundredths

percent (1.31%) of the inpatient net patient-services revenue derived from inpatient net patient-

services revenue of every Tier 3 hospital.

     (2) The outpatient hospital licensing fee for Tier 3 is equal to one and thirty-three

hundredths percent (1.33%) of the outpatient net patient-services revenue derived from outpatient

net patient-services revenue of every Tier 3 hospital.

     (f) There is also imposed a hospital licensing fee for state fiscal year 2024 against state-

government owned and operated hospitals in the state as defined herein. The hospital licensing fee

is equal to five and twenty-five hundredths percent (5.25%) of the net patient-services revenue of

every hospital for the hospital's first fiscal year ending on or after January 1, 2022. There is also

imposed a hospital licensing fee for state fiscal years 2025, and 2026, and 2027 against state-

government owned and operated hospitals in the state as defined herein equal to five and twenty-

five hundredths percent (5.25%) of the net patient-services revenue of every hospital for the

hospital's first fiscal year ending on or after January 1, 2023.

     (g) The hospital licensing fee described in subsections (b) through (f) is subject to U.S.

Department of Health and Human Services approval of a request to waive the requirement that

healthcare-related taxes be imposed uniformly as contained in 42 C.F.R. § 433.68(d).

     (h) This hospital licensing fee shall be administered and collected by the tax administrator,

division of taxation within the department of revenue, and all the administration, collection, and

other provisions of chapter 51 of title 44 shall apply. Every hospital shall pay the licensing fee to

the tax administrator before June 25 of each fiscal year, and payments shall be made by electronic

transfer of monies to the tax administrator and deposited to the general fund. Every hospital shall,

on or before August 1 of each fiscal year, make a return to the tax administrator containing the

correct computation of inpatient and outpatient net patient-services revenue for the hospital data

referenced in subsection (a) and/or (b) this section, and the licensing fee due upon that amount. All

returns shall be signed by the hospital's authorized representative, subject to the pains and penalties

of perjury.

     (i) For purposes of this section the following words and phrases have the following

meanings:

     (1) "Gross patient-services revenue" means the gross revenue related to patient care

services.

     (2) "High Medicaid/uninsured cost hospital" means a hospital for which the hospital's total

uncompensated care, as calculated pursuant to § 40-8.3-2(4), divided by the hospital's total net

patient-services revenues, is equal to six percent (6.0%) or greater.

     (3) "Hospital" means the actual facilities and buildings in existence in Rhode Island,

licensed pursuant to § 23-17-1 et seq. on June 30, 2010, and thereafter any premises included on

that license, regardless of changes in licensure status pursuant to chapter 17.14 of this title (hospital

conversions) and § 23-17-6(b) (change in effective control), that provides short-term acute inpatient

and/or outpatient care to persons who require definitive diagnosis and treatment for injury, illness,

disabilities, or pregnancy. Notwithstanding the preceding language, the negotiated Medicaid

managed care payment rates for a court-approved purchaser that acquires a hospital through

receivership, special mastership, or other similar state insolvency proceedings (which court-

approved purchaser is issued a hospital license after January 1, 2013) shall be based upon the newly

negotiated rates between the court-approved purchaser and the health plan, and such rates shall be

effective as of the date that the court-approved purchaser and the health plan execute the initial

agreement containing the newly negotiated rate. The rate-setting methodology for inpatient hospital

payments and outpatient hospital payments set forth in §§ 40-8-13.4(b) and 40-8-13.4(b)(2),

respectively, shall thereafter apply to negotiated increases for each annual twelve-month (12)

period as of July 1 following the completion of the first full year of the court-approved purchaser's

initial Medicaid managed care contract.

     (4) "Independent hospitals" means a hospital not part of a multi-hospital system.

     (5) "Inpatient net patient-services revenue" means the charges related to inpatient care

services less (i) Charges attributable to charity care; (ii) Bad debt expenses; and (iii) Contractual

allowances.

     (6) "Medicare-designated low-volume hospital" means a hospital that qualifies under 42

C.F.R. 412.101(b)(2) for additional Medicare payments to qualifying hospitals for the higher

incremental costs associated with a low volume of discharges.

     (7) "Net patient-services revenue" means the charges related to patient care services less

(i) Charges attributable to charity care; (ii) Bad debt expenses; and (iii) Contractual allowances.

     (8) "Non-government owned hospitals" means a hospital not owned and operated by the

state of Rhode Island.

     (9) "Outpatient net patient-services revenue" means the charges related to outpatient care

services less (i) Charges attributable to charity care; (ii) Bad debt expenses; and (iii) Contractual

allowances.

     (10) "Rehabilitative hospital" means Rehabilitation Hospital Center licensed by the Rhode

Island department of health.

     (11) "State-government owned and operated hospitals" means a hospital facility licensed

by the Rhode Island department of health, owned and operated by the state of Rhode Island.

     (j) The tax administrator in consultation with the executive office of health and human

services shall make and promulgate any rules, regulations, and procedures not inconsistent with

state law and fiscal procedures that he or she deems necessary for the proper administration of this

section and to carry out the provisions, policy, and purposes of this section.

     (k) The licensing fee imposed by subsections (a) through (f) shall apply to hospitals as

defined herein that are duly licensed on July 1, 2024, and shall be in addition to the inspection fee

imposed by § 23-17-38 and to any licensing fees previously imposed in accordance with this

section.

     SECTION 2. Section 40-8-3 of the General Laws in Chapter 40-8 entitled "Medical

Assistance" is hereby amended to read as follows:

     40-8-3. Eligibility requirements.

     Medical care benefits shall be provided under this chapter to at least any person:

     (1) Who has attained the age of sixty-five (65) years; or

     (2) Who has no vision or whose vision is so defective as to prevent performance of ordinary

activities for which eyesight is essential; or

     (3) Who is at least eighteen (18) years of age and who is permanently and totally disabled;

or

     (4) Who is under the age of eighteen (18) years, and who has been deprived of parental

support or care by reason of the death, continued absence from the home, unemployment, or

physical or mental incapacity of a parent (called hereafter “dependent child”) and who is living

with a relative in a place of residence maintained by one or more of these relatives as his or her or

their own home, or is in foster boarding care; or

     (5) The relative as defined in subsection (8) of § 40-8-2, with whom the dependent child is

living; provided the person:

     (i) Is a resident of this state; and

     (ii) Is not receiving public assistance under the provisions of § 40-5.1-9(b) [repealed] or §

40-6-27; and

     (iii) Is not an inmate of a public institution other than as a patient in a medical institution;

and

     (iv) Is not a patient in an institution for tuberculosis or mental disease, unless the person

has attained the age of sixty-five (65) years; provided, however, that this clause shall become void

and of no effect if and when legislation enacted by the Congress of the United States shall become

effective providing for payments for medical care on behalf of persons who have not attained the

age of sixty-five (65) years who are patients in an institution for tuberculosis or mental disease; and

     (v) Has insufficient income and resources. The department shall establish income and

resource rules, regulations, and limits in accordance with Title XIX of the federal Social Security

Act, 42 U.S.C. § 1396 et seq., as applicable to the medically needy only applicants and recipients.

