Rhode Island 2025 Regular Session

Rhode Island House Bill H6074 Compare Versions

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55 2025 -- H 6074
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99 S T A T E O F R H O D E I S L A N D
1010 IN GENERAL ASSEMBLY
1111 JANUARY SESSION, A.D. 2025
1212 ____________
1313
1414 A N A C T
1515 RELATING TO HUMAN SERVICES -- MEDICAL ASSISTANCE -- LONG-TERM CARE
1616 SERVICE AND FINANCE REFORM
1717 Introduced By: Representatives Shanley, Craven, Edwards, Bennett, Kazarian, Casimiro,
1818 and Batista
1919 Date Introduced: March 12, 2025
2020 Referred To: House Finance
2121
2222
2323 It is enacted by the General Assembly as follows:
2424 SECTION 1. Section 40-8.9-9 of the General Laws in Chapter 40-8.9 entitled "Medical 1
2525 Assistance — Long-Term Care Service and Finance Reform" is hereby amended to read as follows: 2
2626 40-8.9-9. Long-term-care rebalancing system reform goal. 3
2727 (a) Notwithstanding any other provision of state law, the executive office of health and 4
2828 human services is authorized and directed to apply for, and obtain, any necessary waiver(s), waiver 5
2929 amendment(s), and/or state-plan amendments from the Secretary of the United States Department 6
3030 of Health and Human Services, and to promulgate rules necessary to adopt an affirmative plan of 7
3131 program design and implementation that addresses the goal of allocating a minimum of fifty percent 8
3232 (50%) of Medicaid long-term-care funding for persons aged sixty-five (65) and over and adults 9
3333 with disabilities, in addition to services for persons with developmental disabilities, to home- and 10
3434 community-based care; provided, further, the executive office shall report annually as part of its 11
3535 budget submission, the percentage distribution between institutional care and home- and 12
3636 community-based care by population and shall report current and projected waiting lists for long-13
3737 term-care and home- and community-based care services. The executive office is further authorized 14
3838 and directed to prioritize investments in home- and community-based care and to maintain the 15
3939 integrity and financial viability of all current long-term-care services while pursuing this goal. 16
4040 (b) The reformed long-term-care system rebalancing goal is person-centered and 17
4141 encourages individual self-determination, family involvement, interagency collaboration, and 18
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4545 individual choice through the provision of highly specialized and individually tailored home-based 1
4646 services. Additionally, individuals with severe behavioral, physical, or developmental disabilities 2
4747 must have the opportunity to live safe and healthful lives through access to a wide range of 3
4848 supportive services in an array of community-based settings, regardless of the complexity of their 4
4949 medical condition, the severity of their disability, or the challenges of their behavior. Delivery of 5
5050 services and supports in less-costly and less-restrictive community settings will enable children, 6
5151 adolescents, and adults to be able to curtail, delay, or avoid lengthy stays in long-term-care 7
5252 institutions, such as behavioral health residential-treatment facilities, long-term-care hospitals, 8
5353 intermediate-care facilities, and/or skilled nursing facilities. 9
5454 (c) Pursuant to federal authority procured under § 42-7.2-16, the executive office of health 10
5555 and human services is directed and authorized to adopt a tiered set of criteria to be used to determine 11
5656 eligibility for services. The criteria shall be developed in collaboration with the state’s health and 12
5757 human services departments and, to the extent feasible, any consumer group, advisory board, or 13
5858 other entity designated for these purposes, and shall encompass eligibility determinations for long-14
5959 term-care services in nursing facilities, hospitals, and intermediate-care facilities for persons with 15
6060 intellectual disabilities, as well as home- and community-based alternatives, and shall provide a 16
6161 common standard of income eligibility for both institutional and home- and community-based care. 17
6262 The executive office is authorized to adopt clinical and/or functional criteria for admission to a 18
6363 nursing facility, hospital, or intermediate-care facility for persons with intellectual disabilities that 19
6464 are more stringent than those employed for access to home- and community-based services. The 20
6565 executive office is also authorized to promulgate rules that define the frequency of re-assessments 21
6666 for services provided for under this section. Levels of care may be applied in accordance with the 22
6767 following: 23
6868 (1) The executive office shall continue to apply the level-of-care criteria in effect on April 24
