Rhode Island 2025 Regular Session

Rhode Island Senate Bill S0466 Compare Versions

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

Old	New	Differences
1	1
2	2
3	3
4	4
5	5	2025 -- S 0466
6	6	========
7	7	LC000975
8	8	========
9	9	S T A T E O F R H O D E I S L A N D
10	10	IN GENERAL ASSEMBLY
11	11	JANUARY SESSION, A.D. 2025
12	12	____________
13	13
14	14	A N A C T
15	15	RELATING TO HUMAN SERVICES -- MEDICAL ASSISTANCE
16	16	Introduced By: Senators Thompson, Pearson, Murray, Quezada, Bissaillon, LaMountain,
17	17	and Valverde
18	18	Date Introduced: February 26, 2025
19	19	Referred To: Senate Health & Human Services
20	20
21	21
22	22	It is enacted by the General Assembly as follows:
23	23	SECTION 1. Section 40-8-19 of the General Laws in Chapter 40-8 entitled "Medical 1
24	24	Assistance" is hereby amended to read as follows: 2
25	25	40-8-19. Rates of payment to nursing facilities. 3
26	26	(a) Rate reform. 4
27	27	(1) The rates to be paid by the state to nursing facilities licensed pursuant to chapter 17 of 5
28	28	title 23, and certified to participate in Title XIX of the Social Security Act for services rendered to 6
29	29	Medicaid-eligible residents, shall be reasonable and adequate to meet the costs that must be 7
30	30	incurred by efficiently and economically operated facilities in accordance with 42 U.S.C. § 8
31	31	1396a(a)(13). The executive office of health and human services (“executive office”) shall 9
32	32	promulgate or modify the principles of reimbursement for nursing facilities in effect as of July 1, 10
33	33	2011, to be consistent with the provisions of this section and Title XIX, 42 U.S.C. § 1396 et seq., 11
34	34	of the Social Security Act. 12
35	35	(2) The executive office shall review the current methodology for providing Medicaid 13
36	36	payments to nursing facilities, including other long-term care services providers, and is authorized 14
37	37	to modify the principles of reimbursement to replace the current cost-based methodology rates with 15
38	38	rates based on a price-based methodology revert the principles of reimbursement from the current 16
39	39	price-based methodology back to a cost-based methodology to be paid to all facilities with 17
40	40	recognition of the acuity of patients and the relative Medicaid occupancy, and to include the 18
41	41	following elements to be developed by the executive office: 19
42	42
43	43
44	44	LC000975 - Page 2 of 6
45	45	(i) A direct-care rate adjusted for resident acuity; 1
46	46	(ii) An indirect-care and other direct-care rate comprised of a base per diem for all facilities; 2
47	47	(iii) Revision of rates as necessary based on increases in direct and indirect costs beginning 3
48	48	October 2024 utilizing data from the most recent finalized year of facility cost report. The per diem 4
49	49	rate components deferred in subsections (a)(2)(i) and (a)(2)(ii) of this section shall be adjusted 5
50	50	accordingly to reflect changes in direct and indirect care costs since the previous rate review; 6
51	51	(iv) Application of a fair-rental value system; 7
52	52	(v) Application of a pass-through system; and 8
53	53	(vi) Adjustment of rates by the change in a recognized national nursing home inflation 9
54	54	index to be applied on October 1 of each year, beginning October 1, 2012. This adjustment will not 10
55	55	occur on October 1, 2013, October 1, 2014, or October 1, 2015, but will occur on April 1, 2015. 11
56	56	The adjustment of rates will also not occur on October 1, 2017, October 1, 2018, October 1, 2019, 12
57	57	and October 2022. Effective July 1, 2018, rates paid to nursing facilities from the rates approved 13
58	58	by the Centers for Medicare and Medicaid Services and in effect on October 1, 2017, both fee-for-14
59	59	service and managed care, will be increased by one and one-half percent (1.5%) and further 15
60	60	increased by one percent (1%) on October 1, 2018, and further increased by one percent (1%) on 16
61	61	October 1, 2019. Effective October 1, 2022, rates paid to nursing facilities from the rates approved 17
62	62	by the Centers for Medicare and Medicaid Services and in effect on October 1, 2021, both fee-for-18
63	63	service and managed care, will be increased by three percent (3%). In addition to the annual nursing 19
64	64	home inflation index adjustment, there shall be a base rate staffing adjustment of one-half percent 20
65	65	(0.5%) on October 1, 2021, one percent (1.0%) on October 1, 2022, and one and one-half percent 21
66	66	(1.5%) on October 1, 2023. The inflation index shall be applied without regard for the transition 22
67	67	factors in subsections (b)(1) and (b)(2). For purposes of October 1, 2016, adjustment only, any rate 23
68	68	increase that results from application of the inflation index to subsections (a)(2)(i) and (a)(2)(ii) 24