The income limits established by the department must be more than the AFDC standard in effect

on July 16, 1996, under the Rhode Island state plan approved under part A of Title IV of the federal

Social Security Act, 42 U.S.C. § 601 et seq., but shall not be more than one hundred thirty-three

and one-third percent (133⅓%) of the AFDC standard in effect on July 16, 1996, under the Rhode

Island state plan approved under part A of Title IV of the federal Social Security Act; provided,

however, that subject to the maximum percentage increase allowable under § 1931(b)(2)(B), the

department shall increase the income limits on July 1, 1999, by six and six-tenths percent (6.6%),

and on January 1, of each year commencing in the year 2000 by a percentage equal to the annual

federal adjustment percentage as determined under the provisions of Title XVI of the federal Social

Security Act, 42 U.S.C. § 1381 et seq. The department shall establish resource limits equal to two

thousand dollars ($2,000) eight thousand dollars ($8,000) for an individual and three thousand

dollars ($3,000) twelve thousand dollars ($12,000) for a family. Provided, however, the department

shall apply to the United States Department of Health and Human Services for a waiver relating to

application of the reduced resource limit, and subject to the granting of the waiver by the Secretary

of the United States Department of Health and Human Services, the resource limit shall be applied

to all applicants who: (A) Become eligible for benefits under this chapter on or after the effective

date of this amendment and (B) Who were not receiving benefits under this chapter prior to July 1,

1993. In the event the secretary does not approve the waiver request, the current department

regulations relating to resource limits shall remain in effect for all eligible beneficiaries.

     For the purposes of this subsection, a vehicle necessary to transport a family member with

a disability, where the vehicle is specially equipped to meet the specific needs of the person with a

disability or if the vehicle is a special type of vehicle that makes it possible to transport the person

with the disability, shall not be counted as resources of the applicants and recipients.

     SECTION 3. Sections 40-8.3-2 and 40-8.3-3 of the General Laws in Chapter 40-8.3 entitled

"Uncompensated Care" are hereby amended to read as follows:

     40-8.3-2. Definitions.

     As used in this chapter:

     (1) "Base year" means, for the purpose of calculating a disproportionate share payment for

any fiscal year ending after September 30, 20242025, the period from October 1, 20222023,

through September 30, 20232024, and for any fiscal year ending after September 30, 20252026,

the period from October 1, 20232024, through September 30, 20242025.

     (2) "Medicaid inpatient utilization rate for a hospital" means a fraction (expressed as a

percentage), the numerator of which is the hospital's number of inpatient days during the base year

attributable to patients who were eligible for medical assistance during the base year and the

denominator of which is the total number of the hospital's inpatient days in the base year.

     (3) "Participating hospital" means any nonpsychiatric hospital that:

     (i) Was licensed as a hospital in accordance with chapter 17 of title 23 during the base year

and shall mean the actual facilities and buildings in existence in Rhode Island, licensed pursuant to

§ 23-17-1 et seq. on June 30, 2010, and thereafter any premises included on that license, regardless

of changes in licensure status pursuant to chapter 17.14 of title 23 (hospital conversions) and § 23-

17-6(b) (change in effective control), that provides acute inpatient and/or outpatient care to persons

who require definitive diagnosis and treatment for injury, illness, disabilities, or pregnancy.

Notwithstanding the preceding language, the negotiated Medicaid managed care payment rates for

a court-approved purchaser that acquires a hospital through receivership, special mastership, or

other similar state insolvency proceedings (which court-approved purchaser is issued a hospital

license after January 1, 2013), shall be based upon the newly negotiated rates between the court-

approved purchaser and the health plan, and the rates shall be effective as of the date that the court-

approved purchaser and the health plan execute the initial agreement containing the newly

negotiated rate. The rate-setting methodology for inpatient hospital payments and outpatient

hospital payments set forth in §§ 40-8-13.4(b)(1)(ii)(C) and 40-8-13.4(b)(2), respectively, shall

thereafter apply to negotiated increases for each annual twelve-month (12) period as of July 1

following the completion of the first full year of the court-approved purchaser's initial Medicaid

managed care contract;

     (ii) Achieved a medical assistance inpatient utilization rate of at least one percent (1%)

during the base year; and

     (iii) Continues to be licensed as a hospital in accordance with chapter 17 of title 23 during

the payment year.

     (4) "Uncompensated-care costs" means, as to any hospital, the sum of: (i) The cost incurred

by the hospital during the base year for inpatient or outpatient services attributable to charity care

(free care and bad debts) for which the patient has no health insurance or other third-party coverage

less payments, if any, received directly from such patients; (ii) The cost incurred by the hospital

during the base year for inpatient or outpatient services attributable to Medicaid beneficiaries less

any Medicaid reimbursement received therefor; and (iii) the sum of subsections (4)(i) and (4)(ii) of

this section shall be offset by the estimated hospital's commercial equivalent rates state directed

payment for the current SFY in which the disproportionate share hospital (DSH) payment is made.

The sum of subsections (4)(i), (4)(ii), and (4)(iii) of this section shall be multiplied by the

uncompensated care index.

     (5) "Uncompensated-care index" means the annual percentage increase for hospitals

established pursuant to § 27-19-14 [repealed] for each year after the base year, up to and including

the payment year; provided, however, that the uncompensated-care index for the payment year

ending September 30, 2007, shall be deemed to be five and thirty-eight hundredths percent (5.38%),

and that the uncompensated-care index for the payment year ending September 30, 2008, shall be

deemed to be five and forty-seven hundredths percent (5.47%), and that the uncompensated-care

index for the payment year ending September 30, 2009, shall be deemed to be five and thirty-eight

hundredths percent (5.38%), and that the uncompensated-care index for the payment years ending

September 30, 2010, September 30, 2011, September 30, 2012, September 30, 2013, September

30, 2014, September 30, 2015, September 30, 2016, September 30, 2017, September 30, 2018,

September 30, 2019, September 30, 2020, September 30, 2021, September 30, 2022, September

30, 2023, September 30, 2024, September 30, 2025, and September 30, 2026, and September 30,

2027 shall be deemed to be five and thirty hundredths percent (5.30%).

     40-8.3-3. Implementation.

