Rhode Island 2025 Regular Session

Rhode Island Senate Bill S0696 Compare Versions

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55 2025 -- S 0696
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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: Senators Vargas, DiPalma, and Murray
1818 Date Introduced: March 07, 2025
1919 Referred To: Senate Health & Human Services
2020
2121
2222 It is enacted by the General Assembly as follows:
2323 SECTION 1. Section 40-8.9-9 of the General Laws in Chapter 40-8.9 entitled "Medical 1
2424 Assistance — Long-Term Care Service and Finance Reform" is hereby amended to read as follows: 2
2525 40-8.9-9. Long-term-care rebalancing system reform goal. 3
2626 (a) Notwithstanding any other provision of state law, the executive office of health and 4
2727 human services is authorized and directed to apply for, and obtain, any necessary waiver(s), waiver 5
2828 amendment(s), and/or state-plan amendments from the Secretary of the United States Department 6
2929 of Health and Human Services, and to promulgate rules necessary to adopt an affirmative plan of 7
3030 program design and implementation that addresses the goal of allocating a minimum of fifty percent 8
3131 (50%) of Medicaid long-term-care funding for persons aged sixty-five (65) and over and adults 9
3232 with disabilities, in addition to services for persons with developmental disabilities, to home- and 10
3333 community-based care; provided, further, the executive office shall report annually as part of its 11
3434 budget submission, the percentage distribution between institutional care and home- and 12
3535 community-based care by population and shall report current and projected waiting lists for long-13
3636 term-care and home- and community-based care services. The executive office is further authorized 14
3737 and directed to prioritize investments in home- and community-based care and to maintain the 15
3838 integrity and financial viability of all current long-term-care services while pursuing this goal. 16
3939 (b) The reformed long-term-care system rebalancing goal is person-centered and 17
4040 encourages individual self-determination, family involvement, interagency collaboration, and 18
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4444 individual choice through the provision of highly specialized and individually tailored home-based 1
4545 services. Additionally, individuals with severe behavioral, physical, or developmental disabilities 2
4646 must have the opportunity to live safe and healthful lives through access to a wide range of 3
4747 supportive services in an array of community-based settings, regardless of the complexity of their 4
4848 medical condition, the severity of their disability, or the challenges of their behavior. Delivery of 5
4949 services and supports in less-costly and less-restrictive community settings will enable children, 6
5050 adolescents, and adults to be able to curtail, delay, or avoid lengthy stays in long-term-care 7
5151 institutions, such as behavioral health residential-treatment facilities, long-term-care hospitals, 8
5252 intermediate-care facilities, and/or skilled nursing facilities. 9
5353 (c) Pursuant to federal authority procured under § 42-7.2-16, the executive office of health 10
5454 and human services is directed and authorized to adopt a tiered set of criteria to be used to determine 11
5555 eligibility for services. The criteria shall be developed in collaboration with the state’s health and 12
5656 human services departments and, to the extent feasible, any consumer group, advisory board, or 13
5757 other entity designated for these purposes, and shall encompass eligibility determinations for long-14
5858 term-care services in nursing facilities, hospitals, and intermediate-care facilities for persons with 15
5959 intellectual disabilities, as well as home- and community-based alternatives, and shall provide a 16
6060 common standard of income eligibility for both institutional and home- and community-based care. 17
6161 The executive office is authorized to adopt clinical and/or functional criteria for admission to a 18
6262 nursing facility, hospital, or intermediate-care facility for persons with intellectual disabilities that 19
6363 are more stringent than those employed for access to home- and community-based services. The 20
6464 executive office is also authorized to promulgate rules that define the frequency of re-assessments 21
6565 for services provided for under this section. Levels of care may be applied in accordance with the 22
6666 following: 23
6767 (1) The executive office shall continue to apply the level-of-care criteria in effect on April 24
6868 1, 2021, for any recipient determined eligible for and receiving Medicaid-funded long-term services 25