69	69	shall be dedicated to increase compensation for direct-care workers in the following manner: Not 25
70	70	less than 85% of this aggregate amount shall be expended to fund an increase in wages, benefits, 26
71	71	or related employer costs of direct-care staff of nursing homes. For purposes of this section, direct-27
72	72	care staff shall include registered nurses (RNs), licensed practical nurses (LPNs), certified nursing 28
73	73	assistants (CNAs), certified medical technicians, housekeeping staff, laundry staff, dietary staff, or 29
74	74	other similar employees providing direct-care services; provided, however, that this definition of 30
75	75	direct-care staff shall not include: (i) RNs and LPNs who are classified as “exempt employees” 31
76	76	under the federal Fair Labor Standards Act (29 U.S.C. § 201 et seq.); or (ii) CNAs, certified medical 32
77	77	technicians, RNs, or LPNs who are contracted, or subcontracted, through a third-party vendor or 33
78	78	staffing agency. By July 31, 2017, nursing facilities shall submit to the secretary, or designee, a 34
79	79
80	80
81	81	LC000975 - Page 3 of 6
82	82	certification that they have complied with the provisions of this subsection (a)(2)(vi) with respect 1
83	83	to the inflation index applied on October 1, 2016. Any facility that does not comply with the terms 2
84	84	of such certification shall be subjected to a clawback, paid by the nursing facility to the state, in the 3
85	85	amount of increased reimbursement subject to this provision that was not expended in compliance 4
86	86	with that certification. 5
87	87	(vii) The executive office shall establish an incentive-based add-on or other incentive 6
88	88	mechanism to reward facilities that meet certain performance, quality, or staffing benchmarks, as 7
89	89	determined by the executive office. 8
90	90	(viii) The executive office shall conduct a comprehensive re-array of Medicaid rates every 9
91	91	three (3) years, beginning October 1, 2025. This re-array shall use data from the most recent 10
92	92	finalized cost reports to ensure that reimbursement reflects current direct and indirect care costs, 11
93	93	patient acuity levels, and Medicaid occupancy rates. 12
94	94	(3)(i) Commencing on October 1, 2021, and continuing until October 1, 2025, eighty 13
95	95	percent (80%) of any rate increase that results from application of the inflation index to subsections 14
96	96	(a)(2)(i) and (a)(2)(ii) of this section shall be dedicated to increase compensation for all eligible 15
97	97	direct-care workers in the following manner on October 1, of each year. 16
98	98	(ii) Commencing on October 1, 2025, eighty percent (80%) of any rate increase that results 17
99	99	from application of the inflation index to subsections (a)(2)(i), (a)(2)(ii), and (a)(2)(iii) of this 18
100	100	section shall be dedicated to increase compensation for all eligible direct-care workers in the 19
101	101	following manner on October 1, of each year. 20
102	102	(i)(iii) For purposes of this subsection, compensation increases shall include base salary or 21
103	103	hourly wage increases, benefits, other compensation, and associated payroll tax increases for 22
104	104	eligible direct-care workers. This application of the inflation index shall apply for Medicaid 23
105	105	reimbursement in nursing facilities for both managed care and fee-for-service. For purposes of this 24
106	106	subsection, direct-care staff shall include registered nurses (RNs), licensed practical nurses (LPNs), 25
107	107	certified nursing assistants (CNAs), certified medication technicians, licensed physical therapists, 26
108	108	licensed occupational therapists, licensed speech-language pathologists, mental health workers 27
109	109	who are also certified nurse assistants, physical therapist assistants, housekeeping staff, laundry 28
110	110	staff, dietary staff, or other similar employees providing direct-care services; provided, however 29
111	111	that this definition of direct-care staff shall not include: 30
112	112	(A) RNs and LPNs who are classified as “exempt employees” under the federal Fair Labor 31
113	113	Standards Act (29 U.S.C. § 201 et seq.); or 32
114	114	(B) CNAs, certified medication technicians, RNs, or LPNs who are contracted or 33
115	115	subcontracted through a third-party vendor or staffing agency. 34
116	116
117	117
118	118	LC000975 - Page 4 of 6
119	119	(4)(i) By July 31, 2021, and July 31 of each year thereafter, nursing facilities shall submit 1
120	120	to the secretary or designee a certification that they have complied with the provisions of subsection 2
121	121	(a)(3) of this section with respect to the inflation index applied on October 1. The executive office 3
