2023 -- S 0572
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LC001777
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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 HEALTH AND SAFETY -- COMPREHENSIVE HEALTH INSURANCE
PROGRAM
Introduced By: Senators Bell, Ujifusa, Kallman, Ciccone, and Lauria
Date Introduced: March 07, 2023
Referred To: Senate Health & Human Services
It is enacted by the General Assembly as follows:
SECTION 1. Title 23 of the General Laws entitled "HEALTH AND SAFETY" is hereby 1
amended by adding thereto the following chapter: 2
CHAPTER 99 3
THE RHODE ISLAND COMPREHENSIVE HEALTH INSURANCE PROGRAM 4
23-99-1. Legislative findings. 5
(1) Health care is a human right, not a commodity available only to those who can afford 6
it; 7
(2) Although the federal Affordable Care Act (ACA) allowed states to offer more people 8
taxpayer subsidized private health insurance, the ACA has not provided universal, comprehensive, 9
affordable coverage for all Rhode Islanders: 10
(i) In 2019, about four and three-tenths percent (4.3%) of Rhode Islanders had no health 11
insurance, causing about forty-three (43) (1 per 1,000 uninsured) unnecessary deaths each year; 12
(ii) An estimated forty-five percent (45%) of Rhode Islanders are under-insured (e.g., not 13
seeking health care because of high deductibles and co-pays); 14
(3) COVID-19 exacerbated and highlighted problems with the status quo health insurance 15
system including: 16
(i) Coverage is too easily lost when health insurance is tied to jobs - between February and 17
May, 2020, about twenty-one thousand (21,000) more Rhode Islanders lost their jobs and their 18
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health insurance; 1
(ii) Systemic racism is reinforced - Black and Hispanic/Latinx Rhode Islanders, are more 2
likely to be uninsured or underinsured, have suffered the highest rates of COVID-19 mortality and 3
morbidity; 4
(iii) The fear of out-of-pocket costs for uninsured and underinsured puts everyone at risk 5
because they avoid testing and treatment; 6
(4) In 2016, sixty million (60,000,000) people separated from their job at some point during 7
the year (i.e., about forty-two percent (42%) of the American workforce) and although this act may 8
cause some job loss, on balance, single payer would increase employment in Rhode Island by nearly 9
three percent (3%); 10
(5) The existing US health insurance system has failed to control the cost of health care 11
and to provide universal access to health care in a system which is widely accepted to waste thirty 12
percent (30%) of its revenues on activities that do not improve the health of Americans; 13
(6) Every industrialized nation in the world, except the United States, offers universal 14
health care to its citizens and enjoys better health outcomes for less than two thirds (2/3) to one-15
half (1/2) the cost; 16
(7) Health care is rationed under our current multi-payer system, despite the fact that Rhode 17
Island patients, businesses and taxpayers already pay enough to have comprehensive and universal 18
health insurance under a single-payer system; 19
(8) About one-third (1/3) of every "health care" dollar spent in the U.S. is wasted on 20
unnecessary administrative costs and excessive pharmaceutical company profits due to laws 21
preventing Medicare from negotiating prices and private health insurance companies lacking 22
adequate market share to effectively negotiate prices; 23
(9) Private health insurance companies are incentivized to let the cost of health care rise 24
because higher costs require health insurance companies to charge higher health insurance 25
premiums, increasing companies' revenue and stock price; 26
(10) The health care marketplace is not an efficient market and because it represents only 27
eighteen percent (18%) of the US domestic market, significantly restricts economic growth and 28
thus the financial well-being of every American, including every Rhode Islander; 29
(11) Rhode Islanders cannot afford to keep the current multi-payer health insurance system: 30
(i) Between 1991 and 2014, health care spending in Rhode Island per person rose by over 31
two hundred fifty percent (250%) rising much faster than income and greatly reducing disposable 32
income; 33
(ii) It is estimated that by 2025, the cost of health insurance for an average family of four 34
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(4) will equal about one-half (1/2) of their annual income; 1
(iii) In the U.S., about two-thirds (2/3) of personal bankruptcies are medical cost-related 2
and of these, about three-fourths (3/4) had health insurance at the onset of their medical problems. 3
In no other industrialized country do people worry about going bankrupt over medical costs; 4
(12) Rhode Island private businesses bear most of the costs of employee health insurance 5
coverage and spend significant time and money choosing from a confusing array of increasingly 6
expensive plans which do not provide comprehensive coverage; 7
(13) Rhode Island employees and retirees lose significant wages and pensions as they are 8
forced to pay higher amounts of health insurance and health care costs; 9
(14) Rhode Island's hospitals are under increasing financial distress i.e., closing, sold to 10
out-of-state entities, attempting mergers largely due to health insurance reimbursement problems 11
that other nations do not face and are fixed by a single-payer system; 12
(15) The state and its municipalities face enormous other post-employment benefits 13
(OPEB) unfunded liabilities due mostly to health insurance costs; 14
(16) An improved Medicare-for-all style single-payer program would, based on the 15
performance of existing Medicare, eliminate fifty percent (50%) of the administrative waste in the 16
current system of private insurance before other savings achieved through meaningful negotiation 17
of prices and other savings are considered; 18
(17) The high costs of medical care could be lowered significantly if the state could 19
negotiate on behalf of all its residents for bulk purchasing, as well as gain access to usage and price 20
information currently kept confidential by private health insurers as "proprietary information;" 21
(18) Single payer health care would establish a true "free market" system where doctors 22
compete for patients rather than health insurance companies dictating which patients are able to see 23
which doctors and setting reimbursement rates; 24
(19) Health care providers would spend significantly less time with administrative work 25
caused by multiple health insurance company requirements and barriers to care delivery and would 26
spend significantly less for overhead costs because of streamlined billing; 27
(20) Rhode Island must act because there are currently no effective state or federal laws 28
that can provide universal coverage and adequately control rising premiums, co-pays, deductibles 29
and medical costs, or prevent private insurance companies from continuing to limit available 30
providers and coverage; 31
(21) In 1962, Canada's successful single-payer program began in the province of 32
Saskatchewan (with approximately the same population as Rhode Island) and became a national 33
program within ten (10) years; and 34
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(22) The proposed Rhode Island single payer program was studied by Professor Gerald 1
Friedman at UMass Amherst in 2015 and he concluded that: 2
"Single-payer in Rhode Island will finance medical care with substantial savings compared 3
with the existing multi-payer system of public and private insurers and would improve access to 4
health care by extending coverage to the four percent (4%) of Rhode Island residents still without 5
insurance under the Affordable Care Act and expanding coverage for the growing number with 6
inadequate health care coverage. Single-payer would improve the economic health of Rhode Island 7
by: increasing real disposable income for most residents; reducing the burden of health care on 8
businesses and promoting increased employment; and shifting the costs of health care away from 9
working and middle-class residents." 10
23-99-2. Legislative purpose. 11
It is the intent of the general assembly that this chapter establish a universal, 12
comprehensive, affordable single-payer health care insurance program that will help control health 13
care costs which shall be referred to as, "the Rhode Island comprehensive health insurance 14
program" (RICHIP). The program will be paid for by consolidating government and private 15
payments to multiple insurance carriers into a more economical and efficient improved Medicare- 16
for-all style single-payer program and substituting lower progressive taxes for higher health 17
insurance premiums, co-pays, deductibles and costs in excess of caps. This program will save 18
Rhode Islanders from the current overly expensive, inefficient and unsustainable multi-payer health 19
insurance system that unnecessarily prevents access to medically necessary health care. The 20
program will be established after the standard of care funded by Medicaid has been raised to a 21
Medicare standard. 22
23-99-3. Definitions. 23
As used in this chapter: 24
(1) "Affordable Care Act" or "ACA" means the Federal Patient Protection and Affordable 25
Care Act (Pub. L. 111-148), as amended by the Federal Health Care and Education Reconciliation 26
Act of 2010 (Pub. L. 111-152), and any amendments to, or regulations or guidance issued under, 27
those acts. 28
(2) "Carrier" means either a private health insurer authorized to sell health insurance in 29
Rhode Island or a health care service plan, i.e., any person who undertakes to arrange for the 30
provision of health care services to subscribers or enrollees, or to pay for or to reimburse any part 31
of the cost for those services, in return for a prepaid or periodic charge paid by or on behalf of the 32
subscribers or enrollees, or any person, whether located within or outside of this state, who solicits 33
or contracts with a subscriber or enrollee in this state to pay for or reimburse any part of the cost 34
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of, or who undertakes to arrange or arranges for, the provision of health care services that are to be 1
provided, wholly or in part, in a foreign country in return for a prepaid or periodic charge paid by 2
or on behalf of the subscriber or enrollee. 3
(3) "Dependent" has the same definition as set forth in federal tax law (26 U.S.C. § 152). 4
(4) "Emergency and urgently needed services" has the same definition as set forth in the 5
federal Medicare law (42 CFR 422.113). 6
(5) "Federally matched public health program" means the state's Medicaid program under 7
Title XIX of the Social Security Act (42 U.S.C. Sec. 1396 et seq.) and the state's Children's Health 8
Insurance Program (CHIP) under Title XXI of the Social Security Act (42 U.S.C. Sec. 1397aa et 9
seq.). 10
(6) "For-profit provider" means any health care professional or health care institution that 11
provides payments, profits or dividends to investors or owners who do not directly provide health 12
care. 13
(7) "Medicaid" or "medical assistance" means a program that is one of the following: 14
(i) The state's Medicaid program under Title XIX of the Social Security Act (42 U.S.C. 15
Sec. 1396 et seq.); or 16
(ii) The state's Children's Health Insurance Program under Title XXI of the Social Security 17
Act (42 U.S.C. Sec. 1397aa et seq.). 18
(8) "Medically necessary" means medical, surgical or other services or goods (including 19
prescription drugs) required for the prevention, diagnosis, cure, or treatment of a health-related 20
condition including any such services that are necessary to prevent a detrimental change in either 21
medical or mental health status. Medically necessary services shall be provided in a cost-effective 22
and appropriate setting and shall not be provided solely for the convenience of the patient or service 23
provider. "Medically necessary" does not include services or goods that are primarily for cosmetic 24
purposes; and does not include services or goods that are experimental, unless approved pursuant 25
to § 23-99-6(b). 26
(9) "Medicare" means Title XVIII of the Social Security Act (42 U.S.C. Sec. 1395 et seq.) 27
and the programs thereunder. 28
(10) "Qualified health care provider" means any individual who meets requirements set 29
forth in § 23-99-7(a)(1). 30
(11) "Qualified Rhode Island resident" means any individual who is a "resident" as defined 31
by §§ 44-30-5(a)(1) and (a)(2) or a dependent of that resident. 32
(12) "Rhode Island comprehensive health insurance program" or ("RICHIP") means the 33
affordable, comprehensive and effective health insurance program as set forth in this chapter. 34
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(13) "RICHIP participant" means a qualified Rhode Island resident who is enrolled in 1
RICHIP (and not disenrolled or disqualified) at the time they seek health care. 2
23-99-4. Rhode Island health insurance program. 3
(a) Organization. This chapter creates the Rhode Island comprehensive health insurance 4
program (RICHIP), as an independent state government agency. 5
(b) Director. A director shall be appointed by the governor, with the advice and consent of 6
the senate, to lead RICHIP and serve a term of four (4) years, subject to oversight by an executive 7
board. The director shall be compensated in accordance with the job title and job classification 8
established by the division of human resources and approved by the general assembly. The duties 9
of the director shall include: 10
(1) Employ staff and authorize reasonable expenditures, as necessary, from the RICHIP 11
trust fund, to pay program expenses and to administer the program, including creation and oversight 12
of RICHIP budgets; 13
(2) Oversee management of the RICHIP trust fund set forth in § 23-99-12(a) to ensure the 14
operational well-being and fiscal solvency of the program, including ensuring that all available 15
funds from all appropriate sources are collected and placed into the trust fund; 16
(3) Take any actions necessary and proper to implement the provisions of this chapter; 17
(4) Implement standardized claims and reporting procedures; 18
(5) Provide for timely payments to participating providers through a structure that is well 19
organized and that eliminates unnecessary administrative costs, i.e., coordinate with the state 20
comptroller to facilitate billing from and payments to providers using the state's computerized 21
financial system, the Rhode Island financial and accounting network system (RIFANS); 22
(6) Coordinate with federal health care programs, including Medicare and Medicaid, to 23
obtain necessary waivers and streamline federal funding and reimbursement; 24
(7) Monitor billing and reimbursements to detect inappropriate behavior by providers and 25
patients and create prohibitions and penalties regarding bad faith or criminal RICHIP participation, 26
and procedures by which they will be enforced; 27
(8) Support the development of an integrated health care database for health care planning 28
and quality assurance and ensure the legally required confidentiality of all health records it 29
contains; 30
(9) Determine eligibility for RICHIP and establish procedures for enrollment, 31
disenrollment and disqualification from RICHIP, as well as procedures for handling complaints 32
and appeals from affected individuals, as set forth in § 29-99-5; 33
(10) Create RICHIP expenditure, status, and assessment reports, including, but not limited 34
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to, annual reports with the following: 1
(i) Performance of the program; 2
(ii) Fiscal condition of the program; 3
(iii) Recommendations for statutory changes; 4
(iv) Receipt of payments from the federal government; 5
(v) Whether current year goals and priorities were met; and 6
(vi) Future goals and priorities; 7
(11) Review RICHIP collections and disbursements on at least a quarterly basis and 8
recommend adjustments needed to achieve budgetary targets and permit adequate access to care; 9
(12) Develop procedures for accommodating: 10
(i) Employer retiree health benefits for people who have been members of RICHIP but go 11
to live as retirees out of the state; 12
(ii) Employer retiree health benefits for people who earned or accrued those benefits while 13
residing in the state prior to the implementation of RICHIP and live as retirees out of the state; and 14
(iii) RICHIP coverage of health care services currently covered under the workers' 15
compensation system, including whether and how to continue funding for those services under that 16
system and whether and how to incorporate an element of experience rating; and 17
(13) No later than two (2) years after the effective date of this chapter, develop a proposal, 18
consistent with the principles of this chapter, for provision and funding by the program of long- 19
term care coverage. 20
(c) Board. There shall be a RICHIP board composed of nine (9) members serving terms of 21
four (4) years. Members shall be appointed by the governor with advice and consent of the senate. 22
Members of the board shall have no pecuniary interest in any health insurance company or any 23
business subject to regulation of the board and cannot have previously worked for a health 24
insurance company. The duties of the board shall include: 25
(1) Annually establish a RICHIP benefits package for participants, including a formulary 26
and a list of other medically necessary goods, as well as a procedure for handling complaints and 27
appeals relating to the benefits package, pursuant to § 23-99-6. 28
(2) Establish RICHIP provider reimbursement and a procedure for handling provider 29
complaints and appeals as set forth in § 23-99-9; 30
(3) Review budget proposals from providers pursuant to § 23-99-11(b); and 31
(4) The board shall be subject to chapter 46 of title 42 ("open meetings"). 32
23-99-5. Coverage. 33
(a) All qualified Rhode Island residents may participate in RICHIP. The director shall 34
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establish procedures to determine eligibility, enrollment, disenrollment and disqualification, 1
including criteria and procedures by which RICHIP can: 2
(1) Identify, automatically enroll, and provide a RICHIP card to qualified Rhode Island 3
residents; 4
(2) Process applications from individuals seeking to obtain RICHIP coverage for 5
dependents after the implementation date; 6
(3) Ensure eligible residents are knowledgeable and aware of their rights to health care; 7
(4) Determine whether an individual should be disenrolled (e.g., for leaving the state); 8
(5) Determine whether an individual should be disqualified (e.g., for fraudulent receipt of 9
benefits or reimbursements); 10
(6) Determine appropriate actions that should be taken with respect to individuals who are 11
disenrolled or disqualified (including civil and criminal penalties); and 12
(7) Permit individuals to request review and appeal decisions to disenroll or disqualify 13
them. 14
(b) Medicare and Medicaid eligible coverage under RICHIP shall be as follows: 15
(1) If all necessary federal waivers are obtained, qualified Rhode Island residents eligible 16
for federal Medicare ("Medicare eligible residents") shall continue to pay required fees to the 17
federal government. RICHIP shall establish procedures to ensure that Medicare eligible residents 18
shall have such amounts deducted from what they owe to RICHIP under § 23-99-12(h). RICHIP 19
shall become the equivalent of qualifying coverage under Medicare part D and Medicare advantage 20
programs, and as such shall be the vendor for coverage to RICHIP participants. RICHIP shall 21
provide Medicare eligible residents benefits equal to those available to all other RICHIP 22
participants and equal to or greater than those available through the federal Medicare program. To 23
streamline the process, RICHIP shall seek to receive federal reimbursements for services and goods 24
to Medicare eligible residents and administer all Medicare funds. 25
(2) If all necessary federal waivers are obtained, RICHIP shall become the state's sole 26
Medicaid provider. RICHIP shall create procedures to enroll all qualified Rhode Island residents 27
eligible for Medicaid ("Medicaid eligible residents") in the federal Medicaid program to ensure a 28
maximum amount of federal Medicaid funds go to the RICHIP trust fund. RICHIP shall provide 29
benefits to Medicaid eligible residents equal to those available to all other RICHIP participants. 30
(3) If all necessary federal waivers are not granted from the Medicaid or Medicare 31
programs operated under Title XVIII or XIX of the Social Security Act, the Medicaid or Medicare 32
program for which a waiver is not granted shall act as the primary insurer for those eligible for such 33
coverage, and RICHIP shall serve as the secondary or supplemental plan of health insurance 34
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coverage. Until such time as a waiver is granted, the plan shall not pay for services for persons 1
otherwise eligible for the same health care benefits under the Medicaid or Medicare program. The 2
director shall establish procedures for determining amounts owed by Medicare and Medicaid 3
eligible residents for supplemental RICHIP coverage and the extent of such coverage. 4
(4) The director may require Rhode Island residents to provide information necessary to 5
determine whether the resident is eligible for a federally matched public health program or for 6
Medicare, or any program or benefit under Medicare. 7
(5) As a condition of eligibility or continued eligibility for health care services under 8
RICHIP, a qualified Rhode Island resident who is eligible for benefits under Medicare shall enroll 9
in Medicare, including Parts A, B, and D. 10
(c) Veterans. RICHIP shall serve as the secondary or supplemental plan of health insurance 11
coverage for military veterans. The director shall establish procedures for determining amounts 12
owed by military veterans who are qualified residents for such supplemental RICHIP coverage and 13
the extent of such coverage. 14
(d) This chapter does not create any employment benefit, nor require, prohibit, or limit the 15
providing of any employment benefit. 16
(e) This chapter does not affect or limit collective action or collective bargaining on the 17
part of a health care provider with their employer or any other lawful collective action or collective 18
bargaining. 19
23-99-6. Benefits. 20
(a) This chapter shall provide insurance coverage for services and goods (including 21
prescription drugs) deemed medically necessary by a qualified health care provider and that is 22
currently covered under: 23
(1) Services and goods currently covered by the federal Medicare program (Social Security 24
Act title XVIII) parts A, B and D; 25
(2) Services and goods covered by Medicaid as of January 1, 2024; 26
(3) Services and goods currently covered by the state's Children's Health Insurance 27
Program; 28
(4) Essential health benefits mandated by the Affordable Care Act; and 29
(5) Services and goods within the following categories: 30
(i) Primary and preventive care; 31
(ii) Approved dietary and nutritional therapies; 32
(iii) Inpatient care; 33
(iv) Outpatient care; 34
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(v) Emergency and urgently needed care; 1
(vi) Prescription drugs and medical devices; 2
(vii) Laboratory and diagnostic services; 3
(viii) Palliative care; 4
(ix) Mental health services; 5
(x) Oral health, including dental services, periodontics, oral surgery, and endodontics; 6
(xi) Substance abuse treatment services; 7
(xii) Physical therapy and chiropractic services; 8
(xiii) Vision care and vision correction; 9
(xiv) Hearing services, including coverage of hearing aids; 10
(xv) Podiatric care; 11
(xvi) Comprehensive family planning, reproductive, maternity, and newborn care; 12
(xvii) Short-term rehabilitative services and devices; 13
(xviii) Durable medical equipment; 14
(xix) Gender affirming health care; and 15
(xx) Diagnostic and routine medical testing. 16
(b) Additional coverage. The director shall create a procedure that may permit additional 17
medically necessary goods and services beyond that provided by federal laws cited herein and 18
within the areas set forth in § 23-99-5, if the coverage is for services and goods deemed medically 19
necessary based on credible scientific evidence published in peer-reviewed medical literature 20
generally recognized by the relevant medical community, physician specialty society 21
recommendations, and the views of physicians practicing in relevant clinical areas and any other 22
relevant factors. The director shall create procedures for handling complaints and appeals 23
concerning the benefits package. 24
(c) Restrictions shall not apply. In order for RICHIP participants to be able to receive 25
medically necessary goods and services, this chapter shall override any state law that restricts the 26
provision or use of state funds for any medically necessary goods or services, including those 27
related to family planning and reproductive health care. 28
(d) Medically necessary goods: 29
(1) Prescription drug formulary: 30
(i) In general. The director shall establish a prescription drug formulary system, to be 31
approved by the board, and encourage best-practices in prescribing and discourage the use of 32
ineffective, dangerous, or excessively costly medications when better alternatives are available. 33
(ii) Promotion of generics. The formulary under this subsection shall promote the use of 34
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generic medications to the greatest extent possible. 1
(iii) Formulary updates and petition rights. The formulary under this subsection shall be 2
updated frequently and the director shall create a procedure for patients and providers to make 3
requests and appeal denials to add new pharmaceuticals or to remove ineffective or dangerous 4
medications from the formulary. 5
(iv) Use of off-formulary medications. The director shall promulgate rules regarding the 6
use of off-formulary medications which allow for patient access but do not compromise the 7
formulary. 8
(v) Approved devices and equipment. The director shall present a list of medically 9
necessary devices and equipment that shall be covered by RICHIP, subject to final approval by the 10
board. 11
(vi) Bulk purchasing. The director shall seek and implement ways to obtain goods at the 12
lowest possible cost, including bulk purchasing agreements. 13
23-99-7. Providers. 14
(a) Rhode Island providers. 15
(1) Licensing. Participating providers shall meet state licensing requirements in order to 16
participate in RICHIP. No provider whose license is under suspension or has been revoked shall 17
participate in the program. 18
(2) Participation. All providers may participate in RICHIP by providing items on the 19
RICHIP benefits list for which they are licensed. Providers may elect either to participate fully, or 20
not at all, in the program. 21
(3) For-profit providers. For-profit providers may continue to offer services and goods in 22
Rhode Island, but are prohibited from charging patients more than RICHIP reimbursement rates 23
for covered services and goods and shall notify qualified Rhode Island residents when the services 24
and goods they offer will not be reimbursed fully under RICHIP. 25
(b) Out-of-state providers. Except for emergency and urgently needed service, as set forth 26
in § 23-99-7(d), RICHIP shall not pay for health care services obtained outside of Rhode Island 27
unless the following requirements are met: 28
(1) The out-of-state provider agrees to accept the RICHIP rate for out-of-state providers; 29
and 30
(2) The services are medically necessary care. 31
(c) Out-of-state provider reimbursement. The program shall pay out-of-state health care 32
providers at a rate equal to the average rate paid by commercial insurers or Medicare for the services 33
rendered, whichever is higher. 34
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(d) Out-of-state residents. 1
(1) In general. Rhode Island providers who provide any services to individuals who are not 2
RICHIP participants shall not be reimbursed by RICHIP and shall seek reimbursement from those 3
individuals or other sources. 4
(2) Emergency care exception. Nothing in this chapter shall prevent any individual from 5
receiving or any provider from providing emergency health care services and goods in Rhode 6
Island. The director shall adopt rules to provide reimbursement; however, the rules shall reasonably 7
limit reimbursement to protect the fiscal integrity of RICHIP. The director shall implement 8
procedures to secure reimbursement from any appropriate third-party funding source or from the 9
individual to whom the emergency services were rendered. 10
23-99-8. Cross border employees. 11
(a) State residents employed out-of-state. If an individual is employed out-of-state by an 12
employer that is subject to Rhode Island state law, the employer and employee shall be required to 13
pay the payroll taxes as to that employee as if the employment were in the state. If an individual is 14
employed out-of-state by an employer that is not subject to Rhode Island state law, the employee 15
health coverage provided by the out-of-state employer to a resident working out-of-state shall serve 16
as the employee's primary plan of health coverage, and RICHIP shall serve as the employee's 17
secondary plan of health coverage. The director shall establish procedures for determining amounts 18
owed by residents employed out-of-state for such supplemental secondary RICHIP coverage and 19
the extent of such coverage. 20
(b) Out-of-state residents employed in the state. The payroll tax set forth in § 23-99-12(i) 21
shall apply to any out-of-state resident who is employed or self-employed in the state. However, 22
such out-of-state residents shall be able to take a credit for amounts they spend on health benefits 23
for themselves that would otherwise be covered by RICHIP if the individual were a RICHIP 24
participant. The out-of-state resident's employer shall be able to take a credit against such payroll 25
taxes regardless of the form of the health benefit (e.g., health insurance, a self-insured plan, direct 26
services, or reimbursement for services), to ensure that the revenue proposal does not relate to 27
employment benefits in violation of the Federal Employee Retirement Income Security Act 28
("ERISA") law. For non-employment-based spending by individuals, the credit shall be available 29
for and limited to spending for health coverage (not out-of-pocket health spending). The credit shall 30
be available without regard to how little is spent or how sparse the benefit. The credit may only be 31
taken against the payroll taxes set forth in § 23-99-12(i). Any excess amount may not be applied to 32
other tax liability. For employment-based health benefits, the credit shall be distributed between 33
the employer and employee in the same proportion as the spending by each for the benefit. The 34
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employer and employee may each apply their respective portion of the credit to their respective 1
portion of the payroll taxes set forth in § 23-99-12(i). If any provision of this clause or any 2
application of it shall be ruled to violate ERISA, the provision or the application of it shall be null 3
and void and the ruling shall not affect any other provision or application of this section or this 4
chapter. 5
23-99-9. Provider reimbursement. 6
(a) Rates for services and goods. RICHIP reimbursement rates to providers shall be 7
determined by the RICHIP board. These rates shall be equal to or greater than the federal Medicare 8
rates available to Rhode Island qualified residents that are in effect at the time services and goods 9
are provided. For outpatient behavioral health services, the minimum rate shall equal one hundred 10
fifty percent (150%) of federal Medicare rates. If the director determines that there are no such 11
federal Medicare reimbursement rates, the director shall set the minimum rate. The director shall 12
review the rates at least annually, recommend changes to the board, and establish procedures by 13
which complaints about reimbursement rates may be reviewed by the board. 14
(b) Billing and payments. Providers shall submit billing for services to RICHIP participants 15
in the form of electronic invoices entered into RIFANS, the state's computerized financial system. 16
The director shall coordinate the manner of processing and payment with the office of accounts and 17
control and the RIFANS support team within the division of information technology. Payments 18
shall be made by check or electronic funds transfer in accordance with terms and procedures 19
coordinated by the director and the office of accounts and control and consistent with the fiduciary 20
management of the RICHIP trust fund. 21
(c) Provider restrictions. In-state providers who accept any payment from RICHIP shall 22
not bill any patient for any covered benefit. In-state providers cannot use any of their operating 23
budgets for expansion, profit, excessive executive income, including bonuses, marketing, or major 24
capital purchases or leases. 25
23-99-10. Private insurance companies. 26
(a) Non-duplication. It is unlawful for a private health insurer to sell health insurance 27
coverage to qualified Rhode Island residents that duplicates the benefits provided under this 28
chapter. Nothing in this chapter shall be construed as prohibiting the sale of health insurance 29
coverage for any additional benefits not covered by this chapter, including additional benefits that 30
an employer may provide to employees or their dependents, or to former employees or their 31
dependents (e.g., multiemployer plans can continue to provide wrap-around coverage for any 32
benefits not provided by RICHIP). 33
(b) Displaced employees. Re-education and job placement of persons employed in Rhode 34
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Island-located enterprises who have lost their jobs as a result of this chapter shall be managed by 1
the Rhode Island department of labor and training or an appropriate federal retraining program. The 2
director may provide funds from RICHIP or funds otherwise appropriated for this purpose for 3
retraining and assisting job transition for individuals employed or previously employed in the fields 4
of health insurance, health care service plans, and other third-party payments for health care or 5