     (a) For federal fiscal year 2024, commencing on October 1, 2023, and ending September

30, 2024, the executive office of health and human services shall submit to the Secretary of the

United States Department of Health and Human Services a state plan amendment to the Rhode

Island Medicaid DSH Plan to provide:

     (1) That the DSH Plan to all participating hospitals, not to exceed an aggregate limit of

$14.8 million, shall be allocated by the executive office of health and human services to the Pool

D component of the DSH Plan; and

     (2) That the Pool D allotment shall be distributed among the participating hospitals in direct

proportion to the individual participating hospital's uncompensated-care costs for the base year,

inflated by the uncompensated-care index to the total uncompensated-care costs for the base year

inflated by the uncompensated-care index for all participating hospitals. The disproportionate share

payments shall be made on or before June 30, 2024, and are expressly conditioned upon approval

on or before June 23, 2024, by the Secretary of the United States Department of Health and Human

Services, or their authorized representative, of all Medicaid state plan amendments necessary to

secure for the state the benefit of federal financial participation in federal fiscal year 2024 for the

disproportionate share payments.

     (b)(a) For federal fiscal year 2025, commencing on October 1, 2024, and ending on

September 30, 2025, the executive office of health and human services shall submit to the Secretary

of the United States Department of Health and Human Services a state plan amendment to the

Rhode Island Medicaid DSH plan to provide:

     (1) The creation of Pool C which allots no more than twelve million nine hundred thousand

dollars ($12,900,000) to Medicaid eligible government-owned hospitals;

     (2) That the DSH plan to all participating hospitals, not to exceed an aggregate limit of

$27.7 million, shall be allocated by the executive office of health and human services to the Pool

C and D components of the DSH plan;

     (3) That the Pool D allotment shall be distributed among the participating hospitals in direct

proportion to the individual participating hospital's uncompensated-care costs for the base year,

inflated by the uncompensated-care index to the total uncompensated-care costs for the base year

inflated by the uncompensated-care index of all participating hospitals. The disproportionate share

payments shall be made on or before June 30, 2025, and are expressly conditioned upon approval

on or before June 23, 2025, by the Secretary of the United States Department of Health and Human

Services, or their authorized representative, of all Medicaid state plan amendments necessary to

secure for the state the benefit of federal financial participation in federal fiscal year 2025 for the

disproportionate share payments; and

     (4) That the Pool C allotment shall be distributed among the participating hospitals in direct

proportion to the individual participating hospital's uncompensated-care costs for the base year,

inflated by the uncompensated-care index to the total uncompensated-care cost for the base year

inflated by the uncompensated-care index of all participating hospitals. The disproportionate share

payments shall be made on or before June 30, 2025, and are expressly conditioned upon approval

on or before June 23, 2025, by the Secretary of the United States Department of Health and Human

Services, or their authorized representative, of all Medicaid state plan amendments necessary to

secure for the state the benefit of federal financial participation in federal fiscal year 2025 for the

disproportionate share payments.

     (c)(b) For federal fiscal year 2026, commencing on October 1, 2025, and ending on

September 30, 2026, the executive office of health and human services shall submit to the Secretary

of the United States Department of Health and Human Services a state plan amendment to the

Rhode Island Medicaid DSH plan to provide:

     (1) That the DSH plan to all participating hospitals, not to exceed an aggregate limit of

$13.9 million, shall be allocated by the executive office of health and human services to the Pool

C and D components of the DSH plan. Pool C shall not exceed an aggregate limit of $12.9 million.

Pool D shall not exceed an aggregate limit of $1.0 million;

     (2) That the Pool C allotment shall be distributed among the participating hospitals in direct

proportion to the individual participating hospital's uncompensated-care costs for the base year,

inflated by the uncompensated-care index to the total uncompensated-care cost for the base year

inflated by the uncompensated-care index of all participating hospitals. The disproportionate share

payments shall be made on or before June 30, 2026, and are expressly conditioned upon approval

on or before June 23, 2026, by the Secretary of the United States Department of Health and Human

Services, or their authorized representative, of all Medicaid state plan amendments necessary to

secure for the state the benefit of federal financial participation in federal fiscal year 2026 for the

disproportionate share payments; and

     (3) That the Pool D allotment shall be distributed among the participating hospitals in direct

proportion to the individual participating hospital's uncompensated-care costs for the base year,

inflated by the uncompensated-care index to the total uncompensated-care costs for the base year

inflated by the uncompensated-care index of all participating hospitals. The disproportionate share

payments shall be made on or before June 30, 2026, and are expressly conditioned upon approval

on or before June 23, 2026, by the Secretary of the United States Department of Health and Human

Services, or their authorized representative, of all Medicaid state plan amendments necessary to

secure for the state the benefit of federal financial participation in federal fiscal year 2026 for the

disproportionate share payments.

     (c) For federal fiscal year 2027, commencing on October 1, 2026, and ending on September

30, 2027, the DSH plan for all participating hospitals shall not exceed an aggregate limit of thirty-

eight million nine hundred thousand dollars ($38,900,000) and shall be allocated by the executive

office of health and human services to the Pool C and D components of the DSH plan. The Pool C

component of the DSH plan shall not exceed an aggregate limit of twelve million nine hundred

thousand dollars ($12,900,000). The Pool D component of the DSH plan shall not exceed an

aggregate limit of twenty-six million dollars ($26,000,000).

     (1) The Pool C allotment shall be distributed among the participating hospitals in direct

proportion to each individual participating hospital's uncompensated-care costs for the base year,

inflated by the uncompensated-care index as described in § 40-8.3-2(5). The DSH payments shall

be made on or before June 30, 2027; and,

     (2) The Pool D allotment shall be distributed among the participating hospitals in direct

proportion to the individual participating hospital's uncompensated-care costs for the base year,

inflated by the uncompensated-care index as described in § 40-8.3-2(5). The disproportionate share

payments shall be made on or before June 30, 2027.

     (d) No provision is made pursuant to this chapter for disproportionate-share hospital

payments to participating hospitals for uncompensated-care costs related to graduate medical

education programs.

     (e) The executive office of health and human services is directed, on at least a monthly

basis, to collect patient-level uninsured information, including, but not limited to, demographics,

services rendered, and reason for uninsured status from all hospitals licensed in Rhode Island.

     (f) [Deleted by P.L. 2019, ch. 88, art. 13, § 6.]

     SECTION 4. Section 40-8.5-1 of the General Laws in Chapter 40-8.5 entitled "Health Care

for Elderly and Disabled Residents Act" is hereby amended to read as follows:

     40-8.5-1. Categorically needy medical assistance coverage.