6969 1, 2021, for any recipient determined eligible for and receiving Medicaid-funded long-term services 25
7070 and supports in a nursing facility, hospital, or intermediate-care facility for persons with intellectual 26
7171 disabilities on or before that date, unless: 27
7272 (i) The recipient transitions to home- and community-based services because he or she 28
7373 would no longer meet the level-of-care criteria in effect on April 1, 2021; or 29
7474 (ii) The recipient chooses home- and community-based services over the nursing facility, 30
7575 hospital, or intermediate-care facility for persons with intellectual disabilities. For the purposes of 31
7676 this section, a failed community placement, as defined in regulations promulgated by the executive 32
7777 office, shall be considered a condition of clinical eligibility for the highest level of care. The 33
7878 executive office shall confer with the long-term-care ombudsperson with respect to the 34
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8282 determination of a failed placement under the ombudsperson’s jurisdiction. Should any Medicaid 1
8383 recipient eligible for a nursing facility, hospital, or intermediate-care facility for persons with 2
8484 intellectual disabilities as of April 1, 2021, receive a determination of a failed community 3
8585 placement, the recipient shall have access to the highest level of care; furthermore, a recipient who 4
8686 has experienced a failed community placement shall be transitioned back into his or her former 5
8787 nursing home, hospital, or intermediate-care facility for persons with intellectual disabilities 6
8888 whenever possible. Additionally, residents shall only be moved from a nursing home, hospital, or 7
8989 intermediate-care facility for persons with intellectual disabilities in a manner consistent with 8
9090 applicable state and federal laws. 9
9191 (2) Any Medicaid recipient eligible for the highest level of care who voluntarily leaves a 10
9292 nursing home, hospital, or intermediate-care facility for persons with intellectual disabilities shall 11
9393 not be subject to any wait list for home- and community-based services. 12
9494 (3) No nursing home, hospital, or intermediate-care facility for persons with intellectual 13
9595 disabilities shall be denied payment for services rendered to a Medicaid recipient on the grounds 14
9696 that the recipient does not meet level-of-care criteria unless and until the executive office has: 15
9797 (i) Performed an individual assessment of the recipient at issue and provided written notice 16
9898 to the nursing home, hospital, or intermediate-care facility for persons with intellectual disabilities 17
9999 that the recipient does not meet level-of-care criteria; and 18
100100 (ii) The recipient has either appealed that level-of-care determination and been 19
101101 unsuccessful, or any appeal period available to the recipient regarding that level-of-care 20
102102 determination has expired. 21
103103 (d) The executive office is further authorized to consolidate all home- and community-22
104104 based services currently provided pursuant to 42 U.S.C. § 1396n into a single system of home- and 23
105105 community-based services that include options for consumer direction and shared living. The 24
106106 resulting single home- and community-based services system shall replace and supersede all 42 25
107107 U.S.C. § 1396n programs when fully implemented. Notwithstanding the foregoing, the resulting 26
108108 single program home- and community-based services system shall include the continued funding 27
109109 of assisted-living services at any assisted-living facility financed by the Rhode Island housing and 28
110110 mortgage finance corporation prior to January 1, 2006, and shall be in accordance with chapter 66.8 29
111111 of title 42 as long as assisted-living services are a covered Medicaid benefit. 30
112112 (e) The executive office is authorized to promulgate rules that permit certain optional 31
113113 services including, but not limited to, homemaker services, home modifications, respite, and 32
114114 physical therapy evaluations to be offered to persons at risk for Medicaid-funded long-term care 33
115115 subject to availability of state-appropriated funding for these purposes. 34
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119119 (f) To promote the expansion of home- and community-based service capacity, the 1
120120 executive office is authorized to pursue payment methodology reforms that increase access to 2
121121 homemaker, personal care (home health aide), assisted living, adult supportive-care homes, and 3
122122 adult day services, as follows: 4
123123 (1) Development of revised or new Medicaid certification standards that increase access to 5
124124 service specialization and scheduling accommodations by using payment strategies designed to 6
