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art.009/1
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ARTICLE 9 1
RELATING TO MEDICAL ASSISTANCE 2
SECTION 1. Section 23-17-38.1 of the General Laws in Chapter 23-17 entitled "Licensing 3
of Health Care Facilities" is hereby amended to read as follows: 4
23-17-38.1. Hospitals -- Licensing fee. 5
(a) There is imposed a hospital licensing fee for state fiscal year 2021 against each hospital 6
in the state. The hospital licensing fee is equal to five percent (5.0%) of the net patient-services 7
revenue of every hospital for the hospital’s first fiscal year ending on or after January 1, 2019, 8
except that the license fee for all hospitals located in Washington County, Rhode Island shall be 9
discounted by thirty-seven percent (37%). The discount for Washington County hospitals is subject 10
to approval by the Secretary of the U.S. Department of Health and Human Services of a state plan 11
amendment submitted by the executive office of health and human services for the purpose of 12
pursuing a waiver of the uniformity requirement for the hospital license fee. This licensing fee shall 13
be administered and collected by the tax administrator, division of taxation within the department 14
of revenue, and all the administration, collection, and other provisions of chapter 51 of title 44 shall 15
apply. Every hospital shall pay the licensing fee to the tax administrator on or before July 13, 2021, 16
and payments shall be made by electronic transfer of monies to the general treasurer and deposited 17
to the general fund. Every hospital shall, on or before June 15, 2020, make a return to the tax 18
administrator containing the correct computation of net patient-services revenue for the hospital 19
fiscal year ending September 30, 2019, and the licensing fee due upon that amount. All returns 20
shall be signed by the hospital’s authorized representative, subject to the pains and penalties of 21
perjury. 22
(b) (a) There is also imposed a hospital licensing fee for state fiscal year 2022 against each 23
hospital in the state. The hospital licensing fee is equal to five and six hundred fifty-six thousandths 24
percent (5.656%) of the net patient-services revenue of every hospital for the hospital’s first fiscal 25
year ending on or after January 1, 2020, except that the license fee for all hospitals located in 26
Washington County, Rhode Island shall be discounted by thirty-seven percent (37%). The discount 27
for Washington County hospitals is subject to approval by the Secretary of the U.S. Department of 28
Health and Human Services of a state plan amendment submitted by the executive office of health 29
and human services for the purpose of pursuing a waiver of the uniformity requirement for the 30
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hospital license fee. This licensing fee shall be administered and collected by the tax administrator, 1
division of taxation within the department of revenue, and all the administration, collection, and 2
other provisions of chapter 51 of title 44 shall apply. Every hospital shall pay the licensing fee to 3
the tax administrator on or before July 13, 2022, and payments shall be made by electronic transfer 4
of monies to the general treasurer and deposited to the general fund. Every hospital shall, on or 5
before June 15, 2022, make a return to the tax administrator containing the correct computation of 6
net patient-services revenue for the hospital fiscal year ending September 30, 2020, and the 7
licensing fee due upon that amount. All returns shall be signed by the hospital’s authorized 8
representative, subject to the pains and penalties of perjury. 9
(c) (b) There is also imposed a hospital licensing fee for state fiscal year 2023 against each 10
hospital in the state. The hospital licensing fee is equal to five and forty-two hundredths percent 11
(5.42%) of the net patient-services revenue of every hospital for the hospital’s first fiscal year 12
ending on or after January 1, 2021, except that the license fee for all hospitals located in Washington 13
County, Rhode Island shall be discounted by thirty-seven percent (37%). The discount for 14
Washington County hospitals is subject to approval by the Secretary of the U.S. Department of 15
Health and Human Services of a state plan amendment submitted by the executive office of health 16
and human services for the purpose of pursuing a waiver of the uniformity requirement for the 17
hospital license fee. This licensing fee shall be administered and collected by the tax administrator, 18
division of taxation within the department of revenue, and all the administration, collection, and 19
other provisions of chapter 51 of title 44 shall apply. Every hospital shall pay the licensing fee to 20
the tax administrator on or before June 30, 2023, and payments shall be made by electronic transfer 21
of monies to the general treasurer and deposited to the general fund. Every hospital shall, on or 22
before May 25, 2023, make a return to the tax administrator containing the correct computation of 23
net patient-services revenue for the hospital fiscal year ending September 30, 2021, and the 24
licensing fee due upon that amount. All returns shall be signed by the hospital’s authorized 25
representative, subject to the pains and penalties of perjury. 26
(c) There is also imposed a hospital licensing fee described in subsections d through g for 27
state fiscal year 2024 against net patient-services revenue of every non-government owned hospital 28
as defined herein for the hospital’s first fiscal year ending on or after January 1, 2022. The hospital 29
licensing fee shall have three (3) tiers with differing fees based on inpatient and outpatient net 30
patient-services revenue. The executive office of health and human services, in consultation with 31
the tax administrator, shall identify the hospitals in each tier, subject to the definitions in this 32
section, by July 15, 2023, and shall notify each hospital of its tier by August 1, 2023. 33
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(d) Tier 1 is composed of hospitals that do not meet the description of either Tier 2 or Tier 1
3. 2
(1) The inpatient hospital licensing fee for Tier 1 is equal to thirteen and fifty-four 3
hundredths percent (13.54%) of the inpatient net patient-services revenue derived from inpatient 4
net patient-services revenue of every Tier 1 hospital. 5
(2) The outpatient hospital licensing fee for Tier 1 is equal to thirteen and seventy-three 6
hundredths percent (13.73%) of the net patient-services revenue derived from outpatient net 7
patient-services revenue of every Tier 1 hospital. 8
(e) Tier 2 is composed of High Medicaid/Uninsured Cost Hospitals and Independent 9
Hospitals. 10
(1) The inpatient hospital licensing fee for Tier 2 is equal to two and seventy-one 11