those individuals providing services to health care providers to deal with third-party payers for 6
health care, whose jobs may be or have been ended as a result of the implementation of the program, 7
consistent with applicable laws. 8
23-99-11. Budgeting. 9
(a) Operating budget. Annually, the director shall create an operating budget for the 10
program that includes the costs for all benefits set forth in § 23-99-5 and the costs for RICHIP 11
administration. The director shall determine appropriate reimbursement rates for benefits pursuant 12
to § 23-99-9(a). The operating budget shall be approved by the executive board prior to submission 13
to the governor and general assembly. 14
(b) Capital expenditures. The director shall work with representatives from state entities 15
involved with provider capital expenditures (e.g., the Rhode Island department of administration 16
office of capital projects, the Rhode Island health and educational building corporation, etc.), and 17
providers to help ensure that capital expenditures proposed by providers, including amounts to be 18
spent on construction and renovation of health facilities and major equipment purchases, will 19
address health care needs of RICHIP participants. To the extent that providers are seeking to use 20
RICHIP funds for capital expenditures, the director shall have the authority to approve or deny such 21
expenditures. 22
(c) Prohibition against co-mingling operations and capital improvement funds. It is 23
prohibited to use funds under this chapter that are earmarked: 24
(1) For operations for capital expenditures; or 25
(2) For capital expenditures for operations. 26
23-99-12. Financing. 27
(a) RICHIP trust fund. There shall be established a RICHIP trust fund into which funds 28
collected pursuant to this chapter are deposited and from which funds are distributed. All money 29
collected and received shall be used exclusively to finance RICHIP. The governor or general 30
assembly may provide funds to the RICHIP trust fund, but may not remove or borrow funds from 31
the RICHIP trust fund. 32
(b) Revenue proposal. After approval of the RICHIP executive board, the director shall 33
submit to the governor and the general assembly a revenue plan and, if required, legislation 34
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(referred to collectively in this section as the "revenue proposal") to provide the revenue necessary 1
to finance RICHIP. The initial revenue proposal shall be submitted once waiver negotiations have 2
proceeded to a level deemed sufficient by the director and annually, thereafter. The basic structure 3
of the initial revenue proposal will be based on a consideration of: 4
(1) Anticipated savings from a single payer program; 5
(2) Government funds available for health care; 6
(3) Private funds available for health care; and 7
(4) Replacing current regressive health insurance payments made to multiple health 8
insurance carriers with progressive contributions to a single payer (RICHIP) in order to make health 9
care insurance affordable and remove unnecessary barriers to health care access. 10
Subsequent proposals shall adjust the RICHIP contributions, based on projections from the 11
total RICHIP costs in the previous year, and shall include a five (5) year plan for adjusting RICHIP 12
contributions to best meet the goals set forth in this section and § 23-99-2. 13
(c) Anticipated savings. It is anticipated that RICHIP will lower health care costs by: 14
(1) Eliminating payments to private health insurance carriers; 15
(2) Reducing paperwork and administrative expenses for both providers and payers created 16
by the marketing, sales, eligibility checks, network contract management, issues associated 17
multiple benefit packages, and other administrative waste associated with the current multi-payer 18
private health insurance system; 19
(3) Allowing the planning and delivery of a public health strategy for the entire population 20
of Rhode Island; 21
(4) Improving access to preventive health care; and 22
(5) Negotiating on behalf of the state for bulk purchasing of medical supplies and 23
pharmaceuticals. 24
(d) Federal funds. The executive office of health and human services, in collaboration with 25
the director, the board and the Medicaid office, shall seek and obtain waivers and other approvals 26
relating to Medicaid, the Children's Health Insurance Program, Medicare, federal tax exemptions 27
for health care, the ACA, and any other relevant federal programs in order that: 28
(1) Federal funds and other subsidies for health care that would otherwise be paid to the 29
state and its residents and health care providers, would be paid by the federal government to the 30
state and deposited into the RICHIP trust fund; 31
(2) Programs would be waived and such funding from federal programs in Rhode Island 32
would be replaced or merged into RICHIP in order that it can operate as a single payer program; 33
(3) Maximum federal funding for health care is sought even if any necessary waivers or 34
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approvals are not obtained and multiple sources of funding with RICHIP trust fund monies are 1
pooled, in order that RICHIP can act as much as possible like a single payer program to maximize 2
benefits to Rhode Islanders; and 3
(4) Federal financial participation in the programs that are incorporated into RICHIP are 4
not jeopardized. 5
(e) State funds. State funds that would otherwise be appropriated to any governmental 6
agency, office, program, instrumentality, or institution for services and benefits covered under 7
RICHIP shall be directed into the RICHIP trust fund. Payments to the fund pursuant to this section 8
shall be in an amount equal to the money appropriated for those purposes in the fiscal year 9
beginning immediately preceding the effective date of this chapter. 10
(f) Private funds. Private grants (e.g., from nonprofit corporations) and other funds 11
specifically ear-marked for health care (e.g., from litigation against tobacco companies, opioid 12
manufacturers, etc.), shall also be put into the RICHIP trust fund. 13
(g) Assignments from RICHIP participants. Receipt of health care services under the plan 14
shall be deemed an assignment by the RICHIP participant of any right to payment for services from 15
a policy of insurance, a health benefit plan or other source. The other source of health care benefits 16
shall pay to the fund all amounts it is obligated to pay to, or on behalf of, the RICHIP participant 17
for covered health care services. The director may commence any action necessary to recover the 18
amounts due. 19
(h) Replacing current health insurance payments with progressive contributions. Instead of 20
making health insurance payments to multiple carriers (i.e., for premiums, co-pays deductibles, and 21
costs in excess of caps) for limited coverage, individuals and entities subject to Rhode Island 22
taxation pursuant to § 44-30-1 shall pay progressive contributions to the RICHIP trust fund 23
(referred to collectively in this section as the "RICHIP contributions") for comprehensive coverage. 24
These RICHIP contributions shall be set and adjusted over time to an appropriate level to: 25
(1) Cover the actual cost of the program; 26
(2) Ensure that higher brackets of income subject to specified taxes shall be assessed at a 27
higher marginal rate than lower brackets; and 28
(3) Protect the economic welfare of small businesses, low-income earners and working 29
families through tax credits or exemptions. 30
(i) Contributions based on earned income. The amounts currently paid by employers and 31
employees for health insurance shall initially be replaced by a ten percent (10%) payroll tax, based 32
on the projected average payroll of employees over three (3) previous calendar years. The employer 33
shall pay eighty percent (80%) and the employee shall pay twenty percent (20%) of this payroll 34
LC001777 - Page 17 of 96
tax, except that an employer may agree to pay all or part of the employee's share. Self- employed 1
individuals shall initially pay one-hundred percent (100%) of the payroll tax. The ten percent (10%) 2
initial rate will be adjusted by the director in order that higher brackets of income subject to these 3
taxes shall be assessed at a higher marginal rate than lower brackets and in order that small 4
businesses and lower income earners receive a credit or exemption. 5
(j) Contributions based on unearned income. There shall be a progressive contribution 6
based on unearned income, i.e., capital gains, dividends, interest, profits, and rents. Initially, the 7
unearned income RICHIP contributions shall be equal to ten percent (10%) of such unearned 8
income. The ten percent (10%) initial rate may be adjusted by the director to allow for a graduated 9
progressive exemption or credit for individuals with lower unearned income levels. 10
23-99-13. Implementation. 11
(a) State laws and regulations. 12
(1) In general. The director shall work with the executive board and receive such assistance 13
as may be necessary from other state agencies and entities to examine state laws and regulations 14
and to make recommendations necessary to conform such laws and regulations to properly 15
implement the RICHIP program. The director shall report recommendations to the governor and 16
the general assembly. 17
(2) Anti-trust laws. The intent of this chapter is to exempt activities provided for under this 18
chapter from state antitrust laws and to provide immunity from federal antitrust laws through the 19
state action doctrine. 20
(b) The director shall complete an implementation plan to provide health care coverage for 21
qualified residents in accordance with this chapter within twelve (12) months of its effective date. 22
(c) The executive office of health and human services, in collaboration with the director, 23
the board, and the Medicaid director, will have the initial responsibility of negotiating the waivers. 24
(d) Severability. If any provision or application of this chapter shall be held to be invalid, 25
or to violate or be inconsistent with any applicable federal law or regulation, that shall not affect 26
other provisions or applications of this chapter which can be given effect without that provision or 27
application; and to that end, the provisions and applications of this chapter are severable. 28
SECTION 2. Chapter 22-11 of the General Laws entitled "Joint Committee on Legislative 29
Services" is hereby amended by adding thereto the following section: 30
22-11-4.1. Employees needed to maximize federal Medicaid funding. 31
The joint committee on legislative services shall fund five (5) new FTEs for the senate 32
fiscal office and five (5) new FTEs for the house fiscal office exclusively devoted to finding ways 33
to maximize federal Medicaid funding, including compiling proposals for expanding eligibility to 34
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maximize the eligibility allowed by Centers for Medicare & Medicaid Services (CMS). 1
SECTION 3. Section 23-17-38.1 of the General Laws in Chapter 23-17 entitled "Licensing 2
of Healthcare Facilities" is hereby amended to read as follows: 3
23-17-38.1. Hospitals -- Licensing fee. 4
(a) There is imposed a hospital licensing fee for state fiscal year 2021 against each hospital 5
in the state. The hospital licensing fee is equal to five percent (5.0%) of the net patient-services 6
revenue of every hospital for the hospital’s first fiscal year ending on or after January 1, 2019, 7
except that the license fee for all hospitals located in Washington County, Rhode Island shall be 8
discounted by thirty-seven percent (37%). The discount for Washington County hospitals is subject 9
to approval by the Secretary of the U.S. Department of Health and Human Services of a state plan 10
amendment submitted by the executive office of health and human services for the purpose of 11
pursuing a waiver of the uniformity requirement for the hospital license fee. This licensing fee shall 12
be administered and collected by the tax administrator, division of taxation within the department 13
of revenue, and all the administration, collection, and other provisions of chapter 51 of title 44 shall 14
apply. Every hospital shall pay the licensing fee to the tax administrator on or before July 13, 2021, 15
and payments shall be made by electronic transfer of monies to the general treasurer and deposited 16
to the general fund. Every hospital shall, on or before June 15, 2020, make a return to the tax 17
administrator containing the correct computation of net patient-services revenue for the hospital 18
fiscal year ending September 30, 2019, and the licensing fee due upon that amount. All returns 19
shall be signed by the hospital’s authorized representative, subject to the pains and penalties of 20
perjury. 21
(b)(a) There is also imposed a hospital licensing fee for state fiscal year 2023 against each 22
hospital in the state. The hospital licensing fee is equal to five and forty-two hundredths percent 23
(5.42%) of the net patient-services revenue of every hospital for the hospital’s first fiscal year 24
ending on or after January 1, 2021, except that the license fee for all hospitals located in Washington 25
County, Rhode Island shall be discounted by thirty-seven percent (37%). The discount for 26
Washington County hospitals is subject to approval by the Secretary of the U.S. Department of 27
Health and Human Services of a state plan amendment submitted by the executive office of health 28
and human services for the purpose of pursuing a waiver of the uniformity requirement for the 29
hospital license fee. This licensing fee shall be administered and collected by the tax administrator, 30
division of taxation within the department of revenue, and all the administration, collection, and 31
other provisions of chapter 51 of title 44 shall apply. Every hospital shall pay the licensing fee to 32
the tax administrator on or before June 30, 2023, and payments shall be made by electronic transfer 33
of monies to the general treasurer and deposited to the general fund. Every hospital shall, on or 34
LC001777 - Page 19 of 96
before May 25, 2023, make a return to the tax administrator containing the correct computation of 1
net patient-services revenue for the hospital fiscal year ending September 30, 2021, and the 2
licensing fee due upon that amount. All returns shall be signed by the hospital’s authorized 3
representative, subject to the pains and penalties of perjury. 4
(c)(b) There is also imposed a hospital licensing fee for state fiscal year 2022 against each 5
hospital in the state. The hospital licensing fee is equal to five and seven hundred twenty-five 6
thousandths percent (5.725%) of the net patient-services revenue of every hospital for the hospital's 7
first fiscal year ending on or after January 1, 2020, except that the license fee for all hospitals 8
located in Washington County, Rhode Island shall be discounted by thirty-seven percent (37%). 9
The discount for Washington County hospitals is subject to approval by the Secretary of the U.S. 10
Department of Health and Human Services of a state plan amendment submitted by the executive 11
office of health and human services for the purpose of pursuing a waiver of the uniformity 12
requirement for the hospital license fee. This licensing fee shall be administered and collected by 13
the tax administrator, division of taxation within the department of revenue, and all the 14
administration, collection, and other provisions of Chapter 51 of title 44 shall apply. Every hospital 15
shall pay the licensing fee to the tax administrator on or before July 13, 2022, and payments shall 16
be made by electronic transfer of monies to the general treasurer and deposited to the general fund. 17
Every hospital shall, on or before June 15, 2022, make a return to the tax administrator containing 18
the correct computation of net patient-services revenue for the hospital fiscal year ending 19
September 30, 2020, and the licensing fee due upon that amount. All returns shall be signed by the 20
hospital's authorized representative, subject to the pains and penalties of perjury. 21
(c) There is also imposed a hospital licensing fee described in subsections d through g for 22
state fiscal year 2024 against net patient-services revenue of every non-government owned hospital 23
as defined herein for the hospital’s first fiscal year ending on or after January 1, 2022. The hospital 24
licensing fee shall have three (3) tiers with differing fees based on inpatient and outpatient net 25
patient-services revenue. The executive office of health and human services, in consultation with 26
the tax administrator, shall identify the hospitals in each tier, subject to the definitions in this 27
section, by July 15, 2023, and shall notify each hospital of its tier by August 1, 2023. 28
(d) Tier 1 is composed of hospitals that do not meet the description of either Tier 2 or Tier 29
3. 30
(1) The inpatient hospital licensing fee for Tier 1 is equal to thirteen and fifty-four 31
hundredths percent (13.54%) of the inpatient net patient-services revenue derived from inpatient 32
net patient-services revenue of every Tier 1 hospital. 33
(2) The outpatient hospital licensing fee for Tier 1 is equal to thirteen and seventy-three 34
LC001777 - Page 20 of 96
hundredths percent (13.73%) of the net patient-services revenue derived from outpatient net 1
patient-services revenue of every Tier 1 hospital. 2
(e) Tier 2 is composed of High Medicaid/Uninsured Cost Hospitals and Independent 3
Hospitals. 4
(1) The inpatient hospital licensing fee for Tier 2 is equal to two and seventy-one 5
hundredths (2.71%) of the inpatient net patient-services revenue derived from inpatient net patient 6
services revenue of every Tier 2 hospital. 7
(2) The outpatient hospital licensing fee for Tier 2 is equal to two and seven-five one 8
hundredths (2.75%) of the outpatient net patient-services revenue derived from outpatient net 9
patient-services revenue of every Tier 2 hospital. 10
(f) Tier 3 is composed of hospitals that are Medicare-designated Low Volume hospitals 11
and rehabilitative hospitals. 12
(1) The inpatient hospital licensing fee for Tier 3 is equal to one and thirty-five hundredths 13
(1.35%) of the inpatient net patient-services revenue derived from inpatient net patient-services 14
revenue of every Tier 3 hospital. 15
(2) The outpatient hospital licensing fee for Tier 3 is equal to one and thirty-seven 16
hundredths (1.37%) of the outpatient net patient-services revenue derived from outpatient net 17
patient-services revenue of every Tier 3 hospital. 18
(g) There is also imposed a hospital licensing fee for state fiscal year 2024 against state 19
government owned and operated hospitals in the state as defined therein. The hospital licensing fee 20
is equal to five and forty-two hundredths percent (5.42%) of the net patient-services revenue of 21
every hospital for the hospital’s first fiscal year ending on or after January 1, 2023. 22
(h) The hospital licensing fee described in subsections (c) through (g) is subject to U.S. 23
Department of Health and Human Services approval of a request to waive the requirement that 24
health care-related taxes be imposed uniformly as contained in 42 CFR 433.68(d). (i) This hospital 25
licensing fee shall be administered and collected by the tax administrator, division of taxation 26
within the department of revenue, and all the administration, collection, and other provisions of 27
chapter 51 of title 44 shall apply. Every hospital shall pay the licensing fee to the tax administrator 28
on a quarterly basis and fully before June 30, 2024, and payments shall be made by electronic 29
transfer of monies to the tax administrator and deposited to the general fund. Every hospital shall, 30
on or before August 1, 2023, make a return to the tax administrator containing the correct 31
computation of inpatient and outpatient net patient-services revenue for the hospital fiscal year 32
ending in 2022, and the licensing fee due upon that amount. All returns shall be signed by the 33
hospital’s authorized representative, subject to the pains and penalties of perjury. 34
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(d)(i) For purposes of this section the following words and phrases have the following 1
meanings: 2
(2)(1) "Gross patient-services revenue" means the gross revenue related to patient care 3
services. 4
(2) “High Medicaid/Uninsured cost hospital” means a hospital for which the hospital’s total 5
uncompensated care, as calculated pursuant to § 40-8.3-2(4), divided by the hospital’s total net 6
patient-services revenues, is equal to 6.0% or greater. 7
(1)(3) "Hospital" means the actual facilities and buildings in existence in Rhode Island, 8
licensed pursuant to § 23-17-1 et seq. on June 30, 2010, and thereafter any premises included on 9
that license, regardless of changes in licensure status pursuant to chapter 17.14 of title 23 (hospital 10
conversions) and § 23-17-6(b) (change in effective control), that provides short-term acute inpatient 11
and/or outpatient care to persons who require definitive diagnosis and treatment for injury, illness, 12
disabilities, or pregnancy. Notwithstanding the preceding language, the negotiated Medicaid 13
managed care payment rates for a court-approved purchaser that acquires a hospital through 14
receivership, special mastership, or other similar state insolvency proceedings (which court-15
approved purchaser is issued a hospital license after January 1, 2013) shall be based upon the newly 16
negotiated rates between the court-approved purchaser and the health plan, and such rates shall be 17
effective as of the date that the court-approved purchaser and the health plan execute the initial 18
agreement containing the newly negotiated rate. The rate-setting methodology for inpatient hospital 19
payments and outpatient hospital payments set forth in §§ 40-8-13.4(b) and 40-8-13.4(b)(2), 20
respectively, shall thereafter apply to negotiated increases for each annual twelve-month (12) 21
period as of July 1 following the completion of the first full year of the court-approved purchaser's 22
initial Medicaid managed care contract. 23
(4) “Independent hospitals” means a hospital not part of a multi-hospital system 24
(5) “Medicare-designated low volume hospital” means a hospital that qualifies under 42 25
32 CFR 412.101(b)(2) for additional Medicare payments to qualifying hospitals for the higher 26
incremental costs associated with a low volume of discharges. 27
(3)(6) "Net patient-services revenue" means the charges related to patient care services less 28
(i) Charges attributable to charity care; (ii) Bad debt expenses; and (iii) Contractual allowances. 29
(7) “Non-government owned hospitals” means a hospital not owned and operated by the 30
state. 31
(8) “Rehabilitative hospital” means rehabilitation hospital center licensed by the Rhode 32
Island department of health. 33
(9) “State-government owned and operated hospitals” means a hospital facility licensed by 34
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the Rhode Island department of health, owned and operated by the state of Rhode Island. 1
(e)(k) The tax administrator in consultation with the executive office of health and human 2
services shall make and promulgate any rules, regulations, and procedures not inconsistent with 3
state law and fiscal procedures that he or she deems necessary for the proper administration of this 4
section and to carry out the provisions, policy, and purposes of this section. 5
(f)(l) The licensing fee imposed by subsection (a) shall apply to hospitals as defined herein 6
that are duly licensed on July 1, 2020 2021, and shall be in addition to the inspection fee imposed 7
by § 23-17-38 and to any licensing fees previously imposed in accordance with this section. 8
(g)(m) The licensing fee imposed by subsection (b) shall apply to hospitals as defined 9
herein that are duly licensed on July 1, 2021 2022, and shall be in addition to the inspection fee 10
imposed by § 23-17-38 and to any licensing fees previously imposed in accordance with this 11
section. 12
(h)(n) The licensing fee fees imposed by subsection subsections (c) through (g) shall apply 13
to hospitals as defined herein that are duly licensed on July 1, 2022 2023, and shall be in addition 14
to the inspection fee imposed by § 23-17-38 and to any licensing fees previously imposed in 15
accordance with this section. 16
SECTION 4. Section 27-34.3-7 of the General Laws in Chapter 27-34.3 entitled "Rhode 17
Island Life and Health Insurance Guaranty Association Act" is hereby amended to read as follows: 18
27-34.3-7. Board of directors. 19
(a) The board of directors of the association shall consist of: 20
(1) Nine (9) members appointed by the governor with advice and consent of the senate; 21
Not less than five (5) nor more than nine (9) member insurers serving terms as established in the 22
plan of operation; and 23
(2) The commissioner or the commissioner's designee, who shall chair the board in a non-24
voting ex officio capacity. Only member insurers shall be eligible to vote. The members of the 25
board shall be selected by member insurers subject to the approval of the commissioner. The board 26
of directors, previously established under § 27-34.1-8 [Repealed], shall continue to operate in 27
accordance with the provision of this section. Vacancies on the board shall be filled for the 28
remaining period of the term by a majority vote of the remaining board members, subject to the 29
approval of the commissioner. 30
(b) In approving selections to the board, the commissioner shall consider, among other 31
things, whether all member insurers are fairly represented. 32
(c) Members of the board may be reimbursed from the assets of the association for expenses 33
incurred by them as members of the board of directors but members of the board shall not be 34
LC001777 - Page 23 of 96
compensated by the association for their services. 1
SECTION 5. Section 27-66-24 of the General Laws in Chapter 27-66 entitled "The Health 2
Insurance Conversions Act" is hereby amended to read as follows: 3
27-66-24. Exceptions -- Rehabilitation, liquidation or conservation. 4
No proposed conversion shall be subject to this chapter in In the event that the health 5
insurance corporation, health maintenance corporation, a nonprofit hospital service corporation, 6
nonprofit medical service corporation or affiliate or subsidiary of them, hereinafter "the insurer," 7
is subject to an order from the superior court directing the director to rehabilitate, liquidate or 8
conserve, as provided in §§ 27-19-28, 27-20-24, 27-41-18, or chapter 14.1, 14.2,14.3 or 14.4 of this 9
title., certain additional conditions shall apply to the insurer: 10
(1) The insolvency, financial condition, or default of the insurer at any time shall not permit 11
the insurer to fail to pay claims in a timely manner. 12
(2) Should the insurer fail to pay claims in a timely manner, those claims shall become a 13
temporary obligation of the state, who shall pay them in a timely manner. Should the state be 14
compelled to pay claims for this reason, the insurer shall owe the state a fine ten (10) times the 15
value of all claims paid. 16
(3) The insolvency, financial condition, or default of the insurer at any time shall not permit 17
the insurer to fail to pay state taxes on time. Should the insurer fail to pay taxes on time, the size of 18
the tax obligation owed shall increase by a factor of ten (10). 19
(4) The Medicaid office shall be guaranteed a right of first refusal to acquire the insurer 20
before alternate buyers are considered. Any obligations due to the state by the insurer shall be 21
counted towards the purchase price of the insurer. The Rhode Island life and health insurance 22
guaranty association, created pursuant to § 27-34.3-6, shall pay the costs of the acquisition, but all 23
ownership shares shall be held by the Medicaid office. 24
SECTION 6. Title 27 of the General Laws entitled "INSURANCE" is hereby amended by 25
adding thereto the following chapter: 26
CHAPTER 82 27
PRIOR AUTHORIZATION OF CERTAIN HEALTH INSURANCE POLICY CHANGES 28
27-82-1. Prior authorization of general assembly. 29
(a) Prior authorization of the general assembly shall be required for certain policy changes 30
by health insurers: 31
(1) Any change that increases the average amount charged annually to consumers on a per 32
beneficiary basis; 33
(2) Any change that in any way reduces any benefits offered to plan beneficiaries; 34
LC001777 - Page 24 of 96
(3) Any change that increases any premiums, deductibles, or copays; or 1
(4) Ceasing offering any plan a health insurer offers within the State of Rhode Island. 2
(b) No rate reviews pursuant to those utilized in § 27-18-54, § 27-19-30.1, § 27-20-25.2, § 3
27-41-27.2, and §42-62-13 shall be construed to exempt any health insurer from the prior 4
authorization requirements of this chapter. 5
SECTION 7. Section 28-57-5 of the General Laws in Chapter 28-57 entitled "Healthy and 6
Safe Families and Workplaces Act" is hereby amended to read as follows: 7
28-57-5. Accrual of paid sick and safe leave time. 8
(a) All employees employed by an employer of eighteen (18) or more employees in Rhode 9
Island shall accrue a minimum of one hour of paid sick and safe leave time for every thirty five 10
(35) hours worked up to a maximum of twenty-four (24) hours during the calendar year of 2018, 11
thirty-two (32) hours during calendar year 2019, and up to a maximum of forty (40) hours per year 12
during the calendar years 2023 and 2024 and up to a maximum of one hundred sixty (160) hours 13
per year thereafter, unless the employer chooses to provide a higher annual limit in both accrual 14
and use. In determining the number of employees who are employed by an employer for 15
compensation, all employees defined in § 28-57-3(7) shall be counted. 16
(b) Employees who are exempt from the overtime requirements under 29 U.S.C. § 17
213(a)(1) of the Federal Fair Labor Standards Act, 29 U.S.C. § 201 et seq., will be assumed to work 18
forty (40) hours in each work week for purposes of paid sick and safe leave time accrual unless 19
their normal work week is less than forty (40) hours, in which case paid sick and safe leave time 20
accrues based upon that normal work week. 21
(c) Paid sick and safe leave time as provided in this chapter shall begin to accrue at the 22
commencement of employment or pursuant to the law's effective date [July 1, 2018], whichever is 23
later. An employer may provide all paid sick and safe leave time that an employee is expected to 24
accrue in a year at the beginning of the year. 25
(d) An employer may require a waiting period for newly hired employees of up to ninety 26
(90) days. During this waiting period, an employee shall accrue earned sick time pursuant to this 27
section or the employer's policy, if exempt under § 28-57-4(b), but shall not be permitted to use the 28
earned sick time until after he or she has completed the waiting period. 29
(e) Paid sick and safe leave time shall be carried over to the following calendar year; 30
however, an employee's use of paid sick and safe leave time provided under this chapter in each 31
calendar year shall not exceed twenty-four (24) hours during calendar year 2018, and thirty-two 32
(32) hours during calendar year 2019, and forty (40) hours per year thereafter. Alternatively, in lieu 33
of carryover of unused earned paid sick and safe leave time from one year to the next, an employer 34
LC001777 - Page 25 of 96
may pay an employee for unused earned paid sick and safe leave time at the end of a year and 1
provide the employee with an amount of paid sick and safe leave that meets or exceeds the 2
requirements of this chapter that is available for the employee's immediate use at the beginning of 3
the subsequent year. 4
(f) Nothing in this chapter shall be construed as requiring financial or other reimbursement 5
to an employee from an employer upon the employee's termination, resignation, retirement, or other 6
separation from employment for accrued paid sick and safe leave time that has not been used. 7
(g) If an employee is transferred to a separate division, entity, or location within the state, 8
but remains employed by the same employer as defined in 29 C.F.R. § 791.2 of the Federal Fair 9
Labor Standards Act, 29 U.S.C. § 201 et seq., the employee is entitled to all paid sick and safe leave 10
time accrued at the prior division, entity, or location and is entitled to use all paid sick and safe 11
leave time as provided in this act. When there is a separation from employment and the employee 12
is rehired within one hundred thirty-five (135) days of separation by the same employer, previously 13
accrued paid sick and safe leave time that had not been used shall be reinstated. Further, the 14
employee shall be entitled to use accrued paid sick and safe leave time and accrue additional sick 15
and safe leave time at the re-commencement of employment. 16
(h) When a different employer succeeds or takes the place of an existing employer, all 17
employees of the original employer who remain employed by the successor employer within the 18
state are entitled to all earned paid sick and safe leave time they accrued when employed by the 19
original employer, and are entitled to use earned paid sick and safe leave time previously accrued. 20
(i) At its discretion, an employer may loan sick and safe leave time to an employee in 21
advance of accrual by such employee. 22
(j) Temporary employees shall be entitled to use accrued paid sick and safe leave time 23
beginning on the one hundred eightieth (180) calendar day following commencement of their 24
employment, unless otherwise permitted by the employer. On and after the one hundred eightieth 25
(180) calendar day of employment, employees may use paid sick and safe leave time as it is 26
accrued. During this waiting period, an employee shall accrue earned sick time pursuant to this 27
chapter, but shall not be permitted to use the earned sick time until after he or she has completed 28
the waiting period. 29
(k) Seasonal employees shall be entitled to use accrued paid sick and safe leave time 30
beginning on the one hundred fiftieth (150) calendar day following commencement of their 31
employment, unless otherwise permitted by the employer. On and after the one hundred fiftieth 32
(150) calendar day of employment, employees may use paid sick and safe leave time as it is 33
accrued. During this waiting period, an employee shall accrue earned sick time pursuant to this 34