6969 and supports in a nursing facility, hospital, or intermediate-care facility for persons with intellectual 26
7070 disabilities on or before that date, unless: 27
7171 (i) The recipient transitions to home- and community-based services because he or she 28
7272 would no longer meet the level-of-care criteria in effect on April 1, 2021; or 29
7373 (ii) The recipient chooses home- and community-based services over the nursing facility, 30
7474 hospital, or intermediate-care facility for persons with intellectual disabilities. For the purposes of 31
7575 this section, a failed community placement, as defined in regulations promulgated by the executive 32
7676 office, shall be considered a condition of clinical eligibility for the highest level of care. The 33
7777 executive office shall confer with the long-term-care ombudsperson with respect to the 34
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8181 determination of a failed placement under the ombudsperson’s jurisdiction. Should any Medicaid 1
8282 recipient eligible for a nursing facility, hospital, or intermediate-care facility for persons with 2
8383 intellectual disabilities as of April 1, 2021, receive a determination of a failed community 3
8484 placement, the recipient shall have access to the highest level of care; furthermore, a recipient who 4
8585 has experienced a failed community placement shall be transitioned back into his or her former 5
8686 nursing home, hospital, or intermediate-care facility for persons with intellectual disabilities 6
8787 whenever possible. Additionally, residents shall only be moved from a nursing home, hospital, or 7
8888 intermediate-care facility for persons with intellectual disabilities in a manner consistent with 8
8989 applicable state and federal laws. 9
9090 (2) Any Medicaid recipient eligible for the highest level of care who voluntarily leaves a 10
9191 nursing home, hospital, or intermediate-care facility for persons with intellectual disabilities shall 11
9292 not be subject to any wait list for home- and community-based services. 12
9393 (3) No nursing home, hospital, or intermediate-care facility for persons with intellectual 13
9494 disabilities shall be denied payment for services rendered to a Medicaid recipient on the grounds 14
9595 that the recipient does not meet level-of-care criteria unless and until the executive office has: 15
9696 (i) Performed an individual assessment of the recipient at issue and provided written notice 16
9797 to the nursing home, hospital, or intermediate-care facility for persons with intellectual disabilities 17
9898 that the recipient does not meet level-of-care criteria; and 18
9999 (ii) The recipient has either appealed that level-of-care determination and been 19
100100 unsuccessful, or any appeal period available to the recipient regarding that level-of-care 20
101101 determination has expired. 21
102102 (d) The executive office is further authorized to consolidate all home- and community-22
103103 based services currently provided pursuant to 42 U.S.C. § 1396n into a single system of home- and 23
104104 community-based services that include options for consumer direction and shared living. The 24
105105 resulting single home- and community-based services system shall replace and supersede all 42 25
106106 U.S.C. § 1396n programs when fully implemented. Notwithstanding the foregoing, the resulting 26
107107 single program home- and community-based services system shall include the continued funding 27
108108 of assisted-living services at any assisted-living facility financed by the Rhode Island housing and 28
109109 mortgage finance corporation prior to January 1, 2006, and shall be in accordance with chapter 66.8 29
110110 of title 42 as long as assisted-living services are a covered Medicaid benefit. 30
111111 (e) The executive office is authorized to promulgate rules that permit certain optional 31
112112 services including, but not limited to, homemaker services, home modifications, respite, and 32
113113 physical therapy evaluations to be offered to persons at risk for Medicaid-funded long-term care 33
114114 subject to availability of state-appropriated funding for these purposes. 34
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118118 (f) To promote the expansion of home- and community-based service capacity, the 1
119119 executive office is authorized to pursue payment methodology reforms that increase access to 2
120120 homemaker, personal care (home health aide), assisted living, adult supportive-care homes, and 3
121121 adult day services, as follows: 4
122122 (1) Development of revised or new Medicaid certification standards that increase access to 5
123123 service specialization and scheduling accommodations by using payment strategies designed to 6
124124 achieve specific quality and health outcomes. 7
125125 (2) Development of Medicaid certification standards for state-authorized providers of adult 8
