The bill's enactment will broaden the scope of who can provide HCBS under the Rhode Island Medicaid program, allowing family members to be reimbursed for personal care services. This change is seen as a necessary response to the unique challenges posed by the COVID-19 pandemic which heightened the need for flexible care options and delivery mechanisms. By facilitating payments for family caregivers, the legislation aims to alleviate the financial burden on families caring for special needs individuals and to ensure continuity of care in home settings.
Summary
House Bill 5238 seeks to amend the cooperation with the federal government in relation to behavioral healthcare and developmental disabilities by allowing family caregivers and legally responsible individuals to provide home and community-based services (HCBS) to developmentally disabled adults and children with special needs, and to be compensated for these services. This legislative measure, set to take effect on July 1, 2023, indicates a significant shift towards recognition and formalization of the role of family caregivers in the healthcare system, particularly for vulnerable populations requiring specialized care.
Contention
Notably, the bill includes provisions for the executive office of health and human services to pursue a Medicaid Section 1115 demonstration waiver to enable these changes, which raises some concerns regarding the implications for federal compliance. As the bill shifts certain responsibilities and financial burdens from state agencies to family members, it has sparked discussions regarding the sustainability of supporting family caregivers as a viable component of the state's healthcare system. Critics may argue this could lead to inequities in access and quality of care based on family circumstances and resources.
Provides that shared living for older adults and adults with disabilities allow individuals to receive care from family caregivers, related or unrelated regardless of whether they are performing other activities, such as power of attorney for individual.
Requires the secretary of the executive office of health and human services to monitor and mandate changes to the price-setting practices of pharmacy benefit managers to prohibit the spread pricing payment model.
Requires the secretary of the executive office of health and human services to monitor and mandate changes to the price-setting practices of pharmacy benefit managers to prohibit the spread pricing payment model.
Sets controls on Medicaid prescription drug costs by imposing transparency and accountability requirements on managed care organizations (MCOs) and their pharmacy benefit managers (PBMs).
Sets controls on Medicaid prescription drug costs by imposing transparency and accountability requirements on managed care organizations (MCOs) and their pharmacy benefit managers (PBMs).
Authorizes the executive office of health and human services to establish a program providing coverage for nutritional assistance and medically tailored meals for certain beneficiaries where there is a clinical need.
Amends Article 9 of the state budget and various provisions relative to hospital licensing fees, would redefine base year for purposes of calculating disproportionate share payments for fiscal years.
Amends Article 9 of the state budget and various provisions relative to hospital licensing fees, would redefine base year for purposes of calculating disproportionate share payments for fiscal years.
Requesting The Department Of Human Services To File A Request With The Centers For Medicare And Medicaid Services To Amend The State's Existing Section 1115 Demonstration Program To Implement A Housing And Health Opportunities Demonstration Program To Enable Direct Housing Costs For Medicaid Recipients To Be Covered By The Federal Financial Participation For Medicaid.
Requesting The Department Of Human Services To File A Request With The Centers For Medicare And Medicaid Services To Amend The State's Existing Section 1115 Demonstration Program To Implement A Housing And Health Opportunities Demonstration Program To Enable Direct Housing Costs For Medicaid Recipients To Be Covered By The Federal Financial Participation For Medicaid.