Rhode Island 2023 Regular Session

Rhode Island Senate Bill S0512 Compare Versions

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

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5	5	2023 -- S 0512
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7	7	LC002343
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9	9	S TATE OF RHODE IS LAND
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 SE RVICES -- MEDICAL ASSISTANCE -- LONG-TERM CARE
16	16	SERVICE AND FINANCE REFORM
17	17	Introduced By: Senators DiPalma, Ciccone, Felag, Sosnowski, and Gallo
18	18	Date Introduced: March 07, 2023
19	19	Referred To: Senate Finance
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22	22	It is enacted by the General Assembly as follows:
23	23	SECTION 1. Section 40-8.9-9 of the General Laws in Chapter 40-8.9 entitled "Medical 1
24	24	Assistance — Long-Term Care Service and Finance Reform" is hereby amended to read as follows: 2
25	25	40-8.9-9. Long-term-care rebalancing system reform goal. 3
26	26	(a) Notwithstanding any other provision of state law, the executive office of health and 4
27	27	human services is authorized and directed to apply for, and obtain, any necessary waiver(s), waiver 5
28	28	amendment(s), and/or state-plan amendments from the Secretary of the United States Department 6
29	29	of Health and Human Services, and to promulgate rules necessary to adopt an affirmative plan of 7
30	30	program design and implementation that addresses the goal of allocating a minimum of fifty percent 8
31	31	(50%) of Medicaid long-term-care funding for persons aged sixty-five (65) and over and adults 9
32	32	with disabilities, in addition to services for persons with developmental disabilities, to home- and 10
33	33	community-based care; provided, further, the executive office shall report annually as part of its 11
34	34	budget submission, the percentage distribution between institutional care and home- and 12
35	35	community-based care by population and shall report current and projected waiting lists for long-13
36	36	term-care and home- and community-based care services. The executive office is further authorized 14
37	37	and directed to prioritize investments in home- and community-based care and to maintain the 15
38	38	integrity and financial viability of all current long-term-care services while pursuing this goal. 16
39	39	(b) The reformed long-term-care system rebalancing goal is person-centered and 17
40	40	encourages individual self-determination, family involvement, interagency collaboration, and 18
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44	44	individual choice through the provision of highly specialized and individually tailored home-based 1
45	45	services. Additionally, individuals with severe behavioral, physical, or developmental disabilities 2
46	46	must have the opportunity to live safe and healthful lives through access to a wide range of 3
47	47	supportive services in an array of community-based settings, regardless of the complexity of their 4
48	48	medical condition, the severity of their disability, or the challenges of their behavior. Delivery of 5
49	49	services and supports in less-costly and less-restrictive community settings will enable children, 6
50	50	adolescents, and adults to be able to curtail, delay, or avoid lengthy stays in long-term-care 7
51	51	institutions, such as behavioral health residential-treatment facilities, long-term-care hospitals, 8
52	52	intermediate-care facilities, and/or skilled nursing facilities. 9
53	53	(c) Pursuant to federal authority procured under § 42-7.2-16, the executive office of health 10
54	54	and human services is directed and authorized to adopt a tiered set of criteria to be used to determine 11
55	55	eligibility for services. The criteria shall be developed in collaboration with the state’s health and 12
56	56	human services departments and, to the extent feasible, any consumer group, advisory board, or 13
57	57	other entity designated for these purposes, and shall encompass eligibility determinations for long-14
58	58	term-care services in nursing facilities, hospitals, and intermediate-care facilities for persons with 15
59	59	intellectual disabilities, as well as home- and community-based alternatives, and shall provide a 16
60	60	common standard of income eligibility for both institutional and home- and community-based care. 17
61	61	The executive office is authorized to adopt clinical and/or functional criteria for admission to a 18
62	62	nursing facility, hospital, or intermediate-care facility for persons with intellectual disabilities that 19
63	63	are more stringent than those employed for access to home- and community-based services. The 20
64	64	executive office is also authorized to promulgate rules that define the frequency of re-assessments 21
65	65	for services provided for under this section. Levels of care may be applied in accordance with the 22
66	66	following: 23
67	67	(1) The executive office shall continue to apply the level-of-care criteria in effect on June 24
68	68	30, 2015, for any recipient determined eligible for and receiving Medicaid-funded long-term 25
69	69	services and supports in a nursing facility, hospital, or intermediate-care facility for persons with 26
70	70	intellectual disabilities on or before that date, unless: 27
71	71	(i) The recipient transitions to home- and community-based services because he or she 28
72	72	would no longer meet the level-of-care criteria in effect on June 30, 2015; or 29
73	73	(ii) The recipient chooses home- and community-based services over the nursing facility, 30
74	74	hospital, or intermediate-care facility for persons with intellectual disabilities. For the purposes of 31