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chapter, but shall not be permitted to use the earned sick time until after he or she has completed 1
the waiting period. 2
SECTION 8. Section 36-12-2.1 of the General Laws in Chapter 36-12 entitled "Insurance 3
Benefits" is hereby repealed. 4
36-12-2.1. Health insurance benefits -- Coverage for abortions excluded. 5
(a) The state of Rhode Island shall not include in any health insurance contracts, plans, or 6
policies covering employees, any provision which shall provide coverage for induced abortions 7
(except where the life of the mother would be endangered if the fetus were carried to term, or where 8
the pregnancy resulted from rape or incest). This section shall be applicable to all contracts, plans 9
or policies of: 10
(1) All health insurers subject to title 27; 11
(2) All group and blanket health insurers subject to title 27; 12
(3) All nonprofit hospital, medical, surgical, dental, and health service corporations; 13
(4) All health maintenance organizations; and 14
(5) Any provision of medical, hospital, surgical, and funeral benefits and of coverage 15
against accidental death or injury when the benefits or coverage are incidental to or part of other 16
insurance authorized by the statutes of this state. 17
(b) Provided, however, that the provisions of this section shall not apply to benefits 18
provided under existing collective bargaining agreements entered into prior to June 30, 1982. 19
(c) Nothing contained herein shall be construed to pertain to insurance coverage for 20
complications as the result of an abortion. 21
SECTION 9. Sections 40-8-2, 40-8-6, 40-8-10, 40-8-13, 40-8-13.4, 40-8-16, 40-8-19, 40-22
8-26 and 40-8-32 of the General Laws in Chapter 40-8 entitled "Medical Assistance" are hereby 23
amended to read as follows: 24
40-8-2. Definitions. 25
As used in this chapter, unless the context shall otherwise require: 26
(1) "Dental service" means and includes emergency care, X-rays for diagnoses, extractions, 27
palliative treatment, and the refitting and relining of existing dentures and prosthesis. 28
(2) "Department" means the department of human services. 29
(3) "Director" means the director of human services Medicaid director. 30
(4) "Drug" means and includes only drugs and biologicals prescribed by a licensed dentist 31
or physician as are either included in the United States pharmacopoeia, national formulary, or are 32
new and nonofficial drugs and remedies. 33
(5) "Inpatient" means a person admitted to and under treatment or care of a physician or 34
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surgeon in a hospital or nursing facility that meets standards of and complies with rules and 1
regulations promulgated by the director. 2
(6) "Inpatient hospital services" means the following items and services furnished to an 3
inpatient in a hospital other than a hospital, institution, or facility for tuberculosis or mental 4
diseases: 5
(i) Bed and board; 6
(ii) Nursing services and other related services as are customarily furnished by the hospital 7
for the care and treatment of inpatients and drugs, biologicals, supplies, appliances, and equipment 8
for use in the hospital, as are customarily furnished by the hospital for the care and treatment of 9
patients; 10
(iii) (A) Other diagnostic or therapeutic items or services, including, but not limited to, 11
pathology, radiology, and anesthesiology furnished by the hospital or by others under arrangements 12
made by the hospital, as are customarily furnished to inpatients either by the hospital or by others 13
under such arrangements, and services as are customarily provided to inpatients in the hospital by 14
an intern or resident-in-training under a teaching program having the approval of the Council on 15
Medical Education and Hospitals of the American Medical Association or of any other recognized 16
medical society approved by the director. 17
(B) The term "inpatient hospital services" shall be taken to include medical and surgical 18
services provided by the inpatient's physician, but shall not include the services of a private-duty 19
nurse or services in a hospital, institution, or facility maintained primarily for the treatment and 20
care of patients with tuberculosis or mental diseases. Provided, further, it shall be taken to include 21
only the following organ transplant operations: kidney, liver, cornea, pancreas, bone marrow, lung, 22
heart, and heart/lung, and other organ transplant operations as may be designated by the director 23
after consultation with medical advisory staff or medical consultants; and provided that any such 24
transplant operation is determined by the director or his or her designee to be medically necessary. 25
Prior written approval of the director, or his or her designee, shall be required for all covered organ 26
transplant operations. 27
(C) In determining medical necessity for organ transplant procedures, the state plan shall 28
adopt a case-by-case approach and shall focus on the medical indications and contra-indications in 29
each instance; the progressive nature of the disease; the existence of any alternative therapies; the 30
life-threatening nature of the disease; the general state of health of the patient apart from the 31
particular organ disease; and any other relevant facts and circumstances related to the applicant and 32
the particular transplant procedure. 33
(7) "Medicare equivalent rate" means the amount that would be paid for the relevant 34
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services as furnished by the relevant group of facilities under Medicare payment principles 1
delineated in subchapter B of 42 CFR Chapter IV. Should no direct Medicare rates be available for 2
the particular service and facility group, the Medicaid director will estimate the rate. Providers will 3
have standing to bring an action in superior court for a higher rate, but intermediary insurers such 4
as managed care entities shall have no standing to bring an action for a lower rate. 5
(7)(8) "Nursing services" means the following items and services furnished to an inpatient 6
in a nursing facility: 7
(i) Bed and board; 8
(ii) Nursing care and other related services as are customarily furnished to inpatients 9
admitted to the nursing facility, and drugs, biologicals, supplies, appliances, and equipment for use 10
in the facility, as are customarily furnished in the facility for the care and treatment of patients; 11
(iii) Other diagnostic or therapeutic items or services, legally furnished by the facility or 12
by others under arrangements made by the facility, as are customarily furnished to inpatients either 13
by the facility or by others under such arrangement; 14
(iv) Medical services provided in the facility by the inpatient's physician, or by an intern 15
or resident-in-training of a hospital with which the facility is affiliated or that is under the same 16
control, under a teaching program of the hospital approved as provided in subsection (6); and 17
(v) A personal-needs allowance of fifty dollars ($50.00) two hundred dollars ($200) per 18
month. 19
(8)(9) "Relative with whom the dependent child is living" means and includes the father, 20
mother, grandfather, grandmother, brother, sister, stepfather, stepmother, stepbrother, stepsister, 21
uncle, aunt, first cousin, nephew, or niece of any dependent child who maintains a home for the 22
dependent child. 23
(9)(10) "Visiting nurse service" means part-time or intermittent nursing care provided by 24
or under the supervision of a registered professional nurse other than in a hospital or nursing home. 25
40-8-6. Review of application for benefits. 26
The director, or someone designated by him or her, shall review each application for 27
benefits filed in accordance with regulations, and shall make a determination of whether the 28
application will be honored and the extent of the benefits to be made available to the applicant, and 29
shall, within thirty (30) fifteen (15) days after the filing, notify the applicant, in writing, of the 30
determination. If the application is rejected, the notice to the applicant shall set forth therein the 31
reason therefor. The director may at any time reconsider any determination. 32
40-8-10. Recovery of benefits paid in error. 33
Any person, who through error or mistake of himself or herself or another, receives medical 34
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care benefits to which he or she is not entitled or with respect to which he or she was ineligible, 1
shall be required to reimburse the state for the benefits paid through error or mistake within the 2
previous three (3) years. 3
40-8-13. Rules, regulations, and fee schedules. 4
The director shall make and promulgate rules, regulations, and fee schedules not 5
inconsistent with state law and fiscal procedures as he or she deems necessary for the proper 6
administration of this chapter and to carry out the policy and purposes thereof, and to make the 7
department's plan conform to the provisions of the federal Social Security Act, 42 U.S.C. § 1396 8
et seq., and any rules or regulations promulgated pursuant thereto. Except where explicitly 9
authorized by this title, the director shall have no power to set any fee schedule below the Medicare 10
equivalent rate; provided, however, that the director shall be empowered to provide a lower rate 11
equal to the maximum rate where federal reimbursement can be obtained in the event that federal 12
reimbursement cannot be obtained for the Medicare equivalent rate. For outpatient behavioral 13
health services, the minimum fee schedule shall be set at one hundred fifty percent (150%) of the 14
Medicare equivalent rate. The director shall attempt to obtain federal reimbursement for billing 15
outpatient behavioral health services at one hundred fifty percent (150%) of the Medicare 16
equivalent rate, but the state shall bear the costs of this higher rate for outpatient behavioral health 17
services even if federal reimbursement cannot be obtained. Should federal financial participation 18
be impossible to obtain for outpatient behavioral health services rate of one hundred fifty percent 19
(150%) of the Medicare equivalent rate, the director shall impose a surtax on the tax imposed on 20
health insurers pursuant to chapter 17 of title 44 in the amount necessary to defray the costs of the 21
inability to obtain federal reimbursement for an outpatient behavioral health services rate of one 22
hundred fifty percent (150%) of the Medicare equivalent rate. 23
40-8-13.4. Rate methodology for payment for in-state and out-of-state hospital 24
services. 25
(a) The executive office of health and human services ("executive office") shall implement 26
a new methodology for payment for in-state and out-of-state hospital services in order to ensure 27
access to, and the provision of, high-quality and cost-effective hospital care to its eligible recipients. 28
(b) In order to improve efficiency and cost-effectiveness, the executive office shall: 29
(1) (i) With respect to inpatient services for persons in fee-for-service Medicaid, which is 30
non-managed care, implement a new payment methodology for inpatient services utilizing the 31
Diagnosis Related Groups (DRG) method of payment, which is, a patient-classification method 32
that provides a means of relating payment to the hospitals to the type of patients cared for by the 33
hospitals. It is understood that a payment method based on DRG may include cost outlier payments 34
LC001777 - Page 30 of 96
and other specific exceptions. The executive office will review the DRG-payment method and the 1
DRG base price annually, making adjustments as appropriate in consideration of such elements as 2
trends in hospital input costs; patterns in hospital coding; beneficiary access to care; and the Centers 3
for Medicare and Medicaid Services national CMS Prospective Payment System (IPPS) Hospital 4
Input Price index. For the twelve-month (12) period beginning July 1, 2015, the DRG base rate for 5
Medicaid fee-for-service inpatient hospital services shall not exceed ninety-seven and one-half 6
percent (97.5%) of the payment rates in effect as of July 1, 2014. Beginning July 1, 2019, the DRG 7
base rate for Medicaid fee-for-service inpatient hospital services shall be 107.2% of the payment 8
rates in effect as of July 1, 2018. Increases in the Medicaid fee-for-service DRG hospital payments 9
for the twelve-month (12) period beginning July 1, 2020, shall be based on the payment rates in 10
effect as of July 1 of the preceding fiscal year, and shall be the Centers for Medicare and Medicaid 11
Services national Prospective Payment System (IPPS) Hospital Input Price Index. Beginning July 12
1, 2023, payments for inpatient services in fee-for-service Medicaid shall cease utilizing the DRG 13
method of payment, and payments shall take place on a pure fee-for-services basis, unless a 14
provider shall elect to utilize the DRG payment methodology. DRG rates shall be set equal to ninety 15
percent (90%) of a reasonable estimate of the Medicare equivalent rate. Non-DRG rates shall be 16
set by the Medicaid director through regulation in order that the projected overall per capita 17
expenditures shall equal ninety-five percent (95%) of a reasonable estimate of the equivalent 18
overall per capital expenditures that would have been reached under the Medicare equivalent rate. 19
(ii) With respect to inpatient services, (A) It is required as of January 1, 2011, until 20
December 31, 2011, that the Medicaid managed care payment rates between each hospital and 21
health plan shall not exceed ninety and one-tenth percent (90.1%) of the rate in effect as of June 22
30, 2010. Increases in inpatient hospital payments for each annual twelve-month (12) period 23
beginning January 1, 2012, may not exceed the Centers for Medicare and Medicaid Services 24
national CMS Prospective Payment System (IPPS) Hospital Input Price index for the applicable 25
period; (B) Provided, however, for the twenty-four-month (24) period beginning July 1, 2013, the 26
Medicaid managed care payment rates between each hospital and health plan shall not exceed the 27
payment rates in effect as of January 1, 2013, and for the twelve-month (12) period beginning July 28
1, 2015, the Medicaid managed care payment inpatient rates between each hospital and health plan 29
shall not exceed ninety-seven and one-half percent (97.5%) of the payment rates in effect as of 30
January 1, 2013; (C) Increases in inpatient hospital payments for each annual twelve-month (12) 31
period beginning July 1, 2017, shall be the Centers for Medicare and Medicaid Services national 32
CMS Prospective Payment System (IPPS) Hospital Input Price Index, less Productivity 33
Adjustment, for the applicable period and shall be paid to each hospital retroactively to July 1; (D) 34
LC001777 - Page 31 of 96
Beginning July 1, 2019, the Medicaid managed care payment inpatient rates between each hospital 1
and health plan shall be 107.2% of the payment rates in effect as of January 1, 2019, and shall be 2
paid to each hospital retroactively to July 1; (E) Increases in inpatient hospital payments for each 3
annual twelve-month (12) period beginning July 1, 2020, shall be based on the payment rates in 4
effect as of January 1 of the preceding fiscal year, and shall be the Centers for Medicare and 5
Medicaid Services national CMS Prospective Payment System (IPPS) Hospital Input Price Index, 6
less Productivity Adjustment, for the applicable period and shall be paid to each hospital 7
retroactively to July 1; the executive office will develop an audit methodology and process to assure 8
that savings associated with the payment reductions will accrue directly to the Rhode Island 9
Medicaid program through reduced managed care plan payments and shall not be retained by the 10
managed care plans; (F) All hospitals licensed in Rhode Island shall accept such payment rates as 11
payment in full; and (G) For all such hospitals, compliance with the provisions of this section shall 12
be a condition of participation in the Rhode Island Medicaid program. Beginning July 1, 2023, 13
Medicaid managed care payment rates shall equal one hundred five percent (105%) of the fee-for-14
service rates set in subsection (b)(1)(i) of this section. 15
(2) With respect to outpatient services and notwithstanding any provisions of the law to the 16
contrary, for persons enrolled in fee-for-service Medicaid, the executive office will reimburse 17
hospitals for outpatient services using a rate methodology determined by the executive office and 18
in accordance with federal regulations. Fee-for-service outpatient rates shall align with Medicare 19
payments for similar services. Notwithstanding the above, there shall be no increase in the 20
Medicaid fee-for-service outpatient rates effective on July 1, 2013, July 1, 2014, or July 1, 2015. 21
For the twelve-month (12) period beginning July 1, 2015, Medicaid fee-for-service outpatient rates 22
shall not exceed ninety-seven and one-half percent (97.5%) of the rates in effect as of July 1, 2014. 23
Increases in the outpatient hospital payments for the twelve-month (12) period beginning July 1, 24
2016, may not exceed the CMS national Outpatient Prospective Payment System (OPPS) Hospital 25
Input Price Index. Beginning July 1, 2019, the Medicaid fee-for-service outpatient rates shall be 26
107.2% of the payment rates in effect as of July 1, 2018. Increases in the outpatient hospital 27
payments for the twelve-month (12) period beginning July 1, 2020, shall be based on the payment 28
rates in effect as of July 1 of the preceding fiscal year, and shall be the CMS national Outpatient 29
Prospective Payment System (OPPS) Hospital Input Price Index. With respect to the outpatient 30
rate, (i) It is required as of January 1, 2011, until December 31, 2011, that the Medicaid managed 31
care payment rates between each hospital and health plan shall not exceed one hundred percent 32
(100%) of the rate in effect as of June 30, 2010; (ii) Increases in hospital outpatient payments for 33
each annual twelve-month (12) period beginning January 1, 2012, until July 1, 2017, may not 34
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exceed the Centers for Medicare and Medicaid Services national CMS Outpatient Prospective 1
Payment System OPPS hospital price index for the applicable period; (iii) Provided, however, for 2
the twenty-four-month (24) period beginning July 1, 2013, the Medicaid managed care outpatient 3
payment rates between each hospital and health plan shall not exceed the payment rates in effect 4
as of January 1, 2013, and for the twelve-month (12) period beginning July 1, 2015, the Medicaid 5
managed care outpatient payment rates between each hospital and health plan shall not exceed 6
ninety-seven and one-half percent (97.5%) of the payment rates in effect as of January 1, 2013; (iv) 7
Increases in outpatient hospital payments for each annual twelve-month (12) period beginning July 8
1, 2017, shall be the Centers for Medicare and Medicaid Services national CMS OPPS Hospital 9
Input Price Index, less Productivity Adjustment, for the applicable period and shall be paid to each 10
hospital retroactively to July 1; (v) Beginning July 1, 2019, the Medicaid managed care outpatient 11
payment rates between each hospital and health plan shall be one hundred seven and two-tenths 12
percent (107.2%) of the payment rates in effect as of January 1, 2019 and shall be paid to each 13
hospital retroactively to July 1; (vi) Increases in outpatient hospital payments for each annual 14
twelve-month (12) period beginning July 1, 2020, shall be based on the payment rates in effect as 15
of January 1 of the preceding fiscal year, and shall be the Centers for Medicare and Medicaid 16
Services national CMS OPPS Hospital Input Price Index, less Productivity Adjustment, for the 17
applicable period and shall be paid to each hospital retroactively to July 1. Beginning July 1, 2023, 18
fee-for-service and managed care outpatient rates shall equal the Medicare equivalent rate. 19
(3) "Hospital," as used in this section, shall mean the actual facilities and buildings in 20
existence in Rhode Island, licensed pursuant to § 23-17-1 et seq. on June 30, 2010, and thereafter 21
any premises included on that license, regardless of changes in licensure status pursuant to chapter 22
17.14 of title 23 (hospital conversions) and § 23-17-6(b) (change in effective control), that provides 23
short-term, acute inpatient and/or outpatient care to persons who require definitive diagnosis and 24
treatment for injury, illness, disabilities, or pregnancy. Notwithstanding the preceding language, 25
the Medicaid managed care payment rates for a court-approved purchaser that acquires a hospital 26
through receivership, special mastership or other similar state insolvency proceedings (which court-27
approved purchaser is issued a hospital license after January 1, 2013), shall be based upon the new 28
rates between the court-approved purchaser and the health plan, and such rates shall be effective as 29
of the date that the court-approved purchaser and the health plan execute the initial agreement 30
containing the new rates. The rate-setting methodology for inpatient-hospital payments and 31
outpatient-hospital payments set forth in subsections (b)(1)(ii)(C) and (b)(2), respectively, shall 32
thereafter apply to increases for each annual twelve-month (12) period as of July 1 following the 33
completion of the first full year of the court-approved purchaser's initial Medicaid managed care 34
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contract. 1
(c) It is intended that payment utilizing the phasing out the DRG method shall reward 2
hospitals for providing the most efficient highest quality care, and provide the executive office the 3
opportunity to conduct value-based purchasing of inpatient care. 4
(d) The secretary of the executive office is hereby authorized to promulgate such rules and 5
regulations consistent with this chapter, and to establish fiscal procedures he or she deems 6
necessary, for the proper implementation and administration of this chapter in order to provide 7
payment to hospitals using the DRG-payment methodology. Furthermore, amendment of the Rhode 8
Island state plan for Medicaid, pursuant to Title XIX of the federal Social Security Act, 42 U.S.C. 9
§ 1396 et seq., is hereby authorized to provide for payment to hospitals for services provided to 10
eligible recipients in accordance with this chapter. 11
(e) The executive office shall comply with all public notice requirements necessary to 12
implement these rate changes. 13
(f) As a condition of participation in the DRG methodology for payment of hospital 14
services, every hospital shall submit year-end settlement reports to the executive office within one 15
year from the close of a hospital's fiscal year. Should a participating hospital fail to timely submit 16
a year-end settlement report as required by this section, the executive office shall withhold 17
financial-cycle payments due by any state agency with respect to this hospital by not more than ten 18
percent (10%) until the report is submitted. For hospital fiscal year 2010 and all subsequent fiscal 19
years, hospitals will not be required to submit year-end settlement reports on payments for 20
outpatient services. For hospital fiscal year 2011 and all subsequent fiscal years, hospitals will not 21
be required to submit year-end settlement reports on claims for hospital inpatient services. Further, 22
for hospital fiscal year 2010, hospital inpatient claims subject to settlement shall include only those 23
claims received between October 1, 2009, and June 30, 2010. 24
(g) The provisions of this section shall be effective upon implementation of the new 25
payment methodology set forth in this section and § 40-8-13.3, which shall in any event be no later 26
than March 30, 2010, at which time the provisions of §§ 40-8-13.2, 27-19-14, 27-19-15, and 27-27
19-16 shall be repealed in their entirety. 28
40-8-16. Notification of long-term care alternative. 29
(a) The department of human services, before authorizing care in a nursing home or 30
intermediate-care facility for a person who is eligible to receive benefits pursuant to Title XIX of 31
the federal Social Security Act, 42 U.S.C. § 1396 et seq., and who is being discharged from a 32
hospital to a nursing home, shall notify the person, in writing, of the provisions of the long-term-33
care alternative, a home- and a community-based program. 34
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(b) If a person, eligible to receive benefits pursuant to Title XIX of the federal Social 1
Security Act, requires services in a nursing home and desires to remain in his or her own home or 2
the home of a responsible relative or other adult, the person or his or her representative shall so 3
inform the department. 4
(c) The department shall not make payments pursuant to Title XIX of the federal Social 5
Security Act for benefits until written notification documenting the person's choice as to a nursing 6
home or home- and community-based services has been filed with the department. 7
40-8-19. Rates of payment to nursing facilities. 8
(a) Rate reform. 9
(1) The rates to be paid by the state to nursing facilities licensed pursuant to chapter 17 of 10
title 23, and certified to participate in Title XIX of the Social Security Act for services rendered to 11
Medicaid-eligible residents, shall be reasonable and adequate to meet the costs that must be 12
incurred by efficiently and economically operated facilities in accordance with 42 U.S.C. § 13
1396a(a)(13). The executive office of health and human services ("executive office") shall 14
promulgate or modify the principles of reimbursement for nursing facilities in effect as of July 1, 15
2011, to be consistent with the provisions of this section and Title XIX, 42 U.S.C. § 1396 et seq., 16
of the Social Security Act. 17
(2) The executive office shall review the current methodology for providing Medicaid 18
payments to nursing facilities, including other long-term-care services providers, and is authorized 19
to modify the principles of reimbursement to replace the current cost-based methodology rates with 20
rates based on a price-based methodology to be paid to all facilities with recognition of the acuity 21
of patients and the relative Medicaid occupancy, and to include the following elements to be 22
developed by the executive office: 23
(i) A direct-care rate adjusted for resident acuity; 24
(ii) An indirect-care rate comprised of a base per diem for all facilities; 25
(iii) A rearray of costs for all facilities every three (3) years beginning October, 2015, that 26
may or may not result in automatic per diem revisions; 27
(iv) Application of a fair-rental-value system; 28
(v) Application of a pass-through system; and 29
(vi) Adjustment of rates by the change in a recognized national nursing home inflation 30
index to be applied on October 1 of each year, beginning October 1, 2012. This adjustment will not 31
occur on October 1, 2013, October 1, 2014, or October 1, 2015, but will occur on April 1, 2015. 32
The adjustment of rates will also not occur on October 1, 2017, October 1, 2018, and October 1, 33
2019. Effective July 1, 2018, rates paid to nursing facilities from the rates approved by the Centers 34
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for Medicare and Medicaid Services and in effect on October 1, 2017, both fee-for-service and 1
managed care, will be increased by one and one-half percent (1.5%) and further increased by one 2
percent (1%) on October 1, 2018, and further increased by one percent (1%) on October 1, 2019. 3
The inflation index shall be applied without regard for the transition factors in subsections (b)(1) 4
and (b)(2). For purposes of October 1, 2016, adjustment only, any rate increase that results from 5
application of the inflation index to subsections (a)(2)(i) and (a)(2)(ii) shall be dedicated to increase 6
compensation for direct-care workers in the following manner: Not less than 85% of this aggregate 7
amount shall be expended to fund an increase in wages, benefits, or related employer costs of direct-8
care staff of nursing homes. For purposes of this section, direct-care staff shall include registered 9
nurses (RNs), licensed practical nurses (LPNs), certified nursing assistants (CNAs), certified 10
medical technicians, housekeeping staff, laundry staff, dietary staff, or other similar employees 11
providing direct-care services; provided, however, that this definition of direct-care staff shall not 12
include: (i) RNs and LPNs who are classified as "exempt employees" under the Federal Fair Labor 13
Standards Act (29 U.S.C. § 201 et seq.); or (ii) CNAs, certified medical technicians, RNs, or LPNs 14
who are contracted, or subcontracted, through a third-party vendor or staffing agency. By July 31, 15
2017, nursing facilities shall submit to the secretary, or designee, a certification that they have 16
complied with the provisions of this subsection (a)(2)(vi) with respect to the inflation index applied 17
on October 1, 2016. Any facility that does not comply with terms of such certification shall be 18
subjected to a clawback, paid by the nursing facility to the state, in the amount of increased 19
reimbursement subject to this provision that was not expended in compliance with that certification. 20
(b) Transition to full implementation of rate reform. For no less than four (4) years after 21
the initial application of the price-based methodology described in subsection (a)(2) to payment 22
rates, the executive office of health and human services shall implement a transition plan to 23
moderate the impact of the rate reform on individual nursing facilities. Said transition shall include 24
the following components: 25
(1) No nursing facility shall receive reimbursement for direct-care costs that is less than 26
the rate of reimbursement for direct-care costs received under the methodology in effect at the time 27
of passage of this act; for the year beginning October 1, 2017, the reimbursement for direct-care 28
costs under this provision will be phased out in twenty-five-percent (25%) increments each year 29
until October 1, 2021, when the reimbursement will no longer be in effect; and 30
(2) No facility shall lose or gain more than five dollars ($5.00) in its total, per diem rate the 31
first year of the transition. An adjustment to the per diem loss or gain may be phased out by twenty-32
five percent (25%) each year; except, however, for the years beginning October 1, 2015, there shall 33
be no adjustment to the per diem gain or loss, but the phase out shall resume thereafter; and 34
LC001777 - Page 36 of 96
(3) The transition plan and/or period may be modified upon full implementation of facility 1
per diem rate increases for quality of care-related measures. Said modifications shall be submitted 2
in a report to the general assembly at least six (6) months prior to implementation. 3
(4) Notwithstanding any law to the contrary, for the twelve-month (12) period beginning 4
July 1, 2015, Medicaid payment rates for nursing facilities established pursuant to this section shall 5
not exceed ninety-eight percent (98%) of the rates in effect on April 1, 2015. Consistent with the 6
other provisions of this chapter, nothing in this provision shall require the executive office to restore 7
the rates to those in effect on April 1, 2015, at the end of this twelve-month (12) period. 8
(c) Effective July 1, 2023, and for each subsequent year, the executive office of health and 9
human services is hereby authorized and directed to amend its regulations for reimbursement to 10
nursing facilities in order that each nursing facility in the State of Rhode Island shall receive a 11
quarterly adjustment payment each state fiscal year of an amount determined as follows: 12
(1) Determine the percent of the state's total Medicaid outpatient and emergency 13
department services (exclusive of physician services) provided by each nursing home during each 14
nursing facility's prior fiscal year; 15
(2) Determine the sum of all Medicaid payments to nursing facilities made for services 16
provided during each nursing facility's prior fiscal year; 17
(3) Multiply the sum of all Medicaid payments as determined in subsection (c)(2) of this 18
section by a percentage defined as the total identified upper payment limit for all nursing facilities 19
divided by the sum of all Medicaid payments as determined in subsection (c)(2) of this section; and 20
then multiply that result by each nursing facility's percentage of the state's total Medicaid services 21
as determined in subsection (c)(1) of this section to obtain the total adjustment for each nursing 22
facility to be paid each year; and 23
(4) Pay each nursing facility on or before July 20, October 20, January 20, and April 20 24
one quarter (1/4) of its total adjustment as determined in subsection (c)(3) of this section. 25
40-8-26. Community health centers. 26
(a) For the purposes of this section, the term community health centers refers to federally 27
qualified health centers and rural health centers. 28
(b) To support the ability of community health centers to provide high-quality medical care 29
to patients, the executive office of health and human services ("executive office") may adopt and 30
implement an alternative payment methodology (APM) for determining a Medicaid per-visit 31
reimbursement for community health centers that is compliant with the prospective payment system 32
(PPS) provided for in the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection 33
Act of 2000. The following principles are to ensure that the APM PPS rate determination 34
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methodology is part of the executive office overall value purchasing approach. For community 1
health centers that do not agree to the principles of reimbursement that reflect the APM PPS, 2
EOHHS shall reimburse such community health centers at the federal PPS rate, as required per 3
section 1902(bb)(3) of the Social Security Act, 42 U.S.C. § 1396a(bb)(3). For community health 4
centers that are reimbursed at the federal PPS rate, subsections (d) through (f) of this section apply. 5
(c) The APM PPS rate determination methodology will (i) Fairly recognize the reasonable 6
costs of providing services. Recognized reasonable costs will be those appropriate for the 7
organization, management, and direct provision of services and (ii) Provide assurances to the 8
