Rhode Island 2023 Regular Session

Rhode Island House Bill H6332 Compare Versions

Only one version of the bill is available at this time.

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5	5	2023 -- H 6332
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7	7	LC002859
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9	9	S T A T E O F R H O D E I S L A N D
10	10	IN GENERAL ASSEMBLY
11	11	JANUARY SESSION, A.D. 2023
12	12	____________
13	13
14	14	A N A C T
15	15	RELATING TO HUMAN SERVICES -- MEDICAL ASSISTANCE -- LONG-TERM CARE
16	16	SERVICE AND FINANCE REFORM
17	17	Introduced By: Representatives Spears, Donovan, Abney, Speakman, Craven, O'Brien,
18	18	Shanley, McEntee, Morales, and Tanzi
19	19	Date Introduced: April 26, 2023
20	20	Referred To: House Finance
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22	22
23	23	It is enacted by the General Assembly as follows:
24	24	SECTION 1. Section 40-8.9-9 of the General Laws in Chapter 40-8.9 entitled "Medical 1
25	25	Assistance — Long-Term Care Service and Finance Reform" is hereby amended to read as follows: 2
26	26	40-8.9-9. Long-term-care rebalancing system reform goal. 3
27	27	(a) Notwithstanding any other provision of state law, the executive office of health and 4
28	28	human services is authorized and directed to apply for, and obtain, any necessary waiver(s), waiver 5
29	29	amendment(s), and/or state-plan amendments from the Secretary of the United States Department 6
30	30	of Health and Human Services, and to promulgate rules necessary to adopt an affirmative plan of 7
31	31	program design and implementation that addresses the goal of allocating a minimum of fifty percent 8
32	32	(50%) of Medicaid long-term-care funding for persons aged sixty-five (65) and over and adults 9
33	33	with disabilities, in addition to services for persons with developmental disabilities, to home- and 10
34	34	community-based care; provided, further, the executive office shall report annually as part of its 11
35	35	budget submission, the percentage distribution between institutional care and home- and 12
36	36	community-based care by population and shall report current and projected waiting lists for long-13
37	37	term-care and home- and community-based care services. The executive office is further authorized 14
38	38	and directed to prioritize investments in home- and community-based care and to maintain the 15
39	39	integrity and financial viability of all current long-term-care services while pursuing this goal. 16
40	40	(b) The reformed long-term-care system rebalancing goal is person-centered and 17
41	41	encourages individual self-determination, family involvement, interagency collaboration, and 18
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45	45	individual choice through the provision of highly specialized and individually tailored home-based 1
46	46	services. Additionally, individuals with severe behavioral, physical, or developmental disabilities 2
47	47	must have the opportunity to live safe and healthful lives through access to a wide range of 3
48	48	supportive services in an array of community-based settings, regardless of the complexity of their 4
49	49	medical condition, the severity of their disability, or the challenges of their behavior. Delivery of 5
50	50	services and supports in less-costly and less-restrictive community settings will enable children, 6
51	51	adolescents, and adults to be able to curtail, delay, or avoid lengthy stays in long-term-care 7
52	52	institutions, such as behavioral health residential-treatment facilities, long-term-care hospitals, 8
53	53	intermediate-care facilities, and/or skilled nursing facilities. 9
54	54	(c) Pursuant to federal authority procured under § 42-7.2-16, the executive office of health 10
55	55	and human services is directed and authorized to adopt a tiered set of criteria to be used to determine 11
56	56	eligibility for services. The criteria shall be developed in collaboration with the state’s health and 12
57	57	human services departments and, to the extent feasible, any consumer group, advisory board, or 13
58	58	other entity designated for these purposes, and shall encompass eligibility determinations for long-14
59	59	term-care services in nursing facilities, hospitals, and intermediate-care facilities for persons with 15
60	60	intellectual disabilities, as well as home- and community-based alternatives, and shall provide a 16
61	61	common standard of income eligibility for both institutional and home- and community-based care. 17