     The department of human services is hereby authorized and directed to amend its Title XIX

state plan to provide for categorically needy medical assistance coverage as permitted pursuant to

Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq., as amended, to individuals who are

sixty-five (65) years or older or are disabled, as determined under § 1614(a)(3) of the Social

Security Act, 42 U.S.C. § 1382c(a)(3), as amended, whose income does not exceed one hundred

percent (100%) of the federal poverty level (as revised annually) applicable to the individual’s

family size, and whose resources do not exceed four thousand dollars ($4,000) eight thousand

dollars ($8,000) per individual, or six thousand dollars ($6,000) twelve thousand dollars ($12,000)

per couple. The department shall provide medical assistance coverage to such elderly or disabled

persons in the same amount, duration, and scope as provided to other categorically needy persons

under the state’s Title XIX state plan.

     SECTION 5. Section 40-8.9-9 of the General Laws in Chapter 40-8.9 entitled "Medical

Assistance — Long-Term Care Service and Finance Reform" is hereby amended to read as follows:

     40-8.9-9. Long-term-care rebalancing system reform goal.

     (a) Notwithstanding any other provision of state law, the executive office of health and

human services is authorized and directed to apply for, and obtain, any necessary waiver(s), waiver

amendment(s), and/or state-plan amendments from the Secretary of the United States Department

of Health and Human Services, and to promulgate rules necessary to adopt an affirmative plan of

program design and implementation that addresses the goal of allocating a minimum of fifty percent

(50%) of Medicaid long-term-care funding for persons aged sixty-five (65) and over and adults

with disabilities, in addition to services for persons with developmental disabilities, to home- and

community-based care; provided, further, the executive office shall report annually as part of its

budget submission, the percentage distribution between institutional care and home- and

community-based care by population and shall report current and projected waiting lists for long-

term-care and home- and community-based care services. The executive office is further authorized

and directed to prioritize investments in home- and community-based care and to maintain the

integrity and financial viability of all current long-term-care services while pursuing this goal.

     (b) The reformed long-term-care system rebalancing goal is person-centered and

encourages individual self-determination, family involvement, interagency collaboration, and

individual choice through the provision of highly specialized and individually tailored home-based

services. Additionally, individuals with severe behavioral, physical, or developmental disabilities

must have the opportunity to live safe and healthful lives through access to a wide range of

supportive services in an array of community-based settings, regardless of the complexity of their

medical condition, the severity of their disability, or the challenges of their behavior. Delivery of

services and supports in less-costly and less-restrictive community settings will enable children,

adolescents, and adults to be able to curtail, delay, or avoid lengthy stays in long-term-care

institutions, such as behavioral health residential-treatment facilities, long-term-care hospitals,

intermediate-care facilities, and/or skilled nursing facilities.

     (c) Pursuant to federal authority procured under § 42-7.2-16, the executive office of health

and human services is directed and authorized to adopt a tiered set of criteria to be used to determine

eligibility for services. The criteria shall be developed in collaboration with the state's health and

human services departments and, to the extent feasible, any consumer group, advisory board, or

other entity designated for these purposes, and shall encompass eligibility determinations for long-

term-care services in nursing facilities, hospitals, and intermediate-care facilities for persons with

intellectual disabilities, as well as home- and community-based alternatives, and shall provide a

common standard of income eligibility for both institutional and home- and community-based care.

The executive office is authorized to adopt clinical and/or functional criteria for admission to a

nursing facility, hospital, or intermediate-care facility for persons with intellectual disabilities that

are more stringent than those employed for access to home- and community-based services. The

executive office is also authorized to promulgate rules that define the frequency of re-assessments

for services provided for under this section. Levels of care may be applied in accordance with the

following:

     (1) The executive office shall continue to apply the level-of-care criteria in effect on April

1, 2021, for any recipient determined eligible for and receiving Medicaid-funded long-term services

and supports in a nursing facility, hospital, or intermediate-care facility for persons with intellectual

disabilities on or before that date, unless:

     (i) The recipient transitions to home- and community-based services because he or she

would no longer meet the level-of-care criteria in effect on April 1, 2021; or

     (ii) The recipient chooses home- and community-based services over the nursing facility,

hospital, or intermediate-care facility for persons with intellectual disabilities. For the purposes of

this section, a failed community placement, as defined in regulations promulgated by the executive

office, shall be considered a condition of clinical eligibility for the highest level of care. The

executive office shall confer with the long-term-care ombudsperson with respect to the

determination of a failed placement under the ombudsperson's jurisdiction. Should any Medicaid

recipient eligible for a nursing facility, hospital, or intermediate-care facility for persons with

intellectual disabilities as of April 1, 2021, receive a determination of a failed community

placement, the recipient shall have access to the highest level of care; furthermore, a recipient who

has experienced a failed community placement shall be transitioned back into their former nursing

home, hospital, or intermediate-care facility for persons with intellectual disabilities whenever

possible. Additionally, residents shall only be moved from a nursing home, hospital, or

intermediate-care facility for persons with intellectual disabilities in a manner consistent with

applicable state and federal laws.

     (2) Any Medicaid recipient eligible for the highest level of care who voluntarily leaves a

nursing home, hospital, or intermediate-care facility for persons with intellectual disabilities shall

not be subject to any wait list for home- and community-based services.

     (3) No nursing home, hospital, or intermediate-care facility for persons with intellectual

disabilities shall be denied payment for services rendered to a Medicaid recipient on the grounds

that the recipient does not meet level-of-care criteria unless and until the executive office has:

     (i) Performed an individual assessment of the recipient at issue and provided written notice

to the nursing home, hospital, or intermediate-care facility for persons with intellectual disabilities

that the recipient does not meet level-of-care criteria; and

     (ii) The recipient has either appealed that level-of-care determination and been

unsuccessful, or any appeal period available to the recipient regarding that level-of-care

determination has expired.

     (d) The executive office is further authorized to consolidate all home- and community-

based services currently provided pursuant to 42 U.S.C. § 1396n into a single system of home- and

community-based services that include options for consumer direction and shared living. The

resulting single home- and community-based services system shall replace and supersede all 42

U.S.C. § 1396n programs when fully implemented. Notwithstanding the foregoing, the resulting

single program home- and community-based services system shall include the continued funding

of assisted-living services at any assisted-living facility financed by the Rhode Island housing and

mortgage finance corporation prior to January 1, 2006, and shall be in accordance with chapter 66.8

of title 42 as long as assisted-living services are a covered Medicaid benefit.

     (e) The executive office is authorized to promulgate rules that permit certain optional

services including, but not limited to, homemaker services, home modifications, respite, and

physical therapy evaluations to be offered to persons at risk for Medicaid-funded long-term care

subject to availability of state-appropriated funding for these purposes.