75	75	this section, a failed community placement, as defined in regulations promulgated by the executive 32
76	76	office, shall be considered a condition of clinical eligibility for the highest level of care. The 33
77	77	executive office shall confer with the long-term-care ombudsperson with respect to the 34
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81	81	determination of a failed placement under the ombudsperson’s jurisdiction. Should any Medicaid 1
82	82	recipient eligible for a nursing facility, hospital, or intermediate-care facility for persons with 2
83	83	intellectual disabilities as of June 30, 2015, receive a determination of a failed community 3
84	84	placement, the recipient shall have access to the highest level of care; furthermore, a recipient who 4
85	85	has experienced a failed community placement shall be transitioned back into his or her former 5
86	86	nursing home, hospital, or intermediate-care facility for persons with intellectual disabilities 6
87	87	whenever possible. Additionally, residents shall only be moved from a nursing home, hospital, or 7
88	88	intermediate-care facility for persons with intellectual disabilities in a manner consistent with 8
89	89	applicable state and federal laws. 9
90	90	(2) Any Medicaid recipient eligible for the highest level of care who voluntarily leaves a 10
91	91	nursing home, hospital, or intermediate-care facility for persons with intellectual disabilities shall 11
92	92	not be subject to any wait list for home- and community-based services. 12
93	93	(3) No nursing home, hospital, or intermediate-care facility for persons with intellectual 13
94	94	disabilities shall be denied payment for services rendered to a Medicaid recipient on the grounds 14
95	95	that the recipient does not meet level-of-care criteria unless and until the executive office has: 15
96	96	(i) Performed an individual assessment of the recipient at issue and provided written notice 16
97	97	to the nursing home, hospital, or intermediate-care facility for persons with intellectual disabilities 17
98	98	that the recipient does not meet level-of-care criteria; and 18
99	99	(ii) The recipient has either appealed that level-of-care determination and been 19
100	100	unsuccessful, or any appeal period available to the recipient regarding that level-of-care 20
101	101	determination has expired. 21
102	102	(d) The executive office is further authorized to consolidate all home- and community-22
103	103	based services currently provided pursuant to 42 U.S.C. § 1396n into a single system of home- and 23
104	104	community-based services that include options for consumer direction and shared living. The 24
105	105	resulting single home- and community-based services system shall replace and supersede all 42 25
106	106	U.S.C. § 1396n programs when fully implemented. Notwithstanding the foregoing, the resulting 26
107	107	single program home- and community-based services system shall include the continued funding 27
108	108	of assisted-living services at any assisted-living facility financed by the Rhode Island housing and 28
109	109	mortgage finance corporation prior to January 1, 2006, and shall be in accordance with chapter 66.8 29
110	110	of title 42 as long as assisted-living services are a covered Medicaid benefit. 30
111	111	(e) The executive office is authorized to promulgate rules that permit certain optional 31
112	112	services including, but not limited to, homemaker services, home modifications, respite, and 32
113	113	physical therapy evaluations to be offered to persons at risk for Medicaid-funded long-term care 33
114	114	subject to availability of state-appropriated funding for these purposes. 34
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118	118	(f) To promote the expansion of home- and community-based service capacity, the 1
119	119	executive office is authorized to pursue payment methodology reforms that increase access to 2
120	120	homemaker, personal care (home health aide), assisted living, adult supportive-care homes, and 3
121	121	adult day services, as follows: 4
122	122	(1) Development of revised or new Medicaid certification standards that increase access to 5
123	123	service specialization and scheduling accommodations by using payment strategies designed to 6
124	124	achieve specific quality and health outcomes. 7
125	125	(2) Development of Medicaid certification standards for state-authorized providers of adult 8
126	126	day services, excluding providers of services authorized under § 40.1-24-1(3), assisted living, and 9
127	127	adult supportive care (as defined under chapter 17.24 of title 23) that establish for each, an acuity-10
128	128	based, tiered service and payment methodology tied to: licensure authority; level of beneficiary 11
129	129	needs; the scope of services and supports provided; and specific quality and outcome measures. 12
130	130	The standards for adult day services for persons eligible for Medicaid-funded long-term 13
131	131	services may differ from those who do not meet the clinical/functional criteria set forth in § 40-14
132	132	8.10-3. 15
133	133	(3) As the state’s Medicaid program seeks to assist more beneficiaries requiring long-term 16
134	134	services and supports in home- and community-based settings, the demand for home-care workers 17
135	135	has increased, and wages for these workers has not kept pace with neighboring states, leading to 18
136	136	high turnover and vacancy rates in the state’s home-care industry, the executive office shall institute 19
137	137	a one-time increase in the base-payment rates for FY 2019, as described below, for home-care 20