125125 achieve specific quality and health outcomes. 7
126126 (2) Development of Medicaid certification standards for state-authorized providers of adult 8
127127 day services, excluding providers of services authorized under § 40.1-24-1(3), assisted living, and 9
128128 adult supportive care (as defined under chapter 17.24 of title 23) that establish for each, an acuity-10
129129 based, tiered service and payment methodology tied to: licensure authority; level of beneficiary 11
130130 needs; the scope of services and supports provided; and specific quality and outcome measures. As 12
131131 of July 1, 2025, Medicaid certified assisted living residences and adult day service providers shall 13
132132 report to the executive office semi-annually regarding the number of persons served by month and 14
133133 category of certification in the previous six (6) months. 15
134134 The standards for adult day services for persons eligible for Medicaid-funded long-term 16
135135 services may differ from those who do not meet the clinical/functional criteria set forth in § 40-17
136136 8.10-3. 18
137137 (3) As the state’s Medicaid program seeks to assist more beneficiaries requiring long-term 19
138138 services and supports in home- and community-based settings, the demand for home-care workers 20
139139 has increased, and wages for these workers has not kept pace with neighboring states, leading to 21
140140 high turnover and vacancy rates in the state’s home-care industry, the executive office shall institute 22
141141 a one-time increase in the base-payment rates for FY 2019, as described below, for home-care 23
142142 service providers to promote increased access to and an adequate supply of highly trained home-24
143143 healthcare professionals, in amount to be determined by the appropriations process, for the purpose 25
144144 of raising wages for personal care attendants and home health aides to be implemented by such 26
145145 providers. 27
146146 (i) A prospective base adjustment, effective not later than July 1, 2018, of ten percent (10%) 28
147147 of the current base rate for home-care providers, home nursing care providers, and hospice 29
148148 providers contracted with the executive office of health and human services and its subordinate 30
149149 agencies to deliver Medicaid fee-for-service personal care attendant services. 31
150150 (ii) A prospective base adjustment, effective not later than July 1, 2018, of twenty percent 32
151151 (20%) of the current base rate for home-care providers, home nursing care providers, and hospice 33
152152 providers contracted with the executive office of health and human services and its subordinate 34
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156156 agencies to deliver Medicaid fee-for-service skilled nursing and therapeutic services and hospice 1
157157 care. 2
158158 (iii) Effective upon passage of this section, hospice provider reimbursement, exclusively 3
159159 for room and board expenses for individuals residing in a skilled nursing facility, shall revert to the 4
160160 rate methodology in effect on June 30, 2018, and these room and board expenses shall be exempted 5
161161 from any and all annual rate increases to hospice providers as provided for in this section. 6
162162 (iv) On the first of July in each year, beginning on July 1, 2019, the executive office of 7
163163 health and human services will initiate an annual inflation increase to the base rate for home-care 8
164164 providers, home nursing care providers, and hospice providers contracted with the executive office 9
165165 and its subordinate agencies to deliver Medicaid fee-for-service personal care attendant services, 10
166166 skilled nursing and therapeutic services and hospice care. The base rate increase shall be a 11
167167 percentage amount equal to the New England Consumer Price Index card as determined by the 12
168168 United States Department of Labor for medical care and for compliance with all federal and state 13
169169 laws, regulations, and rules, and all national accreditation program requirements. 14
170170 (g) As the state’s Medicaid program seeks to assist more beneficiaries requiring long-term 15
171171 services and supports in home- and community-based settings, the demand for home-care workers 16
172172 has increased, and wages for these workers has not kept pace with neighboring states, leading to 17
173173 high turnover and vacancy rates in the state’s home-care industry. To promote increased access to 18
174174 and an adequate supply of direct-care workers, the executive office shall institute a payment 19
175175 methodology change, in Medicaid fee-for-service and managed care, for FY 2022, that shall be 20
176176 passed through directly to the direct-care workers’ wages who are employed by home nursing care 21