     (f) To promote the expansion of home- and community-based service capacity, the

executive office is authorized to pursue payment methodology reforms that increase access to

homemaker, personal care (home health aide), assisted living, adult supportive-care homes, and

adult day services, as follows:

     (1) Development of revised or new Medicaid certification standards that increase access to

service specialization and scheduling accommodations by using payment strategies designed to

achieve specific quality and health outcomes.

     (2) Development of Medicaid certification standards for state-authorized providers of adult

day services, excluding providers of services authorized under § 40.1-24-1(3), assisted living, and

adult supportive care (as defined under chapter 17.24 of title 23) that establish for each, an acuity-

based, tiered service and payment methodology tied to: licensure authority; level of beneficiary

needs; the scope of services and supports provided; and specific quality and outcome measures.

     The standards for adult day services for persons eligible for Medicaid-funded long-term

services may differ from those who do not meet the clinical/functional criteria set forth in § 40-

8.10-3.

     (3) As the state's Medicaid program seeks to assist more beneficiaries requiring long-term

services and supports in home- and community-based settings, the demand for home-care workers

has increased, and wages for these workers has not kept pace with neighboring states, leading to

high turnover and vacancy rates in the state's home-care industry, the executive office shall institute

a one-time increase in the base-payment rates for FY 2019, as described below, for home-care

service providers to promote increased access to and an adequate supply of highly trained home-

healthcare professionals, in amount to be determined by the appropriations process, for the purpose

of raising wages for personal care attendants and home health aides to be implemented by such

providers.

     (i) A prospective base adjustment, effective not later than July 1, 2018, of ten percent (10%)

of the current base rate for home-care providers, home nursing care providers, and hospice

providers contracted with the executive office of health and human services and its subordinate

agencies to deliver Medicaid fee-for-service personal care attendant services.

     (ii) A prospective base adjustment, effective not later than July 1, 2018, of twenty percent

(20%) of the current base rate for home-care providers, home nursing care providers, and hospice

providers contracted with the executive office of health and human services and its subordinate

agencies to deliver Medicaid fee-for-service skilled nursing and therapeutic services and hospice

care.

     (iii) Effective upon passage of this section, hospice provider reimbursement, exclusively

for room and board expenses for individuals residing in a skilled nursing facility, shall revert to the

rate methodology in effect on June 30, 2018, and these room and board expenses shall be exempted

from any and all annual rate increases to hospice providers as provided for in this section.

     (iv) On the first of July in each year, beginning on July 1, 2019, the executive office of

health and human services will initiate an annual inflation increase to the base rate for home-care

providers, home nursing care providers, and hospice providers contracted with the executive office

and its subordinate agencies to deliver Medicaid fee-for-service personal care attendant services,

skilled nursing and therapeutic services and hospice care. The base rate increase shall be a

percentage amount equal to the New England Consumer Price Index card as determined by the

United States Department of Labor for medical care and for compliance with all federal and state

laws, regulations, and rules, and all national accreditation program requirements, except as of July

1, 2025, and thereafter, when no annual inflation increase shall occur for these rates.

     (g) As the state's Medicaid program seeks to assist more beneficiaries requiring long-term

services and supports in home- and community-based settings, the demand for home-care workers

has increased, and wages for these workers has not kept pace with neighboring states, leading to

high turnover and vacancy rates in the state's home-care industry. To promote increased access to

and an adequate supply of direct-care workers, the executive office shall institute a payment

methodology change, in Medicaid fee-for-service and managed care, for FY 2022, that shall be

passed through directly to the direct-care workers' wages who are employed by home nursing care

and home-care providers licensed by the Rhode Island department of health, as described below:

     (1) Effective July 1, 2021, increase the existing shift differential modifier by $0.19 per

fifteen (15) minutes for personal care and combined personal care/homemaker.

     (i) Employers must pass on one hundred percent (100%) of the shift differential modifier

increase per fifteen-minute (15) unit of service to the CNAs who rendered such services. This

compensation shall be provided in addition to the rate of compensation that the employee was

receiving as of June 30, 2021. For an employee hired after June 30, 2021, the agency shall use not

less than the lowest compensation paid to an employee of similar functions and duties as of June

30, 2021, as the base compensation to which the increase is applied.

     (ii) Employers must provide to EOHHS an annual compliance statement showing wages

as of June 30, 2021, amounts received from the increases outlined herein, and compliance with this

section by July 1, 2022. EOHHS may adopt any additional necessary regulations and processes to

oversee this subsection.

     (2) Effective January 1, 2022, establish a new behavioral healthcare enhancement of $0.39

per fifteen (15) minutes for personal care, combined personal care/homemaker, and homemaker

only for providers who have at least thirty percent (30%) of their direct-care workers (which

includes certified nursing assistants (CNA) and homemakers) certified in behavioral healthcare

training.

     (i) Employers must pass on one hundred percent (100%) of the behavioral healthcare

enhancement per fifteen (15) minute unit of service rendered by only those CNAs and homemakers

who have completed the thirty (30) hour behavioral health certificate training program offered by

Rhode Island College, or a training program that is prospectively determined to be compliant per

EOHHS, to those CNAs and homemakers. This compensation shall be provided in addition to the

rate of compensation that the employee was receiving as of December 31, 2021. For an employee

hired after December 31, 2021, the agency shall use not less than the lowest compensation paid to

an employee of similar functions and duties as of December 31, 2021, as the base compensation to

which the increase is applied.

     (ii) By January 1, 2023, employers must provide to EOHHS an annual compliance

statement showing wages as of December 31, 2021, amounts received from the increases outlined

herein, and compliance with this section, including which behavioral healthcare training programs

were utilized. EOHHS may adopt any additional necessary regulations and processes to oversee

this subsection.

     (h) The executive office shall implement a long-term-care-options counseling program to

provide individuals, or their representatives, or both, with long-term-care consultations that shall

include, at a minimum, information about: long-term-care options, sources, and methods of both

public and private payment for long-term-care services and an assessment of an individual's

functional capabilities and opportunities for maximizing independence. Each individual admitted

to, or seeking admission to, a long-term-care facility, regardless of the payment source, shall be

informed by the facility of the availability of the long-term-care-options counseling program and

shall be provided with long-term-care-options consultation if they so request. Each individual who

applies for Medicaid long-term-care services shall be provided with a long-term-care consultation.