executive office that services are provided in an effective and efficient manner, consistent with 9
industry standards. Except for demonstrated cause and at the discretion of the executive office, the 10
maximum reimbursement rate for a service (e.g., medical, dental) provided by an individual 11
community health center shall not exceed one hundred twenty-five percent (125%) of the median 12
rate for all community health centers within Rhode Island. not only bill the community health center 13
on a fee-for-service basis at ninety percent (90%) of the federal PPS rate but also make a series of 14
quality incentive payments if the community health center meets certain quality incentives. Quality 15
incentive payments shall be set at a percentage of the aggregate monthly billing that would be 16
reached under the traditional federal PPS methodology. The quality incentive payments shall be as 17
follows: 18
(1) Ten percent (10%) for meeting benchmarks set by the Medicaid director for screening 19
patients for Medicaid eligibility or having added one-tenth percent (0.1%) of its monthly patients 20
to the Medicaid rolls. 21
(2) Five percent (5%) for enrolling at least five percent (5%) of patients who identified as 22
tobacco smokers in smoking cessation programs. 23
(3) Ten percent (10%) for meeting benchmarks set by the director of human services for 24
screening patients for supplemental nutrition assistance program eligibility or having added one-25
tenth percent (0.1%) of its monthly patients to the supplemental nutrition assistance program rolls. 26
(4) Ten percent (10%) for ensuring that no more than one percent (1%) of patients are ever 27
not offered an appointment within a month if they request one. 28
(5) Up to fifteen percent (15%) for meeting benchmarks set by the Medicaid director for 29
the improvement of air quality in patients' homes through directly funding interventions such as: 30
air quality inspections, the installation of air filters, the installation of ventilation, and the 31
replacement of gas stoves with electric stoves. 32
(6) Up to fifteen percent (15%) for meeting benchmarks set by the Medicaid director for 33
the removal or mitigation of environmental toxins in patients' homes through the direct funding of 34
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removal or mitigation of environmental toxins. These toxins shall include, but shall not be limited 1
to, lead, radon, asbestos, and carbon monoxide. 2
(d) Community health centers will cooperate fully and timely with reporting requirements 3
established by the executive office. 4
(e) Reimbursement rates established through this methodology shall be incorporated into 5
the PPS reconciliation for services provided to Medicaid-eligible persons who are enrolled in a 6
health plan on the date of service. Monthly payments by the executive office related to PPS for 7
persons enrolled in a health plan shall be made directly to the community health centers. 8
(f) Reimbursement rates established through this the APM methodology shall not be 9
incorporated into the actuarially certified capitation rates paid to a health plan. The health plan shall 10
be responsible for paying the full amount of the reimbursement rate to the community health center 11
for each service eligible for reimbursement under the Medicare, Medicaid, and SCHIP Benefits 12
Improvement and Protection Act of 2000. If the health plan has an alternative payment arrangement 13
with the community health center opts to utilize the APM methodology, the health plan shall bear 14
the full upside and downside risk of decreased or increased costs from the APM methodology may 15
establish a PPS reconciliation process for eligible services and make monthly payments related to 16
PPS for persons enrolled in the health plan on the date of service. The executive office will review, 17
at least annually, the Medicaid reimbursement rates and reconciliation methodology used by the 18
health plans for community health centers to ensure payments to each are made in compliance with 19
the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000. 20
40-8-32. Support for certain patients of nursing facilities. 21
(a) Definitions. For purposes of this section: 22
(1) "Applied income" shall mean the amount of income a Medicaid beneficiary is required 23
to contribute to the cost of his or her care. 24
(2) "Authorized individual" shall mean a person who has authority over the income of a 25
patient of a nursing facility, such as a person who has been given or has otherwise obtained 26
authority over a patient's bank account; has been named as or has rights as a joint account holder; 27
or is a fiduciary as defined below. 28
(3) "Costs of care" shall mean the costs of providing care to a patient of a nursing facility, 29
including nursing care, personal care, meals, transportation, and any other costs, charges, and 30
expenses incurred by a nursing facility in providing care to a patient. Costs of care shall not exceed 31
the customary rate the nursing facility charges to a patient who pays for his or her care directly 32
rather than through a governmental or other third-party payor. 33
(4) "Fiduciary" shall mean a person to whom power or property has been formally entrusted 34
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for the benefit of another, such as an attorney-in-fact, legal guardian, trustee, or representative 1
payee. 2
(5) "Nursing facility" shall mean a nursing facility licensed under chapter 17 of title 23, 3
that is a participating provider in the Rhode Island Medicaid program. 4
(6) "Penalty period" means the period of Medicaid ineligibility imposed pursuant to 42 5
U.S.C. § 1396p(c), as amended from time to time, on a person whose assets have been transferred 6
for less than fair market value. 7
(7) "Uncompensated care" — Care and services provided by a nursing facility to a 8
Medicaid applicant without receiving compensation therefore from Medicaid, Medicare, the 9
Medicaid applicant, or other source. The acceptance of any payment representing actual or 10
estimated applied income shall not disqualify the care and services provided from qualifying as 11
uncompensated care. 12
(b) Penalty period resulting from transfer. Any transfer or assignment of assets resulting in 13
the establishment or imposition of a penalty period shall create a debt that shall be due and owing 14
to a nursing facility for the unpaid costs of care provided during the penalty period to a patient of 15
that facility who has been subject to the penalty period. The amount of the debt established shall 16
not exceed the fair market value of the transferred assets at the time of transfer that are the subject 17
of the penalty period. A nursing facility may bring an action to collect a debt for the unpaid costs 18
of care given to a patient who has been subject to a penalty period, against either the transferor or 19
the transferee, or both. The provisions of this section shall not affect other rights or remedies of the 20
parties. 21
(c) Applied income. A nursing facility may provide written notice to a patient who is a 22
Medicaid recipient and any authorized individual of that patient: 23
(1) Of the amount of applied income due; 24
(2) Of the recipient's legal obligation to pay the applied income to the nursing facility; and 25
(3) That the recipient's failure to pay applied income due to a nursing facility not later than 26
thirty (30) days after receiving notice from the nursing facility may result in a court action to 27
recover the amount of applied income due. 28
A nursing facility that is owed applied income may, in addition to any other remedies 29
authorized under law, bring a claim to recover the applied income against a patient and any 30
authorized individual. If a court of competent jurisdiction determines, based upon clear and 31
convincing evidence, that a defendant willfully failed to pay or withheld applied income due and 32
owing to a nursing facility for more than thirty (30) days after receiving notice pursuant to 33
subsection (c), the court may award the amount of the debt owed, court costs, and reasonable 34
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attorney's fees to the nursing facility. 1
(d) Effects. Nothing contained in this section shall prohibit or otherwise diminish any other 2
causes of action possessed by any such nursing facility. The death of the person receiving nursing 3
facility care shall not nullify or otherwise affect the liability of the person or persons charged with 4
the costs of care rendered or the applied income amount as referenced in this section. 5
SECTION 10. Sections 40-8-3.1, 40-8-9.1, 40-8-13.5, 40-8-15, 40-8-19.2 and 40-8-27 of 6
the General Laws in Chapter 40-8 entitled "Medical Assistance" are hereby repealed. 7
40-8-3.1. Life estate in property -- Retained powers. 8
When an applicant or recipient of Medicaid owns a life estate in property that is his or her 9
principal place of residence with the reserved power and authority, during his or her lifetime, to 10
sell, convey, mortgage, or otherwise dispose of the real property without the consent or joinder by 11
the holder(s) of the remainder interest, the principal place of residence shall not be regarded as an 12
excluded resource for the purpose of Medicaid eligibility, unless the applicant or recipient 13
individually, or through his or her guardian, conservator, or attorney in fact, conveys all outstanding 14
remainder interest to him or herself. 15
An applicant or recipient who, by a deed created, executed and recorded on or before June 16
30, 2014, has reserved a life estate in property that is his or her principal place of residence with 17
the reserved power and authority, during his or her lifetime, to sell, convey, mortgage, or otherwise 18
dispose of the real property without the consent or joinder by the holder(s) of the remainder interest, 19
shall not be ineligible for Medicaid on the basis of the deed, regardless of whether the transferee of 20
the remainder interest is a person or persons, trust, or entity. 21
40-8-9.1. Notice. 22
Whenever an individual who is receiving medical assistance under this chapter transfers 23
an interest in real or personal property, the individual shall notify the executive office of health and 24
human services within ten (10) days of the transfer. The notice shall be sent to the individual's local 25
office and the legal office of the executive office of health and human services and include, at a 26
minimum, the individual's name, social security number or, if different, the executive office of 27
health and human services identification number, the date of transfer, and the dollar value, if any, 28
paid or received by the individual who received benefits under this chapter. In the event an 29
individual fails to provide notice required by this section to the executive office of health and human 30
services and in the event an individual has received medical assistance, any individual and/or entity, 31
who knew or should have known that the individual failed to provide the notice and who receives 32
any distribution of value as a result of the transfer, shall be liable to the executive office of health 33
and human services to the extent of the value of the transfer. Moreover, any such individual shall 34
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be subject to the provisions of § 40-6-15 and any remedy provided by applicable state and federal 1
laws and rules and regulations. Failure to comply with the notice requirements set forth in the 2
section shall not affect the marketability of title to real estate transferred while the transferor is 3
receiving medical assistance. 4
40-8-13.5. Hospital Incentive Program (HIP). 5
The secretary of the executive office of health and human services is authorized to seek the 6
federal authorities required to implement a hospital incentive program (HIP). The HIP shall provide 7
the participating licensed hospitals the ability to obtain certain payments for achieving performance 8
goals established by the secretary. HIP payments shall commence no earlier than July 1, 2016. 9
40-8-15. Lien on deceased recipient's estate for assistance. 10
(a)(1) Upon the death of a recipient of Medicaid under Title XIX of the federal Social 11
Security Act (42 U.S.C. § 1396 et seq. and referred to hereinafter as the "Act"), the total sum for 12
Medicaid benefits so paid on behalf of a beneficiary who was fifty-five (55) years of age or older 13
at the time of receipt shall be and constitute a lien upon the estate, as defined in subsection (a)(2), 14
of the beneficiary in favor of the executive office of health and human services ("executive office"). 15
The lien shall not be effective and shall not attach as against the estate of a beneficiary who is 16
survived by a spouse, or a child who is under the age of twenty-one (21), or a child who is blind or 17
permanently and totally disabled as defined in Title XVI of the federal Social Security Act, 42 18
U.S.C. § 1381 et seq. The lien shall attach against property of a beneficiary, which is included or 19
includable in the decedent's probate estate, regardless of whether or not a probate proceeding has 20
been commenced in the probate court by the executive office or by any other party. Provided, 21
however, that such lien shall only attach and shall only be effective against the beneficiary's real 22
property included or includable in the beneficiary's probate estate if such lien is recorded in the 23
land evidence records and is in accordance with subsection (e). Decedents who have received 24
Medicaid benefits are subject to the assignment and subrogation provisions of §§ 40-6-9 and 40-6-25
10. 26
(2) For purposes of this section, the term "estate" with respect to a deceased individual 27
shall include all real and personal property and other assets included or includable within the 28
individual's probate estate. 29
(b) The executive office is authorized to promulgate regulations to implement the terms, 30
intent, and purpose of this section and to require the legal representative(s) and/or the heirs-at-law 31
of the decedent to provide reasonable written notice to the executive office of the death of a 32
beneficiary of Medicaid benefits who was fifty-five (55) years of age or older at the date of death, 33
and to provide a statement identifying the decedent's property and the names and addresses of all 34
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persons entitled to take any share or interest of the estate as legatees or distributees thereof. 1
(c) The amount of reimbursement for Medicaid benefits imposed under this section shall 2
also become a debt to the state from the person or entity liable for the payment thereof. 3
(d) Upon payment of the amount of reimbursement for Medicaid benefits imposed by this 4
section, the secretary of the executive office, or his or her designee, shall issue a written discharge 5
of lien. 6
(e) Provided, however, that no lien created under this section shall attach nor become 7
effective upon any real property unless and until a statement of claim is recorded naming the 8
debtor/owner of record of the property as of the date and time of recording of the statement of 9
claim, and describing the real property by a description containing all of the following: (1) Tax 10
assessor's plat and lot; and (2) Street address. The statement of claim shall be recorded in the records 11
of land evidence in the town or city where the real property is situated. Notice of the lien shall be 12
sent to the duly appointed executor or administrator, the decedent's legal representative, if known, 13
or to the decedent's next of kin or heirs at law as stated in the decedent's last application for 14
Medicaid benefits. 15
(f) The executive office shall establish procedures, in accordance with the standards 16
specified by the Secretary, United States Department of Health and Human Services, under which 17
the executive office shall waive, in whole or in part, the lien and reimbursement established by this 18
section if the lien and reimbursement would cause an undue hardship, as determined by the 19
executive office, on the basis of the criteria established by the secretary in accordance with 42 20
U.S.C. § 1396p(b)(3). 21
(g) Upon the filing of a petition for admission to probate of a decedent's will or for 22
administration of a decedent's estate, when the decedent was fifty-five (55) years or older at the 23
time of death, a copy of the petition and a copy of the death certificate shall be sent to the executive 24
office. Within thirty (30) days of a request by the executive office, an executor or administrator 25
shall complete and send to the executive office a form prescribed by that office and shall provide 26
such additional information as the office may require. In the event a petitioner fails to send a copy 27
of the petition and a copy of the death certificate to the executive office and a decedent has received 28
Medicaid benefits for which the executive office is authorized to recover, no distribution and/or 29
payments, including administration fees, shall be disbursed. Any person and/or entity that receives 30
a distribution of assets from the decedent's estate shall be liable to the executive office to the extent 31
of such distribution. 32
(h) Compliance with the provisions of this section shall be consistent with the requirements 33
set forth in § 33-11-5 and the requirements of the affidavit of notice set forth in § 33-11-5.2. Nothing 34
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in these sections shall limit the executive office from recovery, to the extent of the distribution, in 1
accordance with all state and federal laws. 2
(i) To ensure the financial integrity of the Medicaid eligibility determination, benefit 3
renewal, and estate recovery processes in this and related sections, the secretary of health and 4
human services is authorized and directed to, by no later than August 1, 2018: (1) Implement an 5
automated asset verification system, as mandated by § 1940 of the Act, that uses electronic data 6
sources to verify the ownership and value of countable resources held in financial institutions and 7
any real property for applicants and beneficiaries subject to resource and asset tests pursuant to the 8
Act in § 1902(e)(14)(D); (2) Apply the provisions required under §§ 1902(a)(18) and 1917(c) of 9
the Act pertaining to the disposition of assets for less than fair market value by applicants and 10
beneficiaries for Medicaid long-term services and supports and their spouses, without regard to 11
whether they are subject to or exempted from resources and asset tests as mandated by federal 12
guidance; and (3) Pursue any state plan or waiver amendments from the United States Centers for 13
Medicare and Medicaid Services and promulgate such rules, regulations, and procedures he or she 14
deems necessary to carry out the requirements set forth herein and ensure the state plan and 15
Medicaid policy conform and comply with applicable provisions of Title XIX. 16
40-8-19.2. Nursing Facility Incentive Program (HIP). 17
The secretary of the executive office of health and human services is authorized to seek the 18
federal authority required to implement a nursing facility incentive program (NFIP). The NFIP 19
shall provide the participating licensed nursing facilities the ability to obtain certain payments for 20
achieving performance goals established by the secretary. NFIP payments shall commence no 21
earlier than July 1, 2016. 22
40-8-27. Cooperation by providers. 23
Medicaid providers who employ individuals applying for benefits under any chapter of this 24
title shall comply in a timely manner with requests made by the department for any documents 25
describing employer-sponsored health insurance coverage or benefits the provider offers that are 26
necessary to determine eligibility for the state's premium assistance program pursuant to § 40-8.4-27
12. Documents requested by the department may include, but are not limited to, certificates of 28
coverage or a summary of benefits and employee obligations. Upon receiving notification that the 29
department has determined that the employee is eligible for premium assistance under § 40-8.4-12, 30
the provider shall accept the enrollment of the employee and his or her family in the employer-31
based health insurance plan without regard to any seasonal enrollment restrictions, including open-32
enrollment restrictions, and/or the impact on the employee's wages. Additionally, the Medicaid 33
provider employing such persons shall not offer "pay in lieu of benefits." Providers who do not 34
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comply with the provisions set forth in this section shall be subject to suspension as a participating 1
Medicaid provider. 2
SECTION 11. Sections 40-8.4-4, 40-8.4-5, 40-8.4-10, 40-8.4-12, 40-8.4-15 and 40-8.4-19 3
of the General Laws in Chapter 40-8.4 entitled "Health Care for Families" are hereby amended to 4
read as follows: 5
40-8.4-4. Eligibility. 6
(a) Medical assistance for families. There is hereby established a category of medical 7
assistance eligibility pursuant to § 1931 of Title XIX of the Social Security Act, 42 U.S.C. § 1396u-8
1, for families whose income and resources are no greater than the standards in effect in the aid to 9
families with dependent children program on July 16, 1996, or such increased standards as the 10
department may determine. The executive office of health and human services is directed to amend 11
the medical assistance Title XIX state plan and to submit to the United States Department of Health 12
and Human Services an amendment to the RIte Care waiver project to provide for medical 13
assistance coverage to families under this chapter in the same amount, scope, and duration as 14
coverage provided to comparable groups under the waiver. The department is further authorized 15
and directed to submit amendments and/or requests for waivers to the Title XXI state plan as may 16
be necessary to maximize federal contribution for provision of medical assistance coverage 17
provided pursuant to this chapter, including providing medical coverage as a "qualified state" in 18
accordance with Title XXI of the Social Security Act, 42 U.S.C. § 1397aa et seq. Implementation 19
of expanded coverage under this chapter shall not be delayed pending federal review of any Title 20
XXI amendment or waiver. 21
(b) Income. The secretary of the executive office of health and human services is 22
authorized and directed to amend the medical assistance Title XIX state plan or RIte Care waiver 23
to provide medical assistance coverage through expanded income disregards or other methodology 24
for parents or relative caretakers whose income levels are below one hundred thirty-three percent 25
(133%) of the federal poverty level. 26
(c) Health care coverage provided under this section shall also be provided without regard 27
to availability of federal financial participation to a noncitizen family member who is a resident of 28
Rhode Island, and who is otherwise eligible for such assistance. The department is further 29
authorized to promulgate any regulations necessary, and in accord with title XIX [42 U.S.C. § 1396 30
et seq.] and title XXI [42 U.S.C. § 1397 et seq.] of the Social Security Act as necessary in order to 31
implement the state plan amendment. The executive office of health and human services is directed 32
to ensure that federal financial participation is assessed to the maximum extent allowable to provide 33
coverage pursuant to this section, at least every two (2) years, and that state-only funds will be used 34
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only if federal financial participation is not available. 1
40-8.4-5. Managed care. 2
The delivery and financing of the healthcare services provided under this chapter shall may 3
be provided through a system of managed care. A managed care system integrates an efficient 4
financing mechanism with quality service delivery; provides a "medical home" to ensure 5
appropriate care and deter unnecessary and inappropriate care; and places emphasis on preventive 6
and primary health care. Beginning July 1, 2027, all payments shall be provided directly by the 7
state without an intermediate payment to a managed care entity or other form of health insurance 8
company. Beginning July 1, 2023, no new contracts may be entered into between the Medicaid 9
office and an intermediate payor such as a managed care entity or other form of health insurance 10
company for the payment of health care services pursuant to this chapter. 11
40-8.4-10. Regulations. 12
(a) The department of human services Medicaid director is authorized to promulgate any 13
regulations necessary to implement this chapter. 14
(b) When promulgating any rule or regulation necessary to implement this chapter, or any 15
rule or regulation related to RIte Care, the department Medicaid director shall send the notice 16
referred to in § 42-35-3 and a true copy of the rule referred to in § 42-35-4 of the Rhode Island 17
administrative procedures act to each of the co-chairpersons of the permanent joint committee on 18
health care oversight established by § 40-8.4-14. 19
40-8.4-12. RIte Share health insurance premium assistance program. 20
(a) Basic RIte Share health insurance premium assistance program. Under the terms of 21
Section 1906 of Title XIX of the U.S. Social Security Act, 42 U.S.C. § 1396e, states are permitted 22
to pay a Medicaid-eligible person's share of the costs for enrolling in employer-sponsored health 23
insurance (ESI) coverage if it is cost-effective to do so. Pursuant to the general assembly's direction 24
in the Rhode Island health reform act of 2000, the Medicaid agency requested and obtained federal 25
approval under § 1916, 42 U.S.C. § 1396o, to establish the RIte Share premium assistance program 26
to subsidize the costs of enrolling Medicaid-eligible persons and families in employer-sponsored 27
health insurance plans that have been approved as meeting certain cost and coverage requirements. 28
The Medicaid agency also obtained, at the general assembly's direction, federal authority to require 29
any such persons with access to ESI coverage to enroll as a condition of retaining eligibility 30
providing that doing so meets the criteria established in Title XIX for obtaining federal matching 31
funds. 32
(b) Definitions. For the purposes of this section, the following definitions apply: 33
(1) "Cost-effective" means that the portion of the ESI that the state would subsidize, as 34
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well as wrap-around costs, would on average cost less to the state than enrolling that same 1
person/family in a managed-care delivery system. 2
(2) "Cost sharing" means any co-payments, deductibles, or co-insurance associated with 3
ESI. 4
(3) "Employee premium" means the monthly premium share a person or family is required 5
to pay to the employer to obtain and maintain ESI coverage. 6
(4) "Employer-sponsored insurance" or "ESI" means health insurance or a group health 7
plan offered to employees by an employer. This includes plans purchased by small employers 8
through the state health insurance marketplace, healthsource, RI (HSRI). 9
(5) "Policy holder" means the person in the household with access to ESI, typically the 10
employee. 11
(6) "RIte Share-approved employer-sponsored insurance (ESI)" means an employer-12
sponsored health insurance plan that meets the coverage and cost-effectiveness criteria for RIte 13
Share. 14
(7) "RIte Share buy-in" means the monthly amount an Medicaid-ineligible policy holder 15
must pay toward RIte Share-approved ESI that covers the Medicaid-eligible children, young adults, 16
or spouses with access to the ESI. The buy-in only applies in instances when household income is 17
above one hundred fifty percent (150%) of the FPL. 18
(8) "RIte Share premium assistance program" means the Rhode Island Medicaid premium 19
assistance program in which the State pays the eligible Medicaid member's share of the cost of 20
enrolling in a RIte Share-approved ESI plan. This allows the state to share the cost of the health 21
insurance coverage with the employer. 22
(9) "RIte Share unit" means the entity within the executive office of health and human 23
services (EOHHS) responsible for assessing the cost-effectiveness of ESI, contacting employers 24
about ESI as appropriate, initiating the RIte Share enrollment and disenrollment process, handling 25
member communications, and managing the overall operations of the RIte Share program. 26
(10) "Third-party liability (TPL)" means other health insurance coverage. This insurance 27
is in addition to Medicaid and is usually provided through an employer. Since Medicaid is always 28
the payer of last resort, the TPL is always the primary coverage. 29
(11) "Wrap-around services or coverage" means any healthcare services not included in 30
the ESI plan that would have been covered had the Medicaid member been enrolled in a RIte Care 31
or Rhody Health Partners plan. Coverage of deductibles and co-insurance is included in the wrap. 32
Co-payments to providers are not covered as part of the wrap-around coverage. 33
(c) RIte Share populations. Medicaid beneficiaries subject to eligible for RIte Share 34
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include: children, families, parent and caretakers eligible for Medicaid or the children's health 1
insurance program (CHIP) under this chapter or chapter 12.3 of title 42; and adults between the 2
ages of nineteen (19) and sixty-four (64) who are eligible under chapter 8.12 of this title, not 3
receiving or eligible to receive Medicare, and are enrolled in managed care delivery systems. The 4
following conditions apply: 5
(1) The income of Medicaid beneficiaries shall affect whether and in what manner they 6
must may participate in RIte Share as follows: 7
(i) Income at or below one hundred fifty percent (150%) of FPL — Persons and families 8
determined to have household income at or below one hundred fifty percent (150%) of the federal 9
poverty level (FPL) guidelines based on the modified adjusted gross income (MAGI) standard or 10
other standard approved by the secretary are required to participate in RIte Share if a Medicaid-11
eligible adult or parent/caretaker has access to cost-effective ESI. Enrolling in ESI through RIte 12
Share shall be a condition of maintaining Medicaid health coverage for any eligible adult with 13
access to such coverage. 14
(ii) Income above one hundred fifty percent (150%) of FPL and policy holder is not 15
Medicaid-eligible — Premium assistance is available when the household includes Medicaid-16
eligible members, but the ESI policy holder (typically a parent/caretaker, or spouse) is not eligible 17
for Medicaid. Premium assistance for parents/caretakers and other household members who are not 18
Medicaid-eligible may be provided in circumstances when enrollment of the Medicaid-eligible 19
family members in the approved ESI plan is contingent upon enrollment of the ineligible policy 20
holder and the executive office of health and human services (executive office) determines, based 21
on a methodology adopted for such purposes, that it is cost-effective to provide premium assistance 22
for family or spousal coverage. 23
(d) RIte Share enrollment not condition of eligibility. RIte Share enrollment shall be 24
purely voluntary and shall never be a condition of eligibility for Medicaid. For Medicaid 25
beneficiaries over the age of nineteen (19), enrollment in RIte Share shall be a condition of 26
eligibility except as exempted below and by regulations promulgated by the executive office. 27
(1) Medicaid-eligible children and young adults up to age nineteen (19) shall not be 28
required to enroll in a parent/caretaker relative's ESI as a condition of maintaining Medicaid 29
eligibility if the person with access to RIte Share-approved ESI does not enroll as required. These 30
Medicaid-eligible children and young adults shall remain eligible for Medicaid and shall be 31
enrolled in a RIte Care plan. 32
(2) There shall be a limited six-month (6) exemption from the mandatory enrollment 33
requirement for persons participating in the RI works program pursuant to chapter 5.2 of this title. 34
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(e) Approval of health insurance plans for premium assistance. The executive office of 1
health and human services shall adopt regulations providing for the approval of employer-based 2
health insurance plans for premium assistance and shall approve employer-based health insurance 3
plans based on these regulations. In order for an employer-based health insurance plan to gain 4
approval, the executive office must determine that the benefits offered by the employer-based 5
health insurance plan are substantially similar in amount, scope, and duration to the benefits 6
provided to Medicaid-eligible persons enrolled in a Medicaid managed care plan, when the plan is 7
evaluated in conjunction with available supplemental benefits provided by the office. The office 8
shall obtain and make available to persons otherwise eligible for Medicaid identified in this section 9
as supplemental benefits those benefits not reasonably available under employer-based health 10
insurance plans that are required for Medicaid beneficiaries by state law or federal law or 11
regulation. Once it has been determined by the Medicaid agency that the ESI offered by a particular 12
employer is RIte Share-approved, all Medicaid members with access to that employer's plan are 13
required to participate in RIte Share. Failure to meet the mandatory enrollment requirement shall 14
result in the termination of the Medicaid eligibility of the policy holder and other Medicaid 15
members nineteen (19) or older in the household who could be covered under the ESI until the 16
policy holder complies with the RIte Share enrollment procedures established by the executive 17
office. 18
(f) Premium assistance. The executive office shall provide premium assistance by paying 19
all or a portion of the employee's cost for covering the eligible person and/or his or her family under 20
such a RIte Share-approved ESI plan subject to the buy-in provisions in this section. 21
(g) Buy-in. Persons who can afford it shall share in the cost. — The executive office is 22
authorized and directed to apply for and obtain any necessary state plan and/or waiver amendments 23
from the Secretary of the United States Department of Health and Human Services (DHHS) to 24