177177 and home-care providers licensed by the Rhode Island department of health, as described below: 22
178178 (1) Effective July 1, 2021, increase the existing shift differential modifier by $0.19 per 23
179179 fifteen (15) minutes for personal care and combined personal care/homemaker. 24
180180 (i) Employers must pass on one hundred percent (100%) of the shift differential modifier 25
181181 increase per fifteen-minute (15) unit of service to the CNAs who rendered such services. This 26
182182 compensation shall be provided in addition to the rate of compensation that the employee was 27
183183 receiving as of June 30, 2021. For an employee hired after June 30, 2021, the agency shall use not 28
184184 less than the lowest compensation paid to an employee of similar functions and duties as of June 29
185185 30, 2021, as the base compensation to which the increase is applied. 30
186186 (ii) Employers must provide to EOHHS an annual compliance statement showing wages 31
187187 as of June 30, 2021, amounts received from the increases outlined herein, and compliance with this 32
188188 section by July 1, 2022. EOHHS may adopt any additional necessary regulations and processes to 33
189189 oversee this subsection. 34
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193193 (2) Effective January 1, 2022, establish a new behavioral healthcare enhancement of $0.39 1
194194 per fifteen (15) minutes for personal care, combined personal care/homemaker, and homemaker 2
195195 only for providers who have at least thirty percent (30%) of their direct-care workers (which 3
196196 includes certified nursing assistants (CNA) and homemakers) certified in behavioral healthcare 4
197197 training. 5
198198 (i) Employers must pass on one hundred percent (100%) of the behavioral healthcare 6
199199 enhancement per fifteen (15) minute unit of service rendered by only those CNAs and homemakers 7
200200 who have completed the thirty (30) hour behavioral health certificate training program offered by 8
201201 Rhode Island College, or a training program that is prospectively determined to be compliant per 9
202202 EOHHS, to those CNAs and homemakers. This compensation shall be provided in addition to the 10
203203 rate of compensation that the employee was receiving as of December 31, 2021. For an employee 11
204204 hired after December 31, 2021, the agency shall use not less than the lowest compensation paid to 12
205205 an employee of similar functions and duties as of December 31, 2021, as the base compensation to 13
206206 which the increase is applied. 14
207207 (ii) By January 1, 2023, employers must provide to EOHHS an annual compliance 15
208208 statement showing wages as of December 31, 2021, amounts received from the increases outlined 16
209209 herein, and compliance with this section, including which behavioral healthcare training programs 17
210210 were utilized. EOHHS may adopt any additional necessary regulations and processes to oversee 18
211211 this subsection. 19
212212 (h) The executive office shall implement a long-term-care-options counseling program to 20
213213 provide individuals, or their representatives, or both, with long-term-care consultations that shall 21
214214 include, at a minimum, information about: long-term-care options, sources, and methods of both 22
215215 public and private payment for long-term-care services and an assessment of an individual’s 23
216216 functional capabilities and opportunities for maximizing independence. Each individual admitted 24
217217 to, or seeking admission to, a long-term-care facility, regardless of the payment source, shall be 25
218218 informed by the facility of the availability of the long-term-care-options counseling program and 26
219219 shall be provided with long-term-care-options consultation if they so request. Each individual who 27
220220 applies for Medicaid long-term-care services shall be provided with a long-term-care consultation. 28
221221 (i) The executive office shall implement, no later than January 1, 2024, a statewide network 29
222222 and rate methodology for conflict-free case management for individuals receiving Medicaid-funded 30
223223 home and community-based services. The executive office shall coordinate implementation with 31
224224 the state’s health and human services departments and divisions authorized to deliver Medicaid-32
225225 funded home and community-based service programs, including the department of behavioral 33
226226 healthcare, developmental disabilities and hospitals; the department of human services; and the 34
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230230 office of healthy aging. It is in the best interest of the Rhode Islanders eligible to receive Medicaid 1
231231 home and community-based services under this chapter, title 40.1, title 42, or any other general 2
232232 laws to provide equitable access to conflict-free case management that shall include person-3