hundredths (2.71%) of the inpatient net patient-services revenue derived from inpatient net patient-12
services revenue of every Tier 2 hospital. 13
(2) The outpatient hospital licensing fee for Tier 2 is equal to two and seven-five one 14
hundredths (2.75%) of the outpatient net patient-services revenue derived from outpatient net 15
patient-services revenue of every Tier 2 hospital. 16
(f) Tier 3 is composed of hospitals that are Medicare-designated Low Volume hospitals 17
and rehabilitative hospitals. 18
(1) The inpatient hospital licensing fee for Tier 3 is equal to one and thirty-five hundredths 19
(1.35%) of the inpatient net patient-services revenue derived from inpatient net patient-services 20
revenue of every Tier 3 hospital. 21
(2) The outpatient hospital licensing fee for Tier 3 is equal to one and thirty-seven 22
hundredths (1.37%) of the outpatient net patient-services revenue derived from outpatient net 23
patient-services revenue of every Tier 3 hospital. 24
(g) There is also imposed a hospital licensing fee for state fiscal year 2024 against state-25
government owned and operated hospitals in the state as defined therein. The hospital licensing 26
fee is equal to five and forty-two hundredths percent (5.42%) of the net patient-services revenue of 27
every hospital for the hospital’s first fiscal year ending on or after January 1, 2022. 28
(h) The hospital licensing fee described in subsections (c) through (g) is subject to U.S. 29
Department of Health and Human Services approval of a request to waive the requirement that 30
health care-related taxes be imposed uniformly as contained in 42 CFR 433.68(d). 31
(i) This hospital licensing fee shall be administered and collected by the tax administrator, 32
division of taxation within the department of revenue, and all the administration, collection, and 33
other provisions of chapter 51 of title 44 shall apply. Every hospital shall pay the licensing fee to 34
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the tax administrator on a quarterly basis and fully before June 30, 2024, and payments shall be 1
made by electronic transfer of monies to the tax administrator and deposited to the general fund. 2
Every hospital shall, on or before August 1, 2023, make a return to the tax administrator containing 3
the correct computation of inpatient and outpatient net patient-services revenue for the hospital 4
fiscal year ending in 2022, and the licensing fee due upon that amount. All returns shall be signed 5
by the hospital’s authorized representative, subject to the pains and penalties of perjury. 6
(d) (j) For purposes of this section the following words and phrases have the following 7
meanings: 8
(1) “Hospital” means the actual facilities and buildings in existence in Rhode Island, 9
licensed pursuant to § 23-17-1 et seq. on June 30, 2010, and thereafter any premises included on 10
that license, regardless of changes in licensure status pursuant to chapter 17.14 of this title (hospital 11
conversions) and § 23-17-6(b) (change in effective control), that provides short-term acute inpatient 12
and/or outpatient care to persons who require definitive diagnosis and treatment for injury, illness, 13
disabilities, or pregnancy. Notwithstanding the preceding language, the negotiated Medicaid 14
managed care payment rates for a court-approved purchaser that acquires a hospital through 15
receivership, special mastership, or other similar state insolvency proceedings (which court-16
approved purchaser is issued a hospital license after January 1, 2013) shall be based upon the newly 17
negotiated rates between the court-approved purchaser and the health plan, and such rates shall be 18
effective as of the date that the court-approved purchaser and the health plan execute the initial 19
agreement containing the newly negotiated rate. The rate-setting methodology for inpatient hospital 20
payments and outpatient hospital payments set forth in §§ 40-8-13.4(b) and 40-8-13.4(b)(2), 21
respectively, shall thereafter apply to negotiated increases for each annual twelve-month (12) 22
period as of July 1 following the completion of the first full year of the court-approved purchaser’s 23
initial Medicaid managed care contract. 24
(2) “Non-government owned hospitals” means a hospital not owned and operated by the 25
state of Rhode Island. 26
(3) “State-government owned and operated hospitals” means a hospital facility licensed by 27
the Rhode Island Department of Health, owned and operated by the state of Rhode Island. 28
(4) “Rehabilitative Hospital” means Rehabilitation Hospital Center licensed by the Rhode 29
Island Department of Health. 30
(5) “Independent Hospitals” means a hospital not part of a multi-hospital system 31
(6) “High Medicaid/Uninsured Cost Hospital” means a hospital for which the hospital’s 32
total uncompensated care, as calculated pursuant to § 40-8.3-2(4), divided by the hospital’s total 33
net patient-services revenues, is equal to 6.0% or greater. 34
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(7) “Medicare-designated Low Volume Hospital” means a hospital that qualifies under 42 1
CFR 412.101(b)(2) for additional Medicare payments to qualifying hospitals for the higher 2
incremental costs associated with a low volume of discharges. 3
(2) (8) “Gross patient-services revenue” means the gross revenue related to patient care 4
services. 5
(3) (9) “Net patient-services revenue” means the charges related to patient care services 6
less (i) Charges attributable to charity care; (ii) Bad debt expenses; and (iii) Contractual allowances. 7
(10) “Inpatient net patient-services revenue” means the charges related to inpatient care 8
services less (i) Charges attributable to charity care; (ii) Bad debt expenses; and (iii) Contractual 9
allowances. 10
(11) “Outpatient net patient-services revenue” means the charges related to outpatient care 11
services less (i) Charges attributable to charity care; (ii) Bad debt expenses; and (iii) Contractual 12
allowances. 13
(e) (k) The tax administrator in consultation with the executive office of health and human 14
services shall make and promulgate any rules, regulations, and procedures not inconsistent with 15
state law and fiscal procedures that he or she deems necessary for the proper administration of this 16
section and to carry out the provisions, policy, and purposes of this section. 17
(f) (l) The licensing fee imposed by subsection (a) shall apply to hospitals as defined herein 18
that are duly licensed on July 1, 2020 2021, and shall be in addition to the inspection fee imposed 19
by § 23-17-38 and to any licensing fees previously imposed in accordance with this section. 20
(g) (m) The licensing fee imposed by subsection (b) shall apply to hospitals as defined 21
herein that are duly licensed on July 1, 2021 2022, and shall be in addition to the inspection fee 22
imposed by § 23-17-38 and to any licensing fees previously imposed in accordance with this 23