138	138	service providers to promote increased access to and an adequate supply of highly trained home-21
139	139	healthcare professionals, in amount to be determined by the appropriations process, for the purpose 22
140	140	of raising wages for personal care attendants and home health aides to be implemented by such 23
141	141	providers. 24
142	142	(i) A prospective base adjustment, effective not later than July 1, 2018, of ten percent (10%) 25
143	143	of the current base rate for home-care providers, home nursing care providers, and hospice 26
144	144	providers contracted with the executive office of health and human services and its subordinate 27
145	145	agencies to deliver Medicaid fee-for-service personal care attendant services. 28
146	146	(ii) A prospective base adjustment, effective not later than July 1, 2018, of twenty percent 29
147	147	(20%) of the current base rate for home-care providers, home nursing care providers, and hospice 30
148	148	providers contracted with the executive office of health and human services and its subordinate 31
149	149	agencies to deliver Medicaid fee-for-service skilled nursing and therapeutic services and hospice 32
150	150	care. 33
151	151	(iii) Effective upon passage of this section, hospice provider reimbursement, exclusively 34
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155	155	for room and board expenses for individuals residing in a skilled nursing facility, shall revert to the 1
156	156	rate methodology in effect on June 30, 2018, and these room and board expenses shall be exempted 2
157	157	from any and all annual rate increases to hospice providers as provided for in this section. 3
158	158	(iv) On the first of July in each year, beginning on July 1, 2019, the executive office of 4
159	159	health and human services will initiate an annual inflation increase to the base rate for home-care 5
160	160	providers, home nursing care providers, and hospice providers contracted with the executive office 6
161	161	and its subordinate agencies to deliver Medicaid fee-for-service personal care attendant services, 7
162	162	skilled nursing and therapeutic services and hospice care. The base rate increase shall be a 8
163	163	percentage amount equal to the New England Consumer Price Index card as determined by the 9
164	164	United States Department of Labor for medical care and for compliance with all federal and state 10
165	165	laws, regulations, and rules, and all national accreditation program requirements. 11
166	166	(g) As the state’s Medicaid program seeks to assist more beneficiaries requiring long-term 12
167	167	services and supports in home- and community-based settings, the demand for home-care workers 13
168	168	has increased, and wages for these workers has not kept pace with neighboring states, leading to 14
169	169	high turnover and vacancy rates in the state’s home-care industry. To promote increased access to 15
170	170	and an adequate supply of direct-care workers, the executive office shall institute a payment 16
171	171	methodology change, in Medicaid fee-for-service and managed care, for FY 2022, that shall be 17
172	172	passed through directly to the direct-care workers’ wages who are employed by home nursing care 18
173	173	and home-care providers licensed by the Rhode Island department of health, as described below: 19
174	174	(1) Effective July 1, 2021, increase the existing shift differential modifier by $0.19 per 20
175	175	fifteen (15) minutes for personal care and combined personal care/homemaker. 21
176	176	(i) Employers must pass on one hundred percent (100%) of the shift differential modifier 22
177	177	increase per fifteen-minute (15) unit of service to the CNAs who rendered such services. This 23
178	178	compensation shall be provided in addition to the rate of compensation that the employee was 24
179	179	receiving as of June 30, 2021. For an employee hired after June 30, 2021, the agency shall use not 25
180	180	less than the lowest compensation paid to an employee of similar functions and duties as of June 26
181	181	30, 2021, as the base compensation to which the increase is applied. 27
182	182	(ii) Employers must provide to EOHHS an annual compliance statement showing wages 28
183	183	as of June 30, 2021, amounts received from the increases outlined herein, and compliance with this 29
184	184	section by July 1, 2022. EOHHS may adopt any additional necessary regulations and processes to 30
185	185	oversee this subsection. 31
186	186	(2) Effective January 1, 2022, establish a new behavioral healthcare enhancement of $0.39 32
187	187	per fifteen (15) minutes for personal care, combined personal care/homemaker, and homemaker 33
188	188	only for providers who have at least thirty percent (30%) of their direct-care workers (which 34
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192	192	includes certified nursing assistants (CNA) and homemakers) certified in behavioral healthcare 1
193	193	training. 2
194	194	(i) Employers must pass on one hundred percent (100%) of the behavioral healthcare 3
195	195	enhancement per fifteen (15) minute unit of service rendered by only those CNAs and homemakers 4
196	196	who have completed the thirty (30) hour behavioral health certificate training program offered by 5
197	197	Rhode Island College, or a training program that is prospectively determined to be compliant per 6
198	198	EOHHS, to those CNAs and homemakers. This compensation shall be provided in addition to the 7
199	199	rate of compensation that the employee was receiving as of December 31, 2021. For an employee 8
200	200	hired after December 31, 2021, the agency shall use not less than the lowest compensation paid to 9
