reglab/statecodes huggingface dataset:
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.4 - Health Care for Families › Section 40-8.4-13. - Utilization of available employer-based health insurance.

§ 40-8.4-13. Utilization of available employer-based health insurance.
To the extent permitted under Titles XIX and XXI of the Social Security Act, 42 U.S.C. § 1396 et seq. and 42 U.S.C. § 1397aa et seq., or by waiver from the Secretary of the United States Department of Health and Human Services, the department of human services shall adopt regulations to restrict eligibility for RIte Care under this chapter and/or chapter 12.3 of title 42, or the RIte Share program under § 40-8.4-12, for certain periods of time for certain individuals or families who have access to, or have refused or terminated employer-based health insurance and for certain periods of time for certain individuals but not including children whose employer has terminated their employer-based health insurance. The department is authorized and directed to amend the medical assistance Title XIX and XXI state plans, and/or to seek and obtain appropriate federal approvals or waivers to implement this section.
History of Section.
P.L. 2000, ch. 200, § 2; P.L. 2000, ch. 229, § 2.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.4 - Health Care for Families › Section 40-8.4-15. - Advisory commission on health care.

§ 40-8.4-15. Advisory commission on health care.
(a)
There is hereby established an advisory commission to be known as the “advisory commission on health care” to advise the director of the department of human services on all matters relating to the RIte Care and RIte Share programs, and other matters concerning access for all Rhode Islanders to quality health care in the most affordable, economical manner. The director of the department of human services shall serve ex officio as chairperson. The director shall appoint the eighteen (18) members:
(1)
Three (3) of whom shall represent the healthcare providers;
(2)
Three (3) of whom shall represent the healthcare insurers;
(3)
Three (3) of whom shall represent healthcare consumers or consumer organizations;
(4)
Two (2) of whom shall represent organized labor;
(5)
One of whom shall be the health care advocate in the office of the attorney general;
(6)
Three (3) of whom shall represent employers; and
(7)
Three (3) of whom shall be other members of the public.
(b)
The commission may study all aspects of the provisions of the RIte Care and RIte Share programs involving purchasers of health care, including employers, consumers, and the state, health insurers, providers of health care, and healthcare facilities, and all matters related to the interaction among these groups, including methods to achieve more effective and timely resolution of disputes, better communication, speedier, more reliable and less-costly administrative processes, claims, payments, and other reimbursement matters, and the application of new processes or technologies to such issues.
(c)
Members of the commission shall be appointed in the month of July, each to hold office until the last day of June in the second year of his or her appointment or until his or her successor is appointed by the director.
(d)
The commission shall meet at least quarterly, and the initial meeting of the commission shall take place on or before September 15, 2000. The commission may meet more frequently than quarterly at the call of the chair or at the call of any three (3) members of the commission.
(e)
Members of the permanent joint committee on health care oversight established pursuant to § 40-8.4-14 shall be notified of each meeting of the commission and shall be invited to participate.
History of Section.
P.L. 2000, ch. 200, § 2; P.L. 2000, ch. 229, § 2.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.4 - Health Care for Families › Section 40-8.4-16. - Pilot program for the uninsured — Legislative findings.

§ 40-8.4-16. Pilot program for the uninsured — Legislative findings.
The general assembly hereby finds and declares that:
(1)
Although Rhode Island has one of the highest rates of health insurance coverage in the nation, gaps in coverage remain and the rate of coverage dropped significantly during the past year; and
(2)
From 2001-2002, the state’s uninsured rate for working-age adults went from eight percent (8%) to eleven percent (11%), one of eighteen (18) states in the country with a significant increase; and
(3)
Significant health-insurance-premium rate increases over the past two (2) years, especially for small businesses and the self-insured, are contributing to an increase in the rate of the uninsured; and
(4)
The largest segment of uninsured Rhode Island residents are adults with low incomes, many of whom are employed; and
(5)
Individuals without health coverage often resort to expensive emergency-room care that ultimately drives up the overall cost of care for everyone and adds to the state’s uncompensated care burden; and
(6)
Rhode Island residents’ use of the emergency room services is greater than that of the nation; and
(7)
The Institute of Medicine defines primary care as the provision of integrated, accessible healthcare services by clinicians who are accountable for addressing a large majority of personal healthcare needs, developing a sustained partnership with patients, and practicing in the context of family and community; and
(8)
Access to primary health care should be available to every resident of the state regardless of income and whether or not they have access to health insurance.
History of Section.
P.L. 2004, ch. 587, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.4 - Health Care for Families › Section 40-8.4-17. - Pilot primary care program established.