section. 24
(h) (n) The licensing fees imposed by subsections (c) through (g) shall apply to hospitals 25
as defined herein that are duly licensed on July 1, 2022 2023, and shall be in addition to the 26
inspection fee imposed by § 23-17-38 and to any licensing fees previously imposed in accordance 27
with this section. 28
SECTION 2. Sections 40-8.3-2 and 40-8.3-3 of the General Laws in Chapter 40-8 entitled 29
“Uncompensated Care” is hereby amended to read as follows: 30
40-8.3-2. Definitions. 31
As used in this chapter: 32
(1) "Base year" means, for the purpose of calculating a disproportionate share payment for 33
any fiscal year ending after September 30, 2021 2022, the period from October 1, 2019 2020, 34
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through September 30, 2020 2021, and for any fiscal year ending after September 30, 2022 2023, 1
the period from October 1, 2019 2021, through September 30, 2020 2022. 2
(2) "Medicaid inpatient utilization rate for a hospital" means a fraction (expressed as a 3
percentage), the numerator of which is the hospital's number of inpatient days during the base year 4
attributable to patients who were eligible for medical assistance during the base year and the 5
denominator of which is the total number of the hospital's inpatient days in the base year. 6
(3) "Participating hospital" means any nongovernment and nonpsychiatric hospital that: 7
(i) Was licensed as a hospital in accordance with chapter 17 of title 23 during the base year 8
and shall mean the actual facilities and buildings in existence in Rhode Island, licensed pursuant to 9
§ 23-17-1 et seq. on June 30, 2010, and thereafter any premises included on that license, regardless 10
of changes in licensure status pursuant to chapter 17.14 of title 23 (hospital conversions) and § 23-11
17-6(b) (change in effective control), that provides short-term, acute inpatient and/or outpatient 12
care to persons who require definitive diagnosis and treatment for injury, illness, disabilities, or 13
pregnancy. Notwithstanding the preceding language, the negotiated Medicaid managed care 14
payment rates for a court-approved purchaser that acquires a hospital through receivership, 15
special mastership, or other similar state insolvency proceedings (which court-approved 16
purchaser is issued a hospital license after January 1, 2013), shall be based upon the newly 17
negotiated rates between the court-approved purchaser and the health plan, and the rates 18
shall be effective as of the date that the court-approved purchaser and the health plan 19
execute the initial agreement containing the newly negotiated rate. The rate-setting 20
methodology for inpatient hospital payments and outpatient hospital payments set forth in §§ 40-21
8-13.4(b)(1)(ii)(C) and 40-8-13.4(b)(2), respectively, shall thereafter apply to negotiated increases 22
for each annual twelve-month (12) period as of July 1 following the completion of the first full year 23
of the court-approved purchaser's initial Medicaid managed care contract; 24
(ii) Achieved a medical assistance inpatient utilization rate of at least one percent (1%) 25
during the base year; and 26
(iii) Continues to be licensed as a hospital in accordance with chapter 17 of title 23 during 27
the payment year. 28
(4) "Uncompensated-care costs" means, as to any hospital, the sum of: (i) The cost 29
incurred by the hospital during the base year for inpatient or outpatient services attributable to 30
charity care (free care and bad debts) for which the patient has no health insurance or other third-31
party coverage less payments, if any, received directly from such patients; and (ii) The cost 32
incurred by the hospital during the base year for inpatient or outpatient services attributable 33
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to Medicaid beneficiaries less any Medicaid reimbursement received therefor; multiplied by 1
the uncompensated-care index. 2
(5) "Uncompensated-care index" means the annual percentage increase for hospitals 3
established pursuant to § 27-19-14 [repealed] for each year after the base year, up to and 4
including the payment year; provided, however, that the uncompensated-care index for the 5
payment year ending September 30, 2007, shall be deemed to be five and thirty-eight 6
hundredths percent (5.38%), and that the uncompensated-care index for the payment year ending 7
September 30, 2008, shall be deemed to be five and forty-seven hundredths percent (5.47%), 8
and that the uncompensated-care index for the payment year ending September 30, 2009, shall 9
be deemed to be five and thirty-eight hundredths percent (5.38%), and that the uncompensated-care 10
index for the payment years ending September 30, 2010, September 30, 2011, September 30, 11
2012, September 30, 2013, September 30, 2014, September 30, 2015, September 30, 2016, 12
September 30, 2017, September 30, 2018, September 30, 2019, September 30, 2020, 13
September 30, 2021, September 30, 2022, September 30, 2023, and September 30, 2024 shall be 14
deemed to be five and thirty hundredths percent (5.30%). 15
40-8.3-3. Implementation. 16
(a) For federal fiscal year 2021, commencing on October 1, 2020, and ending September 17
30, 2021, the executive office of health and human services shall submit to the Secretary of the 18
United States Department of Health and Human Services a state plan amendment to the Rhode 19
Island Medicaid DSH Plan to provide: 20
(1) That the DSH Plan to all participating hospitals, not to exceed an aggregate limit of 21
$142.5 million, shall be allocated by the executive office of health and human services to the Pool 22
D component of the DSH Plan; and 23
(2) That the Pool D allotment shall be distributed among the participating hospitals in direct 24
proportion to the individual participating hospital’s uncompensated-care costs for the base year, 25
inflated by the uncompensated-care index to the total uncompensated-care costs for the base year 26
inflated by the uncompensated-care index for all participating hospitals. The disproportionate share 27
payments shall be made on or before July 12, 2021, and are expressly conditioned upon approval 28
on or before July 5, 2021, by the Secretary of the United States Department of Health and Human 29
Services, or his or her authorized representative, of all Medicaid state plan amendments necessary 30
to secure for the state the benefit of federal financial participation in federal fiscal year 2021 for 31
the disproportionate share payments. 32
(b) (a) For federal fiscal year 2022, commencing on October 1, 2021, and ending 33
September 30, 2022, the executive office of health and human services shall submit to the Secretary 34
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of the United States Department of Health and Human Services a state plan amendment to the 1
Rhode Island Medicaid DSH Plan to provide: 2