122	122	of health and human services (EOHHS) shall create the certification form nursing facilities must 4
123	123	complete with information on how each individual eligible employee’s compensation increased, 5
124	124	including information regarding hourly wages prior to the increase and after the compensation 6
125	125	increase, hours paid after the compensation increase, and associated increased payroll taxes. A 7
126	126	collective bargaining agreement can be used in lieu of the certification form for represented 8
127	127	employees. All data reported on the compliance form is subject to review and audit by EOHHS. 9
128	128	The audits may include field or desk audits, and facilities may be required to provide additional 10
129	129	supporting documents including, but not limited to, payroll records. 11
130	130	(ii) Any facility that does not comply with the terms of certification shall be subjected to a 12
131	131	clawback and twenty-five percent (25%) penalty of the unspent or impermissibly spent funds, paid 13
132	132	by the nursing facility to the state, in the amount of increased reimbursement subject to this 14
133	133	provision that was not expended in compliance with that certification. 15
134	134	(iii) In any calendar year where no inflationary index is applied, eighty percent (80%) of 16
135	135	the base rate staffing adjustment in that calendar year pursuant to subsection (a)(2)(vi) of this 17
136	136	section shall be dedicated to increase compensation for all eligible direct-care workers in the 18
137	137	manner referenced in subsections (a)(3)(i), (a)(3)(i)(A), and (a)(3)(i)(B) of this section. 19
138	138	(b) Transition to full implementation of rate reform. For no less than four (4) years after 20
139	139	the initial application of the price-based methodology described in subsection (a)(2) to payment 21
140	140	rates, the executive office of health and human services shall implement a transition plan to 22
141	141	moderate the impact of the rate reform on individual nursing facilities. The transition shall include 23
142	142	the following components: 24
143	143	(1) No nursing facility shall receive reimbursement for direct-care costs that is less than 25
144	144	the rate of reimbursement for direct-care costs received under the methodology in effect at the time 26
145	145	of passage of this act; for the year beginning October 1, 2017, the reimbursement for direct-care 27
146	146	costs under this provision will be phased out in twenty-five-percent (25%) increments each year 28
147	147	until October 1, 2021, when the reimbursement will no longer be in effect; and 29
148	148	(2) No facility shall lose or gain more than five dollars ($5.00) in its total, per diem rate the 30
149	149	first year of the transition. An adjustment to the per diem loss or gain may be phased out by twenty-31
150	150	five percent (25%) each year; except, however, for the years beginning October 1, 2015, there shall 32
151	151	be no adjustment to the per diem gain or loss, but the phase out shall resume thereafter; and 33
152	152	(3) The transition plan and/or period may be modified upon full implementation of facility 34
153	153
154	154
155	155	LC000975 - Page 5 of 6
156	156	per diem rate increases for quality of care-related measures. Said modifications shall be submitted 1
157	157	in a report to the general assembly at least six (6) months prior to implementation. 2
158	158	(4) Notwithstanding any law to the contrary, for the twelve-month (12) period beginning 3
159	159	July 1, 2015, Medicaid payment rates for nursing facilities established pursuant to this section shall 4
160	160	not exceed ninety-eight percent (98%) of the rates in effect on April 1, 2015. Consistent with the 5
161	161	other provisions of this chapter, nothing in this provision shall require the executive office to restore 6
162	162	the rates to those in effect on April 1, 2015, at the end of this twelve-month (12) period. 7
163	163	SECTION 2. This act shall take effect upon passage. 8
164	164	========
165	165	LC000975
166	166	========
167	167
168	168
169	169	LC000975 - Page 6 of 6
170	170	EXPLANATION
171	171	BY THE LEGISLATIVE COUNCIL
172	172	OF
173	173	A N A C T
174	174	RELATING TO HUMAN SERVICES -- MEDICAL ASSISTANCE
175	175	***
176	176	This act would direct the executive office of health and human services (EOHHS) to revert 1
177	177	the principles of reimbursement from the current price-based methodology back to a cost-based 2
178	178	methodology for providing Medicaid payment to Nursing facilities. It would also allow for the 3
179	179	office to establish an incentive-based mechanism to reward facilities that meet certain benchmarks. 4
180	180	This act would take effect upon passage. 5
181	181	========
182	182	LC000975
183	183	========
184	184