201	201	an employee of similar functions and duties as of December 31, 2021, as the base compensation to 10
202	202	which the increase is applied. 11
203	203	(ii) By January 1, 2023, employers must provide to EOHHS an annual compliance 12
204	204	statement showing wages as of December 31, 2021, amounts received from the increases outlined 13
205	205	herein, and compliance with this section, including which behavioral healthcare training programs 14
206	206	were utilized. EOHHS may adopt any additional necessary regulations and processes to oversee 15
207	207	this subsection. 16
208	208	(h) The executive office shall implement a long-term-care-options counseling program to 17
209	209	provide individuals, or their representatives, or both, with long-term-care consultations that shall 18
210	210	include, at a minimum, information about: long-term-care options, sources, and methods of both 19
211	211	public and private payment for long-term-care services and an assessment of an individua l’s 20
212	212	functional capabilities and opportunities for maximizing independence. Each individual admitted 21
213	213	to, or seeking admission to, a long-term-care facility, regardless of the payment source, shall be 22
214	214	informed by the facility of the availability of the long-term-care-options counseling program and 23
215	215	shall be provided with long-term-care-options consultation if they so request. Each individual who 24
216	216	applies for Medicaid long-term-care services shall be provided with a long-term-care consultation. 25
217	217	(i) The executive office is also authorized, subject to availability of appropriation of 26
218	218	funding, and federal, Medicaid-matching funds, to pay for certain services and supports necessary 27
219	219	to transition or divert beneficiaries from institutional or restrictive settings and optimize their health 28
220	220	and safety when receiving care in a home or the community. The secretary is authorized to obtain 29
221	221	any state plan or waiver authorities required to maximize the federal funds available to support 30
222	222	expanded access to home- and community-transition and stabilization services; provided, however, 31
223	223	payments shall not exceed an annual or per-person amount. 32
224	224	(j) To ensure persons with long-term-care needs who remain living at home have adequate 33
225	225	resources to deal with housing maintenance and unanticipated housing-related costs, the secretary 34
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229	229	is authorized to develop higher resource eligibility limits for persons or obtain any state plan or 1
230	230	waiver authorities necessary to change the financial eligibility criteria for long-term services and 2
231	231	supports to enable beneficiaries receiving home and community waiver services to have the 3
232	232	resources to continue living in their own homes or rental units or other home-based settings. 4
233	233	(k) The executive office shall implement, no later than January 1, 2016, the following 5
234	234	home- and community-based service and payment reforms: 6
235	235	(1) [Deleted by P.L. 2021, ch. 162, art. 12, § 6.] 7
236	236	(2) Adult day services level of need criteria and acuity-based, tiered-payment 8
237	237	methodology; and 9
238	238	(3) Payment reforms that encourage home- and community-based providers to provide the 10
239	239	specialized services and accommodations beneficiaries need to avoid or delay institutional care. 11
240	240	(l) For federal fiscal year 2024, commencing on October 1, 2023, and ending September 12
241	241	30, 2024, the executive office of health and human services shall submit to the Secretary of the 13
242	242	United States Department of Health and Human Services a state plan amendment to provide that: 14
243	243	(1) Chiropractic rates shall be as follows: exam - one hundred fifteen dollars ($115), 15
244	244	manipulation - fifty-five dollars ($55.00), physiotherapy/electric muscle stimulation - thirty-five 16
245	245	dollars ($35.00) and therapeutic exercises - forty-five dollars ($45.00). 17
246	246	(m) The secretary is authorized to seek any Medicaid section 1115 waiver or state-plan 18
247	247	amendments and take any administrative actions necessary to ensure timely adoption of any new 19
248	248	or amended rules, regulations, policies, or procedures and any system enhancements or changes, 20
249	249	for which appropriations have been authorized, that are necessary to facilitate implementation of 21
250	250	the requirements of this section by the dates established. The secretary shall reserve the discretion 22
251	251	to exercise the authority established under §§ 42-7.2-5(6)(v) and 42-7.2-6.1, in consultation with 23
252	252	the governor, to meet the legislative directives established herein. 24
253	253	SECTION 2. This act shall take effect upon passage. 25
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260	260	EXPLANATION
261	261	BY THE LEGISLATIVE COUNCIL
262	262	OF
263	263	A N A C T
264	264	RELATING TO HUMAN SE RVICES -- MEDICAL ASSISTANCE -- LONG-TERM CARE
265	265	SERVICE AND FINANCE REFORM
266	266	***
267	267	This act would provide that for federal fiscal year 2024, commencing on October 1, 2023, 1
268	268	and ending September 30, 2024, the executive office of health and human services would submit 2
269	269	to the Secretary of the United States Department of Health and Human Services a state plan 3
270	270	amendment to provide set rates related to chiropractic services. 4
271	271	This act would take effect upon passage. 5
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