(1) That the DSH Plan to all participating hospitals, not to exceed an aggregate limit of 3
$145.1 million, shall be allocated by the executive office of health and human services to the Pool 4
D component of the DSH Plan; and 5
(2) That the Pool D allotment shall be distributed among the participating hospitals in direct 6
proportion to the individual participating hospital’s uncompensated-care costs for the base year, 7
inflated by the uncompensated-care index to the total uncompensated-care costs for the base year 8
inflated by the uncompensated-care index for all participating hospitals. The disproportionate share 9
payments shall be made on or before June 30, 2022, and are expressly conditioned upon approval 10
on or before July 5, 2022, by the Secretary of the United States Department of Health and Human 11
Services, or his or her authorized representative, of all Medicaid state plan amendments necessary 12
to secure for the state the benefit of federal financial participation in federal fiscal year 2022 for 13
the disproportionate share payments. 14
(c) (b) For federal fiscal year 2023, commencing on October 1, 2022, and ending 15
September 30, 2023, the executive office of health and human services shall submit to the Secretary 16
of the United States Department of Health and Human Services a state plan amendment to the 17
Rhode Island Medicaid DSH Plan to provide: 18
(1) That the DSH Plan to all participating hospitals, not to exceed an aggregate limit of 19
$145.1 million, shall be allocated by the executive office of health and human services to the Pool 20
D component of the DSH Plan; and 21
(2) That the Pool D allotment shall be distributed among the participating hospitals in direct 22
proportion to the individual participating hospital’s uncompensated-care costs for the base year, 23
inflated by the uncompensated-care index to the total uncompensated-care costs for the base year 24
inflated by the uncompensated-care index for all participating hospitals. The disproportionate share 25
payments shall be made on or before June 15, 2023, and are expressly conditioned upon approval 26
on or before June 23, 2023, by the Secretary of the United States Department of Health and Human 27
Services, or his or her authorized representative, of all Medicaid state plan amendments necessary 28
to secure for the state the benefit of federal financial participation in federal fiscal year 2023 for 29
the disproportionate share payments. 30
(c) For federal fiscal year 2024, commencing on October 1, 2023, and ending September 31
30, 2024, the executive office of health and human services shall submit to the Secretary of the 32
United States Department of Health and Human Services a state plan amendment to the Rhode 33
Island Medicaid DSH Plan to provide: 34
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(1) That the DSH Plan to all participating hospitals, not to exceed an aggregate limit of 1
$15.2 million shall be allocated by the executive office of health and human services to the Pool D 2
component of the DSH Plan; and 3
(2) That the Pool D allotment shall be distributed among the participating hospitals in direct 4
proportion to the individual participating hospital’s uncompensated-care costs for the base year, 5
inflated by the uncompensated-care index to the total uncompensated-care costs for the base year 6
inflated by the uncompensated-care index for all participating hospitals. The disproportionate share 7
payments shall be made on or before June 15, 2024, and are expressly conditioned upon approval 8
on or before June 23, 2024, by the Secretary of the United States Department of Health and Human 9
Services, or his or her authorized representative, of all Medicaid state plan amendments necessary 10
to secure for the state the benefit of federal financial participation in federal fiscal year 2024 for 11
the disproportionate share payments. 12
(d) No provision is made pursuant to this chapter for disproportionate-share hospital 13
payments to participating hospitals for uncompensated-care costs related to graduate medical 14
education programs. 15
(e) The executive office of health and human services is directed, on at least a monthly 16
basis, to collect patient-level uninsured information, including, but not limited to, demographics, 17
services rendered, and reason for uninsured status from all hospitals licensed in Rhode Island. 18
(f) [Deleted by P.L. 2019, ch. 88, art. 13, § 6.] 19
SECTION 3. Sections 40-8.9-1 and 40-8.9-9 of the General Laws in Chapter 40-8.9 entitled 20
"Long-Term Care Service and Finance Reform" are hereby amended to read as follows: 21
40-8.9-1. Findings. 22
(a) The number of Rhode Islanders in need of long-term-care services continues to rise 23
substantially, and the quality of life of these Rhode Islanders is determined by the capacity of the 24
long-term-care system state to provide ensure equitable access to the full array of services and 25
supports required to meet their healthcare needs and maintain their independence. 26
(b) It is in the interest of all Rhode Islanders to endorse and fund statewide efforts to build 27
a fiscally sound, dynamic and resilient long-term-care system that supports fosters: consumer 28
independence and choice; the delivery of high-quality, coordinated services; the financial integrity 29
of all participants-purchasers, payers, providers, and consumers; and the responsible and efficient 30
allocation of all available public and private resources., including preservation of federal financial 31
participation. 32
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(c) It is in the interest of all Rhode Islanders to assure that rates paid for community-based 1
long-term-care services are adequate to assure high quality as well as and supportive of support 2
workforce recruitment and retention. 3
(d) It is in the interest of all Rhode Islanders to improve consumers’ access information 4
regarding community-based alternatives to institutional settings of care. 5
(e) It is in the best interest of all Rhode Islanders to maintain a person-centered, quality 6
driven, and conflict-free system of publicly financed long-term services and supports that is 7
responsive to the goals and preferences of those served. 8
40-8.9-9. Long-term-care rebalancing system reform goal. 9
(a) Notwithstanding any other provision of state law, the executive office of health and 10
human services is authorized and directed to apply for, and obtain, any necessary waiver(s), waiver 11
amendment(s), and/or state-plan amendments from the Secretary of the United States Department 12
of Health and Human Services, and to promulgate rules necessary to adopt an affirmative plan of 13
program design and implementation that addresses the goal of allocating a minimum of fifty percent 14
(50%) of Medicaid long-term-care funding for persons aged sixty-five (65) and over and adults 15