     (i) The executive office shall implement, no later than January 1, 2024, a statewide network

and rate methodology for conflict-free case management for individuals receiving Medicaid-funded

home and community-based services. The executive office shall coordinate implementation with

the state's health and human services departments and divisions authorized to deliver Medicaid-

funded home and community-based service programs, including the department of behavioral

healthcare, developmental disabilities and hospitals; the department of human services; and the

office of healthy aging. It is in the best interest of the Rhode Islanders eligible to receive Medicaid

home and community-based services under this chapter, title 40.1, title 42, or any other general

laws to provide equitable access to conflict-free case management that shall include person-

centered planning, service arranging, and quality monitoring in the amount, duration, and scope

required by federal law and regulations. It is necessary to ensure that there is a robust network of

qualified conflict-free case management entities with the capacity to serve all participants on a

statewide basis and in a manner that promotes choice, self-reliance, and community integration.

The executive office, as the designated single state Medicaid authority and agency responsible for

coordinating policy and planning for health and human services under § 42-7.2-1 et seq., is directed

to establish a statewide conflict-free case management network under the management of the

executive office and to seek any Medicaid waivers, state plan amendments, and changes in rules,

regulations, and procedures that may be necessary to ensure that recipients of Medicaid home and

community-based services have access to conflict-free case management in a timely manner and in

accordance with the federal requirements that must be met to preserve financial participation.

     (j) The executive office is also authorized, subject to availability of appropriation of

funding, and federal, Medicaid-matching funds, to pay for certain services and supports necessary

to transition or divert beneficiaries from institutional or restrictive settings and optimize their health

and safety when receiving care in a home or the community. The secretary is authorized to obtain

any state plan or waiver authorities required to maximize the federal funds available to support

expanded access to home- and community-transition and stabilization services; provided, however,

payments shall not exceed an annual or per-person amount.

     (k) To ensure persons with long-term-care needs who remain living at home have adequate

resources to deal with housing maintenance and unanticipated housing-related costs, the secretary

is authorized to develop higher implement resource eligibility limits of eight thousand dollars

($8,000) for single persons or and twelve thousand dollars ($12,000) for couples and obtain any

state plan or waiver authorities necessary to change the financial eligibility criteria for long-term

services and supports to enable beneficiaries receiving home and community waiver services to

have the resources to continue living in their own homes or rental units or other home-based

settings.

     (l) The executive office shall implement, no later than January 1, 2016, the following home-

and community-based service and payment reforms:

     (1) [Deleted by P.L. 2021, ch. 162, art. 12, § 6.]

     (2) Adult day services level of need criteria and acuity-based, tiered-payment

methodology; and

     (3) Payment reforms that encourage home- and community-based providers to provide the

specialized services and accommodations beneficiaries need to avoid or delay institutional care.

     (m) The secretary is authorized to seek any Medicaid section 1115 waiver or state-plan

amendments and take any administrative actions necessary to ensure timely adoption of any new

or amended rules, regulations, policies, or procedures and any system enhancements or changes,

for which appropriations have been authorized, that are necessary to facilitate implementation of

the requirements of this section by the dates established. The secretary shall reserve the discretion

to exercise the authority established under §§ 42-7.2-5(6)(v) and 42-7.2-6.1, in consultation with

the governor, to meet the legislative directives established herein.

     SECTION 6. Section 42-7.2-5 of the General Laws in Chapter 42-7.2 entitled "Office of

Health and Human Services" is hereby amended to read as follows:

     42-7.2-5. Duties of the secretary.

     The secretary shall be subject to the direction and supervision of the governor for the

oversight, coordination, and cohesive direction of state-administered health and human services

and in ensuring the laws are faithfully executed, notwithstanding any law to the contrary. In this

capacity, the secretary of the executive office of health and human services (EOHHS) shall be

authorized to:

     (1) Coordinate the administration and financing of healthcare benefits, human services, and

programs including those authorized by the state's Medicaid section 1115 demonstration waiver

and, as applicable, the Medicaid state plan under Title XIX of the U.S. Social Security Act.

However, nothing in this section shall be construed as transferring to the secretary the powers,

duties, or functions conferred upon the departments by Rhode Island public and general laws for

the administration of federal/state programs financed in whole or in part with Medicaid funds or

the administrative responsibility for the preparation and submission of any state plans, state plan

amendments, or authorized federal waiver applications, once approved by the secretary.

     (2) Serve as the governor's chief advisor and liaison to federal policymakers on Medicaid

reform issues as well as the principal point of contact in the state on any such related matters.

     (3)(i) Review and ensure the coordination of the state's Medicaid section 1115

demonstration waiver requests and renewals as well as any initiatives and proposals requiring

amendments to the Medicaid state plan or formal amendment changes, as described in the special

terms and conditions of the state's Medicaid section 1115 demonstration waiver with the potential

to affect the scope, amount, or duration of publicly funded healthcare services, provider payments

or reimbursements, or access to or the availability of benefits and services as provided by Rhode

Island general and public laws. The secretary shall consider whether any such changes are legally

and fiscally sound and consistent with the state's policy and budget priorities. The secretary shall

also assess whether a proposed change is capable of obtaining the necessary approvals from federal

officials and achieving the expected positive consumer outcomes. Department directors shall,

within the timelines specified, provide any information and resources the secretary deems necessary

in order to perform the reviews authorized in this section.

     (ii) Direct the development and implementation of any Medicaid policies, procedures, or

systems that may be required to assure successful operation of the state's health and human services

integrated eligibility system and coordination with HealthSource RI, the state's health insurance

marketplace.

     (iii) Beginning in 2015, conduct on a biennial basis a comprehensive review of the

Medicaid eligibility criteria for one or more of the populations covered under the state plan or a

waiver to ensure consistency with federal and state laws and policies, coordinate and align systems,

and identify areas for improving quality assurance, fair and equitable access to services, and

opportunities for additional financial participation.

     (iv) Implement service organization and delivery reforms that facilitate service integration,

increase value, and improve quality and health outcomes.

     (4) Beginning in 2020, prepare and submit to the governor, the chairpersons of the house

and senate finance committees, the caseload estimating conference, and to the joint legislative

committee for health-care oversight, by no later than September 15 of each year, a comprehensive

overview of all Medicaid expenditures outcomes, administrative costs, and utilization rates. The

overview shall include, but not be limited to, the following information:

     (i) Expenditures under Titles XIX and XXI of the Social Security Act, as amended;

     (ii) Expenditures, outcomes, and utilization rates by population and sub-population served

(e.g., families with children, persons with disabilities, children in foster care, children receiving

adoption assistance, adults ages nineteen (19) to sixty-four (64), and elders);

     (iii) Expenditures, outcomes, and utilization rates by each state department or other

municipal or public entity receiving federal reimbursement under Titles XIX and XXI of the Social

Security Act, as amended;

     (iv) Expenditures, outcomes, and utilization rates by type of service and/or service

provider;

     (v) Expenditures by mandatory population receiving mandatory services and, reported

separately, optional services, as well as optional populations receiving mandatory services and,

reported separately, optional services for each state agency receiving Title XIX and XXI funds; and

     (vi) Information submitted to the Centers for Medicare & Medicaid Services for the

mandatory annual state reporting of the Core Set of Children's Health Care Quality Measures for

Medicaid and Children's Health Insurance Program, behavioral health measures on the Core Set of

Adult Health Care Quality Measures for Medicaid and the Core Sets of Health Home Quality

Measures for Medicaid to ensure compliance with the Bipartisan Budget Act of 2018, Pub. L. No.

