2025 -- S 0412
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LC001761
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S T A T E O F R H O D E I S L A N D
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2025
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J O I N T R E S O L U T I O N
TO AMEND THE MEDICAID SECTION 1115 DEMONSTRATION WAIVER REQUE STS
AND RENEWALS – RHODE ISLAND MEDICAID REFORM ACT OF 2008
Introduced By: Senators Tikoian, Ciccone, Burke, Lawson, Patalano, Urso, Dimitri,
Rogers, Thompson, and Gu
Date Introduced: February 26, 2025
Referred To: Senate Finance
WHEREAS, The General Assembly enacted Chapter 12.4 of Title 42 entitled “The 1
Rhode Island Medicaid Reform Act of 2008”; and 2
WHEREAS, A legislative enactment is required pursuant to Rhode Island General Laws 3
chapter 12.4 of title 42, et seq.; and 4
WHEREAS, Rhode Island General Laws § 42-7.2-5(3)(i) provides that the secretary of 5
the executive office of health and human services is responsible for the review and coordination 6
of any Medicaid section 1115 demonstration waiver requests and renewals as well as any 7
initiatives and proposals requiring amendments to the Medicaid state plan or category II or III 8
changes as described in the demonstration, “with potential to affect the scope, amount, or 9
duration of publicly-funded health care services, provider payments or reimbursements, or access 10
to or the availability of benefits and services provided by Rhode Island general and public laws”; 11
and 12
WHEREAS, In pursuit of a more cost-effective consumer choice system of care that is 13
fiscally sound and sustainable, the secretary requests legislative approval of the following 14
proposals to amend the demonstration; and 15
WHEREAS, Implementation of adjustments may require amendments to the Rhode 16
Island’s Medicaid state plan and/or section 1115 waiver under the terms and conditions of the 17
demonstration. Further, adoption of new or amended rules, regulations and procedures may also 18
be required: 19
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(1) Nursing facility rate increase alignment with state revenue growth. The executive 1
office of health and human services will pursue and implement any state plan amendments 2
needed to limit rate increases for nursing facilities in Fiscal Year 2025-2026 to the anticipated 3
rate of growth of state tax revenue, estimated to be 2.3 percent. 4
(2) Inpatient and outpatient hospital rate increase alignment with state revenue growth. 5
The executive office of health and human services will pursue and implement any state plan 6
amendments needed to limit rate increases for inpatient and outpatient hospital services in Fiscal 7
Year 2025-2026 to the anticipated rate of growth of state tax revenue, estimated to be 2.3 percent. 8
(3) Home care rates. The secretary of the executive office of health and human services 9
will pursue and implement any state plan amendments needed to eliminate annual rate increases 10
for home care services. 11
(4) Elimination of inpatient and outpatient hospital upper payment limit payments. The 12
secretary of the executive office of health and human services will pursue and implement any 13
state plan amendments needed to eliminate inpatient and outpatient hospital upper payment limit 14
payments. 15
(5) Establishment of interprofessional consultation program. The secretary of the 16
executive office of health and human services will pursue and implement any state plan 17
amendments needed to establish an interprofessional consultation program in Medicaid effective 18
October 1, 2025. 19
(6) Federal financing opportunities. The executive office health and human services 20
proposes that it shall review Medicaid requirements and opportunities under the U.S. Patient 21
Protection and Affordable Care Act of 2010 (PPACA) and various other recently enacted federal 22
laws and pursue any changes in the Rhode Island Medicaid program that promote, increase and 23
enhance service quality, access and cost-effectiveness that may require a Medicaid state plan 24
amendment or amendment under the terms and conditions of Rhode Island’s section 1115 waiver, 25
its successor, or any extension thereof. Any such actions by the executive office of health and 26
human services shall not have an adverse impact on beneficiaries or cause there to be an increase 27
in expenditures beyond the amount appropriated for Fiscal Year 2024-2025. 28
(7) Hospital state directed managed care payment. The secretary of the executive office is 29
hereby authorized and directed to amend its regulations for reimbursement to Medicaid Managed 30
Care Organizations and authorized to direct MMCOs to make quarterly state directed payments to 31
hospitals for inpatient and outpatient services in accordance with the payment methodology 32
contained in the approved Centers for Medicare and Medicaid services preprint for hospital state 33
directed payments. The total amount of these payments for Fiscal Year 2025-2026 shall be $396 34
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million; now, therefore, be it 1
RESOLVED, That the General Assembly hereby approves the above-referenced 2
proposals; and be it further 3
RESOLVED, That the secretary of the executive office of health and human services is 4
authorized to pursue and implement any waiver amendments, state plan amendments, and/or 5
changes to the applicable department’s rules, regulations and procedures approved herein and as 6
authorized by Rhode Island general laws chapter 12.4 of title 42; and be it further 7
RESOLVED, that this Joint Resolution shall take effect on July 1, 2025. 8
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EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
J O I N T R E S O L U T I O N
TO AMEND THE MEDICAID SECTION 1115 DEMONSTRATION WAIVER REQU ESTS
AND RENEWALS – RHODE ISLAND MEDICAID REFORM ACT OF 2008
***
This joint resolution would approve an amendment to the Medicaid section 1115 1
demonstration waiver requests and renewals. 2
This joint resolution would take effect on July 1, 2025. 3
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