62	62	The executive office is authorized to adopt clinical and/or functional criteria for admission to a 18
63	63	nursing facility, hospital, or intermediate-care facility for persons with intellectual disabilities that 19
64	64	are more stringent than those employed for access to home- and community-based services. The 20
65	65	executive office is also authorized to promulgate rules that define the frequency of re-assessments 21
66	66	for services provided for under this section. Levels of care may be applied in accordance with the 22
67	67	following: 23
68	68	(1) The executive office shall continue to apply the level-of-care criteria in effect on June 24
69	69	30, 2015, for any recipient determined eligible for and receiving Medicaid-funded long-term 25
70	70	services and supports in a nursing facility, hospital, or intermediate-care facility for persons with 26
71	71	intellectual disabilities on or before that date, unless: 27
72	72	(i) The recipient transitions to home- and community-based services because he or she 28
73	73	would no longer meet the level-of-care criteria in effect on June 30, 2015; or 29
74	74	(ii) The recipient chooses home- and community-based services over the nursing facility, 30
75	75	hospital, or intermediate-care facility for persons with intellectual disabilities. For the purposes of 31
76	76	this section, a failed community placement, as defined in regulations promulgated by the executive 32
77	77	office, shall be considered a condition of clinical eligibility for the highest level of care. The 33
78	78	executive office shall confer with the long-term-care ombudsperson with respect to the 34
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82	82	determination of a failed placement under the ombudsperson’s jurisdiction. Should any Medicaid 1
83	83	recipient eligible for a nursing facility, hospital, or intermediate-care facility for persons with 2
84	84	intellectual disabilities as of June 30, 2015, receive a determination of a failed community 3
85	85	placement, the recipient shall have access to the highest level of care; furthermore, a recipient who 4
86	86	has experienced a failed community placement shall be transitioned back into his or her former 5
87	87	nursing home, hospital, or intermediate-care facility for persons with intellectual disabilities 6
88	88	whenever possible. Additionally, residents shall only be moved from a nursing home, hospital, or 7
89	89	intermediate-care facility for persons with intellectual disabilities in a manner consistent with 8
90	90	applicable state and federal laws. 9
91	91	(2) Any Medicaid recipient eligible for the highest level of care who voluntarily leaves a 10
92	92	nursing home, hospital, or intermediate-care facility for persons with intellectual disabilities shall 11
93	93	not be subject to any wait list for home- and community-based services. 12
94	94	(3) No nursing home, hospital, or intermediate-care facility for persons with intellectual 13
95	95	disabilities shall be denied payment for services rendered to a Medicaid recipient on the grounds 14
96	96	that the recipient does not meet level-of-care criteria unless and until the executive office has: 15
97	97	(i) Performed an individual assessment of the recipient at issue and provided written notice 16
98	98	to the nursing home, hospital, or intermediate-care facility for persons with intellectual disabilities 17
99	99	that the recipient does not meet level-of-care criteria; and 18
100	100	(ii) The recipient has either appealed that level-of-care determination and been 19
101	101	unsuccessful, or any appeal period available to the recipient regarding that level-of-care 20
102	102	determination has expired. 21
103	103	(d) The executive office is further authorized to consolidate all home- and community-22
104	104	based services currently provided pursuant to 42 U.S.C. § 1396n into a single system of home- and 23
105	105	community-based services that include options for consumer direction and shared living. The 24
106	106	resulting single home- and community-based services system shall replace and supersede all 42 25
107	107	U.S.C. § 1396n programs when fully implemented. Notwithstanding the foregoing, the resulting 26
108	108	single program home- and community-based services system shall include the continued funding 27
109	109	of assisted-living services at any assisted-living facility financed by the Rhode Island housing and 28
110	110	mortgage finance corporation prior to January 1, 2006, and shall be in accordance with chapter 66.8 29
111	111	of title 42 as long as assisted-living services are a covered Medicaid benefit. 30