with disabilities, in addition to services for persons with developmental disabilities, to home- and 16
community-based care; provided, further, the executive office shall report annually as part of its 17
budget submission, the percentage distribution between institutional care and home- and 18
community-based care by population and shall report current and projected waiting lists for long-19
term-care and home- and community-based care services. The executive office is further authorized 20
and directed to prioritize investments in home- and community-based care and to maintain the 21
integrity and financial viability of all current long-term-care services while pursuing this goal. 22
(b) The reformed long-term-care system rebalancing goal is person-centered and 23
encourages individual self-determination, family involvement, interagency collaboration, and 24
individual choice through the provision of highly specialized and individually tailored home-based 25
services. Additionally, individuals with severe behavioral, physical, or developmental disabilities 26
must have the opportunity to live safe and healthful lives through access to a wide range of 27
supportive services in an array of community-based settings, regardless of the complexity of their 28
medical condition, the severity of their disability, or the challenges of their behavior. Delivery of 29
services and supports in less-costly and less-restrictive community settings will enable children, 30
adolescents, and adults to be able to curtail, delay, or avoid lengthy stays in long-term-care 31
institutions, such as behavioral health residential-treatment facilities, long-term-care hospitals, 32
intermediate-care facilities, and/or skilled nursing facilities. 33
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(c) Pursuant to federal authority procured under § 42-7.2-16, the executive office of health 1
and human services is directed and authorized to adopt a tiered set of criteria to be used to determine 2
eligibility for services. The criteria shall be developed in collaboration with the state’s health and 3
human services departments and, to the extent feasible, any consumer group, advisory board, or 4
other entity designated for these purposes, and shall encompass eligibility determinations for long-5
term-care services in nursing facilities, hospitals, and intermediate-care facilities for persons with 6
intellectual disabilities, as well as home- and community-based alternatives, and shall provide a 7
common standard of income eligibility for both institutional and home- and community-based care. 8
The executive office is authorized to adopt clinical and/or functional criteria for admission to a 9
nursing facility, hospital, or intermediate-care facility for persons with intellectual disabilities that 10
are more stringent than those employed for access to home- and community-based services. The 11
executive office is also authorized to promulgate rules that define the frequency of re-assessments 12
for services provided for under this section. Levels of care may be applied in accordance with the 13
following: 14
(1) The executive office shall continue to apply the level-of-care criteria in effect on June 15
30, 2015 April 1, 2021, for any recipient determined eligible for and receiving Medicaid-funded 16
long-term services and supports in a nursing facility, hospital, or intermediate-care facility for 17
persons with intellectual disabilities on or before that date, unless: 18
(i) The recipient transitions to home- and community-based services because he or she 19
would no longer meet the level-of-care criteria in effect on June 30, 2015 April 1, 2021; or 20
(ii) The recipient chooses home- and community-based services over the nursing facility, 21
hospital, or intermediate-care facility for persons with intellectual disabilities. For the purposes of 22
this section, a failed community placement, as defined in regulations promulgated by the executive 23
office, shall be considered a condition of clinical eligibility for the highest level of care. The 24
executive office shall confer with the long-term-care ombudsperson with respect to the 25
determination of a failed placement under the ombudsperson’s jurisdiction. Should any Medicaid 26
recipient eligible for a nursing facility, hospital, or intermediate-care facility for persons with 27
intellectual disabilities as of June 30, 2015 April 1, 2021, receive a determination of a failed 28
community placement, the recipient shall have access to the highest level of care; furthermore, a 29
recipient who has experienced a failed community placement shall be transitioned back into his or 30
her former nursing home, hospital, or intermediate-care facility for persons with intellectual 31
disabilities whenever possible. Additionally, residents shall only be moved from a nursing home, 32
hospital, or intermediate-care facility for persons with intellectual disabilities in a manner 33
consistent with applicable state and federal laws. 34
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(2) Any Medicaid recipient eligible for the highest level of care who voluntarily leaves a 1
nursing home, hospital, or intermediate-care facility for persons with intellectual disabilities shall 2
not be subject to any wait list for home- and community-based services. 3
(3) No nursing home, hospital, or intermediate-care facility for persons with intellectual 4
disabilities shall be denied payment for services rendered to a Medicaid recipient on the grounds 5
that the recipient does not meet level-of-care criteria unless and until the executive office has: 6
(i) Performed an individual assessment of the recipient at issue and provided written notice 7
to the nursing home, hospital, or intermediate-care facility for persons with intellectual disabilities 8
that the recipient does not meet level-of-care criteria; and 9
(ii) The recipient has either appealed that level-of-care determination and been 10
unsuccessful, or any appeal period available to the recipient regarding that level-of-care 11
determination has expired. 12
(d) The executive office is further authorized to consolidate all home- and community-13
based services currently provided pursuant to 42 U.S.C. § 1396n into a single system of home- and 14
community-based services that include options for consumer direction and shared living. The 15
resulting single home- and community-based services system shall replace and supersede all 42 16
U.S.C. § 1396n programs when fully implemented. Notwithstanding the foregoing, the resulting 17
single program home- and community-based services system shall include the continued funding 18
of assisted-living services at any assisted-living facility financed by the Rhode Island housing and 19
mortgage finance corporation prior to January 1, 2006, and shall be in accordance with chapter 66.8 20
of title 42 as long as assisted-living services are a covered Medicaid benefit. 21
