97-S 0784A
Approved Jul. 7, 1997


It is enacted by the General Assembly as follows

SECTION 1. Title 42 of the General Laws entitled "State Affairs and Government" is hereby amended by adding thereto the following chapter:



{ADD 42-66.8-1. Legislative findings. -- ADD} {ADD It is hereby found and declared as follows:

(1) Rhode Island has one of the highest proportion of elders in the nation. Persons age eighty-five (85) years old and over are the fastest growing segment of the state's population.

(2) A significant number of Rhode Island elders have difficulty carrying out basic life activities, many are at high risk for institutionalization due to chronic illness and disability.

(3) There is a growing consumer preference for more housing and care alternatives designed specifically for persons who need assistance with basic life activities, but do not need the level of skilled nursing care and therapy that nursing homes provide.

(4) There exists a lack of private sector initiatives to create assisted living options which are affordable to low and moderate income frail elders and other frail persons.

(5) It is imperative for state government and long term health providers to develop cost effective means of caring for at risk elders, and in particular those low and moderate income frail elders whose needs are appropriate for assisted living placement but who cannot afford the costs of market rate, private pay assisted living facilities.

(6) An alternative form of housing and care must be developed in Rhode Island for low and moderate income frail elders and other frail persons to enable them to live in a residential setting as independently as possible while achieving cost savings in the state medicaid program. ADD}

{ADD (7) An assisted living demonstration program sponsored by the state through the collaboration and cooperation of the Rhode Island Housing and Mortgage Finance Corporation, the department of elderly affairs, and the department of human services will allow the state to provide appropriate housing and care needed by frail elderly and other frail persons in Rhode Island and to evaluate the cost savings and other benefits of assisted living. ADD}

{ADD 42-66.8-2. Purpose -- Assisted living waiver request. -- ADD} {ADD The purpose of this legislation is to provide assisted living alternatives to low and moderate income chronically impaired or disabled elders and other chronically impaired or disabled adults who are eligible for or at risk of placement in nursing facility care. The director of the department of elderly affairs and the director of the department of human services shall cooperate and collaborate in obtaining approval from the health care financing administration for a home and community based services waiver designated to fund assisted living supportive services for up to two hundred (200) persons residing in assisted living facilities certified and financed by the Rhode Island housing and mortgage corporation. The director of the department of elderly affairs and the director of the department of human services shall formulate the waiver application and submit the waiver request no later than September 30, 1997. The waiver shall be reviewed and expanded periodically as funding is made available. ADD}

{ADD 42-66.8-3. Definitions. -- ADD} {ADD As used in this chapter, the following words and phrases shall have the following meanings unless the context otherwise requires:

(1) An "assisted living facility" means a publicly or privately operated residential development (including a designated wing or section of such development) certified and financed by the Rhode Island housing and mortgage corporation that provides lodging, meals and assisted living supportive services to two (2) or more adults and which is licensed by the state pursuant to chapter 23.17.4 of the general laws of Rhode Island excluding however, those facilities licensed by or under the jurisdiction of the department of mental health, retardation and hospitals, the department of children and their families, or any other state agency.

(2) An "assisted living unit" means an apartment, condominium, bed or other dwelling quarters in an assisted living facility as defined by this chapter.

(3) "Assisted living rules and regulations and guidelines" means the rules and regulations of the Rhode Island housing and mortgage finance corporation applicable to the rental housing production and rehabilitation program, as such rules and regulations may be amended from time to time, and the resources and guidelines for assisted living developments adopted by the board of commissioners of the Rhode Island housing and mortgage finance corporation, as such guidelines may be amended from time to time.

(4) "Assisted living supportive services" means: Personal care and services, homemaker, chore, attendant care, companion services, medication oversight (to the extent permitted under state law), therapeutic social and recreational programming, provided in a home-like environment in a licensed assisted living facility, in conjunction with residing in the facility. This service includes twenty-four (24) hour on-site response staff to meet scheduled or unpredictable needs in a way that promotes maximum dignity and independence, and to provide supervision, safety and security. Other individuals or agencies may also furnish care directly, or under arrangement with the assisted living facility, but the care provided by these other entities supplements that provided by the assisted living facility and does not supplant it.