126126 day services, excluding providers of services authorized under § 40.1-24-1(3), assisted living, and 9
127127 adult supportive care (as defined under chapter 17.24 of title 23) that establish for each, an acuity-10
128128 based, tiered service and payment methodology tied to: licensure authority; level of beneficiary 11
129129 needs; the scope of services and supports provided; and specific quality and outcome measures. As 12
130130 of July 1, 2025, Medicaid certified assisted living residences and adult day service providers shall 13
131131 report to the executive office semi-annually regarding the number of persons served by month and 14
132132 category of certification in the previous six (6) months. 15
133133 The standards for adult day services for persons eligible for Medicaid-funded long-term 16
134134 services may differ from those who do not meet the clinical/functional criteria set forth in § 40-17
135135 8.10-3. 18
136136 (3) As the state’s Medicaid program seeks to assist more beneficiaries requiring long-term 19
137137 services and supports in home- and community-based settings, the demand for home-care workers 20
138138 has increased, and wages for these workers has not kept pace with neighboring states, leading to 21
139139 high turnover and vacancy rates in the state’s home-care industry, the executive office shall institute 22
140140 a one-time increase in the base-payment rates for FY 2019, as described below, for home-care 23
141141 service providers to promote increased access to and an adequate supply of highly trained home-24
142142 healthcare professionals, in amount to be determined by the appropriations process, for the purpose 25
143143 of raising wages for personal care attendants and home health aides to be implemented by such 26
144144 providers. 27
145145 (i) A prospective base adjustment, effective not later than July 1, 2018, of ten percent (10%) 28
146146 of the current base rate for home-care providers, home nursing care providers, and hospice 29
147147 providers contracted with the executive office of health and human services and its subordinate 30
148148 agencies to deliver Medicaid fee-for-service personal care attendant services. 31
149149 (ii) A prospective base adjustment, effective not later than July 1, 2018, of twenty percent 32
150150 (20%) of the current base rate for home-care providers, home nursing care providers, and hospice 33
151151 providers contracted with the executive office of health and human services and its subordinate 34
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155155 agencies to deliver Medicaid fee-for-service skilled nursing and therapeutic services and hospice 1
156156 care. 2
157157 (iii) Effective upon passage of this section, hospice provider reimbursement, exclusively 3
158158 for room and board expenses for individuals residing in a skilled nursing facility, shall revert to the 4
159159 rate methodology in effect on June 30, 2018, and these room and board expenses shall be exempted 5
160160 from any and all annual rate increases to hospice providers as provided for in this section. 6
161161 (iv) On the first of July in each year, beginning on July 1, 2019, the executive office of 7
162162 health and human services will initiate an annual inflation increase to the base rate for home-care 8
163163 providers, home nursing care providers, and hospice providers contracted with the executive office 9
164164 and its subordinate agencies to deliver Medicaid fee-for-service personal care attendant services, 10
165165 skilled nursing and therapeutic services and hospice care. The base rate increase shall be a 11
166166 percentage amount equal to the New England Consumer Price Index card as determined by the 12
167167 United States Department of Labor for medical care and for compliance with all federal and state 13
168168 laws, regulations, and rules, and all national accreditation program requirements. 14
169169 (g) As the state’s Medicaid program seeks to assist more beneficiaries requiring long-term 15
170170 services and supports in home- and community-based settings, the demand for home-care workers 16
171171 has increased, and wages for these workers has not kept pace with neighboring states, leading to 17
172172 high turnover and vacancy rates in the state’s home-care industry. To promote increased access to 18
173173 and an adequate supply of direct-care workers, the executive office shall institute a payment 19
174174 methodology change, in Medicaid fee-for-service and managed care, for FY 2022, that shall be 20
175175 passed through directly to the direct-care workers’ wages who are employed by home nursing care 21
176176 and home-care providers licensed by the Rhode Island department of health, as described below: 22