(e) The executive office is authorized to promulgate rules that permit certain optional 22
services including, but not limited to, homemaker services, home modifications, respite, and 23
physical therapy evaluations to be offered to persons at risk for Medicaid-funded long-term care 24
subject to availability of state-appropriated funding for these purposes. 25
(f) To promote the expansion of home- and community-based service capacity, the 26
executive office is authorized to pursue payment methodology reforms that increase access to 27
homemaker, personal care (home health aide), assisted living, adult supportive-care homes, and 28
adult day services, as follows: 29
(1) Development of revised or new Medicaid certification standards that increase access to 30
service specialization and scheduling accommodations by using payment strategies designed to 31
achieve specific quality and health outcomes. 32
(2) Development of Medicaid certification standards for state-authorized providers of adult 33
day services, excluding providers of services authorized under § 40.1-24-1(3), assisted living, and 34
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adult supportive care (as defined under chapter 17.24 of title 23) that establish for each, an acuity-1
based, tiered service and payment methodology tied to: licensure authority; level of beneficiary 2
needs; the scope of services and supports provided; and specific quality and outcome measures. 3
The standards for adult day services for persons eligible for Medicaid-funded long-term 4
services may differ from those who do not meet the clinical/functional criteria set forth in § 40-5
8.10-3. 6
(3) As the state’s Medicaid program seeks to assist more beneficiaries requiring long-term 7
services and supports in home- and community-based settings, the demand for home-care workers 8
has increased, and wages for these workers has not kept pace with neighboring states, leading to 9
high turnover and vacancy rates in the state’s home-care industry, the executive office shall institute 10
a one-time increase in the base-payment rates for FY 2019, as described below, for home-care 11
service providers to promote increased access to and an adequate supply of highly trained home-12
healthcare professionals, in amount to be determined by the appropriations process, for the purpose 13
of raising wages for personal care attendants and home health aides to be implemented by such 14
providers. 15
(i) A prospective base adjustment, effective not later than July 1, 2018, of ten percent 16
(10%) of the current base rate for home-care providers, home nursing care providers, and hospice 17
providers contracted with the executive office of health and human services and its subordinate 18
agencies to deliver Medicaid fee-for-service personal care attendant services. 19
(ii) A prospective base adjustment, effective not later than July 1, 2018, of twenty percent 20
(20%) of the current base rate for home-care providers, home nursing care providers, and hospice 21
providers contracted with the executive office of health and human services and its subordinate 22
agencies to deliver Medicaid fee-for-service skilled nursing and therapeutic services and hospice 23
care. 24
(iii) Effective upon passage of this section, hospice provider reimbursement, exclusively 25
for room and board expenses for individuals residing in a skilled nursing facility, shall revert to the 26
rate methodology in effect on June 30, 2018, and these room and board expenses shall be exempted 27
from any and all annual rate increases to hospice providers as provided for in this section. 28
(iv) On the first of July in each year, beginning on July 1, 2019, the executive office of 29
health and human services will initiate an annual inflation increase to the base rate for home-care 30
providers, home nursing care providers, and hospice providers contracted with the executive office 31
and its subordinate agencies to deliver Medicaid fee-for-service personal care attendant services, 32
skilled nursing and therapeutic services and hospice care. The base rate increase shall be a 33
percentage amount equal to the New England Consumer Price Index card as determined by the 34
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United States Department of Labor for medical care and for compliance with all federal and state 1
laws, regulations, and rules, and all national accreditation program requirements. 2
(g) As the state’s Medicaid program seeks to assist more beneficiaries requiring long-term 3
services and supports in home- and community-based settings, the demand for home-care workers 4
has increased, and wages for these workers has not kept pace with neighboring states, leading to 5
high turnover and vacancy rates in the state’s home-care industry. To promote increased access to 6
and an adequate supply of direct-care workers, the executive office shall institute a payment 7
methodology change, in Medicaid fee-for-service and managed care, for FY 2022, that shall be 8
passed through directly to the direct-care workers’ wages who are employed by home nursing care 9
and home-care providers licensed by the Rhode Island department of health, as described below: 10
(1) Effective July 1, 2021, increase the existing shift differential modifier by $0.19 per 11
fifteen (15) minutes for personal care and combined personal care/homemaker. 12
(i) Employers must pass on one hundred percent (100%) of the shift differential modifier 13
increase per fifteen-minute (15) unit of service to the CNAs who rendered such services. This 14
compensation shall be provided in addition to the rate of compensation that the employee was 15
receiving as of June 30, 2021. For an employee hired after June 30, 2021, the agency shall use not 16
less than the lowest compensation paid to an employee of similar functions and duties as of June 17
30, 2021, as the base compensation to which the increase is applied. 18
(ii) Employers must provide to EOHHS an annual compliance statement showing wages 19
as of June 30, 2021, amounts received from the increases outlined herein, and compliance with this 20
section by July 1, 2022. EOHHS may adopt any additional necessary regulations and processes to 21
oversee this subsection. 22
(2) Effective January 1, 2022, establish a new behavioral healthcare enhancement of $0.39 23
per fifteen (15) minutes for personal care, combined personal care/homemaker, and homemaker 24
only for providers who have at least thirty percent (30%) of their direct-care workers (which 25
includes certified nursing assistants (CNA) and homemakers) certified in behavioral healthcare 26
training. 27
(i) Employers must pass on one hundred percent (100%) of the behavioral healthcare 28
enhancement per fifteen (15) minute unit of service rendered by only those CNAs and homemakers 29
who have completed the thirty (30) hour behavioral health certificate training program offered by 30