require that persons enrolled in a RIte Share-approved employer-based health plan who have 25
income equal to or greater than one hundred fifty percent (150%) of the FPL to buy-in to pay a 26
share of the costs based on the ability to pay, provided that the buy-in cost shall not exceed five 27
percent (5%) of the person's annual income. The executive office shall implement the buy-in by 28
regulation, and shall consider co-payments, premium shares, or other reasonable means to do so. 29
(h) Maximization of federal contribution. The executive office of health and human 30
services is authorized and directed to apply for and obtain federal approvals and waivers necessary 31
to maximize the federal contribution for provision of medical assistance coverage under this 32
section, including the authorization to amend the Title XXI state plan and to obtain any waivers 33
necessary to reduce barriers to provide premium assistance to recipients as provided for in Title 34
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XXI of the Social Security Act, 42 U.S.C. § 1397aa et seq. 1
(i) Implementation by regulation. The executive office of health and human services is 2
authorized and directed to adopt regulations to ensure the establishment and implementation of the 3
premium assistance program in accordance with the intent and purpose of this section, the 4
requirements of Title XIX, Title XXI, and any approved federal waivers. 5
(j) Outreach and reporting. The executive office of health and human services shall develop 6
a plan to identify Medicaid-eligible individuals who have access to employer-sponsored insurance 7
and increase the use of RIte Share benefits. Beginning October 1, 2019, the executive office shall 8
submit the plan to be included as part of the reporting requirements under § 35-17-1. Starting 9
January 1, 2020, the executive office of health and human services shall include the number of 10
Medicaid recipients with access to employer-sponsored insurance, the number of plans that did not 11
meet the cost-effectiveness criteria for RIte Share, and enrollment in the premium assistance 12
program as part of the reporting requirements under § 35-17-1. 13
(k) Employer-sponsored insurance. The executive office of health and human services shall 14
dedicate staff and resources to reporting monthly as part of the requirements under § 35-17-1 which 15
employer-sponsored insurance plans meet the cost-effectiveness criteria for RIte Share. 16
Information in the report shall be used for screening for Medicaid enrollment to encourage Rite 17
Share participation. By October 1, 2021, the report shall include any employers with 300 or more 18
employees. By January 1, 2022, the report shall include employers with 100 or more employees. 19
The January report shall also be provided to the chairperson of the house finance committee; the 20
chairperson of the senate finance committee; the house fiscal advisor; the senate fiscal advisor; and 21
the state budget officer. 22
40-8.4-15. Advisory commission on health care. 23
(a) There is hereby established an advisory commission to be known as the "advisory 24
commission on health care" to advise the director of the department of human services on all 25
matters relating to the RIte Care and RIte Share programs, and other matters concerning access for 26
all Rhode Islanders to quality health care in the most affordable, economical manner. The director 27
of the department of human services shall serve ex officio as chairperson. The director shall appoint 28
the eighteen (18) members: 29
(1) Three (3) of whom shall represent the healthcare providers; 30
(2) Three (3) of whom shall represent the members of the public with significant health 31
care conditions healthcare insurers; 32
(3) Three (3) of whom shall represent healthcare consumers or consumer organizations; 33
(4) Two (2) of whom shall represent organized labor; 34
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(5) One of whom shall be the health care advocate in the office of the attorney general; 1
(6) Three (3) of whom shall represent employers; and 2
(7) Three (3) of whom shall be other members of the public. 3
(b) The commission may study all aspects of the provisions of the RIte Care and RIte Share 4
programs involving purchasers of health care, including employers, consumers, and the state, health 5
insurers, providers of health care, and healthcare facilities, and all matters related to the interaction 6
among these groups, including methods to achieve more effective and timely resolution of disputes, 7
better communication, speedier, more reliable and less-costly administrative processes, claims, 8
payments, and other reimbursement matters, and the application of new processes or technologies 9
to such issues. 10
(c) Members of the commission shall be appointed in the month of July, each to hold office 11
until the last day of June in the second year of his or her appointment or until his or her successor 12
is appointed by the director. 13
(d) The commission shall meet at least quarterly, and the initial meeting of the commission 14
shall take place on or before September 15, 2000. The commission may meet more frequently than 15
quarterly at the call of the chair or at the call of any three (3) members of the commission. 16
(e) Members of the permanent joint committee on health care oversight established 17
pursuant to § 40-8.4-14 shall be notified of each meeting of the commission and shall be invited to 18
participate. 19
40-8.4-19. Managed healthcare delivery systems for families.Cost sharing. 20
(a) Notwithstanding any other provision of state law, the delivery and financing of the 21
healthcare services provided under this chapter shall be provided through a system of managed 22
care. "Managed care" is defined as systems that: integrate an efficient financing mechanism with 23
quality service delivery; provide a "medical home" to ensure appropriate care and deter unnecessary 24
services; and place emphasis on preventive and primary care. 25
(b) Enrollment in managed care health delivery systems is mandatory for individua ls 26
eligible for medical assistance under this chapter. This includes children in substitute care, children 27
receiving medical assistance through an adoption subsidy, and children eligible for medical 28
assistance based on their disability. Beneficiaries with third-party medical coverage or insurance 29
may be exempt from mandatory managed care in accordance with rules and regulations 30
promulgated by the department of human services for such purposes. 31
(c) Individuals who can afford to contribute shall share in the cost. The department of 32
human services is authorized and directed to apply for and obtain any necessary waivers and/or 33
state plan amendments from the Secretary of the United States Department of Health and Human 34
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Services, including, but not limited to, a waiver of the appropriate sections of Title XIX, 42 U.S.C. 1
§ 1396 et seq., to require that beneficiaries eligible under this chapter or chapter 12.3 of title 42, 2
with incomes equal to or greater than one hundred fifty percent (150%) of the federal poverty level, 3
pay a share of the costs of health coverage based on the ability to pay. The department of human 4
services shall implement this cost-sharing obligation by regulation, and shall consider co-payments, 5
premium shares, or other reasonable means to do so in accordance with approved provisions of 6
appropriate waivers and/or state plan amendments approved by the Secretary of the United States 7
Department of Health and Human Services. 8
SECTION 12. Section 40-8.4-13 of the General Laws in Chapter 40-8.4 entitled "Health 9
Care for Families" is hereby repealed in its entirety. 10
40-8.4-13. Utilization of available employer-based health insurance. 11
To the extent permitted under Titles XIX and XXI of the Social Security Act, 42 U.S.C. § 12
1396 et seq. and 42 U.S.C. § 1397aa et seq., or by waiver from the Secretary of the United States 13
Department of Health and Human Services, the department of human services shall adopt 14
regulations to restrict eligibility for RIte Care under this chapter and/or chapter 12.3 of title 42, or 15
the RIte Share program under § 40-8.4-12, for certain periods of time for certain individuals or 16
families who have access to, or have refused or terminated employer-based health insurance and 17
for certain periods of time for certain individuals but not including children whose employer has 18
terminated their employer-based health insurance. The department is authorized and directed to 19
amend the medical assistance Title XIX and XXI state plans, and/or to seek and obtain appropriate 20
federal approvals or waivers to implement this section. 21
SECTION 13. Sections 40-8.5-1 and 40-8.5-1.1 of the General Laws in Chapter 40-8.5 22
entitled "Health Care for Elderly and Disabled Residents Act" are hereby amended to read as 23
follows: 24
40-8.5-1. Categorically needy medical assistance coverage. 25
The department of human services is hereby authorized and directed to amend its Title XIX 26
state plan to provide for categorically needy medical assistance coverage as permitted pursuant to 27
Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq., as amended, to individuals who are 28
sixty-five (65) years or older or are disabled, as determined under § 1614(a)(3) of the Social 29
Security Act, 42 U.S.C. § 1382c(a)(3), as amended, whose income does not exceed one hundred 30
percent (100%) one hundred thirty-three percent (133%) of the federal poverty level (as revised 31
annually) applicable to the individual's family size, and whose resources do not exceed four 32
thousand dollars ($4,000) per individual, or six thousand dollars ($6,000) per couple. The 33
department shall provide medical assistance coverage to such elderly or disabled persons in the 34
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same amount, duration, and scope as provided to other categorically needy persons under the state's 1
Title XIX state plan. 2
40-8.5-1.1. Managed health care delivery systems. 3
(a) The delivery and financing of the health care services provided under this chapter may 4
be provided through a system of managed care. Beginning July 1, 2027, all payments shall be 5
provided directly by the state without an intermediate payment to a managed care entity or other 6
form of health insurance company. Beginning July 1, 2023, no new contracts may be entered into 7
between the Medicaid office and an intermediate payor such as a managed care entity or other form 8
of health insurance company for the payment of health care services pursuant to this chapter. To 9
ensure that all medical assistance beneficiaries, including the elderly and all individuals with 10
disabilities, have access to quality and affordable health care, the executive office of health and 11
human services ("executive office") is authorized to implement mandatory managed-care health 12
systems. 13
(b) "Managed care" is defined as systems that: integrate an efficient financing mechanism 14
with quality service delivery; provide a "medical home" to ensure appropriate care and deter 15
unnecessary services; and place emphasis on preventive and primary care. For purposes of this 16
section, managed care systems may also be defined to include a primary care case-management 17
model, community health teams, and/or other such arrangements that meet standards established 18
by the executive office and serve the purposes of this section. Managed care systems may also 19
include services and supports that optimize the health and independence of beneficiaries who are 20
determined to need Medicaid-funded long-term care under chapter 8.10 of this title or to be at risk 21
for the care under applicable federal state plan or waiver authorities and the rules and regulations 22
promulgated by the executive office. Any Medicaid beneficiaries who have third-party medical 23
coverage or insurance may be provided such services through an entity certified by, or in a 24
contractual arrangement with, the executive office or, as deemed appropriate, exempt from 25
mandatory managed care in accordance with rules and regulations promulgated by the executive 26
office. 27
(c) In accordance with § 42-12.4-7, the executive office is authorized to obtain any approval 28
through waiver(s), category II or III changes, and/or state-plan amendments, from the Secretary of 29
the United States Department of Health and Human Services, that are necessary to implement 30
mandatory, managed healthcare delivery systems for all Medicaid beneficiaries. The waiver(s), 31
category II or III changes, and/or state-plan amendments shall include the authorization to extend 32
managed care to cover long-term-care services and supports. Authorization shall also include, as 33
deemed appropriate, exempting certain beneficiaries with third-party medical coverage or 34
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insurance from mandatory managed care in accordance with rules and regulations promulgated by 1
the executive office. 2
(d)(b) To ensure the delivery of timely and appropriate services to persons who become 3
eligible for Medicaid by virtue of their eligibility for a United States Social Security Administration 4
program, the executive office is authorized to seek any and all data-sharing agreements or other 5
agreements with the Social Security Administration as may be necessary to receive timely and 6
accurate diagnostic data and clinical assessments. This information shall be used exclusively for 7
the purpose of service planning, and shall be held and exchanged in accordance with all applicable 8
state and federal medical record confidentiality laws and regulations. 9
SECTION 14. Sections 40-8.12-2 and 40-8.12-3 of the General Laws in Chapter 40-8.12 10
entitled "Health Care for Adults" are hereby amended to read as follows: 11
40-8.12-2. Eligibility. 12
(a) Medicaid coverage for nonpregnant adults without children. There is hereby 13
established, effective January 1, 2014, a category of Medicaid eligibility pursuant to Title XIX of 14
the Social Security Act, as amended by the U.S. Patient Protection and Affordable Care Act (ACA) 15
of 2010, 42 U.S.C. § 1396u-1, for adults ages nineteen (19) to sixty-four (64) who do not have 16
dependent children and do not qualify for Medicaid under Rhode Island general laws applying to 17
families with children and adults who are blind, aged, or living with a disability. The executive 18
office of health and human services is directed to make any amendments to the Medicaid state plan 19
and waiver authorities established under Title XIX necessary to implement this expansion in 20
eligibility and ensure the maximum federal contribution for health insurance coverage provided 21
pursuant to this chapter. 22
(b) Income. The secretary of the executive office of health and human services is 23
authorized and directed to amend the Medicaid Title XIX state plan and, as deemed necessary, any 24
waiver authority to effectuate this expansion of coverage to any Rhode Islander who qualifies for 25
Medicaid eligibility under this chapter with income at or below one hundred and thirty-three 26
percent (133%) of the federal poverty level, based on modified adjusted-gross income. 27
(c) Delivery system. The executive office of health and human services is authorized and 28
directed to apply for and obtain any waiver authorities necessary to provide persons eligible under 29
this chapter with managed, coordinated healthcare coverage consistent with the principles set forth 30
in chapter 12.4 of title 42, pertaining to a healthcare home. Beginning July 1, 2027, all payments 31
shall be provided directly by the state without an intermediate payment to a managed care entity or 32
other form of health insurance company. Beginning July 1, 2023, no new contracts may be entered 33
into between the Medicaid office and an intermediate payor such as a managed care entity or other 34
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form of health insurance company for the payment of health care services pursuant to this chapter. 1
40-8.12-3. Premium assistance program. 2
(a) The executive office of health and human services is directed to amend its rules and 3
regulations to implement a premium assistance program for adults with dependent children, 4
enrolled in the state's health-benefits exchange, whose annual income and resources meet the 5
guidelines established in § 40-8.4-4 in effect on December 1, 2013. The premium assistance will 6
pay one-half of the cost of a commercial plan that a parent may incur after subtracting the cost-7
sharing requirement under § 40-8.4-4 as of December 31, 2013, and any applicable federal tax 8
credits available. The office is also directed to amend the 1115 waiver demonstration extension and 9
the medical assistance Title XIX state plan for this program if it is determined that it is eligible for 10
funding pursuant to Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq. 11
(b) The executive office of health and human services shall require any individual receiving 12
benefits under a state-funded, healthcare assistance program to apply for any health insurance for 13
which he or she is eligible, including health insurance available through the health benefits 14
exchange. Nothing shall preclude the state from using funds appropriated for Affordable Care Act 15
transition expenses to reduce the impact on an individual who has been transitioned from a state 16
program to a health insurance plan available through the health benefits exchange. It shall not be 17
deemed cost-effective for the state if it would result in a loss of benefits or an increase in the cost 18
of healthcare services for the person above an amount deemed de minimus as determined by state 19
regulation. 20
SECTION 15. Chapter 44-8.13 of the General Law entitled "Long-Term Managed Care 21
Arrangements" is hereby repealed in its entirety. 22
40-8.13-1. Definitions. 23
For purposes of this section the following terms shall have the meanings indicated: 24
(1) "Beneficiary" means an individual who is eligible for medical assistance under the 25
Rhode Island Medicaid state plan established in accordance with 42 U.S.C. § 1396, and includes 26
individuals who are additionally eligible for benefits under the Medicare program (42 U.S.C. § 27
1395 et seq.) or other health plan. 28
(2) "Duals demonstration project" means a demonstration project established pursuant to 29
the financial alignment demonstration established under section 2602 of the Patient Protection and 30
Affordable Care Act (Pub. L. No. 111-148) [42 U.S.C. § 1315b], involving a three-way contract 31
between Rhode Island, the federal Centers for Medicare and Medicaid Services ("CMS"), and 32
qualified health plans, and covering healthcare services provided to beneficiaries. 33
(3) "EOHHS" means the Rhode Island executive office of health and human services. 34
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(4) "EOHHS level-of-care tool" refers to a set of criteria established by EOHHS and used 1
in January, 2014 to determine the long-term-care needs of a beneficiary as well as the appropriate 2
setting for delivery of that care. 3
(5) "Long-term-care services and supports" means a spectrum of services covered by the 4
Rhode Island Medicaid program and/or the Medicare program, that are required by individuals with 5
functional impairments and/or chronic illness, and includes skilled or custodial nursing facility 6
care, as well as various home- and community-based services. 7
(6) "Managed care organization" means any health plan, health-maintenance organization, 8
managed care plan, or other person or entity that enters into a contract with the state under which 9
it is granted the authority to arrange for the provision of, and/or payment for, long-term-care 10
supports and services to eligible beneficiaries under a managed long-term-care arrangement. 11
(7) "Managed long-term-care arrangement" means any arrangement under which a 12
managed care organization is granted some or all of the responsibility for providing and/or paying 13
for long-term-care services and supports that would otherwise be provided or paid under the Rhode 14
Island Medicaid program. The term includes, but is not limited to, a duals demonstration project, 15
and/or phase I and phase II of the integrated care initiative established by the executive office of 16
health and human services. 17
(8) "Plan of care" means a care plan established by a nursing facility in accordance with 18
state and federal regulations and that identifies specific care and services provided to a beneficiary. 19
40-8.13-2. Beneficiary choice. 20
Any managed long-term-care arrangement shall offer beneficiaries the option to decline 21
participation and remain in traditional Medicaid and, if a duals demonstration project, traditional 22
Medicare. Beneficiaries must be provided with sufficient information to make an informed choice 23
regarding enrollment, including: 24
(1) Any changes in the beneficiary's payment or other financial obligations with respect to 25
long-term-care services and supports as a result of enrollment; 26
(2) Any changes in the nature of the long-term-care services and supports available to the 27
beneficiary as a result of enrollment, including specific descriptions of new services that will be 28
available or existing services that will be curtailed or terminated; 29
(3) A contact person who can assist the beneficiary in making decisions about enrollment; 30
(4) Individualized information regarding whether the managed care organization's network 31
includes the healthcare providers with whom beneficiaries have established provider relationships. 32
Directing beneficiaries to a website identifying the plan's provider network shall not be sufficient 33
to satisfy this requirement; and 34
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(5) The deadline by which the beneficiary must make a choice regarding enrollment, and 1
the length of time a beneficiary must remain enrolled in a managed care organization before being 2
permitted to change plans or opt out of the arrangement. 3
40-8.13-3. Ombudsman process. 4
EOHHS shall designate an ombudsperson to advocate for beneficiaries enrolled in a 5
managed long-term-care arrangement. The ombudsperson shall advocate for beneficiaries through 6
complaint and appeal processes and ensure that necessary healthcare services are provided. At the 7
time of enrollment, a managed care organization must inform enrollees of the availability of the 8
ombudsperson, including contact information. 9
40-8.13-4. Provider/plan liaison. 10
EOHHS shall designate an individual, not employed by or otherwise under contract with a 11
participating managed care organization, who shall act as liaison between healthcare providers and 12
managed care organizations, for the purpose of facilitating communications and ensuring that issues 13
and concerns are promptly addressed. 14
40-8.13-5. Financial principles under managed care. 15
(a) To the extent that financial savings are a goal under any managed long-term-care 16
arrangement, it is the intent of the legislature to achieve savings through administrative efficiencies, 17
care coordination, improvements in care outcomes and in a way that encourages the highest quality 18
care for patients and maximizes value for the managed-care organization and the state. Therefore, 19
any managed long-term-care arrangement shall include a requirement that the managed care 20
organization reimburse providers for services in accordance with these principles. Notwithstanding 21
any law to the contrary, for the twelve-month (12) period beginning July 1, 2015, Medicaid 22
managed long-term-care payment rates to nursing facilities established pursuant to this section shall 23
not exceed ninety-eight percent (98.0%) of the rates in effect on April 1, 2015. 24
(1) For a duals demonstration project, the managed care organization: 25
(i) Shall not combine the rates of payment for post-acute skilled and rehabilitation care 26
provided by a nursing facility and long-term and chronic care provided by a nursing facility in order 27
to establish a single-payment rate for dual eligible beneficiaries requiring skilled nursing services; 28
(ii) Shall pay nursing facilities providing post-acute skilled and rehabilitation care or long-29
term and chronic care rates that reflect the different level of services and intensity required to 30
provide these services; and 31
(iii) For purposes of determining the appropriate rate for the type of care identified in 32
subsection (a)(1)(ii) of this section, the managed care organization shall pay no less than the rates 33
that would be paid for that care under traditional Medicare and Rhode Island Medicaid for these 34
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service types. The managed care organization shall not, however, be required to use the same 1
payment methodology. 2
The state shall not enter into any agreement with a managed care organization in connection 3
with a duals demonstration project unless that agreement conforms to this section, and any existing 4
such agreement shall be amended as necessary to conform to this subsection. 5
(2) For a managed long-term-care arrangement that is not a duals demonstration project, 6
the managed care organization shall reimburse providers in an amount not less than the amount that 7
would be paid for the same care by the executive office of health and human services under the 8
Medicaid program. The managed care organization shall not, however, be required to use the same 9
payment methodology as the executive office of health and human services. 10
(3) Notwithstanding any provisions of the general or public laws to the contrary, the 11
protections of subsections (a)(1) and (a)(2) of this section may be waived by a nursing facility in 12
the event it elects to accept a payment model developed jointly by the managed care organization 13
and skilled nursing facilities, that is intended to promote quality of care and cost-effectiveness, 14
including, but not limited to, bundled-payment initiatives, value-based purchasing arrangements, 15
gainsharing, and similar models. 16
(b) Notwithstanding any law to the contrary, for the twelve-month (12) period beginning 17
July 1, 2015, Medicaid managed long-term-care payment rates to nursing facilities established 18
pursuant to this section shall not exceed ninety-eight percent (98.0%) of the rates in effect on April 19
1, 2015. 20
40-8.13-6. Payment incentives. 21
In order to encourage quality improvement and promote appropriate utilization incentives 22
for providers in a managed long-term-care arrangement, a managed care organization may use 23
incentive or bonus payment programs that are in addition to the rates identified in § 40-8.13-5. 24
40-8.13-7. Willing provider. 25
A managed care organization must contract with and cover services furnished by any 26
nursing facility licensed under chapter 17 of title 23 and certified by CMS that provides Medicaid-27
covered nursing facility services pursuant to a provider agreement with the state, provided that the 28
nursing facility is not disqualified under the managed care organization's quality standards that are 29
applicable to all nursing facilities; and the nursing facility is willing to accept the reimbursement 30
rates described in § 40-8.13-5. 31
40-8.13-8. Level-of-care tool. 32
A managed long-term-care arrangement must require that all participating managed care 33
organizations use only the EOHHS level-of-care tool in determining coverage of long-term-care 34
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supports and services for beneficiaries. EOHHS may amend the level-of-care tool provided that 1
any changes are established in consultation with beneficiaries and providers of Medicaid-covered 2
long-term-care supports and services, and are based upon reasonable medical evidence or 3
consensus, in consideration of the specific needs of Rhode Island beneficiaries. Notwithstanding 4
any other provisions herein, however, in the case of a duals demonstration project, a managed care 5
organization may use a different level-of-care tool for determining coverage of services that would 6
otherwise be covered by Medicare, since the criteria established by EOHHS are directed towards 7
Medicaid-covered services; provided, that the level-of-care tool is based on reasonable medical 8
evidence or consensus in consideration of the specific needs of Rhode Island beneficiaries. 9
40-8.13-9. Case management/plan of care. 10
No managed care organization acting under a managed long-term-care arrangement may 11
require a provider to change a plan of care if the provider reasonably believes that such an action 12
would conflict with the provider's responsibility to develop an appropriate care plan under state and 13
federal regulations. 14
40-8.13-10. Care transitions. 15
In the event that a beneficiary: 16
(1) Has been determined to meet level-of-care requirements for nursing facility coverage 17
as of the date of his or her enrollment in a managed care organization; or 18
(2) Has been determined to meet level of care requirements for nursing facility coverage 19
by a managed care organization after enrollment; and there is a change in condition whereby the 20
managed care organization determines that the beneficiary no longer meets such level-of-care 21
requirements, the nursing facility shall promptly arrange for an appropriate and safe discharge (with 22
the assistance of the managed care organization if the facility requests it), and the managed care 23
organization shall continue to pay for the beneficiary's nursing facility care at the same rate until 24
the beneficiary is discharged. 25
40-8.13-11. Reporting requirements. 26
EOHHS shall report to the general assembly and shall make available to interested persons 27
a separate accounting of state expenditures for long-term-care supports and services under any 28
managed long-term-care arrangement, specifically and separately identifying expenditures for 29
home- and community-based services, assisted-living services, hospice services within nursing 30
facilities, hospice services outside of nursing facilities, and nursing facility services. Such reports 31
shall be made twice annually, six (6) months apart, beginning six (6) months following the 32
implementation of any managed long-term-care arrangement, and shall include a detailed report of 33
utilization of each service. In order to facilitate reporting, any managed long-term-care arrangement 34
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shall include a requirement that a participating managed care organization make timely reports of 1
the data necessary to compile the reports. 2
SECTION 16. Sections 42-7.2-10, 42-7.2-16 and 42-7.2-16.1 of the General Laws in 3
Chapter 42-7.2 entitled "Office of Health and Human Services" are hereby amended to read as 4
follows: 5
42-7.2-10. Appropriations and disbursements. 6
(a) The general assembly shall annually appropriate such sums as it may deem necessary 7
for the purpose of carrying out the provisions of this chapter. The state controller is hereby 8
authorized and directed to draw his or her orders upon the general treasurer for the payment of such 9
sum or sums, or so much thereof as may from time to time be required, upon receipt by him or her 10
of proper vouchers approved by the secretary of the executive office of health and human services, 11
or his or her designee. 12
(b) The general assembly shall, through the utilization of federal Medicaid reimbursement 13
for administrative costs, and additional funds, appropriate such funds as may be necessary to hire 14
additional personnel for the Medicaid office as follows: one hundred (100) outreach social workers 15
to encourage, assist and expedite individuals applying for Medicaid benefits; one hundred (100) 16
new programmers in order to build digital infrastructure for the Medicaid office; thirty (30) new 17
social workers and ten (10) new programmers to help increase spend down program utilization and 18
feasibility and examine possible legal changes necessary to increase spend down program 19
eligibility; and fifty (50) additional personnel for building administrative capacity. The Medicaid 20
office shall be exempt from any limitations placed on the number of full-time equivalent personnel 21
employed by the executive office of health and human services. 22
(b)(c) For the purpose of recording federal financial participation associated with 23
qualifying healthcare workforce development activities at the state's public institutions of higher 24
education, and pursuant to the Rhode Island designated state health programs (DSHP), as approved 25
by the Centers for Medicare & Medicaid Services (CMC) October 20, 2016, in the 11-W-00242/1 26
amendment to Rhode Island's section 1115 Demonstration Waiver, there is hereby established a 27
restricted-receipt account entitled "Health System Transformation Project" in the general fund of 28
the state and included in the budget of the office of health and human services. Due to the COVID-29
19 pandemic, the office of health and human services is forbidden from utilizing any funds within 30
the health system transformation project restricted receipts account for any imposition of downside 31
risk for providers. No payment models that impose downside risk or in any way deviate from fee-32
for-service shall be utilized for the Medicaid program without explicit authorization by the general 33
assembly. 34
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(c)(d) There are hereby created within the general fund of the state and housed within the 1
budget of the office of health and human services two restricted receipt accounts, respectively 2
entitled “HCBS Support-ARPA” and “HCBS Admin Support-ARPA”. Amounts deposited into 3
these accounts are equivalent to the general revenue savings generated by the enhanced federal 4
match received on eligible home and community-based services between April 1, 2021, and March 5
31, 2022, allowable under Section 9817 of the American Rescue Plan Act of 2021, Pub. L. No. 6
117-2. Funds deposited into the “HCBS Support-ARPA” account will be used to finance the state 7
share of newly eligible Medicaid expenditures by the office of health and human services and its 8
sister agencies, including the department of children, youth and families, the department of health, 9
and the department of behavioral healthcare, developmental disabilities and hospitals. Funds 10