177177 (1) Effective July 1, 2021, increase the existing shift differential modifier by $0.19 per 23
178178 fifteen (15) minutes for personal care and combined personal care/homemaker. 24
179179 (i) Employers must pass on one hundred percent (100%) of the shift differential modifier 25
180180 increase per fifteen-minute (15) unit of service to the CNAs who rendered such services. This 26
181181 compensation shall be provided in addition to the rate of compensation that the employee was 27
182182 receiving as of June 30, 2021. For an employee hired after June 30, 2021, the agency shall use not 28
183183 less than the lowest compensation paid to an employee of similar functions and duties as of June 29
184184 30, 2021, as the base compensation to which the increase is applied. 30
185185 (ii) Employers must provide to EOHHS an annual compliance statement showing wages 31
186186 as of June 30, 2021, amounts received from the increases outlined herein, and compliance with this 32
187187 section by July 1, 2022. EOHHS may adopt any additional necessary regulations and processes to 33
188188 oversee this subsection. 34
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192192 (2) Effective January 1, 2022, establish a new behavioral healthcare enhancement of $0.39 1
193193 per fifteen (15) minutes for personal care, combined personal care/homemaker, and homemaker 2
194194 only for providers who have at least thirty percent (30%) of their direct-care workers (which 3
195195 includes certified nursing assistants (CNA) and homemakers) certified in behavioral healthcare 4
196196 training. 5
197197 (i) Employers must pass on one hundred percent (100%) of the behavioral healthcare 6
198198 enhancement per fifteen (15) minute unit of service rendered by only those CNAs and homemakers 7
199199 who have completed the thirty (30) hour behavioral health certificate training program offered by 8
200200 Rhode Island College, or a training program that is prospectively determined to be compliant per 9
201201 EOHHS, to those CNAs and homemakers. This compensation shall be provided in addition to the 10
202202 rate of compensation that the employee was receiving as of December 31, 2021. For an employee 11
203203 hired after December 31, 2021, the agency shall use not less than the lowest compensation paid to 12
204204 an employee of similar functions and duties as of December 31, 2021, as the base compensation to 13
205205 which the increase is applied. 14
206206 (ii) By January 1, 2023, employers must provide to EOHHS an annual compliance 15
207207 statement showing wages as of December 31, 2021, amounts received from the increases outlined 16
208208 herein, and compliance with this section, including which behavioral healthcare training programs 17
209209 were utilized. EOHHS may adopt any additional necessary regulations and processes to oversee 18
210210 this subsection. 19
211211 (h) The executive office shall implement a long-term-care-options counseling program to 20
212212 provide individuals, or their representatives, or both, with long-term-care consultations that shall 21
213213 include, at a minimum, information about: long-term-care options, sources, and methods of both 22
214214 public and private payment for long-term-care services and an assessment of an individual’s 23
215215 functional capabilities and opportunities for maximizing independence. Each individual admitted 24
216216 to, or seeking admission to, a long-term-care facility, regardless of the payment source, shall be 25
217217 informed by the facility of the availability of the long-term-care-options counseling program and 26
218218 shall be provided with long-term-care-options consultation if they so request. Each individual who 27
219219 applies for Medicaid long-term-care services shall be provided with a long-term-care consultation. 28
220220 (i) The executive office shall implement, no later than January 1, 2024, a statewide network 29
221221 and rate methodology for conflict-free case management for individuals receiving Medicaid-funded 30
222222 home and community-based services. The executive office shall coordinate implementation with 31
223223 the state’s health and human services departments and divisions authorized to deliver Medicaid-32
224224 funded home and community-based service programs, including the department of behavioral 33
225225 healthcare, developmental disabilities and hospitals; the department of human services; and the 34
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229229 office of healthy aging. It is in the best interest of the Rhode Islanders eligible to receive Medicaid 1
230230 home and community-based services under this chapter, title 40.1, title 42, or any other general 2
231231 laws to provide equitable access to conflict-free case management that shall include person-3
232232 centered planning, service arranging, and quality monitoring in the amount, duration, and scope 4
