RI
Rhode Island Senate Bill S0277

Rhode Island 2023 Regular Session

Rhode Island Senate Bill S0277 Compare Versions

OldNewDifferences
11
22
33
44
5-2023 -- S 0277 SUBSTITUTE A
5+2023 -- S 0277
66 ========
7-LC000270/SUB A
7+LC000270
88 ========
99 S TATE OF RHODE IS LAND
1010 IN GENERAL ASSEMBLY
1111 JANUARY SESSION, A.D. 2023
1212 ____________
1313
1414 A N A C T
15-RELATING TO HUMAN SERVICES -- RESTORATIVE AND RECU PERATIVE CARE
16-PILOT PROGRAM
15+RELATING TO HUMAN SE RVICES -- RHODE ISLAND PATHWAYS PROJ ECT
1716 Introduced By: Senators Miller, DiPalma, Euer, DiMario, Lauria, Lawson, Ujifusa,
1817 Kallman, Murray, and Valverde
1918 Date Introduced: February 16, 2023
2019 Referred To: Senate Health & Human Services
2120
2221
2322 It is enacted by the General Assembly as follows:
2423 SECTION 1. Title 40 of the General Laws entitled "HUMAN SERVICES" is hereby 1
2524 amended by adding thereto the following chapter: 2
2625 CHAPTER 23 3
27-RESTORATIVE AND RECUPERATIVE CARE PILOT PROGRAM 4
26+RHODE ISLAND PATHWAYS PROJECT 4
2827 40-23-1. Short title. 5
29-This chapter shall be known and may be cited as the "Restorative and Recuperative Care 6
30-Pilot Program." 7
31-40-23-2. Definitions. 8
32-For the purposes of this chapter, and consistent with 42 U.S.C. § 11360(2) et seq., the 9
33-following words and phrases are construed as follows: 10
34-(1) "At risk of homelessness" means, with respect to an individual or family, that the 11
35-individual or family: 12
36-(i) Has income below thirty percent (30%) of the median income for the geographic area; 13
37-(ii) Has insufficient resources immediately available to attain housing stability; and 14
38-(iii) Has moved frequently because of economic reasons; is living in the home of another 15
39-because of economic hardship; has been notified that their right to occupy their current housing or 16
40-living situation will be terminated; lives in a hotel or motel; lives in severely overcrowded housing; 17
41-is exiting an institution; or otherwise lives in housing that has characteristics associated with 18
28+This chapter shall be known and may be cited as the "Rhode Island pathways project." 6
29+40-23-2. Definitions. 7
30+(a) For the purposes of this chapter, and consistent with 42 U.S.C. § 11360(2) et seq., 8
31+"chronically homeless" means, with respect to an individual or family, that the individual or family: 9
32+(1) Is homeless and lives or resides in a place not meant for human habitation, a safe haven, 10
33+or in an emergency shelter; 11
34+(2) Has been homeless and living or residing in a place not meant for human habitation, a 12
35+safe haven, or in an emergency shelter continuously for at least one year or on at least four (4) 13
36+separate occasions in the last three (3) years; and 14
37+(3) Has an adult head of household (or a minor head of household if no adult is present in 15
38+the household) with a diagnosable substance use disorder, serious mental illness, developmental 16
39+disability, post-traumatic stress disorder, cognitive impairments resulting from a brain injury, or 17
40+chronic physical illness or disability, including the co-occurrence of two (2) or more of those 18
41+conditions. 19
4242
4343
44-LC000270/SUB A - Page 2 of 5
45-instability and an increased risk of homelessness. 1
46-(2) "Homeless" means: 2
47-(i) An individual or family who lacks a fixed, regular, and adequate nighttime residence; 3
48-(ii) An individual or family with a primary nighttime residence that is a public or private 4
49-place not designed for or ordinarily used as a regular sleeping accommodation for human beings, 5
50-including a car, park, abandoned building, bus or train station, airport, or camping ground; 6
51-(iii) An individual or family living in a supervised publicly or privately operated shelter 7
52-designated to provide temporary living arrangements (including hotels and motels paid for by 8
53-federal, state, or local government programs for low-income individuals or by charitable 9
54-organizations, congregate shelters, and transitional housing); 10
55-(iv) An individual who resided in a shelter or place not meant for human habitation and 11
56-who is exiting an institution where he or she temporarily resided; 12
57-(v) An individual or family who will imminently lose their housing, including housing they 13