Rhode Island College, or a training program that is prospectively determined to be compliant per 31
EOHHS, to those CNAs and homemakers. This compensation shall be provided in addition to the 32
rate of compensation that the employee was receiving as of December 31, 2021. For an employee 33
hired after December 31, 2021, the agency shall use not less than the lowest compensation paid to 34
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an employee of similar functions and duties as of December 31, 2021, as the base compensation to 1
which the increase is applied. 2
(ii) By January 1, 2023, employers must provide to EOHHS an annual compliance 3
statement showing wages as of December 31, 2021, amounts received from the increases outlined 4
herein, and compliance with this section, including which behavioral healthcare training programs 5
were utilized. EOHHS may adopt any additional necessary regulations and processes to oversee 6
this subsection. 7
(h) The executive office shall implement a long-term-care-options counseling program to 8
provide individuals, or their representatives, or both, with long-term-care consultations that shall 9
include, at a minimum, information about: long-term-care options, sources, and methods of both 10
public and private payment for long-term-care services and an assessment of an individual’s 11
functional capabilities and opportunities for maximizing independence. Each individual admitted 12
to, or seeking admission to, a long-term-care facility, regardless of the payment source, shall be 13
informed by the facility of the availability of the long-term-care-options counseling program and 14
shall be provided with long-term-care-options consultation if they so request. Each individual who 15
applies for Medicaid long-term-care services shall be provided with a long-term-care consultation. 16
(i) The executive office shall implement, no later than January 1, 2024, a statewide network 17
and rate methodology for conflict-free case management for individuals receiving Medicaid-funded 18
home and community-based services. The executive office shall coordinate implementation with 19
the state’s health and human services departments and divisions authorized to deliver Medicaid-20
funded home and community-based service programs, including the department of behavioral 21
healthcare, developmental disabilities and hospitals; the department of human services; and the 22
office of healthy aging. It is in the best interest of the Rhode Islanders eligible to receive Medicaid 23
home and community-based services under this chapter, chapter 40.1, chapter 42 or any other 24
general laws to provide equitable access to conflict-free case management that shall include person-25
centered planning, service arranging and quality monitoring in the amount, duration and scope 26
required by federal law and regulations. It is necessary to ensure that there is a robust network of 27
qualified conflict-free case management entities with the capacity to serve all participants on a 28
statewide basis and in a manner that promotes choice, self-reliance, and community integration. 29
The executive office, as the designated single state Medicaid authority and agency responsible for 30
coordinating policy and planning for health and human services under § 42-7.2 et seq., is directed 31
to establish a statewide conflict-free case management network under the management of the 32
executive office and to seek any Medicaid waivers, state plan amendments and changes in rules, 33
regulations and procedures that may be necessary to ensure that recipients of Medicaid home and 34
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community-based services have access to conflict-free case management in a timely manner and in 1
accordance with the federal requirements that must be met to preserve financial participation. 2
(ij) The executive office is also authorized, subject to availability of appropriation of 3
funding, and federal, Medicaid-matching funds, to pay for certain services and supports necessary 4
to transition or divert beneficiaries from institutional or restrictive settings and optimize their health 5
and safety when receiving care in a home or the community. The secretary is authorized to obtain 6
any state plan or waiver authorities required to maximize the federal funds available to support 7
expanded access to home- and community-transition and stabilization services; provided, however, 8
payments shall not exceed an annual or per-person amount. 9
(jk) To ensure persons with long-term-care needs who remain living at home have adequate 10
resources to deal with housing maintenance and unanticipated housing-related costs, the secretary 11
is authorized to develop higher resource eligibility limits for persons or obtain any state plan or 12
waiver authorities necessary to change the financial eligibility criteria for long-term services and 13
supports to enable beneficiaries receiving home and community waiver services to have the 14
resources to continue living in their own homes or rental units or other home-based settings. 15
(kl) The executive office shall implement, no later than January 1, 2016, the following 16
home- and community-based service and payment reforms: 17
(1) [Deleted by P.L. 2021, ch. 162, art. 12, § 6.] 18
(2) Adult day services level of need criteria and acuity-based, tiered-payment 19
methodology; and 20
(3) Payment reforms that encourage home- and community-based providers to provide the 21
specialized services and accommodations beneficiaries need to avoid or delay institutional care. 22
(lm) The secretary is authorized to seek any Medicaid section 1115 waiver or state-plan 23
amendments and take any administrative actions necessary to ensure timely adoption of any new 24
or amended rules, regulations, policies, or procedures and any system enhancements or changes, 25
for which appropriations have been authorized, that are necessary to facilitate implementation of 26
the requirements of this section by the dates established. The secretary shall reserve the discretion 27
to exercise the authority established under §§ 42-7.2-5(6)(v) and 42-7.2-6.1, in consultation with 28
the governor, to meet the legislative directives established herein. 29
SECTION 4. Section 40.1-8.5-8 of the General Laws in Chapter 40 entitled "General 30
Provisions" is hereby amended to read as follows: 31
40.1-8.5-8. Certified community behavioral health clinics. 32
(a) The executive office of health and human services is authorized and directed to submit 33
to the Secretary of the United States Department of Health and Human Services a state plan 34
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amendment for the purposes of establishing Certified Community Behavioral Health Clinics in 1
accordance with Section 223 of the federal Protecting Access to Medicare Act of 2014. 2