115-123.

     The directors of the departments, as well as local governments and school departments,

shall assist and cooperate with the secretary in fulfilling this responsibility by providing whatever

resources, information, and support shall be necessary.

     (5) Resolve administrative, jurisdictional, operational, program, or policy conflicts among

departments and their executive staffs and make necessary recommendations to the governor.

     (6) Ensure continued progress toward improving the quality, the economy, the

accountability, and the efficiency of state-administered health and human services. In this capacity,

the secretary shall:

     (i) Direct implementation of reforms in the human resources practices of the executive

office and the departments that streamline and upgrade services, achieve greater economies of scale

and establish the coordinated system of the staff education, cross-training, and career development

services necessary to recruit and retain a highly-skilled, responsive, and engaged health and human

services workforce;

     (ii) Encourage EOHHS-wide consumer-centered approaches to service design and delivery

that expand their capacity to respond efficiently and responsibly to the diverse and changing needs

of the people and communities they serve;

     (iii) Develop all opportunities to maximize resources by leveraging the state's purchasing

power, centralizing fiscal service functions related to budget, finance, and procurement,

centralizing communication, policy analysis and planning, and information systems and data

management, pursuing alternative funding sources through grants, awards, and partnerships and

securing all available federal financial participation for programs and services provided EOHHS-

wide;

     (iv) Improve the coordination and efficiency of health and human services legal functions

by centralizing adjudicative and legal services and overseeing their timely and judicious

administration;

     (v) Facilitate the rebalancing of the long-term system by creating an assessment and

coordination organization or unit for the expressed purpose of developing and implementing

procedures EOHHS-wide that ensure that the appropriate publicly funded health services are

provided at the right time and in the most appropriate and least restrictive setting;

     (vi) Strengthen health and human services program integrity, quality control and

collections, and recovery activities by consolidating functions within the office in a single unit that

ensures all affected parties pay their fair share of the cost of services and are aware of alternative

financing;

     (vii) Assure protective services are available to vulnerable elders and adults with

developmental and other disabilities by reorganizing existing services, establishing new services

where gaps exist, and centralizing administrative responsibility for oversight of all related

initiatives and programs.

     (7) Prepare and integrate comprehensive budgets for the health and human services

departments and any other functions and duties assigned to the office. The budgets shall be

submitted to the state budget office by the secretary, for consideration by the governor, on behalf

of the state's health and human services agencies in accordance with the provisions set forth in §

35-3-4.

     (8) Utilize objective data to evaluate health and human services policy goals, resource use

and outcome evaluation and to perform short and long-term policy planning and development.

     (9) Establish an integrated approach to interdepartmental information and data

management that complements and furthers the goals of the unified health infrastructure project

initiative and that will facilitate the transition to a consumer-centered integrated system of state-

administered health and human services.

     (10) At the direction of the governor or the general assembly, conduct independent reviews

of state-administered health and human services programs, policies, and related agency actions and

activities and assist the department directors in identifying strategies to address any issues or areas

of concern that may emerge thereof. The department directors shall provide any information and

assistance deemed necessary by the secretary when undertaking such independent reviews.

     (11) Provide regular and timely reports to the governor and make recommendations with

respect to the state's health and human services agenda.

     (12) Employ such personnel and contract for such consulting services as may be required

to perform the powers and duties lawfully conferred upon the secretary.

     (13) Assume responsibility for complying with the provisions of any general or public law

or regulation related to the disclosure, confidentiality, and privacy of any information or records,

in the possession or under the control of the executive office or the departments assigned to the

executive office, that may be developed or acquired or transferred at the direction of the governor

or the secretary for purposes directly connected with the secretary's duties set forth herein.

     (14) Hold the director of each health and human services department accountable for their

administrative, fiscal, and program actions in the conduct of the respective powers and duties of

their agencies.

     (15) Identify opportunities for inclusion with the EOHHS' October 1, 2023, budget

submission, to remove fixed eligibility thresholds for programs under its purview by establishing

sliding scale decreases in benefits commensurate with income increases up to four hundred fifty

percent (450%) of the federal poverty level. These shall include but not be limited to, medical

assistance, childcare assistance, and food assistance.

     (16) Ensure that insurers minimize administrative burdens on providers that may delay

medically necessary care, including requiring that insurers do not impose a prior authorization

requirement for any admission, item, service, treatment, or procedure ordered by an in-network

primary care provider. Provided, the prohibition shall not be construed to prohibit prior

authorization requirements for prescription drugs. Provided further, that as used in this subsection

(16) of this section, the terms "insurer," "primary care provider," and "prior authorization" means

the same as those terms are defined in § 27-18.9-2.

     (17) The secretary shall convene, in consultation with the governor, an advisory working

group to assist in the review and analysis of potential impacts of any adopted federal actions related

to Medicaid programs. The working group shall develop options for administrative action or

general assembly consideration that may be needed to address any federal funding changes that

impact Rhode Island's Medicaid programs.

     (i) The advisory working group may include, but not be limited to, the secretary of health

and human services, director of management and budget, and designees from the following: state

agencies, businesses, healthcare, public sector unions, and advocates.

     (ii) As soon as practicable after the enactment federal budget for fiscal year 2026, but no

later than October 31, 2025, the advisory working group shall forward a report to the governor,

speaker of the house, and president of the senate containing the findings, recommendations and

options for consideration to become compliant with federal changes prior to the governor's budget

submission pursuant to § 35-3-7.

     (18) The secretary shall implement, in coordination with the health insurance

commissioner, the Achieving Healthcare Efficiency through Accountable Design (AHEAD) Model

Grant Program and produce a report to the governor and the general assembly outlining the

program's activities. The report, due no later than October 31, 2026, and annually thereafter by

October 31 for the duration of the state's participation in the grant, should address, at minimum:

     (i) A description of activities and funding uses during the grant year;

     (ii) The legislative authority, including budgetary authority, required to implement changes

to the Rhode Island Medical Assistance program;

     (ii) Stakeholder interest and participation in the model; and

     (iv) Overall long-term value of implementing the alternative payment models required by

the AHEAD model.