deposited into the “HCBS Admin Support-ARPA” account will be used to finance the state share 11
of allowable administrative expenditures attendant to the implementation of these newly eligible 12
Medicaid expenditures. The accounts created under this subsection shall be exempt from the 13
indirect cost recovery provisions of § 35-4-27. 14
(d)(e) There is hereby created within the general fund of the state and housed within the 15
budget of the office of health and human services a restricted receipt account entitled “Rhode Island 16
Statewide Opioid Abatement Account” for the purpose of receiving and expending monies from 17
settlement agreements with opioid manufacturers, pharmaceutical distributors, pharmacies, or their 18
affiliates, as well as monies resulting from bankruptcy proceedings of the same entities. The 19
executive office of health and human services shall deposit any revenues from such sources that 20
are designated for opioid abatement purposes into the restricted receipt account. Funds from this 21
account shall only be used for forward-looking opioid abatement efforts as defined and limited by 22
any settlement agreements, state-city and town agreements, or court orders pertaining to the use of 23
such funds. By January 1 of each calendar year, the secretary of health and human services shall 24
report to the governor, the speaker of the house of representatives, the president of the senate, and 25
the attorney general on the expenditures that were funded using monies from the Rhode Island 26
statewide opioid abatement account and the amount of funds spent. The account created under this 27
subsection shall be exempt from the indirect cost recovery provisions of § 35-4-27. No 28
governmental entity has the authority to assert a claim against the entities with which the attorney 29
general has entered into settlement agreements concerning the manufacturing, marketing, 30
distributing, or selling of opioids that are the subject of the Rhode Island Memorandum of 31
Understanding Between the State and Cities and Towns Receiving Opioid Settlement Funds 32
executed by every city and town and the attorney general and wherein every city and town agreed 33
to release all such claims against these settling entities, and any amendment thereto. Governmental 34
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entity means any state or local governmental entity or sub-entity and includes, but is not limited to, 1
school districts, fire districts, and any other such districts. The claims that shall not be asserted are 2
the released claims, as that term is defined in the settlement agreements executed by the attorney 3
general, or, if not defined therein, the claims sought to be released in such settlement agreements. 4
42-7.2-16. Medicaid System Reform 2008 Medicaid System Reform. 5
(a) The executive office of health and human services, in conjunction with the department 6
of human services, the department of children, youth and families, the department of health and the 7
department of behavioral healthcare, developmental disabilities and hospitals, is authorized to 8
design options that further the reforms in Medicaid initiated in 2008 Medicaid reform to ensure that 9
the program: transitions to a Medicare level of care as a first step in the transition to a state-level 10
Medicare for All system; phases out the use of intermediary insurance companies such as managed 11
care entities; transitions to the management of health insurers acquired due to insolvency, smoothly 12
integrating publicly owned health insurers with the Medicaid system; utilizes payment models such 13
as fee-for-service that incentivize higher quality of care and more utilization of care; provides for 14
the financial health of Rhode Island health care providers; encourages fair wages and benefits for 15
Rhode Island's health care workforce; develops and builds out the Medicaid office's human capital, 16
technological infrastructure, expertise, and general ability to manage health care payments to 17
prepare for the transition to a single-payer Medicare-for-All system; and guides the transition of 18
the Rhode Island health care funding system to a state-level Medicare-for-All system. utilizes 19
competitive and value based purchasing to maximize the available service options, promotes 20
accountability and transparency, and encourages and rewards healthy outcomes, independence, and 21
responsible choices; promotes efficiencies and the coordination of services across all health and 22
human services agencies; and ensures the state will have a fiscally sound source of publicly-23
financed health care for Rhode Islanders in need. 24
(b) Principles and goals. In developing and implementing this system of reform, the 25
executive office of health and human services and the four (4) health and human services 26
departments shall pursue the following principles and goals: 27
(1) Empower consumers to make reasoned and cost-effective choices about their health by 28
providing them with the information and array of service options they need and offering rewards 29
for healthy decisions; 30
(2) Encourage personal responsibility by assuring the information available to beneficiaries 31
is easy to understand and accurate, provide that a fiscal intermediary is provided when necessary, 32
and adequate access to needed services; 33
(3) When appropriate, promote community-based care solutions by transitioning 34
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beneficiaries from institutional settings back into the community and by providing the needed 1
assistance and supports to beneficiaries requiring long-term care or residential services who wish 2
to remain, or are better served in the community; 3
(4) Enable consumers to receive individualized health care that is outcome-oriented, 4
focused on prevention, disease management, recovery and maintaining independence; 5
(5) Promote competition between healthcare providers to ensure best value purchasing, to 6
leverage resources and to create opportunities for improving service quality and performance; 7
(6) Redesign purchasing and payment methods to promote payment models such as fee-8
for-service that incentivize higher quality of care and more utilization of care and phase out the use 9
of payment models that shift risk to providers assure fiscal accountability and encourage and to 10
reward service quality and cost-effectiveness by tying reimbursements to evidence-based 11
performance measures and standards, including those related to patient satisfaction; and 12
(7) Continually improve technology to take advantage of recent innovations and advances 13
that help decision makers, consumers and providers to make informed and cost-effective decisions 14
regarding health care. 15
(c) The executive office of health and human services shall annually submit a report to the 16
governor and the general assembly describing the status of the administration and implementation 17
of the Medicaid Section 1115 demonstration waiver. 18
42-7.2-16.1. Reinventing Medicaid Act of 2015. 19
(a) Findings. The Rhode Island Medicaid program is an integral component of the state's 20
healthcare system that provides crucial services and supports to many Rhode Islanders. As the 21
program's reach has expanded, the costs of the program have continued to rise and the delivery of 22
care has become more fragmented and uncoordinated. Given the crucial role of the Medicaid 23
program to the state, it is of compelling importance that the state conduct a fundamental 24
restructuring of its Medicaid program that achieves measurable improvement in health outcomes 25
for the people and transforms the healthcare system to one that pays for the outcomes and quality 26
they deserve at a sustainable, predictable and affordable cost. The Reinventing Medicaid Act of 27
2015, as implemented in the budget for fiscal year two thousand sixteen (FY2016), involved drastic 28
cuts to the Medicaid program, along with policies that shifted risk to providers away from 29
intermediary insurers. Since the passage of that act, the finances of health care providers in Rhode 30
Island have deteriorated significantly, and it is therefore the duty of the general assembly to seek 31
corrective action to restore critical investments in the Medicaid system and redesign payment 32
models to remove risk from providers and concentrate risk in private insurance companies during 33
their phase-out period along the transition to Medicare-for-All. 34
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(b) The Working Group to Reinvent Medicaid, which was established to refine the 1
principles and goals of the Medicaid reforms begun in 2008, was directed to present to the general 2
assembly and the governor initiatives to improve the value, quality, and outcomes of the health care 3
funded by the Medicaid program. 4
SECTION 17. Chapter 42-12.1 of the General Laws entitled "Department of Behavioral 5
Healthcare, Developmental Disabilities, and Hospitals" is hereby amended by adding thereto the 6
following section: 7
42-12.1-11. The Rhode Island institute for mental disease. 8
(a) There is hereby established a state hospital for the care for Rhode Islanders in need of 9
hospital-level inpatient behavioral health care known as the Rhode Island institute for mental 10
disease. The Rhode Island institute for mental disease shall fall within the purview of the 11
department, and the chief executive officer, chief financial officer, and chief medical officer shall 12
be appointed by the governor with advice and consent of the senate. 13
(b) All forensic patients in the care of the Eleanor Slater Hospital shall be immediately 14
transferred to the Rhode Island institute for mental disease. 15
(c) The Reagan Building of the Eleanor Slater Hospital shall be immediately transferred to 16
the Rhode Island institute for mental disease. 17
(d) A section of the Zambarano Building of the Eleanor Slater Hospital shall be designated 18
by the department for the use of the Rhode Island institute for mental disease. 19
(e) In the event that the director determines that the patient mix at the Eleanor Slater 20
Hospital may be at risk of jeopardizing federal Medicaid reimbursement through the classification 21
of the Eleanor Slater Hospital as an institution for mental disease, the director shall be empowered 22
to administratively transfer inpatient behavioral health patients at Eleanor Slater Hospital to the 23
Rhode Island institute for mental disease. 24
(f) The Medicaid director is hereby directed to apply for a waiver to allow for Medicaid 25
reimbursement of some or all inpatient behavioral health patients at the Rhode Island institute for 26
mental disease. 27
SECTION 18. Sections 42-12.3-2, 42-12.3-3, 42-12.3-5, 42-12.3-7 and 42-12.3-9 of the 28
General Laws in Chapter 42-12.3 entitled "Health Care for Children and Pregnant Women" are 29
hereby amended to read as follows: 30
42-12.3-2. Purposes. 31
(a) It is the intent of the general assembly to assure access to the comprehensive health care 32
by providing health insurance to all Rhode Islanders who are uninsured; 33
Universal comprehensive coverage for all Rhode Islanders is a goal to be achieved over 34
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the course of several years; 1
The first step in providing comprehensive health coverage is to assure coverage for the 2
most vulnerable residents of the state; 3
Uninsured pregnant women and children under age eight (8) nineteen (19) are among the 4
most vulnerable residents of the state; and 5
The governor's health care advisory committee has provided advice and recommendations 6
in its report of January, 1993 to improve access to health care for pregnant women and children up 7
to age six (6); 8
The objectives to meet the goal of comprehensive health coverage are: 9
(1) Every child under age eight (8) nineteen (19) in Rhode Island will have a reliable source 10
of health coverage and health care; 11
(2) Every pregnant woman in Rhode Island will have early and comprehensive prenatal 12
and maternity care services; 13
(3) All low income families will have improved access to family planning and reproductive 14
services; and 15
(4) Every pregnant woman and child in Rhode Island will receive effective, preventive 16
primary care. 17
(b) To assure access to care and availability of services, the following principles will guide 18
the design of the health care act: 19
(1) There will be equal access to health care for children and pregnant women, regardless 20
of the type of coverage; 21
(2) There shall be an emphasis on primary and preventive care which will include a 22
"medical home" for every child; 23
(3) Current deficiencies in the fee for service delivery system will be addressed; 24
(4) In addition to accessibility of health care, provisions must be made to address language, 25
cultural and transportation barriers; 26
(5) Enrollment must be both timely and accomplished in a user friendly fashion; 27
(6) An adequate source of primary care providers should be developed; 28
(7) An enhanced set of services should be developed to support and address the needs of 29
families at risk. 30
42-12.3-3. Medical assistance expansion for pregnant women/RIte Start. 31
(a) The secretary of the executive office of health and human services is authorized to 32
amend its Title XIX state plan pursuant to Title XIX of the Social Security Act to provide Medicaid 33
coverage and to amend its Title XXI state plan pursuant to Title XXI of the Social Security Act to 34
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provide medical assistance coverage through expanded family income disregards for pregnant 1
women persons whose family income levels are between one hundred eighty-five percent (185%) 2
and two hundred fifty percent (250%) of the federal poverty level. The department is further 3
authorized to promulgate any regulations necessary and in accord with Title XIX [42 U.S.C. § 1396 4
et seq.] and Title XXI [42 U.S.C. § 1397aa et seq.] of the Social Security Act necessary in order to 5
implement said state plan amendment. The services provided shall be in accord with Title XIX [42 6
U.S.C. § 1396 et seq.] and Title XXI [42 U.S.C. § 1397aa et seq.] of the Social Security Act. 7
(b) The secretary of health and human services is authorized and directed to establish a 8
payor of last resort program to cover prenatal, delivery and postpartum care. The program shall 9
cover the cost of maternity care for any woman person who lacks health insurance coverage for 10
maternity care and who is not eligible for medical assistance under Title XIX [42 U.S.C. § 1396 et 11
seq.] and Title XXI [42 U.S.C. § 1397aa et seq.] of the Social Security Act including, but not limited 12
to, a noncitizen pregnant woman person lawfully admitted for permanent residence on or after 13
August 22, 1996, without regard to the availability of federal financial participation, provided such 14
pregnant woman person satisfies all other eligibility requirements. The secretary shall promulgate 15
regulations to implement this program. Such regulations shall include specific eligibility criteria; 16
the scope of services to be covered; procedures for administration and service delivery; referrals 17
for non-covered services; outreach; and public education. Excluded services under this subsection 18
will include, but not be limited to, induced abortion except in cases of rape or incest or to save the 19
life of the pregnant individual. 20
(c) The secretary of health and human services may enter into cooperative agreements with 21
the department of health and/or other state agencies to provide services to individuals eligible for 22
services under subsections (a) and (b) above. 23
(d) The following services shall be provided through the program: 24
(1) Ante-partum and postpartum care; 25
(2) Delivery; 26
(3) Cesarean section; 27
(4) Newborn hospital care; 28
(5) Inpatient transportation from one hospital to another when authorized by a medical 29
provider; and 30
(6) Prescription medications and laboratory tests. 31
(e) The secretary of health and human services shall provide enhanced services, as 32
appropriate, to pregnant women persons as defined in subsections (a) and (b), as well as to other 33
pregnant women persons eligible for medical assistance. These services shall include: care 34
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coordination; nutrition and social service counseling; high-risk obstetrical care; childbirth and 1
parenting preparation programs; smoking cessation programs; outpatient counseling for drug-2
alcohol use; interpreter services; mental health services; and home visitation. The provision of 3
enhanced services is subject to available appropriations. In the event that appropriations are not 4
adequate for the provision of these services, the executive office has the authority to limit the 5
amount, scope, and duration of these enhanced services. 6
(f) The executive office of health and human services shall provide for extended family 7
planning services for up to twenty-four (24) months postpartum. These services shall be available 8
to women persons who have been determined eligible for RIte Start or for medical assistance under 9
Title XIX [42 U.S.C. § 1396 et seq.] or Title XXI [42 U.S.C. § 1397aa et seq.] of the Social Security 10
Act. 11
(g) Effective October 1, 2022, individuals eligible for RIte Start pursuant to this section or 12
for medical assistance under Title XIX or Title XXI of the Social Security Act while pregnant 13
(including during a period of retroactive eligibility), are eligible for full Medicaid benefits through 14
the last day of the month in which their twelve-month (12) postpartum period ends. This benefit 15
will be provided to eligible Rhode Island residents without regard to the availability of federal 16
financial participation. The executive office of health and human services is directed to ensure that 17
federal financial participation is used to the maximum extent allowable to provide coverage 18
pursuant to this section, and that state-only funds will be used only if federal financial participation 19
is not available. 20
(h) Any person eligible for services under subsections (a) and (b) of this section, or 21
otherwise eligible for medical assistance under title XIX [42 U.S.C. § 1396 et seq.] and title XXI 22
[42 U.S.C. § 1397 et seq.] of the Social Security Act, shall also be entitled to services for any 23
termination of pregnancy permitted under § 23-4.13-2; provided, however, that no federal funds 24
shall be used to pay for such services, except as authorized under federal law. 25
42-12.3-5. Managed care. 26
The delivery and financing of the health care services provided pursuant to §§ 42-12.3-3 27
and 42-12.3-4 shall may be provided through a system of managed care. The delivery and financing 28
of the health care services provided under this chapter may be provided through a system of 29
managed care. Beginning July 1, 2027, all payments shall be provided directly by the state without 30
an intermediate payment to a managed care entity or other form of health insurance company. 31
Beginning July 1, 2023, no new contracts may be entered into between the Medicaid office and an 32
intermediate payor such as a managed care entity or other form of health insurance company for 33
the payment of health care services pursuant to this chapter. 34
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A managed care system integrates an efficient financing mechanism with quality service 1
delivery, provides a "medical home" to assure appropriate care and deter unnecessary and 2
inappropriate care, and places emphasis on preventive and primary health care. In developing a 3
managed care system the department of human services shall consider managed care models 4
recognized by the health care financing administration. The department of human services is hereby 5
authorized and directed to seek any necessary approvals or waivers from the U.S. Department of 6
Health and Human Services, Health Care Financing Administration, needed to assure that services 7
are provided through a mandatory managed care system. Certain health services may be provided 8
on an interim basis through a fee for service arrangement upon a finding that there are temporary 9
barriers to implementation of mandatory managed care for a particular population or particular 10
geographic area. Nothing in this section shall prohibit the department of human services from 11
providing enhanced services to medical assistance recipients within existing appropriations. 12
42-12.3-7. Financial contributions. 13
The department of human services may not require the payment of enrollment fees, sliding 14
fees, deductibles, co-payments, and/or other contributions based on ability to pay. These fees shall 15
be established by rules and regulations to be promulgated by the department of human services or 16
the department of health, as appropriate. 17
42-12.3-9. Insurance coverage -- Third party insurance. 18
(a) No payment will be made nor service provided in the RIte Start or RIte Track program 19
with respect to any health care that is covered or would be covered, by any employee welfare benefit 20
plan under which a woman or child is either covered or eligible to be covered either as an employee 21
or dependent, whether or not coverage under such plan is elected. 22
(b) A premium may be charged for participation in the RIte Track or RIte Start programs 23
for eligible individuals whose family incomes are in excess of two hundred fifty percent (250%) of 24
the federal poverty level and who have voluntarily terminated health care insurance within one year 25
of the date of application for benefits under this chapter. 26
(c)(b) Every family who is eligible to participate in the RIte Track program, who has an 27
additional child who because of age is not eligible for RIte Track, or whose child becomes ineligible 28
for RIte Track because of his or her age, may be offered by the managed care provider with whom 29
the family is enrolled, the opportunity to enroll such ineligible child or children in the same 30
managed care program on a self-pay basis at the same cost, charge or premium as is being charged 31
to the state under the provisions of this chapter for other covered children within the managed care 32
program. The family may also purchase a package of enhanced services at the same cost or charge 33
to the department. 34
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SECTION 19. Section 42-12.3-14 of the General Laws in Chapter 42-12.3 entitled "Health 1
Care for Children and Pregnant Women" is hereby repealed in its entirety. 2
42-12.3-14. Benefits and coverage -- Exclusion. 3
For as long as the United States Department of Health and Human Services, Health Care 4
Financing Administration Project No. 11-W-0004/1-01 entitled "RIte Care" remains in effect, any 5
health care services provided pursuant to this chapter shall be exempt from all mandatory benefits 6
and coverage as may otherwise be provided for in the general laws. 7
SECTION 20. Sections 42-14.5-2 and 42-14.5-3 of the General Laws in Chapter 42-14.5 8
entitled "The Rhode Island Health Care Reform Act of 2004 - Health Insurance Oversight" are 9
hereby amended to read as follows: 10
42-14.5-2. Purpose. 11
With respect to health insurance as defined in § 42-14-5, the health insurance commissioner 12
shall discharge the powers and duties of office to: 13
(1) Claw back excessive profits, reserves charges, and other monies that health insurers 14
may have accumulated against the public interest of the people of Rhode Island Guard the solvency 15
of health insurers; 16
(2) Protect the interests of consumers; 17
(3) Encourage fair treatment of health care providers; 18
(4) Encourage policies and developments that improve the quality and efficiency of health 19
care service delivery and outcomes; and 20
(5) View the health care system as a comprehensive entity and encourage and direct 21
insurers towards policies that advance the welfare of the public through overall efficiency, 22
improved health care quality, and appropriate access; and 23
(6) Facilitate the transformation of the health care payments system to a state-level 24
Medicare-for-All system. 25
42-14.5-3. Powers and duties. 26
The health insurance commissioner shall have the following powers and duties: 27
(a) To conduct quarterly public meetings throughout the state, separate and distinct from 28
rate hearings pursuant to § 42-62-13, regarding the rates, services, and operations of insurers 29
licensed to provide health insurance in the state; the effects of such rates, services, and operations 30
on consumers, medical care providers, patients, and the market environment in which the insurers 31
operate; and efforts to bring new health insurers into the Rhode Island market. Notice of not less 32
than ten (10) days of the hearing(s) shall go to the general assembly, the governor, the Rhode Island 33
Medical Society, the Hospital Association of Rhode Island, the director of health, the attorney 34
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general, and the chambers of commerce. Public notice shall be posted on the department’s website 1
and given in the newspaper of general circulation, and to any entity in writing requesting notice. 2
(b) To make recommendations to the governor and the house of representatives and senate 3
finance committees regarding healthcare insurance and the regulations, rates, services, 4
administrative expenses, reserve requirements, and operations of insurers providing health 5
insurance in the state, and to prepare or comment on, upon the request of the governor or 6
chairpersons of the house or senate finance committees, draft legislation to improve the regulation 7
of health insurance. In making the recommendations, the commissioner shall recognize that it is 8
the intent of the legislature that the maximum disclosure be provided regarding the reasonableness 9
of individual administrative expenditures as well as total administrative costs. The commissioner 10
shall make recommendations on the levels of reserves, including consideration of: targeted reserve 11
levels; trends in the increase or decrease of reserve levels; and insurer plans for distributing excess 12
reserves. 13
(c) To establish a consumer/business/labor/medical advisory council to obtain information 14
and present concerns of consumers, business, and medical providers affected by health insurance 15
decisions. The council shall develop proposals to allow the market for small business health 16
insurance to be affordable and fairer. The council shall be involved in the planning and conduct of 17
the quarterly public meetings in accordance with subsection (a). The advisory council shall develop 18
measures to inform small businesses of an insurance complaint process to ensure that small 19
businesses that experience rate increases in a given year may request and receive a formal review 20
by the department. The advisory council shall assess views of the health provider community 21
relative to insurance rates of reimbursement, billing, and reimbursement procedures, and the 22
insurers’ role in promoting efficient and high-quality health care. The advisory council shall issue 23
an annual report of findings and recommendations to the governor and the general assembly and 24
present its findings at hearings before the house and senate finance committees. The advisory 25
council is to be diverse in interests and shall include representatives of community consumer 26
organizations; small businesses, other than those involved in the sale of insurance products; and 27
hospital, medical, and other health provider organizations. Such representatives shall be nominated 28
by their respective organizations. The advisory council shall be co-chaired by the health insurance 29
commissioner and a community consumer organization or small business member to be elected by 30
the full advisory council. 31
(d) To establish and provide guidance and assistance to a subcommittee (“the professional-32
provider-health-plan work group”) of the advisory council created pursuant to subsection (c), 33
composed of healthcare providers and Rhode Island licensed health plans. This subcommittee The 34
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health insurance commissioner shall include provide in its an annual report and presentation before 1
the house and senate finance committees the following information: 2
(1) A method whereby health plans shall disclose to contracted providers the fee schedules 3
used to provide payment to those providers for services rendered to covered patients; 4
(2) A standardized provider application and credentials verification process, for the 5
purpose of verifying professional qualifications of participating healthcare providers; 6
(3) The uniform health plan claim form utilized by participating providers; 7
(4) Methods for health maintenance organizations, as defined by § 27-41-2, and nonprofit 8
hospital or medical-service corporations, as defined by chapters 19 and 20 of title 27, to make 9
facility-specific data and other medical service-specific data available in reasonably consistent 10
formats to patients regarding quality and costs. This information would help consumers make 11
informed choices regarding the facilities and clinicians or physician practices at which to seek care. 12
Among the items considered would be the unique health services and other public goods provided 13
by facilities and clinicians or physician practices in establishing the most appropriate cost 14
comparisons; 15
(5) All activities related to contractual disclosure to participating providers of the 16
mechanisms for resolving health plan/provider disputes; 17
(6) The uniform process being utilized for confirming, in real time, patient insurance 18
enrollment status, benefits coverage, including co-pays and deductibles; 19
(7) Information related to temporary credentialing of providers seeking to participate in the 20
plan’s network and the impact of the activity on health plan accreditation; 21
(8) The feasibility of regular contract renegotiations between plans and the providers in 22
their networks; and 23
(9) Efforts conducted related to reviewing impact of silent PPOs on physician practices. 24
(e) To enforce the provisions of title 27 and title 42 as set forth in § 42-14-5(d). 25
(f) To provide analysis of the Rhode Island affordable health plan reinsurance fund. The 26
fund shall be used to effectuate the provisions of §§ 27-18.5-9 and 27-50-17. 27
(g) To analyze the impact of changing the rating guidelines and/or merging the individual 28
health insurance market, as defined in chapter 18.5 of title 27, and the small-employer health 29
insurance market, as defined in chapter 50 of title 27, in accordance with the following: 30
(1) The analysis shall forecast the likely rate increases required to effect the changes 31
recommended pursuant to the preceding subsection (g) in the direct-pay market and small-employer 32
health insurance market over the next five (5) years, based on the current rating structure and 33
current products. 34
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(2) The analysis shall include examining the impact of merging the individual and small-1
employer markets on premiums charged to individuals and small-employer groups. 2
(3) The analysis shall include examining the impact on rates in each of the individual and 3
small-employer health insurance markets and the number of insureds in the context of possible 4
changes to the rating guidelines used for small-employer groups, including: community rating 5
principles; expanding small-employer rate bonds beyond the current range; increasing the employer 6
group size in the small-group market; and/or adding rating factors for broker and/or tobacco use. 7
(4) The analysis shall include examining the adequacy of current statutory and regulatory 8
oversight of the rating process and factors employed by the participants in the proposed, new 9
merged market. 10
(5) The analysis shall include assessment of possible reinsurance mechanisms and/or 11
federal high-risk pool structures and funding to support the health insurance market in Rhode Island 12
by reducing the risk of adverse selection and the incremental insurance premiums charged for this 13
risk, and/or by making health insurance affordable for a selected at-risk population. 14
(6) The health insurance commissioner shall work with an insurance market merger task 15
force to assist with the analysis. The task force shall be chaired by the health insurance 16
commissioner and shall include, but not be limited to, representatives of the general assembly, the 17
business community, small-employer carriers as defined in § 27-50-3, carriers offering coverage in 18
the individual market in Rhode Island, health insurance brokers, and members of the general public. 19
(7) For the purposes of conducting this analysis, the commissioner may contract with an 20
outside organization with expertise in fiscal analysis of the private insurance market. In conducting 21
its study, the organization shall, to the extent possible, obtain and use actual health plan data. Said 22
data shall be subject to state and federal laws and regulations governing confidentiality of health 23
care and proprietary information. 24
(8) The task force shall meet as necessary and include its findings in the annual report, and 25
the commissioner shall include the information in the annual presentation before the house and 26
senate finance committees. 27
(h) To establish and convene a workgroup representing healthcare providers and health 28
insurers for the purpose of coordinating the development of processes, guidelines, and standards to 29
streamline healthcare administration that are to be adopted by payors and providers of healthcare 30
services operating in the state. This workgroup shall include representatives with expertise who 31
would contribute to the streamlining of healthcare administration and who are selected from 32
hospitals, physician practices, community behavioral health organizations, each health insurer 33
labor union representing health care workers, and other affected entities. The workgroup shall also 34
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include at least one designee each from the Rhode Island Medical Society, Rhode Island Council 1
of Community Mental Health Organizations, the Rhode Island Health Center Association, and the 2
Hospital Association of Rhode Island. The workgroup shall consider and make recommendations 3
for: 4