233233 centered planning, service arranging, and quality monitoring in the amount, duration, and scope 4
234234 required by federal law and regulations. It is necessary to ensure that there is a robust network of 5
235235 qualified conflict-free case management entities with the capacity to serve all participants on a 6
236236 statewide basis and in a manner that promotes choice, self-reliance, and community integration. 7
237237 The executive office, as the designated single state Medicaid authority and agency responsible for 8
238238 coordinating policy and planning for health and human services under § 42-7.2-1 et seq., is directed 9
239239 to establish a statewide conflict-free case management network under the management of the 10
240240 executive office and to seek any Medicaid waivers, state plan amendments, and changes in rules, 11
241241 regulations, and procedures that may be necessary to ensure that recipients of Medicaid home and 12
242242 community-based services have access to conflict-free case management in a timely manner and in 13
243243 accordance with the federal requirements that must be met to preserve financial participation. 14
244244 (j) The executive office is also authorized, subject to availability of appropriation of 15
245245 funding, and federal, Medicaid-matching funds, to pay for certain services and supports necessary 16
246246 to transition or divert beneficiaries from institutional or restrictive settings and optimize their health 17
247247 and safety when receiving care in a home or the community. The secretary is authorized to obtain 18
248248 any state plan or waiver authorities required to maximize the federal funds available to support 19
249249 expanded access to home- and community-transition and stabilization services; provided, however, 20
250250 payments shall not exceed an annual or per-person amount. 21
251251 (k) To ensure persons with long-term-care needs who remain living at home have adequate 22
252252 resources to deal with housing maintenance and unanticipated housing-related costs, the secretary 23
253253 is authorized to develop higher implement resource eligibility limits of twelve thousand dollars 24
254254 ($12,000) for single persons or and eighteen thousand dollars ($18,000) for couples and obtain any 25
255255 state plan or waiver authorities necessary to change the financial eligibility criteria for long-term 26
256256 services and supports to enable beneficiaries receiving home and community waiver services to 27
257257 have the resources to continue living in their own homes or rental units or other home-based 28
258258 settings. 29
259259 (l) The executive office shall implement, no later than January 1, 2016, the following home- 30
260260 and community-based service and payment reforms: 31
261261 (1) [Deleted by P.L. 2021, ch. 162, art. 12, § 6.] 32
262262 (2) Adult day services level of need criteria and acuity-based, tiered-payment 33
263263 methodology; and 34
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267267 (3) Payment reforms that encourage home- and community-based providers to provide the 1
268268 specialized services and accommodations beneficiaries need to avoid or delay institutional care. 2
269269 (m) The secretary is authorized to seek any Medicaid section 1115 waiver or state-plan 3
270270 amendments and take any administrative actions necessary to ensure timely adoption of any new 4
271271 or amended rules, regulations, policies, or procedures and any system enhancements or changes, 5
272272 for which appropriations have been authorized, that are necessary to facilitate implementation of 6
273273 the requirements of this section by the dates established. The secretary shall reserve the discretion 7
274274 to exercise the authority established under §§ 42-7.2-5(6)(v) and 42-7.2-6.1, in consultation with 8
275275 the governor, to meet the legislative directives established herein. 9
276276 SECTION 2. This act shall take effect upon passage. 10
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283283 EXPLANATION
284284 BY THE LEGISLATIVE COUNCIL
285285 OF
286286 A N A C T
287287 RELATING TO HUMAN SERVICES -- MEDICAL ASSISTANCE -- LONG-TERM CARE
288288 SERVICE AND FINANCE REFORM
289289 ***
290290 This act would authorize the secretary of the executive office of health and human services 1
291291 (EOHHS) to increase resource eligibility limits for persons with long-term-care needs who reside 2
292292 at home to $12,000 for single persons and $18,000 for couples. The act would also require that 3
293293 Medicaid certified assisted living facilities and adult day service providers furnish semi-annual 4
294294 reports to the EOHHS regarding the number of persons served each month and patients’ 5
295295 certification categories for the prior six months. 6
296296 This act would take effect upon passage. 7
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