     SECTION 7. Chapter 42-72 of the General Laws entitled "Department of Children, Youth

and Families" is hereby amended by adding thereto the following section:

     42-72-37. Family care community partnerships.

     (a) As used in this section, "family care community partnership" (FCCP) means a specific,

community-based child abuse and neglect prevention service that an agency or entity provides to

children and families through a Medicaid certification, department license, or contract with the

department.

     (b) There are hereby established five (5) FCCP catchment regions to serve residents of a

specific area within the state, as follows:

     (1) West Urban Core: The cities of Providence and Cranston;

     (2) East Urban Core: The cities of East Providence, Central Falls, and Pawtucket;

     (3) East Bay: The towns of Barrington, Bristol, Jamestown, Little Compton, Middletown,

Portsmouth, Tiverton, and Warren, and the city of Newport;

     (4) Washington and Kent Counties: The towns of Charlestown, Coventry, East Greenwich,

Exeter, Hopkinton, Narragansett, New Shoreham, North Kingstown, Richmond, South Kingstown,

West Greenwich, West Warwick, and Westerly, and the city of Warwick; and

     (5) Northern Rhode Island: The towns of Burrillville, Cumberland, Foster, Glocester,

Johnston, Lincoln, North Providence, North Smithfield, Scituate, Smithfield, and the city of

Woonsocket.

     (c) Exactly one FCCP Lead Agency shall be permitted to operate in each region set forth

in subsection (b) of this section.

     SECTION 8. Rhode Island Medicaid Reform Act of 2008 Resolution.

     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 §

42-12.4-1, 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:

     (a) Substance Abuse Residential Services 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 substance abuse residential services.

     (b) Assisted Living Tier C Rates. 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 required to

increase Tier C Assisted Living reimbursement rates by 13 percent starting January 1, 2027

     (c) Children's Services Rate Setting. 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

required to implement reimbursement rates resulting from the Children's Services Rate Setting

project.

     (d) Provider Reimbursement Rates. 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

required to implement updates to Medicaid provider reimbursement rates consisting of rate

increases limited to the lower amount of the increases recommended or one hundred percent

(100%) of the Medicare rates identified in the Social and Human Service Programs Review Final

Report produced by the office of the health insurance commissioner pursuant to Rhode Island

general laws § 42-14.5-3(t)(2)(x), effective October 1, 2026.

     (e) Change to Rates for Nursing Facility Services. 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

required to update the behavioral health per-diem add-on program for particularly complex patients

starting April 1, 2027, to include, but not limited to, those who:

     (1) Require nursing home level of care and have complex needs that are barriers to

placement in a traditional nursing home, and have a history of persistent, disruptive behaviors

requiring moderate-to-frequent intervention;

     (2) Admission to a specialized nursing home is consistent with the least restrictive setting

requirement enunciated in the landmark U.S. Supreme Court case, Olmstead v. L.C (1999); and

     (3) The individual must meet nursing facility level of care criteria and has been approved

by BHDDH for specialized services through the BHDDH Level II PASRR determination process

prior to admission to a specialized nursing home.

     (f) Glucagon-like Peptide-1 (GLP-1) Coverage. 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

required to remove coverage for GLP-1 medications, except if prescribed to treat type 2 diabetes.

     (g) Targeted Case Management. 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 required to

implement updates to Medicaid's authority to reimburse for the governmental provision of targeted

case management to Medicaid enrolled children and youth (up to 21 years old) by qualified staff at

the Department of Children, Youth and Families.

     (h) Graduate Medical Education for Federally Qualified Health Centers.  The executive

office of health and human services shall review and assess any Medicaid waiver or state plan

opportunities that support Rhode Island Federally Qualified Health Centers that operate, or

participate in the operation of, accredited primary care-focused physician residency programs. The

Secretary shall provide a report with options, recommendations, and estimated fiscal impact to the

General Assembly and Governor by November 1, 2026, for consideration in the FY 2028 enacted

budget.

     (i) 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 required to increase resource limits

effective January 1, 2027, for Community Medicaid, long-term services and supports, and

medically needy beneficiaries to eight thousand dollars ($8,000) for an individual and twelve

thousand dollars ($12,000) for a couple.

     (i)(j) Federal Financing Opportunities. The executive office of 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 state fiscal year 2027; 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 chapter 12.4 of title 42; and be it further

     SECTION 9. Joint Resolution. AUTHORIZING THE SECRETARY OF THE

EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES TO CONTINUE AND

EXPAND AN ACUTE HOSPITAL CARE AT HOME PROGRAM

     WHEREAS, The State of Rhode Island has received a multi-hundred-million-dollar,

multiyear award from the Centers for Medicare and Medicaid Services called The Rural Health

Transformation Program (RHTP); and

     WHEREAS, RHTP strongly favors and funds states that have hospitals that participate in

the Centers for Medicare and Medicaid Services Acute Hospital Care at Home initiative, the

services of which are often called hospital at home programs; and

     WHEREAS, Hospital at home models have shown over decades 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 outcomes and satisfaction compared with inpatient hospitalization; 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; and

     WHEREAS, The Centers for Medicare and Medicaid Services has extended the Acute

Hospital Care at Home initiative through September 30, 2030, via the Consolidated Appropriations

Act; and

     WHEREAS, The Acute Hospital Care at Home initiative applies to Medicare beneficiaries,

but can be extended to Medicaid beneficiaries if states choose to cover such services; and

     WHEREAS, The State of Rhode Island wishes to extend the Acute Hospital Care at Home

initiative benefits to both traditional and managed Medicaid enrollees;

     NOW, THEREFORE BE IT RESOLVED,

     (1) Notwithstanding any provision of law to the contrary, the Executive Office of Health

and Human Services shall establish and maintain a program to cover hospital at home services for

all eligible medical assistance enrollees and managed Medicaid enrollees. The program shall be

established and maintained in a manner that is consistent with the provisions of the Acute Hospital

Care at Home initiative, as authorized by the federal Centers for Medicare and Medicaid Services.

     (2) Any Rhode Island licensed hospital 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 initiative, shall be permitted to operate or to continue to operate its program in the manner

permitted under federal law.

     (3) For as long the Acute Hospital Care at Home initiative, or a successor, remains in effect,

the Rhode Island Medical Assistance program, including managed Medicaid plans, 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,

at a rate no higher than the payer's then applicable reimbursement rates for the same service in the

same hospital.

     (4) The 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

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

the provisions of this resolution; and be it further

     RESOLVED, 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 program.

     SECTION 10. Sections 8 and 9 of this article shall take effect on July 1, 2026. Sections 2,

4 and 5 shall take effect on January 1, 2027. The remainder of the article shall take effect upon

passage