(1) Establishing a consistent standard for electronic eligibility and coverage verification. 5
Such standard shall: 6
(i) Include standards for eligibility inquiry and response and, wherever possible, be 7
consistent with the standards adopted by nationally recognized organizations, such as the Centers 8
for Medicare and Medicaid Services; 9
(ii) Enable providers and payors to exchange eligibility requests and responses on a system-10
to-system basis or using a payor-supported web browser; 11
(iii) Provide reasonably detailed information on a consumer’s eligibility for healthcare 12
coverage; scope of benefits; limitations and exclusions provided under that coverage; cost-sharing 13
requirements for specific services at the specific time of the inquiry; current deductible amounts; 14
accumulated or limited benefits; out-of-pocket maximums; any maximum policy amounts; and 15
other information required for the provider to collect the patient’s portion of the bill; 16
(iv) Reflect the necessary limitations imposed on payors by the originator of the eligibility 17
and benefits information; 18
(v) Recommend a standard or common process to protect all providers from the costs of 19
services to patients who are ineligible for insurance coverage in circumstances where a payor 20
provides eligibility verification based on best information available to the payor at the date of the 21
request of eligibility. 22
(2) Developing implementation guidelines and promoting adoption of the guidelines for: 23
(i) The use of the National Correct Coding Initiative code-edit policy by payors and 24
providers in the state; 25
(ii) Publishing any variations from codes and mutually exclusive codes by payors in a 26
manner that makes for simple retrieval and implementation by providers; 27
(iii) Use of Health Insurance Portability and Accountability Act standard group codes, 28
reason codes, and remark codes by payors in electronic remittances sent to providers; 29
(iv) The processing of corrections to claims by providers and payors. 30
(v) A standard payor-denial review process for providers when they request a 31
reconsideration of a denial of a claim that results from differences in clinical edits where no single, 32
common-standards body or process exists and multiple conflicting sources are in use by payors and 33
providers. 34
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(vi) Nothing in this section, nor in the guidelines developed, shall inhibit an individual 1
payor’s ability to employ, and not disclose to providers, temporary code edits for the purpose of 2
detecting and deterring fraudulent billing activities. The guidelines shall require that each payor 3
disclose to the provider its adjudication decision on a claim that was denied or adjusted based on 4
the application of such edits and that the provider have access to the payor’s review and appeal 5
process to challenge the payor’s adjudication decision. 6
(vii) Nothing in this subsection shall be construed to modify the rights or obligations of 7
payors or providers with respect to procedures relating to the investigation, reporting, appeal, or 8
prosecution under applicable law of potentially fraudulent billing activities. 9
(3) Developing and promoting widespread adoption by payors and providers of guidelines 10
to: 11
(i) Ensure payors do not automatically deny claims for services when extenuating 12
circumstances make it impossible for the provider to obtain a preauthorization before services are 13
performed or notify a payor within an appropriate standardized timeline of a patient’s admission; 14
(ii) Require payors to use common and consistent processes and time frames when 15
responding to provider requests for medical management approvals. Whenever possible, such time 16
frames shall be consistent with those established by leading national organizations and be based 17
upon the acuity of the patient’s need for care or treatment. For the purposes of this section, medical 18
management includes prior authorization of services, preauthorization of services, precertification 19
of services, post-service review, medical-necessity review, and benefits advisory; 20
(iii) Develop, maintain, and promote widespread adoption of a single, common website 21
where providers can obtain payors’ preauthorization, benefits advisory, and preadmission 22
requirements; 23
(iv) Establish guidelines for payors to develop and maintain a website that providers can 24
use to request a preauthorization, including a prospective clinical necessity review; receive an 25
authorization number; and transmit an admission notification. 26
(4) To provide a report to the house and senate, on or before January 1, 2017, with 27
recommendations for establishing guidelines and regulations for systems that give patients 28
electronic access to their claims information, particularly to information regarding their obligations 29
to pay for received medical services, pursuant to 45 C.F.R. § 164.524. 30
(i) To issue an anti-cancer medication report. Not later than June 30, 2014, and annually 31
thereafter, the office of the health insurance commissioner (OHIC) shall provide the senate 32
committee on health and human services, and the house committee on corporations, with: (1) 33
Information on the availability in the commercial market of coverage for anti-cancer medication 34
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options; (2) For the state employee’s health benefit plan, the costs of various cancer-treatment 1
options; (3) The changes in drug prices over the prior thirty-six (36) months; and (4) Member 2
utilization and cost-sharing expense. 3
(j) To monitor the adequacy of each health plan’s compliance with the provisions of the 4
federal Mental Health Parity Act, including a review of related claims processing and 5
reimbursement procedures. Findings, recommendations, and assessments shall be made available 6
to the public. 7
(k) To monitor the prevent by regulation transition from fee-for-service and toward global 8
and other alternative payment methodologies for the payment for healthcare services that the health 9
insurance commissioner shall deem against the interest of public health. The health insurance 10
commissioner shall have no power to impose, encourage, or in any way incentivize any rate caps, 11
global budgets, episode-based payments, or capitation structures in the payment models utilized in 12
contracts between health insurers and providers. Alternative payment methodologies should be 13
assessed for their likelihood to promote damage access to affordable health insurance care, health 14
outcomes, and performance. 15
(l) To report annually, no later than July 1, 2014, then biannually thereafter, on hospital 16
payment variation, including findings and recommendations, subject to available resources. 17
(m) Notwithstanding any provision of the general or public laws or regulation to the 18
contrary, provide a report with findings and recommendations to the president of the senate and the 19
speaker of the house, on or before April 1, 2014, including, but not limited to, the following 20
information: 21
(1) The impact of the current, mandated healthcare benefits as defined in §§ 27-18-48.1, 22
27-18-60, 27-18-62, 27-18-64, similar provisions in chapters 19, 20 and 41 of title 27, and §§ 27-23
18-3(c), 27-38.2-1 et seq., or others as determined by the commissioner, on the cost of health 24
insurance for fully insured employers, subject to available resources; 25
(2) Current provider and insurer mandates that are unnecessary and/or duplicative due to 26
the existing standards of care and/or delivery of services in the healthcare system; 27
(3) A state-by-state comparison of health insurance mandates and the extent to which 28
Rhode Island mandates exceed other states benefits; and 29
(4) Recommendations for amendments to existing mandated benefits based on the findings 30
in (m)(1), (m)(2), and (m)(3) above. 31
(n) On or before July 1, 2014, the office of the health insurance commissioner, in 32
collaboration with the director of health and lieutenant governor’s office, shall submit a report to 33
the general assembly and the governor to inform the design of accountable care organizations 34
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(ACOs) in Rhode Island as unique structures for comprehensive healthcare delivery and value-1
based payment arrangements, that shall include, but not be limited to: 2
(1) Utilization review; 3
(2) Contracting; and 4
(3) Licensing and regulation. 5
(o) On or before February 3, 2015, the office of the health insurance commissioner shall 6
submit a report to the general assembly and the governor that describes, analyzes, and proposes 7
recommendations to improve compliance of insurers with the provisions of § 27-18-76 with regard 8
to patients with mental health and substance use disorders. 9
(p) To work to ensure the health insurance coverage of behavioral health care under the 10
same terms and conditions as other health care, and to integrate behavioral health parity 11
requirements into the office of the health insurance commissioner insurance oversight and health 12
care transformation efforts. 13
(q) To work with other state agencies to seek delivery system improvements that enhance 14
access to a continuum of mental health and substance use disorder treatment in the state; and 15
integrate that treatment with primary and other medical care to the fullest extent possible. 16
(r) To direct insurers toward policies and practices that address the behavioral health needs 17
of the public and greater integration of physical and behavioral healthcare delivery. 18
(s) The office of the health insurance commissioner shall conduct an analysis of the impact 19
of the provisions of § 27-38.2-1(i) on health insurance premiums and access in Rhode Island and 20
submit a report of its findings to the general assembly on or before June 1, 2023. 21
(t) To undertake the analyses, reports, and studies contained in this section: 22
(1) The office shall hire the necessary staff and prepare a request for proposal for a qualified 23
and competent firm or firms to undertake the following analyses, reports, and studies: 24
(i) The firm shall undertake a comprehensive review of all social and human service 25
programs having a contract with or licensed by the state or any subdivision of the department of 26
children, youth and families (DCYF), the department of behavioral healthcare, developmental 27
disabilities and hospitals (BHDDH), the department of human services (DHS), the department of 28
health (DOH), and Medicaid for the purposes of: 29
(A) Establishing a baseline of the eligibility factors for receiving services; 30
(B) Establishing a baseline of the service offering through each agency for those 31
determined eligible; 32
(C) Establishing a baseline understanding of reimbursement rates for all social and human 33
service programs including rates currently being paid, the date of the last increase, and a proposed 34
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model that the state may use to conduct future studies and analyses; 1
(D) Ensuring accurate and adequate reimbursement to social and human service providers 2
that facilitate the availability of high-quality services to individuals receiving home and 3
community-based long-term services and supports provided by social and human service providers; 4
(E) Ensuring the general assembly is provided accurate financial projections on social and 5
human service program costs, demand for services, and workforce needs to ensure access to entitled 6
beneficiaries and services; 7
(F) Establishing a baseline and determining the relationship between state government and 8
the provider network including functions, responsibilities, and duties; 9
(G) Determining a set of measures and accountability standards to be used by EOHHS and 10
the general assembly to measure the outcomes of the provision of services including budgetary 11
reporting requirements, transparency portals, and other methods; and 12
(H) Reporting the findings of human services analyses and reports to the speaker of the 13
house, senate president, chairs of the house and senate finance committees, chairs of the house and 14
senate health and human services committees, and the governor. 15
(2) The analyses, reports, and studies required pursuant to this section shall be 16
accomplished and published as follows and shall provide: 17
(i) An assessment and detailed reporting on all social and human service program rates to 18
be completed by January 1, 2023, including rates currently being paid and the date of the last 19
increase; 20
(ii) An assessment and detailed reporting on eligibility standards and processes of all 21
mandatory and discretionary social and human service programs to be completed by January 1, 22
2023; 23
(iii) An assessment and detailed reporting on utilization trends from the period of January 24
1, 2017, through December 31, 2021, for social and human service programs to be completed by 25
January 1, 2023; 26
(iv) An assessment and detailed reporting on the structure of the state government as it 27
relates to the provision of services by social and human service providers including eligibility and 28
functions of the provider network to be completed by January 1, 2023; 29
(v) An assessment and detailed reporting on accountability standards for services for social 30
and human service programs to be completed by January 1, 2023; 31
(vi) An assessment and detailed reporting by April 1, 2023, on all professional licensed 32
and unlicensed personnel requirements for established rates for social and human service programs 33
pursuant to a contract or established fee schedule; 34
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(vii) An assessment and reporting on access to social and human service programs, to 1
include any wait lists and length of time on wait lists, in each service category by April 1, 2023; 2
(viii) An assessment and reporting of national and regional Medicaid rates in comparison 3
to Rhode Island social and human service provider rates by April 1, 2023; 4
(ix) An assessment and reporting on usual and customary rates paid by private insurers and 5
private pay for similar social and human service providers, both nationally and regionally, by April 6
1, 2023; and 7
(x) Completion of the development of an assessment and review process that includes the 8
following components: eligibility; scope of services; relationship of social and human service 9
provider and the state; national and regional rate comparisons and accountability standards that 10
result in recommended rate adjustments; and this process shall be completed by September 1, 2023, 11
and conducted biennially hereafter. The biennial rate setting shall be consistent with payment 12
requirements established in § 1902(a)(30)(A) of the Social Security Act, 42 U.S.C. § 13
1396a(a)(30)(A), and all federal and state law, regulations, and quality and safety standards. The 14
results and findings of this process shall be transparent, and public meetings shall be conducted to 15
allow providers, recipients, and other interested parties an opportunity to ask questions and provide 16
comment beginning in September 2023 and biennially thereafter. 17
(3) In fulfillment of the responsibilities defined in subsection (t), the office of the health 18
insurance commissioner shall consult with the Executive Office of Health and Human Services. 19
(u) Annually, each department (namely, EOHHS, DCYF, DOH, DHS, and BHDDH) shall 20
include the corresponding components of the assessment and review (i.e., eligibility; scope of 21
services; relationship of social and human service provider and the state; and national and regional 22
rate comparisons and accountability standards including any changes or substantive issues between 23
biennial reviews) including the recommended rates from the most recent assessment and review 24
with their annual budget submission to the office of management and budget and provide a detailed 25
explanation and impact statement if any rate variances exist between submitted recommended 26
budget and the corresponding recommended rate from the most recent assessment and review 27
process starting October 1, 2023, and biennially thereafter. 28
(v) The general assembly shall appropriate adequate funding as it deems necessary to 29
undertake the analyses, reports, and studies contained in this section relating to the powers and 30
duties of the office of the health insurance commissioner. 31
(w) To approve or deny any compensation of employees of health insurers subject to the 32
laws of the State of Rhode Island in excess of one million dollars ($1,000,000) per employee. 33
(x) To approve or deny any dividends or stock buybacks of health insurers subject to the 34
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laws of the State of Rhode Island. 1
SECTION 20. Section 44-17-1 of the General Laws in Chapter 44-17 entitled "Taxation of 2
Insurance Companies" is hereby amended to read as follows: 3
44-17-1. Companies required to file -- Payment of tax -- Retaliatory rates. 4
(a) Every domestic, foreign, or alien insurance company, mutual association, organization, 5
or other insurer, including any health maintenance organization as defined in § 27-41-2, any 6
medical malpractice insurance joint underwriters association as defined in § 42-14.1-1, any 7
nonprofit dental service corporation as defined in § 27-20.1-2 and any nonprofit hospital or medical 8
service corporation as defined in chapters 19 and 20 of title 27, except companies mentioned in § 9
44-17-6 and organizations defined in § 27-25-1, transacting business in this state, shall, on or before 10
April 15 in each year, file with the tax administrator, in the form that he or she may prescribe, a 11
return under oath or affirmation signed by a duly authorized officer or agent of the company, 12
containing information that may be deemed necessary for the determination of the tax imposed by 13
this chapter, and shall at the same time pay an annual tax to the tax administrator of two percent 14
(2%) three percent (3%) of the gross premiums on contracts of insurance, except for ocean marine 15
insurance as referred to in § 44-17-6, covering property and risks within the state, written during 16
the calendar year ending December 31st next preceding. 17
(b) Qualifying insurers for purposes of this section means every domestic, foreign, or alien 18
insurance company, mutual association, organization, or other insurer and excludes: 19
(1) Health maintenance organizations, as defined in § 27-41-2; 20
(2) Nonprofit dental service corporations, as defined in § 27-20.1-2; and 21
(3) Nonprofit hospital or medical service corporations, as defined in §§ 27-19-1 and 27-22
20-1. 23
(c) For tax years 2018 and thereafter, the rate of taxation may be reduced as set forth below 24
and, if so reduced, shall be fully applicable to qualifying insurers instead of the two percent (2%) 25
rate listed in subsection (a). In the case of foreign or alien companies, except as provided in § 27-26
2-17(d), the tax shall not be less in amount than is imposed by the laws of the state or country under 27
which the companies are organized upon like companies incorporated in this state or upon its 28
agents, if doing business to the same extent in the state or country. The tax rate shall not be reduced 29
for gross premiums written on contracts of health insurance as defined in § 42-14-5(c) but shall 30
remain at two percent (2%) three percent (3%) or the appropriate retaliatory tax rate, whichever is 31
higher. 32
(d) For qualifying insurers, the premium tax rate may be decreased based upon Rhode 33
Island jobs added by the industry as detailed below: 34
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(1) A committee shall be established for the purpose of implementing tax rates using the 1
framework established herein. The committee shall be comprised of the following persons or their 2
designees: the secretary of commerce, the director of the department of business regulation, the 3
director of the department of revenue, and the director of the office of management and budget. No 4
rule may be issued pursuant to this section without the prior, unanimous approval of the committee; 5
(2) On the timetable listed below, the committee shall determine whether qualifying 6
insurers have added new qualifying jobs in this state in the preceding calendar year. A qualifying 7
job for purposes of this section is any employee with total annual wages equal to or greater than 8
forty percent (40%) of the average annual wages of the Rhode Island insurance industry, as 9
published by the annual employment and wages report of the Rhode Island department of labor and 10
training, in NAICS code 5241; 11
(3) If the committee determines that there has been a sufficient net increase in qualifying 12
jobs in the preceding calendar year(s) to offset a material reduction in the premium tax, it shall 13
calculate a reduced premium tax rate. Such rate shall be determined via a method selected by the 14
committee and designed such that the estimated personal income tax generated by the increase in 15
qualifying jobs is at least one hundred and twenty-five percent (125%) of the anticipated reduction 16
in premium tax receipts resulting from the new rate. For purposes of this calculation, the committee 17
may consider personal income tax withholdings or receipts, but in no event may the committee 18
include for the purposes of determining revenue neutrality income taxes that are subject to 19
segregation pursuant to § 44-48.3-8(f) or that are otherwise available to the general fund; 20
(4) Any reduced rate established pursuant to this section must be established in a 21
rulemaking proceeding pursuant to chapter 35 of title 42, subject to the following conditions: 22
(i) Any net increase in qualifying jobs and the resultant premium tax reduction and revenue 23
impact shall be determined in any rulemaking proceeding conducted under this section and shall 24
be set forth in a report included in the rulemaking record, which report shall also include a 25
description of the data sources and calculation methods used. The first such report shall also include 26
a calculation of the baseline level of employment of qualifying insurers for the calendar year 2015; 27
and 28
(ii) Notwithstanding any provision of the law to the contrary, no rule changing the tax rate 29
shall take effect until one hundred and twenty (120) days after notice of the rate change is provided 30
to the speaker of the house, the president of the senate, the house and senate fiscal advisors, and 31
the auditor general, which notice shall include the report required under the preceding provision. 32
(5) For each of the first three (3) rulemaking proceedings required under this section, the 33
tax rate may remain unchanged or be decreased consistent with the requirements of this section, 34
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but may not be increased. These first three (3) rulemaking proceedings shall be conducted by the 1
division of taxation and occur in the following manner: 2
(i) The first rulemaking proceeding shall take place in calendar year 2017. This proceeding 3
shall establish a rule that sets forth: (A) A new premium tax rate, if allowed under the requirements 4
of this section, which rate shall take effect in 2018, and (B) A method for calculating the number 5
of jobs at qualifying insurers; 6
(ii) The second rulemaking proceeding shall take place in calendar year 2018. This 7
proceeding shall establish a rule that sets forth: (A) A new premium tax rate, if allowed under the 8
requirements of this section, which rate shall take effect in 2019, and (B) The changes, if any, to 9
the method for calculating the number of jobs at qualifying insurers; and 10
(iii) The third rulemaking proceeding shall take place in calendar year 2019. This 11
proceeding shall establish a rule that sets forth: (A) A new premium tax rate, if allowed under the 12
requirements of this section, which rate shall take effect in 2020, and (B) The changes, if any, to 13
the method for calculating the number of jobs at qualifying insurers. 14
(6) The tax rate established in the regulation following regulatory proceedings that take 15
place in 2019 shall remain in effect through and including 2023. In calendar year 2023, the 16
department of business regulation will conduct a rulemaking proceeding and issue a rule that sets 17
forth: (A) A new premium tax rate, if allowed under the requirements of this section, which rate 18
shall take effect in 2024, and (B) The changes, if any, to the method for calculating the number of 19
jobs at qualifying insurers. A rule issued by the department of business regulation may decrease 20
the tax rate if the requirements for a rate reduction contained in this section are met, or it may 21
increase the tax rate to the extent necessary to achieve the overall revenue level sought when the 22
then-existing tax rate was established. Any rate established shall be no lower than one percent (1%) 23
and no higher than two percent (2%). This proceeding shall be repeated every three (3) calendar 24
years thereafter, however, the base for determination of job increases or decreases shall remain the 25
number of jobs existing during calendar year 2022; 26
(7) No reduction in the premium tax rate pursuant to this section shall be allowed absent a 27
determination that qualifying insurers have added in this state at least three hundred fifty (350) 28
new, full-time, qualifying jobs above the baseline level of employment of qualifying insurers for 29
the calendar year 2015; 30
(8) Notwithstanding any provision of this section to the contrary, the premium tax rate shall 31
never be set lower than one percent (1%); 32
(9) The division of taxation may adopt implementation guidelines, directives, criteria, rules 33
and regulations pursuant to chapter 35 of title 42 as are necessary to implement this section; and 34
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(10) The calculation of revenue impacts under this section is at the sole discretion of the 1
committee established under subsection (d)(1). Notwithstanding any provision of law to the 2
contrary, any administrative action or rule setting a tax rate pursuant to this section or failing or 3
declining to alter a tax rate pursuant to this section shall not be subject to judicial review under 4
chapter 35 of title 42. 5
(d) The department of revenue shall calculate the impacts of changes made to Medicaid 6
taking effect in fiscal year two thousand twenty three (FY2023) on state funds, excluding increased 7
federal reimbursements, hereinafter the "FY23 Medicaid adjustment." Should the Medicaid 8
adjustment exceed the revenue impact of raising the gross premiums tax rate from two percent (2%) 9
to three percent (3%), hereinafter the "insurance premium tax rate adjustment revenue bonus" 10
surtax shall be imposed on gross premiums written on contracts of health insurance as defined in § 11
42-14-5(c) at the rate that shall raise aggregate revenue equal to the Medicaid adjustment minus 12
the insurance premium tax rate adjustment revenue bonus. 13
SECTION 21. Section 44-51-3 of the General Laws in Chapter 44-51 entitled "Nursing 14
Facility Provider Assessment Act" is hereby amended to read as follows: 15
44-51-3. Imposition of assessment -- Nursing facilities. 16
(a) For purposes of this section, a "nursing facility" means a person or governmental unit 17
licensed in accordance with chapter 17 of title 23 to establish, maintain, and operate a nursing 18
facility. 19
(b) An assessment is imposed upon the gross patient revenue received by every nursing 20
facility in each month beginning January 1, 2008, at a rate of five and one-half percent (5.5%) six 21
percent (6%) for services provided on or after January 1, 2008. Every provider shall pay the 22
monthly assessment no later than the twenty-fifth (25th) day of each month following the month of 23
receipt of gross patient revenue. 24
(c) The assessment imposed by this section shall be repealed on the effective date of the 25
repeal or a restricted amendment of those provisions of the Medicaid Voluntary Contribution and 26
Provider-Specific Tax Amendments of 1991 (P.L. 102-234) that permit federal financial 27
participation to match state funds generated by taxes. 28
(d) If, after applying the applicable federal law and/or rules, regulations, or standards 29
relating to health care providers, the tax administrator determines that the assessment rate 30
established in subsection (b) of this section exceeds the maximum rate of assessment that federal 31
law will allow without reduction in federal financial participation, then the tax administrator is 32
directed to reduce the assessment to a rate equal to the maximum rate which the federal law will 33
allow without reduction in federal participation. Provided, however, that the authority of the tax 34
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administrator to lower the assessment rate established in subsection (b) of this section shall be 1
limited solely to such determination. 2
(e) In order that the tax administrator may properly carry out his/her responsibilities under 3
this section, the director of the department of human services shall notify the tax administrator of 4
any damages in federal law and/or any rules, regulations, or standards which affect any rates for 5
health care provider assessments. 6
SECTION 22. Title 44 of the General Laws entitled "TAXATION" is hereby amended by 7
adding thereto the following chapter: 8
CHAPTER 71 9
PRIVATE HEALTH CARE PROVIDERS ASSESSMENT ACT 10
44-71-1. Short title. 11
This chapter shall be known and may be cited as the "Private Health Care Providers 12
Assessment Act." 13
44-71-2. Definitions. 14
Except where the context otherwise requires, the following words and phrases as used in 15
this chapter shall have the following meaning: 16
(1) "Administrator" means the tax administrator. 17
(2) "Assessment" means the assessment imposed upon gross patient revenue pursuant to 18
this chapter. 19
(3) "Eligible provider" means a privately operated health care facility, which is eligible for 20
taxation up to six percent (6%) of gross patient revenue pursuant to 42 CFR 433.68. Nursing 21
facilities taxed pursuant to § 44-51-3 and hospital facilities taxed pursuant to § 23-17-38.1 shall not 22
be considered providers subject to taxation under this chapter. 23
(4) "Gross patient revenue" means the gross amount received on a cash basis by the 24
provider from all patient care services. Charitable contributions, donated goods and services, fund 25
raising proceeds, endowment support, income from meals on wheels, income from investments, 26
and other nonpatient revenues defined by the tax administrator upon the recommendation of the 27
department of human services shall not be considered as "gross patient revenue". 28
(5) "Person" means any individual, corporation, company, association, partnership, joint 29
stock association, and the legal successor thereof. 30
44-71-3. Imposition of assessment. 31
(a) An assessment is imposed upon the gross patient revenue received by every eligible 32
provider in each month beginning July 1, 2023, at a rate of six percent (6%) for services provided 33
on or after July 1, 2023. Every eligible provider shall pay the monthly assessment no later than the 34
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twenty-fifth day of each month following the month of receipt of gross patient revenue. 1
(b) The assessment rate established in subsection (a) of this section shall be reduced by the 2
effective rate of any tax subject to the six percent (6%) limit established pursuant to 42 CFR 433.68 3
imposed on the eligible provider in other chapters of the general laws in order that the total 4
aggregate tax shall be at a rate of six percent (6%). 5
(c) If, after applying the applicable federal law and/or rules, regulations, or standards 6
relating to health care providers, the tax administrator determines that the assessment rate 7
established in subsection (a) of this section exceeds the maximum rate of assessment that federal 8
law will allow without reduction in federal financial participation, then the tax administrator is 9
directed to reduce the assessment to a rate equal to the maximum rate which the federal law will 10
allow without reduction in federal participation. Provided, however, that the authority of the tax 11
administrator to lower the assessment rate established in subsection (a) of this section shall be 12
limited solely to such determination. In order that the tax administrator may properly carry out 13
his/her responsibilities under this section, the director of the department of human services shall 14
notify the tax administrator of any changes in federal law and/or any rules, regulations, or standards 15
which affect any rates for health care provider assessments. 16
44-71-4. Returns. 17
(a) Every eligible provider shall on or before the twenty-fifth day of the month following 18
the month of receipt of gross patient revenue make a return to the tax administrator. 19
(b) The tax administrator shall adopt rules, pursuant to this chapter, relative to the form of 20
the return and the data which it must contain for the correct computation of gross patient revenue 21
and the assessment upon that amount. All returns shall be signed by the eligible provider or by its 22
authorized representative, subject to the pains and penalties of perjury. If a return shows an 23
overpayment of the assessment due, the tax administrator shall refund or credit the overpayment to 24
the eligible provider. 25
(c) For good cause, the tax administrator may extend the time within which an eligible 26
provider is required to file a return, and if the return is filed during the period of extension, no 27
penalty or late filing charge may be imposed for failure to file the return at the time required by this 28
chapter, but the provider may be liable for interest as prescribed in this chapter. Failure to file the 29
return during the period for the extension shall void the extension. 30
44-71-5. Set-off for delinquent assessments. 31
If an eligible provider shall fail to pay an assessment within thirty (30) days of its due date, 32
the tax administrator may request any agency of state government making payments to the eligible 33
provider to set off the amount of the delinquency against any payment due the provider from the 34
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agency of state government and remit the sum to the tax administrator. Upon receipt of the set off 1