§ 40-8.4-17. Pilot primary care program established.
(a)
To increase primary-care access for those state residents who do not have access to health insurance coverage, or who are unable to afford health insurance coverage, the director of the state department of human services, in collaboration with the director of the department of health, shall develop a plan for a pilot primary-care program for uninsured residents of the state. The pilot program may include enrollee premiums and co-insurance payments that are income-based with premiums and/or co-insurance subsidized by the state. The pilot program may also include catastrophic or reinsurance coverage provided under the auspices of the state. In designing the pilot program, the director may consider a variety of service-delivery and financing models, including capitation payments to private physicians, a buy-in program under RIte Care, and coverage arrangements purchased from qualified community health centers. In developing the pilot program, the director may seek available federal grant monies, including Medicaid, and private foundation grants.
(b)
The director shall submit the plan for the pilot primary-care program to the governor, the speaker of the house, the president of the senate, the majority leaders of the house and senate, and the chairpersons of the house and senate finance committees by January 15, 2005. The plan shall include: eligibility criteria for participation in the pilot program; the scope of services to be offered; the geographic area and population to be served; and cost estimates to implement the program.
History of Section.
P.L. 2004, ch. 587, § 2; P.L. 2006, ch. 216, § 20.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.4 - Health Care for Families › Section 40-8.4-18. - Public health access beneficiary employer report.

§ 40-8.4-18. Public health access beneficiary employer report.
The department of human services shall annually prepare a public-health-access-beneficiary employer report. A “public-health-access-program beneficiary” means any person who receives medical benefits from RIte Care, RIte Share, or Medicaid. Any applicant for public health-benefits through RIte-Care, RIte Share, and/or Medicaid shall identify the employer, or the employers, of the proposed beneficiary of the healthcare benefits. The report shall provide the following information for each employer of fifty (50) or more public-health-access beneficiaries:
(1)
The name and address of the employer;
(2)
The number of public-health-access-program beneficiaries who are employees of the employer;
(3)
The number of public-health-access-program beneficiaries who are spouses or dependents of employees of the employer;
(4)
Whether the employer offers health benefits to its employees;
(5)
Whether the employer participates in the RIte Share program; and
(6)
The cost to the state of Rhode Island for providing public-health-access benefits to their employees and enrolled dependents.
In determining whether the fifty-employee threshold is met, the department of human services shall include all public-health-access-program beneficiaries employed by the employer and its subsidiaries throughout the state. The report shall not include the names of any individual public-health-access-program beneficiaries and shall be subject to privacy standards pursuant to Pub. L. No. 104-91, and the Health Insurance Portability and Accountability Act of 1996. The report shall be submitted annually on the third Tuesday in January to the joint committee on health care oversight, the house finance committee, and the senate finance committee.
History of Section.
P.L. 2006, ch. 327, § 1; P.L. 2006, ch. 445, § 1; P.L. 2007, ch. 378, § 1; P.L. 2007, ch. 459, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.4 - Health Care for Families › Section 40-8.4-19. - Managed healthcare delivery systems for families.

§ 40-8.4-19. Managed healthcare delivery systems for families.
(a)
Notwithstanding any other provision of state law, the delivery and financing of the healthcare services provided under this chapter shall be provided through a system of managed care. “Managed care” is defined as systems that: integrate an efficient financing mechanism with quality service delivery; provide a “medical home” to ensure appropriate care and deter unnecessary services; and place emphasis on preventive and primary care.
(b)
Enrollment in managed care health delivery systems is mandatory for individuals eligible for medical assistance under this chapter. This includes children in substitute care, children receiving medical assistance through an adoption subsidy, and children eligible for medical assistance based on their disability. Beneficiaries with third-party medical coverage or insurance may be exempt from mandatory managed care in accordance with rules and regulations promulgated by the department of human services for such purposes.
(c) Individuals who can afford to contribute shall share in the cost.
The department of human services is authorized and directed to apply for and obtain any necessary waivers and/or state plan amendments from the Secretary of the United States Department of Health and Human Services, including, but not limited to, a waiver of the appropriate sections of Title XIX, 42 U.S.C. § 1396 et seq., to require that beneficiaries eligible under this chapter or chapter 12.3 of title 42, with incomes equal to or greater than one hundred fifty percent (150%) of the federal poverty level, pay a share of the costs of health coverage based on the ability to pay. The department of human services shall implement this cost-sharing obligation by regulation, and shall consider co-payments, premium shares, or other reasonable means to do so in accordance with approved provisions of appropriate waivers and/or state plan amendments approved by the Secretary of the United States Department of Health and Human Services.
History of Section.
P.L. 2008, ch. 100, art. 17, § 4; P.L. 2009, ch. 68, art. 22, § 2; P.L. 2009, ch. 69, § 2.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.4 - Health Care for Families › Section 40-8.4-20. - Full year coverage for contraception.