Assisted living services will also include transportation specified in the plan of care.

However, nursing and skilled therapy services (except periodic nursing evaluations if specified above) are incidental, rather than integral to the provision of assisted living supportive services. Payment will not be made for twenty-four (24) hour skilled care or supervision.

(5) "Long term care assessment" means a program, approved by the directors of human services and elderly affairs, that provides a uniform health, social and functional assessment of persons in need of long-term care services due to chronic impairment or disability.

(6) "Government funds" means funds provided under the provisions of chapter 8 of title 40.

(7) "Rhode Island housing" means that public corporation authorized and created by section 42-55-4. ADD}

{ADD (8) "Certified" means the assisted living facility has been determined by Rhode Island housing to comply with its rules, regulations and guidelines for assisted living. ADD}

{ADD 42-66.8-4. Provision of service. -- ADD} {ADD (a) Provision of assisted living supportive services paid for with government funds in an assisted living facility as defined and delineated in this chapter shall be provided only to those persons who are eligible for or at risk for placement in a nursing facility and who have had a long term care assessment which indicates the person can receive appropriate care in the assisted living facility.

(b) The long term care assessment required under this chapter shall be completed by persons designated by the director of elderly affairs and the director of the department of human services and shall include representatives of the department of human services and persons designated by the department of elderly affairs to provide long term care assessment services under chapter 42-66.6-3.

(c) If a person determined to be eligible to receive waiver services under this chapter desires to reside in an assisted living unit and an appropriate assisted living facility is available, the department of elderly affairs shall authorize such placement.

(d) Continued provision of assisted living supportive services paid for with government funds in an assisted living facility shall be based on a reassessment of the recipient's care needs to be performed at least every one hundred and eighty (180) days. ADD}

{ADD 42-66.8-5. Duties of director of human services. -- ADD} {ADD For the purposes of this section, director means the director of human services. Notwithstanding any inconsistent provision of law but subject to expenditure limitations of this chapter, the director subject to the approval of the state director of the budget, may authorize the utilization of medical assistance funds to pay for assisted living supportive services provided by specified assisted living facilities in addition to those services included in the medical assistance program under title 40 of this code, so long as federal financial participation is available for those services. Expenditures made under this subdivision shall be deemed payments for medical assistance for needy persons.

(a) The department shall not make payments pursuant to title XIX of the federal Social Security Act 42 U.S.C. section 1396 et seq.! for benefits available under title XVIII 42 U.S.C. section 1395 et seq.! of such act without documentation that title XVIII claims have been filed and denied.

(b) The department shall not make payment for a person receiving assisted living services while payments are being made for that person under another medicaid waiver program or for inpatient care in a skilled nursing and intermediate care facility or hospital; provided, however, this shall not effect monthly payments made under prospective reimbursement contracts. ADD}

{ADD 42-66.8-6. Evaluation of assisted living waiver demonstration. -- ADD} {ADD Upon implementation of the demonstration program and occupancy of assisted living facilities by low and moderate income persons, the Rhode Island department of elderly affairs will work in conjunction with Rhode Island housing to develop a tool to evaluate the qualitative benefits and cost effectiveness of the demonstration program. ADD}

SECTION 2. In addition to the assisted living demonstration required under sections 42-66.8-1 through 42-66.8-6, in order to promote further access to affordable residential care/assisted living < by low income frail elders and disabled adults, the department of human services shall conduct a study of (1) the special Supplementary Security Income (SSI) benefit level for persons residing in residential care/assisted living facilities to determine a benefit payment level which is adequate to allow beneficiaries to (a) purchase residential care/assisted living services which meet state licensing requirements as required by chapter 23.17.4 of the general laws of Rhode Island and (b) maintain a reasonable quality of life; and (2) the cost effectiveness of using Medicaid waiver funds to pay for personal care and supportive services for Supplementary Security Income (SSI) beneficiaries residing in residential care/assisted living. The director of the department of human services shall complete the study and issue a report of her findings and recommendations to the Speaker of the House, the Majority Leader of the Senate, the Chairpersons of the House and Senate Finance Committees and the Chairperson of the Long Term Care Coordinating Council by January 6, 1998.

SECTION 3. This act shall take effect upon passage.

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