112	112	(e) The executive office is authorized to promulgate rules that permit certain optional 31
113	113	services including, but not limited to, homemaker services, home modifications, respite, and 32
114	114	physical therapy evaluations to be offered to persons at risk for Medicaid-funded long-term care 33
115	115	subject to availability of state-appropriated funding for these purposes. 34
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119	119	(f) To promote the expansion of home- and community-based service capacity, the 1
120	120	executive office is authorized to pursue payment methodology reforms that increase access to 2
121	121	homemaker, personal care (home health aide), assisted living, adult supportive-care homes, and 3
122	122	adult day services, as follows: 4
123	123	(1) Development of revised or new Medicaid certification standards that increase access to 5
124	124	service specialization and scheduling accommodations by using payment strategies designed to 6
125	125	achieve specific quality and health outcomes. 7
126	126	(2) Development of Medicaid certification standards for state-authorized providers of adult 8
127	127	day services, excluding providers of services authorized under § 40.1-24-1(3), assisted living, and 9
128	128	adult supportive care (as defined under chapter 17.24 of title 23) that establish for each, an acuity-10
129	129	based, tiered service and payment methodology tied to: licensure authority; level of beneficiary 11
130	130	needs; the scope of services and supports provided; and specific quality and outcome measures. 12
131	131	The standards for adult day services for persons eligible for Medicaid-funded long-term 13
132	132	services may differ from those who do not meet the clinical/functional criteria set forth in § 40-14
133	133	8.10-3. 15
134	134	(3) As the state’s Medicaid program seeks to assist more beneficiaries requiring long-term 16
135	135	services and supports in home- and community-based settings, the demand for home-care workers 17
136	136	has increased, and wages for these workers has not kept pace with neighboring states, leading to 18
137	137	high turnover and vacancy rates in the state’s home-care industry, the executive office shall institute 19
138	138	a one-time increase in the base-payment rates for FY 2019, as described below, for home-care 20
139	139	service providers to promote increased access to and an adequate supply of highly trained home-21
140	140	healthcare professionals, in amount to be determined by the appropriations process, for the purpose 22
141	141	of raising wages for personal care attendants and home health aides to be implemented by such 23
142	142	providers. 24
143	143	(i) A prospective base adjustment, effective not later than July 1, 2018, of ten percent (10%) 25
144	144	of the current base rate for home-care providers, home nursing care providers, and hospice 26
145	145	providers contracted with the executive office of health and human services and its subordinate 27
146	146	agencies to deliver Medicaid fee-for-service personal care attendant services. 28
147	147	(ii) A prospective base adjustment, effective not later than July 1, 2018, of twenty percent 29
148	148	(20%) of the current base rate for home-care providers, home nursing care providers, and hospice 30
149	149	providers contracted with the executive office of health and human services and its subordinate 31
150	150	agencies to deliver Medicaid fee-for-service skilled nursing and therapeutic services and hospice 32
151	151	care. 33
152	152	(iii) Effective upon passage of this section, hospice provider reimbursement, exclusively 34
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156	156	for room and board expenses for individuals residing in a skilled nursing facility, shall revert to the 1
157	157	rate methodology in effect on June 30, 2018, and these room and board expenses shall be exempted 2
158	158	from any and all annual rate increases to hospice providers as provided for in this section. 3
159	159	(iv) On the first of July in each year, beginning on July 1, 2019, the executive office of 4
160	160	health and human services will initiate an annual inflation increase to the base rate for home-care 5
161	161	providers, home nursing care providers, and hospice providers contracted with the executive office 6
162	162	and its subordinate agencies to deliver Medicaid fee-for-service personal care attendant services, 7
163	163	skilled nursing and therapeutic services and hospice care. The base rate increase shall be a 8
