Establishes Medicaid fee-for-service reimbursement rates set by the general assembly as the rate floor for Medicaid managed care by home care, home nursing care and hospice providers licensed by the DOH and continue the EEOHH.
Impact
This reform is expected to significantly alter the landscape of long-term care within the state. By prioritizing home and community-based services, the bill seeks to reduce the reliance on institutional settings, thereby facilitating a more person-centered approach to care. The plan includes provisions for tracking funding distribution and maintaining the integrity of current services, while enhancing the financial viability of care providers. It also encourages investments in specialized services tailored to individual needs, aligning with national trends toward deinstitutionalization.
Summary
House Bill 5774 focuses on amending existing regulations surrounding Medicaid and long-term care services in Rhode Island. It establishes a mandate for the executive office of health and human services to apply for necessary waivers and amendments to enhance the allocation of Medicaid funding. The bill aims for at least 50% of Medicaid long-term care funding to be distributed for home- and community-based care, particularly benefitting individuals aged 65 and over as well as those with disabilities. This shift is poised to promote a more integrated and supportive service model emphasizing community living over institutionalization.
Contention
Debate over HB 5774 includes discussions on the adequacy of funding and the capacity of community services to meet increased demands. Supporters argue that the bill will lead to more individualized care and choice for beneficiaries, allowing them to live with dignity in their communities. Conversely, critics raise concerns about potential underfunding and the ability of home care systems to absorb additional complexities, especially in areas such as behavioral health. The bill's impacts on the existing provider ecosystem and workforce shortages in home care settings remain contested points among stakeholders.
All Medicaid programs operated by EOHHS would not reimburse home care providers less than fee-for-service rates adopted by rate review recommendations of the office of health insurance commissioners.
Provides the executive office of health and human services would submit to the US Department of Health and Human Services a state plan to set rates for chiropractic services.
Provides the executive office of health and human services would submit to the US Department of Health and Human Services a state plan to set rates for chiropractic services.
Prohibits contractors and subcontractors from paying employees the cash equivalent of any applicable healthcare benefit in lieu of actually purchasing the healthcare benefit unless the employee is covered under a different healthcare plan.
Includes the definition of "primary care services" and requires that all biennial reports shall include a review and recommendation of rates for primary care services on and after September 1, 2025.
Establishes Medicaid fee-for-service reimbursement rates set by the general assembly as the rate floor for Medicaid managed care by home care, home nursing care and hospice providers licensed by the DOH and continue the EEOHH.
Raises the per diem rate by thirteen percent (13%) for Medicaid reimbursement for Tier C services provide by assisted living residence beginning January 1, 2026.
Authorizes an increase in resource eligibility limits for persons with long-term-care needs who reside at home and requires semi-annual reports from Medicaid certified assisted living facilities and adult day service providers to the EOHHS.
Authorizes an increase in resource eligibility limits for persons with long-term-care needs who reside at home and requires semi-annual reports from Medicaid certified assisted living facilities and adult day service providers to the EOHHS.
Prohibits contractors and subcontractors from paying employees the cash equivalent of any applicable healthcare benefit in lieu of actually purchasing the healthcare benefit unless the employee is covered under a different healthcare plan.
All Medicaid programs operated by EOHHS would not reimburse home care providers less than fee-for-service rates adopted by rate review recommendations of the office of health insurance commissioners.
Provides the executive office of health and human services would submit to the US Department of Health and Human Services a state plan to set rates for chiropractic services.
Provides the executive office of health and human services would submit to the US Department of Health and Human Services a state plan to set rates for chiropractic services.