58-own, rent, or live in without paying rent, are sharing with others, and rooms in hotels or motels not 14
59-paid for by federal, state, or local government programs for low-income individuals or by charitable 15
60-organizations, as evidenced by: 16
61-(A) A court order resulting from an eviction action that notifies the individual or family 17
62-that they must leave within fourteen (14) days; 18
63-(B) The individual or family having a primary nighttime residence that is a room in a hotel 19
64-or motel and where they lack the resources necessary to reside there for more than fourteen (14) 20
65-days; or 21
66-(C) Credible evidence indicating that the owner or renter of the housing will not allow the 22
67-individual or family to stay for more than fourteen (14) days, and any oral statement from an 23
68-individual or family seeking homeless assistance that is found to be credible shall be considered 24
69-credible evidence for purposes of satisfying the requirements of this subsection; 25
70-(vi) An individual or family who has no subsequent residence identified; 26
71-(vii) An individual or family who lacks the resources or support networks needed to obtain 27
72-other permanent housing; and 28
73-(viii) Unaccompanied youth and homeless families with children and youth defined as 29
74-homeless under other federal statutes who: 30
75-(A) Have experienced a long-term period without living independently in permanent 31
76-housing; 32
77-(B) Have experienced persistent instability as measured by frequent moves over such 33
78-period; and 34
44+LC000270 - Page 2 of 5
45+(b) A person who currently lives or resides in an institutional care facility, including a jail, 1
46+substance abuse or mental health treatment facility, hospital or other similar facility, and has resided 2
47+there for fewer than ninety (90) days shall be considered chronically homeless if such person met 3
48+all of the requirements described in subsections (a)(1) through (a)(3) of this section prior to entering 4
49+that facility. 5
50+(c) For purposes of this chapter, "Medicaid-expansion population" means any individual 6
51+who became newly eligible to receive Medicaid-funded health coverage as of January 1, 2014 as 7
52+defined under the federal Social Security Act, 1902(a)(10)(A)(i)(VIII), and enrolled in such 8
53+Medicaid-funded health coverage. 9
54+40-23-3. Purpose. 10
55+The purpose of this chapter is to require the executive office of health and human services 11
56+(EOHHS) to conduct a study to assess the impact of using Medicaid funds to provide coverage for 12
57+the treatment of underlying conditions that contribute to homelessness. 13
58+40-23-4. Establishment of the Rhode Island pathways project pilot study. 14
59+(a) EOHHS shall conduct a study to assess the impact of using Medicaid funds to provide 15
60+coverage for the treatment of underlying conditions that contribute to homelessness, including the 16
61+costs to provide coverage for the chronically homeless population in the state; provided, that for 17
62+the purposes of this chapter, "treatment" or "treatment of underlying conditions that contribute to 18
63+homelessness" includes: 19
64+(1) Behavioral health services, including mental health and substance abuse services; 20
65+(2) Case management; 21
66+(3) Personal care and personal assistance services; 22
67+(4) Home and community-based services; and 23
68+(5) Housing support services, including rental payment assistance. 24
69+(b) EOHHS shall submit findings and recommendations, including any proposed 25
70+legislation, to the general assembly no later than January 1, 2024, and annually on or before January 26
71+1 thereafter. 27
72+40-23-5. Duties and responsibilities. 28
73+(a) The executive office of health and human services (EOHHS) will have the authority to 29
74+utilize Medicaid waiver funds to provide coverage for supportive housing for the chronically 30
75+homeless population in the state. 31
76+(b) In planning for the expansion of supportive housing services provided through 32
77+Medicaid managed care plans, EOHHS shall consider the following: 33
78+(1) Benefit eligibility, including criteria related to: 34
7979
8080
81-LC000270/SUB A - Page 3 of 5
82-(C) Can be expected to continue in such status for an extended period of time because of 1