164	164	percentage amount equal to the New England Consumer Price Index card as determined by the 9
165	165	United States Department of Labor for medical care and for compliance with all federal and state 10
166	166	laws, regulations, and rules, and all national accreditation program requirements. 11
167	167	(g) As the state’s Medicaid program seeks to assist more beneficiaries requiring long-term 12
168	168	services and supports in home- and community-based settings, the demand for home-care workers 13
169	169	has increased, and wages for these workers has not kept pace with neighboring states, leading to 14
170	170	high turnover and vacancy rates in the state’s home-care industry. To promote increased access to 15
171	171	and an adequate supply of direct-care workers, the executive office shall institute a payment 16
172	172	methodology change, in Medicaid fee-for-service and managed care, for FY 2022, that shall be 17
173	173	passed through directly to the direct-care workers’ wages who are employed by home nursing care 18
174	174	and home-care providers licensed by the Rhode Island department of health, as described below: 19
175	175	(1) Effective July 1, 2021, increase the existing shift differential modifier by $0.19 per 20
176	176	fifteen (15) minutes for personal care and combined personal care/homemaker. 21
177	177	(i) Employers must pass on one hundred percent (100%) of the shift differential modifier 22
178	178	increase per fifteen-minute (15) unit of service to the CNAs who rendered such services. This 23
179	179	compensation shall be provided in addition to the rate of compensation that the employee was 24
180	180	receiving as of June 30, 2021. For an employee hired after June 30, 2021, the agency shall use not 25
181	181	less than the lowest compensation paid to an employee of similar functions and duties as of June 26
182	182	30, 2021, as the base compensation to which the increase is applied. 27
183	183	(ii) Employers must provide to EOHHS an annual compliance statement showing wages 28
184	184	as of June 30, 2021, amounts received from the increases outlined herein, and compliance with this 29
185	185	section by July 1, 2022. EOHHS may adopt any additional necessary regulations and processes to 30
186	186	oversee this subsection. 31
187	187	(2) Effective January 1, 2022, establish a new behavioral healthcare enhancement of $0.39 32
188	188	per fifteen (15) minutes for personal care, combined personal care/homemaker, and homemaker 33
189	189	only for providers who have at least thirty percent (30%) of their direct-care workers (which 34
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193	193	includes certified nursing assistants (CNA) and homemakers) certified in behavioral healthcare 1
194	194	training. 2
195	195	(i) Employers must pass on one hundred percent (100%) of the behavioral healthcare 3
196	196	enhancement per fifteen (15) minute unit of service rendered by only those CNAs and homemakers 4
197	197	who have completed the thirty (30) hour behavioral health certificate training program offered by 5
198	198	Rhode Island College, or a training program that is prospectively determined to be compliant per 6
199	199	EOHHS, to those CNAs and homemakers. This compensation shall be provided in addition to the 7
200	200	rate of compensation that the employee was receiving as of December 31, 2021. For an employee 8
201	201	hired after December 31, 2021, the agency shall use not less than the lowest compensation paid to 9
202	202	an employee of similar functions and duties as of December 31, 2021, as the base compensation to 10
203	203	which the increase is applied. 11
204	204	(ii) By January 1, 2023, employers must provide to EOHHS an annual compliance 12
205	205	statement showing wages as of December 31, 2021, amounts received from the increases outlined 13
206	206	herein, and compliance with this section, including which behavioral healthcare training programs 14
207	207	were utilized. EOHHS may adopt any additional necessary regulations and processes to oversee 15
208	208	this subsection. 16
209	209	(h) The executive office shall implement a long-term-care-options counseling program to 17
210	210	provide individuals, or their representatives, or both, with long-term-care consultations that shall 18
211	211	include, at a minimum, information about: long-term-care options, sources, and methods of both 19
212	212	public and private payment for long-term-care services and an assessment of an individual’s 20