233233 required by federal law and regulations. It is necessary to ensure that there is a robust network of 5
234234 qualified conflict-free case management entities with the capacity to serve all participants on a 6
235235 statewide basis and in a manner that promotes choice, self-reliance, and community integration. 7
236236 The executive office, as the designated single state Medicaid authority and agency responsible for 8
237237 coordinating policy and planning for health and human services under § 42-7.2-1 et seq., is directed 9
238238 to establish a statewide conflict-free case management network under the management of the 10
239239 executive office and to seek any Medicaid waivers, state plan amendments, and changes in rules, 11
240240 regulations, and procedures that may be necessary to ensure that recipients of Medicaid home and 12
241241 community-based services have access to conflict-free case management in a timely manner and in 13
242242 accordance with the federal requirements that must be met to preserve financial participation. 14
243243 (j) The executive office is also authorized, subject to availability of appropriation of 15
244244 funding, and federal, Medicaid-matching funds, to pay for certain services and supports necessary 16
245245 to transition or divert beneficiaries from institutional or restrictive settings and optimize their health 17
246246 and safety when receiving care in a home or the community. The secretary is authorized to obtain 18
247247 any state plan or waiver authorities required to maximize the federal funds available to support 19
248248 expanded access to home- and community-transition and stabilization services; provided, however, 20
249249 payments shall not exceed an annual or per-person amount. 21
250250 (k) To ensure persons with long-term-care needs who remain living at home have adequate 22
251251 resources to deal with housing maintenance and unanticipated housing-related costs, the secretary 23
252252 is authorized to develop higher implement resource eligibility limits of twelve thousand dollars 24
253253 ($12,000) for single persons or and eighteen thousand dollars ($18,000) for couples and obtain any 25
254254 state plan or waiver authorities necessary to change the financial eligibility criteria for long-term 26
255255 services and supports to enable beneficiaries receiving home and community waiver services to 27
256256 have the resources to continue living in their own homes or rental units or other home-based 28
257257 settings. 29
258258 (l) The executive office shall implement, no later than January 1, 2016, the following home- 30
259259 and community-based service and payment reforms: 31
260260 (1) [Deleted by P.L. 2021, ch. 162, art. 12, § 6.] 32
261261 (2) Adult day services level of need criteria and acuity-based, tiered-payment 33
262262 methodology; and 34
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266266 (3) Payment reforms that encourage home- and community-based providers to provide the 1
267267 specialized services and accommodations beneficiaries need to avoid or delay institutional care. 2
268268 (m) The secretary is authorized to seek any Medicaid section 1115 waiver or state-plan 3
269269 amendments and take any administrative actions necessary to ensure timely adoption of any new 4
270270 or amended rules, regulations, policies, or procedures and any system enhancements or changes, 5
271271 for which appropriations have been authorized, that are necessary to facilitate implementation of 6
272272 the requirements of this section by the dates established. The secretary shall reserve the discretion 7
273273 to exercise the authority established under §§ 42-7.2-5(6)(v) and 42-7.2-6.1, in consultation with 8
274274 the governor, to meet the legislative directives established herein. 9
275275 SECTION 2. This act shall take effect upon passage. 10
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282282 EXPLANATION
283283 BY THE LEGISLATIVE COUNCIL
284284 OF
285285 A N A C T
286286 RELATING TO HUMAN SERVICES -- MEDICAL ASSISTANCE -- LONG-TERM CARE
287287 SERVICE AND FINANCE REFORM
288288 ***
289289 This act would authorize the secretary of the executive office of health and human services 1
290290 (EOHHS) to increase resource eligibility limits for persons with long-term-care needs who reside 2
291291 at home to $12,000 for single persons and $18,000 for couples. The act would also require that 3
292292 Medicaid certified assisted living facilities and adult day service providers furnish semi-annual 4
293293 reports to the EOHHS regarding the number of persons served each month and patients’ 5
294294 certification categories for the prior six months. 6
295295 This act would take effect upon passage. 7
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