83-chronic disabilities, chronic physical health or mental health conditions, substance addiction, 2
84-histories of domestic violence or childhood abuse, the presence of a child or youth with a disability, 3
85-or multiple barriers to employment. 4
86-40-23-3. Purpose. 5
87-The purpose of this chapter is to require the executive office of health and human services 6
88-(EOHHS) to establish a program to use Medicaid funds to provide coverage to support Medicaid 7
89-beneficiaries who are experiencing homelessness or who are at risk of homelessness to the 8
90-maximum extent allowed by federal law. 9
91-40-23-4. Duties and responsibilities. 10
92-(a) The executive office of health and human services (EOHHS) shall have the authority 11
93-to utilize Medicaid waiver funds to provide coverage for: 12
94-(1) One-time transitional supports for individuals receiving services under the Medicaid 13
95-home stabilization benefit; and 14
96-(2) A restorative and recuperative care pilot program to provide acute and post-acute care 15
97-for persons experiencing homelessness who are too ill or frail to recover from a physical illness or 16
98-injury on the streets, a congregate setting, or other location inappropriate for their condition or 17
99-treatment needs, but do not meet hospital level of care criteria from a clinical standpoint. 18
100-(b) One-time transitional supports shall include: 19
101-(1) A one-time payment for each of a security deposit, first month's rent and last month's 20
102-rent at one hundred twenty-five percent (125%) of fair market rent (FMR) based on family size. 21
103-(2) A one-time payment for move-in supports, which includes setting up essential utility 22
104-services/payment of past-due amounts, remediation of asthma triggers, and pest removal, at one 23
105-hundred twenty-five percent (125%) of FMR based on family size. 24
106-(3) A one-time allocation of funds equal to one hundred percent (100%) of FMR based on 25
107-family size for healthy home goods, which includes mold/asthma remediation and pest control, and 26
108-that covers non-durable medical equipment household items needed to support a healthy home 27
109-environment. Healthy home goods include air filtration, refrigerator, humidifier, air conditioner, 28
110-mattresses, linens, pantry stocking, kitchen items needed for meal preparation, adequate lighting, 29
111-household furniture, and other goods as approved. Healthy home goods also can include smart 30
112-home devices that will advance the ability of the participants to safely remain in a home and are 31
113-preventive in nature; and 32
114-(4) Up to six (6) months of rent payments. 33
115-(c) The restorative and recuperative care pilot program will provide services to individuals 34
81+LC000270 - Page 3 of 5
82+(i) Health conditions; 1
83+(ii) Housing status; and 2
84+(iii) Current or potential system costs; 3
85+(2) Supportive housing services including, but not limited to: 4
86+(i) Outreach and engagement; 5
87+(ii) Housing search assistance; 6
88+(iii) Tenancy rights and responsibilities education; 7
89+(iv) Eviction prevention; 8
90+(v) Rental payment assistance; 9
91+(vi) Service plan development; 10
92+(vii) Coordination with primary care and health homes; 11
93+(viii) Coordination with substance use treatment providers; 12
94+(ix) Coordination with mental health providers; 13
95+(x) Coordination of vision and dental providers; 14
96+(xi) Coordination with hospitals and emergency departments; 15
97+(xii) Crisis intervention and critical time intervention; 16
98+(xiii) Independent living skills coaching; and 17
99+(xiv) Linkages to education, job skills training, and employment; 18
100+(3) Pursuant to § 40-8-17, EOHHS is directed and authorized to apply for and obtain any 19
101+necessary waiver(s), waiver amendment(s) and/or state plan amendment(s) from the Secretary of 20
102+the United States Department of Health and Human Services, that will ensure that individuals who 21
103+are chronically homeless have access to housing and supportive housing services; 22
104+(4) Financing and reinvestment strategies, including: 23
105+(i) Health care costs and housing status of current Medicaid-funded populations; 24
106+(ii) The degree to which accurate and up-to-date information on housing status is available 25