213	213	functional capabilities and opportunities for maximizing independence. Each individual admitted 21
214	214	to, or seeking admission to, a long-term-care facility, regardless of the payment source, shall be 22
215	215	informed by the facility of the availability of the long-term-care-options counseling program and 23
216	216	shall be provided with long-term-care-options consultation if they so request. Each individual who 24
217	217	applies for Medicaid long-term-care services shall be provided with a long-term-care consultation. 25
218	218	(i) The executive office is also authorized, subject to availability of appropriation of 26
219	219	funding, and federal, Medicaid-matching funds, to pay for certain services and supports necessary 27
220	220	to transition or divert beneficiaries from institutional or restrictive settings and optimize their health 28
221	221	and safety when receiving care in a home or the community. The secretary is authorized to obtain 29
222	222	any state plan or waiver authorities required to maximize the federal funds available to support 30
223	223	expanded access to home- and community-transition and stabilization services; provided, however, 31
224	224	payments shall not exceed an annual or per-person amount. 32
225	225	(j) To ensure persons with long-term-care needs who remain living at home have adequate 33
226	226	resources to deal with housing maintenance and unanticipated housing-related costs, the secretary 34
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230	230	is authorized to develop higher resource eligibility limits for persons or obtain any state plan or 1
231	231	waiver authorities necessary to change the financial eligibility criteria for long-term services and 2
232	232	supports to enable beneficiaries receiving home and community waiver services to have the 3
233	233	resources to continue living in their own homes or rental units or other home-based settings. 4
234	234	(k) The executive office shall implement, no later than January 1, 2016, the following 5
235	235	home- and community-based service and payment reforms: 6
236	236	(1) [Deleted by P.L. 2021, ch. 162, art. 12, § 6.] 7
237	237	(2) Adult day services level of need criteria and acuity-based, tiered-payment 8
238	238	methodology; and 9
239	239	(3) Payment reforms that encourage home- and community-based providers to provide the 10
240	240	specialized services and accommodations beneficiaries need to avoid or delay institutional care. 11
241	241	(l) For federal fiscal year 2024, commencing on October 1, 2023, and ending September 12
242	242	30, 2024, the executive office of health and human services shall submit to the Secretary of the 13
243	243	United States Department of Health and Human Services a state plan amendment to provide that: 14
244	244	(1) Chiropractic rates shall be as follows: exam - one hundred fifteen dollars ($115), 15
245	245	manipulation - fifty-five dollars ($55.00), physiotherapy/electric muscle stimulation - thirty-five 16
246	246	dollars ($35.00) and therapeutic exercises - forty-five dollars ($45.00). 17
247	247	(m) The secretary is authorized to seek any Medicaid section 1115 waiver or state-plan 18
248	248	amendments and take any administrative actions necessary to ensure timely adoption of any new 19
249	249	or amended rules, regulations, policies, or procedures and any system enhancements or changes, 20
250	250	for which appropriations have been authorized, that are necessary to facilitate implementation of 21
251	251	the requirements of this section by the dates established. The secretary shall reserve the discretion 22
252	252	to exercise the authority established under §§ 42-7.2-5(6)(v) and 42-7.2-6.1, in consultation with 23
253	253	the governor, to meet the legislative directives established herein. 24
254	254	SECTION 2. This act shall take effect upon passage. 25
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261	261	EXPLANATION
262	262	BY THE LEGISLATIVE COUNCIL
263	263	OF
264	264	A N A C T
265	265	RELATING TO HUMAN SERVICES -- MEDICAL ASSISTANCE -- LONG-TERM CARE
266	266	SERVICE AND FINANCE REFORM
267	267	***
268	268	This act would provide that for federal fiscal year 2024, commencing on October 1, 2023, 1
269	269	and ending September 30, 2024, the executive office of health and human services would submit 2
270	270	to the Secretary of the United States Department of Health and Human Services a state plan 3
271	271	amendment to provide set rates related to chiropractic services. 4
272	272	This act would take effect upon passage. 5
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