request from the tax administrator, any agency of state government is authorized and empowered 2
to set off the amount of the delinquency against any payment or amounts due the eligible provider. 3
The amount of set-off shall be credited against the assessment due from the eligible provider. 4
44-71-6. Assessment on available information -- Interest on delinquencies -- Penalties 5
-- Collection powers. 6
If any eligible provider shall fail to file a return within the time required by this chapter, or 7
shall file an insufficient or incorrect return, or shall not pay the assessment imposed by this chapter 8
when it is due, the tax administrator shall assess upon the information as may be available, which 9
shall be payable upon demand and shall bear interest at the annual rate provided by § 44-1-7 from 10
the date when the assessment should have been paid. If any part of the assessment made is due to 11
negligence or intentional disregard of the provisions of this chapter, a penalty of ten percent (10%) 12
of the amount of the determination shall be added to the assessment. The tax administrator shall 13
collect the assessment with interest in the same manner and with the same powers as are prescribed 14
for collection of taxes in this title. 15
44-71-7. Claims for refund -- Hearing upon denial. 16
(a) Any eligible provider subject to the provisions of this chapter may file a claim for refund 17
with the tax administrator at any time within two (2) years after the assessment has been paid. If 18
the tax administrator shall determine that the assessment has been overpaid, he or she shall make a 19
refund with interest from the date of overpayment. 20
(b) Any eligible provider whose claim for refund has been denied may, within thirty (30) 21
days from the date of the mailing by the tax administrator of the notice of the decision, request a 22
hearing and the tax administrator shall, as soon as practicable, set a time and place for the hearing 23
and shall notify the eligible provider. 24
44-71-8. Hearing by administrator on application. 25
Any eligible provider aggrieved by the action of the tax administrator in determining the 26
amount of any assessment or penalty imposed under the provisions of this chapter may apply to the 27
tax administrator, in writing, within thirty (30) days after the notice of the action is mailed to it, for 28
a hearing relative to the assessment or penalty. The tax administrator shall fix a time and place for 29
the hearing and shall notify the provider. Upon the hearing, the tax administrator shall correct 30
manifest errors, if any, disclosed at the hearing and assess and collect the amount lawfully due 31
together with any penalty or interest. 32
44-71-9. Appeals. 33
Appeals from administrative orders or decisions made pursuant to any provisions of this 34
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chapter shall be to the sixth division district court pursuant to §§ 8-8-24 through 8-8-29. The eligible 1
provider's right to appeal under this section shall be expressly made conditional upon prepayment 2
of all assessments, interest, and penalties unless the provider moves for and is granted an exemption 3
from the prepayment requirement pursuant to § 8-8-26. If the court, after appeal, holds that the 4
eligible provider is entitled to a refund, the eligible provider shall also be paid interest on the amount 5
at the rate provided in § 44-1-7.1. 6
44-71-10. Eligible provider records. 7
Every eligible provider shall: 8
(1) Keep records as may be necessary to determine the amount of its liability under this 9
chapter. 10
(2) Preserve those records for the period of three (3) years following the date of filing of 11
any return required by this chapter, or until any litigation or prosecution under this chapter is finally 12
determined. 13
(3) Make those records available for inspection by the tax administrator or the 14
administrator's authorized agents, upon demand, at reasonable times during regular business hours. 15
44-71-11. Method of payment and deposit of assessment. 16
(a) The payments required by this chapter may be made by electronic transfer of monies to 17
the general treasurer and deposited to the general fund. 18
(b) The general treasurer is authorized to establish an account or accounts and to take all 19
steps necessary to facilitate the electronic transfer of monies. The general treasurer shall provide 20
the tax administrator with a record of any monies transferred and deposited. 21
44-71-12. Rules and regulations. 22
The tax administrator shall make and promulgate rules, regulations, and procedures not 23
inconsistent with state law and fiscal procedures as the tax administrator deems necessary for the 24
proper administration of this chapter and to implement the provisions, policy, and purposes of this 25
chapter. 26
44-71-13. Release of assessment information. 27
Notwithstanding any other provisions of the general laws, the tax administrator shall not 28
be prohibited from providing assessment information to the director of the department of human 29
services or his or her designee, with respect to the assessment imposed by this chapter; provided 30
that, the director of human services and the director's agents and employees may use or disclose 31
that information only for purposes directly connected with the administration of the duties and 32
programs of the department of human services. 33
44-71-14. Severability. 34
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If any provision of this chapter or the application of this chapter to any person or 1
circumstances is held invalid, that invalidity shall not affect other provisions or applications of the 2
chapter which can be given effect without the invalid provision or application, and to this end the 3
provisions of this chapter are declared to be severable. 4
SECTION 23. Relating to Capital Development Programs - Statewide Referendum. 5
Section 1. Proposition to be submitted to the people. -- At the general election to be held 6
on the Tuesday next after the first Monday in November, 2024, there shall be submitted to the 7
people of the State of Rhode Island, for their approval or rejection, the following proposition: 8
"Shall the action of the general assembly, by an act passed at the January 2023 session, 9
authorizing the issuance of a bond, refunding bond, and/or temporary note of the State of Rhode 10
Island for the local capital projects and in the total amount with respect to the projects listed below 11
be approved, and the issuance of a bond, refunding bond, and/or temporary note authorized in 12
accordance with the provisions of said act? 13
Funding 14
The bond, refunding bond and/or temporary note shall be allocated to the Medicaid office 15
for oversight of the funds. 16
Project 17
(1) Group homes, assisted living facilities, and recovery beds $300,000,000 18
Approval of this question will allow the State of Rhode Island to issue general obligation 19
bonds, refunding bonds, and/or temporary notes in an amount not to exceed three hundred million 20
dollars ($300,000,000) for expansion of and investment in Rhode Island Community Living and 21
Supports. One hundred million dollars ($100,000,000) shall be allocated for investment in and 22
expansion of state group homes operated by Rhode Island Community Living and Supports. One 23
hundred million dollars ($100,000,000) shall be allocated for the construction of assisted living-24
level care facilities for people with mental illnesses and developmental disabilities operated by 25
Rhode Island Community Living and Supports for persons who are eligible for Medicaid. One 26
hundred million dollars ($100,000,000) shall be allocated for the construction of inpatient recovery 27
facilities operated by Rhode Island Community Living and Supports for persons who are eligible 28
for Medicaid and suffering from substance abuse issues in need of inpatient recovery services. 29
None of these funds may be allocated to private facilities. 30
(2) Hospital facilities expansion $50,000,000 31
Approval of this question will allow the State of Rhode Island to issue general obligation 32
bonds, refunding bonds, and/or temporary notes in an amount not to exceed fifty million dollars 33
($50,000,000) for the improvement of state operated hospital facilities. 34
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(3) University of Rhode Island Medical School $500,000,000 1
Approval of this question will allow the State of Rhode Island to issue a general obligation 2
bond, refunding bond, and/or temporary note in an amount not to exceed five hundred million 3
dollars ($500,000,000) for the construction of a medical school at the University of Rhode Island. 4
The Medicaid office shall work with the University of Rhode Island Medical School to establish a 5
reasonable annual contribution to fund the debt service on this bond from tuition revenue. While 6
these contributions shall continue until the entire debt service costs are paid, the Medicaid office 7
may allow for an amortization schedule that lasts for up to fifty (50) years." 8
Section 2. Ballot labels and applicability of general election laws. -- The secretary of state 9
shall prepare and deliver to the state board of elections ballot labels for each of the projects provided 10
for in Section 1 hereof with the designations "approve" or "reject" provided next to the description 11
of each such project to enable voters to approve or reject each such proposition. The general 12
election laws, so far as consistent herewith, shall apply to this proposition. 13
Section 3. Approval of projects by people. -- If a majority of the people voting on the 14
proposition in Section 1 hereof shall vote to approve any project stated therein, said project shall 15
be deemed to be approved by the people. The authority to issue bonds, refunding bonds and/or 16
temporary notes of the state shall be limited to the aggregate amount for all such projects as set 17
forth in the proposition, which have been approved by the people. 18
Section 4. Bonds for capital development program. -- The general treasurer is hereby 19
authorized and empowered, with the approval of the governor, and in accordance with the 20
provisions of this act to issue capital development bonds in serial form, in the name of and on behalf 21
of the State of Rhode Island, in amounts as may be specified by the governor in an aggregate 22
principal amount not to exceed the total amount for all projects approved by the people and 23
designated as "capital development loan of 2024 bonds." Provided, however, that the aggregate 24
principal amount of such capital development bonds and of any temporary notes outstanding at any 25
one time issued in anticipation thereof pursuant to Section 7 hereof shall not exceed the total amount 26
for all such projects approved by the people. All provisions in this act relating to "bonds" shall also 27
be deemed to apply to "refunding bonds." 28
Capital development bonds issued under this act shall be in denominations of one thousand 29
dollars ($1,000) each, or multiples thereof, and shall be payable in any coin or currency of the 30
United States which at the time of payment shall be legal tender for public and private debts. 31
These capital development bonds shall bear such date or dates, mature at specified time or 32
times, but not mature beyond the end of the twentieth state fiscal year following the fiscal year in 33
which they are issued; bear interest payable semi-annually at a specified rate or different or varying 34
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rates; be payable at designated time or times at specified place or places; be subject to express terms 1
of redemption or recall, with or without premium; be in a form, with or without interest coupons 2
attached; carry such registration, conversion, reconversion, transfer, debt retirement, acceleration 3
and other provisions as may be fixed by the general treasurer, with the approval of the governor, 4
upon each issue of such capital development bonds at the time of each issue. Whenever the 5
governor shall approve the issuance of such capital development bonds, the governor's approval 6
shall be certified to the secretary of state; the bonds shall be signed by the general treasurer and 7
countersigned by the secretary of state and shall bear the seal of the state. The signature approval 8
of the governor shall be endorsed on each bond. 9
Section 5. Refunding bonds for 2024 capital development program. -- The general treasurer 10
is hereby authorized and empowered, with the approval of the governor, and in accordance with 11
the provisions of this act, to issue bonds to refund the 2024 capital development program bonds, in 12
the name of and on behalf of the state, in amounts as may be specified by the governor in an 13
aggregate principal amount not to exceed the total amount approved by the people, to be designated 14
as "capital development program loan of 2024 refunding bonds" (hereinafter "refunding bonds"). 15
The general treasurer with the approval of the governor shall fix the terms and form of any 16
refunding bonds issued under this act in the same manner as the capital development bonds issued 17
under this act, except that the refunding bonds may not mature more than twenty (20) years from 18
the date of original issue of the capital development bonds being refunded. The proceeds of the 19
refunding bonds, exclusive of any premium and accrual interest and net the underwriters' cost, and 20
cost of bond insurance, shall, upon their receipt, be paid by the general treasurer immediately to 21
the paying agent for the capital development bonds which are to be called and prepaid. The paying 22
agent shall hold the refunding bond proceeds in trust until they are applied to prepay the capital 23
development bonds. While the proceeds are held in trust, the proceeds may be invested for the 24
benefit of the state in obligations of the United States of America or the State of Rhode Island. 25
If the general treasurer shall deposit with the paying agent for the capital development 26
bonds the proceeds of the refunding bonds, or proceeds from other sources, amounts that, when 27
invested in obligations of the United States or the State of Rhode Island, are sufficient to pay all 28
principal, interest, and premium, if any, on the capital development bonds until these bonds are 29
called for prepayment, then such capital development bonds shall not be considered debts of the 30
State of Rhode Island for any purpose starting from the date of deposit of such monies with the 31
paying agent. The refunding bonds shall continue to be a debt of the state until paid. 32
The term "bond" shall include "note," and the term "refunding bonds" shall include 33
"refunding notes" when used in this act. 34
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Section 6. Proceeds of capital development program. -- The general treasurer is directed to 1
deposit the proceeds from the sale of capital development bonds issued under this act, exclusive of 2
premiums and accrued interest and net the underwriters' cost, and cost of bond insurance, in one or 3
more of the depositories in which the funds of the state may be lawfully kept in special accounts 4
(hereinafter cumulatively referred to as "such capital development bond fund") appropriately 5
designated for each of the projects set forth in Section 1 hereof which shall have been approved by 6
the people to be used for the purpose of paying the cost of all such projects so approved. 7
All monies in the capital development bond fund shall be expended for the purposes 8
specified in the proposition provided for in Section 1 hereof under the direction and supervision of 9
the director of administration (hereinafter referred to as "director"). The director, or designee, shall 10
be vested with all power and authority necessary or incidental to the purposes of this act, including, 11
but not limited to, the following authority: 12
(1) To acquire land or other real property or any interest, estate, or right therein as may be 13
necessary or advantageous to accomplish the purposes of this act; 14
(2) To direct payment for the preparation of any reports, plans and specifications, and 15
relocation expenses and other costs such as for furnishings, equipment designing, inspecting, and 16
engineering, required in connection with the implementation of any projects set forth in Section 1 17
hereof; 18
(3) To direct payment for the costs of construction, rehabilitation, enlargement, provision 19
of service utilities, and razing of facilities, and other improvements to land in connection with the 20
implementation of any projects set forth in Section 1 hereof; and 21
(4) To direct payment for the cost of equipment, supplies, devices, materials, and labor for 22
repair, renovation, or conversion of systems and structures as necessary for the 2023 capital 23
development program bonds or notes hereunder from the proceeds thereof. No funds shall be 24
expended in excess of the amount of the capital development bond fund designated for each project 25
authorized in Section 1 hereof. 26
Section 7. Sale of bonds and notes. --Any bonds or notes issued under the authority of this 27
act shall be sold at not less than the principal amount thereof, in such mode and on such terms and 28
conditions as the general treasurer, with the approval of the governor, shall deem to be in the best 29
interests of the state. 30
Any bonds or notes issued under the provisions of this act and coupons on any capital 31
development bonds, if properly executed by the manual or electronic signatures of officers of the 32
state in office on the date of execution, shall be valid and binding according. to their tenor, 33
notwithstanding that before the delivery thereof and payment therefor, any or all such officers shall 34
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for any reason have ceased to hold office. 1
Section 8. Bonds and notes to be tax exempt and general obligations of the state. -- All 2
bonds and notes issued under the authority of this act shall be exempt from taxation in the state and 3
shall be general obligations of the state, and the full faith and credit of the state is hereby pledged 4
for the due payment of the principal and interest on each of such bonds and notes as the same shall 5
become due. 6
Section 9. Investment of monies in fund. -- All monies in the capital development fund not 7
immediately required for payment pursuant to the provisions of this act may be invested by the 8
investment commission, as established by chapter 10 of title 35, entitled "state investment 9
commission," pursuant to the provisions of such chapter; provided, however, that the securities in 10
which the capital development fund is invested shall remain a part of the capital development fund 11
until exchanged for other securities; and provided further, that the income from investments of the 12
capital development fund shall become a part of the general fund of the state and shall be applied 13
to the payment of debt service charges of the state, unless directed by federal law or regulation to 14
be used for some other purpose, or to the extent necessary, to rebate to the United States treasury 15
any income from investments (including gains from the disposition of investments) of proceeds of 16
bonds or notes to the extent deemed necessary to exempt (in whole or in part) the interest paid on 17
such bonds or notes from federal income taxation. 18
Section 10. Appropriation. -- To the extent the debt service on these bonds is not otherwise 19
provided, a sum sufficient to pay the interest and principal due each year on bonds and notes 20
hereunder is hereby annually appropriated out of any money in the treasury not otherwise 21
appropriated. 22
Section 11. Advances from general fund. -- The general treasurer is authorized, with the 23
approval of the director and the governor, in anticipation of the issuance of bonds or notes under 24
the authority of this act, to advance to the capital development bond fund for the purposes specified 25
in Section 1 hereof, any funds of the state not specifically held for any particular purpose; provided, 26
however, that all advances made to the capital development bond fund shall be returned to the 27
general fund from the capital development bond fund forthwith upon the receipt by the capital 28
development fund of proceeds resulting from the issue of bonds or notes to the extent of such 29
advances. 30
Section 12. Federal assistance and private funds. -- In carrying out this act, the director, or 31
designee, is authorized on behalf of the state, with the approval of the governor, to apply for and 32
accept any federal assistance which may become available for the purpose of this act, whether in 33
the form of a loan or grant or otherwise, to accept the provision of any federal legislation therefor, 34
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to enter into, act and carry out contracts in connection therewith, to act as agent for the federal 1
government in connection therewith, or to designate a subordinate so to act. Where federal 2
assistance is made available, the project shall be carried out in accordance with applicable federal 3
law, the rules and regulations thereunder and the contract or contracts providing for federal 4
assistance, notwithstanding any contrary provisions of state law. Subject to the foregoing, any 5
federal funds received for the purposes of this act shall be deposited in the capital development 6
bond fund and expended as a part thereof. The director or designee may also utilize any private 7
funds that may be made available for the purposes of this act. 8
Section 13. Effective Date. -- Sections 1, 2, 3, 11, 12 and 13 of this act shall take effect 9
upon passage. The remaining sections of this act shall take effect when and if the state board of 10
elections shall certify to the secretary of state that a majority of the qualified electors voting on the 11
proposition contained in Section 1 hereof have indicated their approval of all or any projects 12
thereunder. 13
SECTION 24. Rhode Island Medicaid Reform Act of 2008 Joint Resolution. 14
WHEREAS, The General Assembly enacted chapter 12.4 of title 42 entitled "The Rhode 15
Island Medicaid Reform Act of 2008"; and 16
WHEREAS, A legislative enactment is required pursuant to Rhode Island General Laws 17
chapter 12.4 of title 42; and 18
WHEREAS, Rhode Island General Laws § 42-7.2-5(3)(i) provides that the Secretary of the 19
Executive Office of Health and Human Services ("Executive Office") is responsible for the review 20
and coordination of any Medicaid section 1115 demonstration waiver requests and renewals as well 21
as any initiatives and proposals requiring amendments to the Medicaid state plan or category II or 22
III changes as described in the demonstration, "with potential to affect the scope, amount, or 23
duration of publicly-funded health care services, provider payments or reimbursements, or access 24
to or the availability of benefits and services provided by Rhode Island general and public laws"; 25
and 26
WHEREAS, In pursuit of a more cost-effective consumer choice system of care that is 27
fiscally sound and sustainable, the Secretary requests legislative approval of the following 28
proposals to amend the demonstration; and 29
WHEREAS, Implementation of adjustments may require amendments to Rhode Island's 30
Medicaid state plan and/or section 1115 waiver under the terms and conditions of the 31
demonstration. Further, adoption of new or amended rules, regulations and procedures may also be 32
required: 33
(a) Section 1115 Demonstration Waiver – Extension Request. The Executive Office 34
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proposes to seek approval from the federal Centers for Medicare and Medicaid Services ("CMS") 1
to extend the Medicaid section 1115 demonstration waiver as authorized in Rhode Island General 2
Laws Chapter 12.4 of Title 42. In the Medicaid section 1115 demonstration waiver extension 3
request due to CMS by December 31, 2023 in addition to maintaining existing Medicaid section 4
1115 demonstration waiver authorities, the Executive Office proposes to seek additional federal 5
authorities including, but not limited to, promoting choice and community integration. 6
(b) Raising Hospital Licensing Fee. The Secretary of the Executive Office is authorized to 7
pursue and implement any waiver amendments, state plan amendments, and/or changes to the 8
applicable department’s rules, regulations and procedures required to implement a hospital 9
licensing rate, including but not limited to, a three-tiered hospital licensing rate for non-government 10
owned hospitals and one rate for government-owned and operated hospitals. 11
(c) Raising Nursing Facility Personal Needs Allowance. The Executive Office proposes 12
raising the personal needs allowance for nursing facility residents to two hundred dollars ($200). 13
(d) Medicare Equivalent Rate. The Executive Office proposes raising all Medicaid rates, 14
except for hospital rates, nursing home rates, dental rates, and outpatient behavioral health rates to 15
equal the Medicare equivalent rate. Specific to early intervention services, a fifty dollars ($50.00) 16
per member per month payment shall be established in addition to these rates, and a floor of a fifty 17
percent (50%) rate increase shall be established within the calculation of the Medicare equivalent 18
rate. 19
(e) Setting Outpatient Behavioral Healthcare Rates at one hundred fifty percent (150%) of 20
Medicare Equivalent Rates. The Executive Office proposes to set outpatient behavioral health rates 21
at one hundred fifty percent (150%) of the Medicare equivalent rate. The Executive Office will 22
maximize federal financial participation if and when available, though state-only funds will be used 23
if federal financial participation is not available. 24
(f) Establishing a Nursing Facility Upper Payment Limit Payment. The Executive Office 25
proposes to establish an upper payment limit payment for nursing facilities. 26
(g) FQHC APM Modernization. The Executive Office proposes certain modifications to 27
modernize and standardize the alternative payment methodology option for federally qualified 28
health centers. 29
(h) Hospital Payment Modernization. The Executive Office proposes certain changes to 30
hospital payment rates to modernize payment methodologies to encourage utilization and quality. 31
Inpatient FFS DRG rates will be set at ninety percent (90%) of the Medicare equivalent rate, 32
inpatient non-DRG FFS rates will be established at ninety-five percent (95%) of the Medicare 33
equivalent rate, inpatient managed care rates will be set at one hundred five percent (105%) of FFS 34
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rates, and outpatient rates will be set at one hundred percent (100%) of Medicare rates. 1
(i) RIteShare Freedom of Choice. The Executive Office proposes to make employee 2
participation in the RIteShare program voluntary. 3
(j) Elderly and Disabled Eligibility Expansion. The Executive Office proposes expanding 4
Medicaid eligibility for elderly and disabled residents to one hundred thirty-three percent (133%) 5
of the federal poverty level. 6
(k) Payments Streamlining. The Executive Office proposes a multifaceted initiative to 7
begin the phase-out of intermediary payers such as managed care entities, streamlining payments 8
and reducing wasteful expenditures on intermediary payers. 9
(l) Medicaid Office Expansion. The Executive Office proposes an expansion of Medicaid 10
office staffing to improve administrative capacities. 11
(m) COVID-19 Adjustments to Health System Transformation Project. The Executive 12
Office proposes to eliminate the imposition of downside risk as part of the Health System 13
Transformation Project to protect the solvency of providers in light of the COVID-19 pandemic. 14
(n) Rhode Island Institute for Mental Disease. The Executive Office proposes to construct 15
a new Institution for Mental Disease (IMD) to serve vulnerable Rhode Island residents. The 16
Executive Office seeks a waiver of the IMD exclusion rule similar to that granted to Vermont to 17
allow federal Medicaid reimbursement. 18
(o) Raising Nursing Facility Assessment Rate. The Executive Office proposes to raise the 19
nursing facility assessment rate to six percent (6%). 20
(p) Universal Provider Assessment. Consistent with overall goals of transitioning all 21
services to a model where rates are at the Medicare equivalent rate, the Executive Office proposes 22
to extend the existing nursing facility assessment model to cover all providers eligible for taxation 23
under federal regulations to help defray the costs of the state component. 24
(q) Dental Optimization. The Executive Office proposes to make an array of changes to 25
dental benefits offered under Medicaid. Rates will be the rates utilized in § 27-18-54; § 27-19-30.1; 26
§ 27-20-25.2; and § 27-41-27.2; billing will be extended to teledentistry services, Silver 27
Diamine Fluoride (code D1354), and denture billing (codes D5130, D5140, D5221, D5222, D5213, 28
and D5214); the mobile dentistry encounter rate will be raised to the FQHC rate; and a fifty percent 29
(50%) payment shall be established for undeliverable dentures. 30
(t) Commencement of Inpatient Substance Use Disorder Recovery Bed Federal Billing. 31
The Executive Office proposes to utilize the IMD waiver authority granted in 2019 to begin federal 32
reimbursement billing for inpatient substance use disorder recovery beds, a service that will also 33
see a rate increase pursuant to subsection (d). The Executive Office also proposes a general 34
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obligation bond referendum to fund the necessary capital expenditures associated with the 1
expansion of RICLAS to inpatient substance use disorder recovery services. 2
(u) Coverage of Abortion Services. The Executive Office proposes to end the exclusion of 3
abortion care from covered Medicaid services. The Executive Office will maximize federal 4
financial participation if and when available, though state-only funds will be used if federal 5
financial participation is not available. 6
(v) Transition to State-Level Medicare for All. The Executive Office proposes to begin the 7
process of negotiating the necessary waivers for a transition to a state-level Medicare for All health 8
care payments system for Rhode Island. These waivers shall include the combining of all federal 9
health care funding streams into the system financing including, but not limited to, Medicaid, 10
Medicare, federal health care tax exemptions, and exchange subsides established pursuant to the 11
U.S. Patient Protection and Affordable Care Act of 2010. The Executive Office plans to begin the 12
transition process after the completion of the raising of the Medicaid system to a Medicare standard 13
of care and the associated stabilization of the Rhode Island health care workforce and provider 14
network; provided, however, that the Executive Office, understanding the complexity of the 15
proposed waiver application, reserves the right to begin the waiver negotiation process before the 16
transition of Medicaid to a Medicare standard is complete. The Executive Office shall only proceed 17
with the waiver and transition should waiver conditions be favorable to the state as a whole, in the 18
judgment of the Executive Office. In the event that a full waiver cannot be complete, and health 19
insurers have been acquired by the Medicaid Office due to insolvency and the Medicaid Office's 20
goal of payer system stabilization, the Executive Office is empowered to seek limited waivers for 21
the streamlining and integration of acquired health insurers with the Medicaid system. The 22
Executive Office shall submit the final approved waiver and transition plan to the general assembly 23
for final approval. 24
(w) Federal Financing Opportunities. The Executive Office proposes to review Medicaid 25
requirements and opportunities under the U.S. Patient Protection and Affordable Care Act of 2010 26
(PPACA) and various other recently enacted federal laws and pursue any changes in the Rhode 27
Island Medicaid program that promote service quality, access and cost-effectiveness that may 28
warrant a Medicaid state plan amendment or amendment under the terms and conditions of Rhode 29
Island's section 1115 waiver, its successor, or any extension thereof. Any such actions by the 30
Executive Office shall not have an adverse impact on beneficiaries. 31
Now, therefore, be it: 32
RESOLVED, That the General Assembly hereby approves the proposals stated above in 33
the recitals; and be it further; 34
LC001777 - Page 95 of 96
RESOLVED, That the Secretary of the Executive Office of Health and Human Services is 1
authorized to pursue and implement any waiver amendments, state plan amendments, and/or 2
changes to the applicable department's rules, regulations and procedures approved herein and as 3
authorized by chapter 12.4 of title 42; and be it further; 4
RESOLVED, That this Joint Resolution shall take effect upon passage. 5
SECTION 25. This act shall take effect upon passage; however, the RICHIP program shall 6
not come into operation until the necessary waivers are obtained, and the final financing proposal 7
is approved by the general assembly. 8
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EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO HEALTH AND SAFETY -- COMPREHENSIVE HEALTH INSURANCE
PROGRAM
***
This act would establish a universal, comprehensive, affordable single-payer health care 1
insurance program and help control health care costs, which would be referred to as, "the Rhode 2
Island Comprehensive Health Insurance Program" (RICHIP). The program would be paid for by 3
consolidating government and private payments to multiple insurance carriers into a more 4
economical and efficient improved Medicare-for-all style single-payer program and substituting 5
lower progressive taxes for higher health insurance premiums, co-pays, deductibles and costs due 6
to caps. This program would save Rhode Islanders from the current overly expensive, inefficient 7
and unsustainable multi-payer health insurance system that unnecessarily prevents access to 8
medically necessary health care. 9
This act would take effect upon passage; however, the RICHIP program would not come 10
into operation until the necessary waivers are obtained, and the final financing proposal is approved 11
by the general assembly. 12
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