(b) The executive office of health and human services shall amend its Title XIX state plan 3
pursuant to Title XIX [42 U.S.C. § 1396 et seq.] and Title XXI [42 U.S.C § 1397 et seq.] of the 4
Social Security Act as necessary to cover all required services for persons with mental health and 5
substance use disorders at a certified community behavioral health clinic through a daily or monthly 6
bundled payment methodology that is specific to each organization’s anticipated costs and inclusive 7
of all required services within Section 223 of the federal Protecting Access to Medicare Act of 8
2014. Such certified community behavioral health clinics shall adhere to the federal model, 9
including payment structures and rates. 10
(c) A certified community behavioral health clinic means any licensed behavioral health 11
organization that meets the federal certification criteria of Section 223 of the Protecting Access to 12
Medicare Act of 2014. The department of behavioral healthcare, developmental disabilities and 13
hospitals shall define additional criteria to certify the clinics including, but not limited to the 14
provision of, these services: 15
(1) Outpatient mental health and substance use services; 16
(2) Twenty-four (24) hour mobile crisis response and hotline services; 17
(3) Screening, assessment, and diagnosis, including risk assessments; 18
(4) Person-centered treatment planning; 19
(5) Primary care screening and monitoring of key indicators of health risks; 20
(6) Targeted case management; 21
(7) Psychiatric rehabilitation services; 22
(8) Peer support and family supports; 23
(9) Medication-assisted treatment; 24
(10) Assertive community treatment; and 25
(11) Community-based mental health care for military service members and veterans. 26
(d) Subject to the approval from the United States Department of Health and Human 27
Services’ Centers for Medicare and Medicaid Services, the certified community behavioral health 28
clinic model pursuant to this chapter, shall be established by July 1, 2023 February 1, 2024, and 29
include any enhanced Medicaid match for required services or populations served. 30
(e) By August 1, 2022, the executive office of health and human services will issue the 31
appropriate purchasing process and vehicle for organizations who want to participate in the 32
Certified Community Behavioral Health Clinic model program. 33
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(f) By December 1, 2022, the The organizations will submit a detailed cost report 1
developed by the department of behavioral healthcare, developmental disabilities and hospitals 2
with approval from the executive office of health and human services, that includes the cost for the 3
organization to provide the required services. 4
(g) By January 15, 2023, the The department of behavioral healthcare, developmental 5
disabilities and hospitals, in coordination with the executive office of health and human services, 6
will prepare an analysis of proposals, determine how many behavioral health clinics can be certified 7
in FY 2024 and the costs for each one. Funding for the Certified Behavioral Health Clinics will be 8
included in the FY 2024 budget recommended by the Governor. 9
(h) The executive office of health and human services shall apply for the federal Certified 10
Community Behavioral Health Clinics Demonstration Program if another round of funding 11
becomes available. 12
SECTION 5. Rhode Island Medicaid Reform Act of 2008 Resolution. 13
WHEREAS, the General Assembly enacted Chapter 12.4 of Title 42 entitled “The Rhode 14
Island Medicaid Reform Act of 2008”; and 15
WHEREAS, a legislative enactment is required pursuant to Rhode Island General Laws 16
42-12.4-1, et seq.; and 17
WHEREAS, Rhode Island General Laws section 42-7.2-5(3)(i) provides that the Secretary 18
of the Executive Office of Health and Human Services (“Executive Office”) is responsible for the 19
review and coordination of any Medicaid section 1115 demonstration waiver requests and renewals 20
as well as any initiatives and proposals requiring amendments to the Medicaid state plan or category 21
II or III changes as described in the demonstration, “with potential to affect the scope, amount, or 22
duration of publicly-funded health care services, provider payments or reimbursements, or access 23
to or the availability of benefits and services provided by Rhode Island general and public laws”; 24
and 25
WHEREAS, in pursuit of a more cost-effective consumer choice system of care that is 26
fiscally sound and sustainable, the Secretary requests legislative approval of the following 27
proposals to amend the demonstration; and 28
WHEREAS, implementation of adjustments may require amendments to the Rhode 29
Island’s Medicaid state plan and/or section 1115 waiver under the terms and conditions of the 30
demonstration. Further, adoption of new or amended rules, regulations and procedures may also 31
be required 32
(a) Cedar Rate Increase. The Secretary of the Executive Office is authorized to pursue and 33
implement any waiver amendments, state plan amendments, and/or changes to the applicable 34
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department’s rules, regulations and procedures required to implement an increase to existing fee-1
for-service and managed care rates and an updated code structure for the Cedar Family Centers. 2
(b) Hospital State Directed Managed Care Payment. The Secretary of the Executive Office 3
is hereby authorized and directed to amend its regulations for reimbursement to Medicaid Managed 4
Care Organizations (MMCO) and authorized to direct MMCO’s to make quarterly state directed 5
payments to hospitals for inpatient and outpatient services in accordance with the payment 6
methodology contained in the approved CMS preprint for hospital state directed payments. 7
(c) Hospital Licensing Fee. The Secretary of the Executive Office is authorized to pursue 8
and implement any waiver amendments, state plan amendments, and/or changes to the applicable 9
department’s rules, regulations and procedures required to implement a hospital licensing rate, 10
including but not limited to, a three-tiered hospital licensing rate for non-government owned 11
hospitals and one rate for government-owned and operated hospitals. 12
Now, therefore, be it 13
RESOLVED, that the General Assembly hereby approves the proposals stated above in the 14
recitals; and be it further 15
RESOLVED, that the Secretary of the Executive Office of Health and Human Services is 16
authorized to pursue and implement any waiver amendments, state plan amendment, and/or 17
changes to the applicable department’s rules, regulations and procedures approved herein and as 18
authorized by 42-12.4; and be it further; 19
RESOLVED, that this Joint Resolution shall take effect on July 1, 2023. 20
SECTION 6. This article shall take effect upon passage, except for Section 5 which shall 21
take effect as of July 1, 2023. 22