2023 -- H 5238
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LC000805
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S TATE OF RHODE IS LAND
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2023
____________
A N A C T
RELATING TO BEHAVIORAL HEALTHCARE, DEVELOPMENTAL DISABI LITIES AND
HOSPITALS -- COOPERATION WITH FED ERAL GOVERNMENT
Introduced By: Representatives Fellela, Carson, Donovan, Kazarian, Cortvriend,
Sanchez, and Nardone
Date Introduced: January 25, 2023
Referred To: House Finance
It is enacted by the General Assembly as follows:
SECTION 1. Chapter 40.1-1.1 of the General Laws entitled "Cooperation with Federal 1
Government" is hereby amended by adding thereto the following section: 2
40.1-1.1-5. Home and community based services to permit payments for family 3
caregivers and legally responsible individuals. 4
(a) Commencing July 1, 2023, and continuing thereafter, family caregivers and legally 5
responsible individuals, including guardians appointed for an adult by a court of competent 6
jurisdiction, and for children with special needs, shall be eligible to provide home and community 7
based services ("HCBS"), including personal care services, to developmentally disabled adults and 8
children with special needs, and be eligible to be paid for such services pursuant to the HCBS final 9
rules. As used in this section, the term "family caregivers" shall include a member of the individua l's 10
family and a legally responsible relative. Provided, the caregiver shall be required to meet the 11
provisions of subsection (b) of this section. 12
(b) The executive office of health and human services ("EOHHS") shall permit payment 13
for family caregivers and legally responsible individuals to provide HCBS, including personal care 14
services and all home-based services for children with special needs, and developmentally disabled 15
adults. To ensure that individuals receive necessary services as authorized in the plan of care, family 16
caregivers/legally responsible individuals will be required to document case notes reflecting the 17
services they provide, as well as an attestation that they have reviewed the plan of care and will 18
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provide the supports in the plan to the extent possible given the public health emergency and will 1
identify safe alternatives where necessary and possible. To ensure that payments are made for 2
services rendered, EOHHS will utilize the self-directed plan process. Under this process, 3
individuals who self-direct their services shall go through a fiscal intermediary agency, which 4
reviews employment paperwork and time sheets submitted by the parent/guardian. 5
(c) The EOHHS is directed to ensure that federal financial participation is used to the 6
maximum extent allowable to provide coverage pursuant to this section, and that state-only funds 7
will be used only if federal financial participation is not available. To the extent the EOHHS 8
determines it necessary to implement the provisions of this section, the EOHHS is authorized to 9
pursue a Medicaid section 1115 demonstration waiver request and renewal to seek a waiver of the 10
compliance provisions of 42 U.S.C. section 1396d(a) ("definitions"). 11
SECTION 2. Rhode Island Medicaid Reform Act of 2008 Joint Resolution. 12
WHEREAS, The General Assembly enacted Chapter 12.4 of Title 42 entitled "The Rhode 13
Island Medicaid Reform Act of 2008"; and 14
WHEREAS, A legislative enactment is required pursuant to Rhode Island General Laws § 15
42-12.4-1, et seq.; and 16
WHEREAS, Rhode Island General Laws § 42-7.2-5(3)(i) provides that the secretary of the 17
executive office of health and human services ("executive office") is responsible for the review and 18
coordination of any Medicaid section 1115 demonstration waiver requests and renewals as well as 19
any initiatives and proposals requiring amendments to the Medicaid state plan or category II or III 20
changes as described in the demonstration, "with potential to affect the scope, amount, or duration 21
of publicly-funded health care services, provider payments or reimbursements, or access to or the 22
availability of benefits and services provided by Rhode Island general and public laws"; and 23
WHEREAS, In pursuit of a more cost-effective consumer choice system of care that is 24
fiscally sound and sustainable, the secretary requests legislative approval of the following proposals 25
to amend the demonstration; and 26
WHEREAS, Implementation of adjustments may require amendments to the Rhode 27
Island's Medicaid state plan and/or section 1115 waiver under the terms and conditions of the 28
demonstration. Further, adoption of new or amended rules, regulations and procedures may also be 29
required: 30
(a) Section 1115 demonstration waiver – extension request. The executive office proposes 31
to seek approval from the federal centers for Medicare and Medicaid services ("CMS") to extend 32
the Medicaid section 1115 demonstration waiver as authorized in Rhode Island General Laws 33
chapter 12.4 of title 42. In the Medicaid section 1115 demonstration waiver extension request due 34
LC000805 - Page 3 of 4
to CMS by December 31, 2023, in addition to maintaining existing Medicaid section 1115 1
demonstration waiver authorities, the executive office proposes to seek a Medicaid section 1115 2
demonstration waiver request and renewal to a seek waiver of the compliance provisions of 42 3
U.S.C. section 1396d(a) ("definitions"), as set forth in subsection (b) of this resolution. 4
(b) Home and community based services ("HBCS"). The executive office proposes to 5
permit payment for family caregivers and legally responsible individuals, to provide HCBS, 6
including personal care services and all home-based services for children with special needs, and 7
developmentally disabled adults. To ensure that individuals receive necessary services as 8
authorized in the plan of care, family caregivers/legally responsible individuals will be required to 9
document case notes reflecting the services they provide, as well as an attestation that they have 10
reviewed the plan of care and will provide the supports in the plan to the extent possible given the 11
public health emergency and will identify safe alternatives where necessary and possible. To ensure 12
that payments are made for services rendered, EOHHS will utilize the self-directed plan process. 13
Under this process, individuals who self-direct their services go through a fiscal intermediary 14
agency, which reviews employment paperwork and time sheets submitted by the parent/guardian. 15
As used in this section, the term "family caregivers" may include a member of the individua l's 16
family and a legally responsible relative; now, therefore be it 17
RESOLVED, That the general assembly hereby approves the proposals stated above in the 18
recitals; and be it further; 19
RESOLVED, That the secretary of the executive office of health and human services is 20
authorized to pursue and implement any waiver amendments, state plan amendments, and/or 21
changes to the applicable department's rules, regulations and procedures approved herein and as 22
authorized by chapter 12.4 of title 42; and be it further; 23
RESOLVED, That this joint resolution shall take effect upon passage. 24
SECTION 3. This act shall take effect upon passage. 25
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EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO BEHAVIORAL HEALTHCARE, DEVEL OPMENTAL DISABILITIES AND
HOSPITALS -- COOPERATION WITH FED ERAL GOVERNMENT
***
This act would codify in state law portions of an Attachment K Emergency and 1
Preparedness Response which included actions that state could take under existing section 1915(c) 2
of the Social Security Act relating to home and community-based waiver authority in order to 3
respond to the COVID-19 pandemic. More specifically, the act authorizes members of an 4
individual's family as well as a legally responsible adult to receive payment for delivering home 5
and community based services to a developmentally disabled adult and a child with special needs. 6
This act would also include a Medicaid Section 1115 Demonstration Waiver to permit this payment 7
to be made, notwithstanding the provisions of 42 U.S.C. section 1396d(a). 8
This act would take effect upon passage. 9
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