Introduced By: Senators Paiva-Weed, Gibbs, Perry, Roberts and Cicilline
Date Introduced : February 9, 1999
It is enacted by the General Assembly as follows:
SECTION 1. Section 40-8-2 of the General Laws in Chapter 40-8 entitled "Medical Assistance" is hereby amended to read as follows:
40-8-2. Definitions. -- As used in this chapter, unless the context shall otherwise require:
(1) "Dental service" means and includes emergency care, X-rays for diagnoses, extractions, palliative treatment, and the refitting and relining of existing dentures and prosthesis.
(2) "Department" means the department of human services.
(3) "Director" means the director of human services.
(4) "Drug" means and includes only such drugs and biologicals prescribed by a licensed dentist or physician as are either included in the United States pharmacopoeia, national formulary, or are new and nonofficial drugs and remedies.
(5) "Inpatient" means a person admitted to and under treatment or care of a physician or surgeon in a hospital or nursing facility which meets standards of and complies with rules and regulations promulgated by the director.
(6) "Inpatient hospital services" means the following items and services furnished to an inpatient in a hospital other than a hospital, institution or facility for tuberculosis or mental diseases:
(i) Bed and board;
(ii) Such nursing services and other related services as are customarily furnished by the hospital for the care and treatment of inpatients and such drugs, biologicals, supplies, appliances, and equipment for use in the hospital, as are customarily furnished by the hospital for the care and treatment of patients;
(iii) (A) Such other diagnostic or therapeutic items or services, including, but not limited to, pathology, radiology, and anesthesiology furnished by the hospital or by others under arrangements made by the hospital, as are customarily furnished to inpatients either by the hospital or by others under such arrangements, and services as are customarily provided to inpatients in the hospital by an intern or resident-in-training under a teaching program having the approval of the council on medical education and hospitals of the American medical association or of any other recognized medical society approved by the director.
(B) The term "inpatient hospital services" shall be taken to include medical and surgical services provided by the inpatient's physician, but shall not include the services of a private duty nurse or services in a hospital, institution, or facility maintained primarily for the treatment and care of patients with tuberculosis or mental diseases. Provided, further, it shall be taken to include only the following organ transplant operations: kidney, liver, cornea, pancreas, bone marrow, lung, heart, and heart/lung, and such other organ transplant operations as may be designated by the director after consultation with medical advisory staff or medical consultants; and provided that any such transplant operation is determined by the director or his or her designee to be medically necessary. Prior written approval of the director or his or her designee shall be required for all covered organ transplant operations.
(C) In determining medical necessity for organ transplant procedures, the state plan shall adopt a case-by-case approach and shall focus on the medical indications and contra-indications in each instance, the progressive nature of the disease, the existence of any alternative therapies, the life threatening nature of the disease, the general state of health of the patient apart from the particular organ disease, and any other relevant facts and circumstances related to the applicant and the particular transplant procedure.
(7) "Nursing services" means the following items and services furnished to an inpatient in a nursing facility:
(i) Bed and board;
(ii) Such nursing care and other related services as are customarily furnished to inpatients admitted to the nursing facility, and such drugs, biologicals, supplies, appliances, and equipment for use in the facility, as are customarily furnished in the facility for the care and treatment of patients;
(iii) Such other diagnostic or therapeutic items or services, legally furnished by the facility or by others under arrangements made by the facility, as are customarily furnished to inpatients either by the facility or by others under such arrangement;
(iv) Medical services provided in the facility by the inpatient's physician, or by an intern or resident-in-training of a hospital with which the facility is affiliated or which is under the same control, under a teaching program of the hospital approved as provided in subsection (6) of this section.
(v) A personal needs allowance of {DEL thirty-five ($35.00) DEL}
{DEL dollars DEL} {ADD fifty dollars ($50.00) ADD} per month.
(8) "Relative with whom such dependent child is living" means and includes the father, mother, grandfather, grandmother, brother, sister, stepfather, stepmother, stepbrother, stepsister, uncle, aunt, first cousin, nephew, or niece of any dependent child who maintains a home for the dependent child.
(9) "Visiting nurse service" means part-time or intermittent nursing care provided by or under the supervision of a registered professional nurse other than in a hospital or nursing home.
{ADD SECTION 2. Section 40-6-27 of the General Laws in Chapter 40-6 entitled "Public Assistance Act" is hereby amended to read as follows:
40-6-27. Supplemental security income. --
(a) (1) The director of the department is hereby authorized to enter into agreements on behalf of the state with the secretary of the department of health and human services or other appropriate federal officials, under the supplementary and security income (SSI) program established by title XVI of the Social Security Act, 42 U.S.C. section 1381 et seq., concerning the administration and determination of eligibility for SSI benefits for residents of this state, except as otherwise provided herein. The state's monthly share of supplementary assistance to the supplementary security income program effective January 1, 1993 shall be as follows:
| Individual living with others: | 74.60 |
| Couple living alone: | 120.50 |
| Couple living with others: | 136.50 |
| Individual living in state licensed residential | |
| care and assisted living facilities, | |
| effective October 1, 1998: | 582.00 |
(2) Individuals living in institutions
shall receive a {ADD twenty dollar ($20.00) ADD} {DEL ten dollar
($10.00) DEL} per month personal needs allowance from the
state which shall be in addition to the personal needs allowance
allowed by the Social Security Act, 42 U.S.C. section 301 et seq.
(3) Individuals living in state licensed residential care and
assisted living facilities who are receiving SSI shall be allowed
to retain a minimum personal needs allowance of fifty-five dollars
($55.00) per month from their SSI monthly benefit prior to payment
of the residential care and assisted living facility monthly fee.
(4) The department is authorized and directed to establish rules
for screening and assessment procedures and eligibility criteria
for those persons who: (i) Have applied for or are receiving SSI,
and who apply for admission to residential care and assisted living
facilities on or after October 1, 1998; or (ii) Who are residing
in residential care and assisted living facilities, and who apply
for or begin to receive SSI on or after October 1, 1998. (5) The
department shall collaborate with the department of elderly affairs
to design and implement the screening and assessment procedures
as required in the above section. (b) The department is authorized
and directed to provide additional assistance to individuals eligible
for SSI benefits for: (1) Moving costs or other expenses as a
result of an emergency of a catastrophic nature which is defined
as a fire or natural disaster, and (2) Lost or stolen SSI benefit
checks or proceeds thereof, and (3) Assistance payments to SSI
eligible individuals in need because of the application of federal
SSI regulations regarding estranged spouses; and the department
shall provide such assistance in a form and amount which the department
shall by regulation determine. ADD}
SECTION {DEL 2. DEL} {ADD 3. ADD} This act shall take effect upon passage.