107+for current Medicaid-funded populations; 26
108+(iii) Health care costs of current residents of supportive housing; 27
109+(iv) Health care costs of the Medicaid-expansion population; 28
110+(v) Potential impact on costs to other systems, such as jails, long-term care, and treatment 29
111+facilities; 30
112+(vi) Affordable housing investments that can be leveraged to create new units of supportive 31
113+housing; and 32
114+(vii) Amount of flexible service dollars available to cover the costs that Medicaid cannot; 33
115+and 34
116116
117117
118-LC000270/SUB A - Page 4 of 5
119-experiencing homelessness to prepare for, undergo, and recover from medical treatment, injuries, 1
120-and illness. Individuals shall be required to obtain a referral or be evaluated for medical necessity 2
121-to receive services. The length of stay will be limited to active treatment and/or recovery not to 3
122-exceed thirty-six (36) months. The EOHHS shall design the pilot program in compliance with terms 4
123-established in the state’s 1115 demonstration waiver. 5
124-(d) Pursuant to § 40-8-17, the EOHHS is directed and authorized to apply for and obtain 6
125-any necessary waiver(s), waiver amendment(s) and/or state plan amendment(s) from the Secretary 7
126-of the United States Department of Health and Human Services, necessary to receive federal 8
127-financial participation for one-time transitional supports and the restorative and recuperative care 9
128-pilot program. 10
129-(e) The EOHHS shall submit to the general assembly a copy of any interim and summative 11
130-final reports on an 1115 demonstration waiver that includes one-time transitional supports and/or 12
131-the restorative and recuperative care pilot program. 13
132-SECTION 2. This act shall take effect upon passage. 14
118+LC000270 - Page 4 of 5
119+(5) Administration of the benefit, including: 1
120+(i) The role of managed care; 2
121+(ii) The role of supportive housing service providers; and 3
122+(iii) Coordination with existing and emerging systems. 4
123+(c) EOHHS shall submit a report to the legislature regarding the status of its efforts, 5
124+including any proposed legislation, no later than January 1, 2024, and annually on or before January 6
125+1 thereafter. The report shall include: 7
126+(1) The status of proposed amendment(s) to expand Medicaid waivers pursuant to § 40-8-8
127+17; 9
128+(2) A description of housing and/or supportive housing services currently being provided 10
129+to the chronically homeless population in the state; 11
130+(3) An analysis of the effectiveness of providing housing and/or supportive housing 12
131+services at current levels in the state; 13
132+(4) Estimates of the cost and potential savings of expanding the program(s) to meet the 14
133+needs of the chronically homeless in the state; and 15
134+(5) Proposed eligibility criteria to qualify for supportive housing services. 16
135+SECTION 2. This act shall take effect upon passage. 17
133136 ========
134-LC000270/SUB A
137+LC000270
135138 ========
136139
137140
138-LC000270/SUB A - Page 5 of 5
141+LC000270 - Page 5 of 5
139142 EXPLANATION
140143 BY THE LEGISLATIVE COUNCIL
141144 OF
142145 A N A C T
143-RELATING TO HUMAN SERVICES -- RESTORATIVE AND RECU PERATIVE CARE
144-PILOT PROGRAM
146+RELATING TO HUMAN SE RVICES -- RHODE ISLAND PATHWAY S PROJECT
145147 ***
146-This act would require the executive office of health and human services (EOHHS) to apply 1
147-for and obtain any necessary waivers from the Secretary of the United States Department of Health 2
148-and Human Services to establish a restorative and recuperative care pilot program utilizing 3
149-Medicaid funds to provide support to homelessness and those at risk of homelessness. Support 4
150-would include payment of a one-time payment to cover the first and last month's rent and security 5
151-deposit, health home goods and up to six (6) months rent. 6
152-This act would take effect upon passage. 7
148+This act would require the executive office of health and human services (EOHHS) to 1
149+conduct a study to assess the impact of using Medicaid funds to provide coverage for the treatment 2
150+of the chronically homeless. 3
151+This act would take effect upon passage. 4
153152 ========
154-LC000270/SUB A
153+LC000270
155154 ========
156155