§ 40-8.4-20. Full year coverage for contraception.
No later than July 1, 2019, the executive office of health and human services (EOHHS) shall apply for the appropriate federal approval to provide Medicaid beneficiaries up to three hundred sixty-five (365) days of prescription contraception dispensed as a single prescription.
History of Section.
P.L. 2018, ch. 230, § 9; P.L. 2018, ch. 234, § 9.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.5 - Health Care for Elderly and Disabled Residents Act › Section 40-8.5-1. - Categorically needy medical assistance coverage.

§ 40-8.5-1. Categorically needy medical assistance coverage.
The department of human services is hereby authorized and directed to amend its Title XIX state plan to provide for categorically needy medical assistance coverage as permitted pursuant to Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq., as amended, to individuals who are sixty-five (65) years or older or are disabled, as determined under § 1614(a)(3) of the Social Security Act, 42 U.S.C. § 1382c(a)(3), as amended, whose income does not exceed one hundred percent (100%) of the federal poverty level (as revised annually) applicable to the individual’s family size, and whose resources do not exceed four thousand dollars ($4,000) per individual, or six thousand dollars ($6,000) per couple. The department shall provide medical assistance coverage to such elderly or disabled persons in the same amount, duration, and scope as provided to other categorically needy persons under the state’s Title XIX state plan.
History of Section.
P.L. 2000, ch. 104, § 1; P.L. 2000, ch. 165, § 1; P.L. 2005, ch. 351, § 1; P.L. 2005, ch. 394, § 1; P.L. 2006, ch. 263, § 2; P.L. 2006, ch. 286, § 2; P.L. 2007, ch. 424, § 1; P.L. 2008, ch. 100, art. 17, § 5; P.L. 2009, ch. 310, § 16.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.6 - Special Program for Care of Severely Disabled Elderly Residents Who Need Nursing Facility Services › Section 40-8.6-1. - Special pilot program for care of severely disabled elderly residents who need nursing facility services.

§ 40-8.6-1. Special pilot program for care of severely disabled elderly residents who need nursing facility services.
(a) Purpose.
Contingent on appropriation, there is hereby established a special pilot program to be administered by the department of human services to provide payment for nursing facility services and the following ancillary services: pharmacy, physician, laboratory, dental, and vision services for certain low-income elderly Rhode Island residents who are ineligible for federal and state medical assistance coverage.
(b) Eligibility.
To be eligible for payment from the program the individual must be:
(1)
Age sixty-five (65) or older;
(2)
Legally present in the United States and a resident of the state of Rhode Island;
(3)
Determined to meet all eligibility requirements of the federal Medical Assistance Program (Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq.) but for the citizenship or alienage criteria;
(4)
Determined to be ineligible for § 40-8-1 provisions of state-funded medical assistance for aliens; and
(5)
Certified by the department of human services to be in need of nursing facility services.
(c) Continuation of coverage.
Eligibility shall be reviewed periodically and renewed as long as the individual continues to meet the criteria.
(d) Payment to nursing facility.
The department shall make payments to the nursing facility in which an eligible individual is residing in the same amount as the payment for nursing facility services under the medical assistance program.
History of Section.
P.L. 2003, ch. 376, art. 21, § 1; P.L. 2004, ch. 535, § 1; P.L. 2004, ch. 564, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.6 - Special Program for Care of Severely Disabled Elderly Residents Who Need Nursing Facility Services › Section 40-8.6-2. - Appropriation.

§ 40-8.6-2. Appropriation.
The department may establish rules and regulations regarding which nursing facility or facilities may provide services as part of this pilot program, waiting list procedures, and any other administrative functions that are necessary for the conduct of this program.
History of Section.
P.L. 2003, ch. 376, art. 21, § 1; P.L. 2004, ch. 535, § 1; P.L. 2004, ch. 564, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.6 - Special Program for Care of Severely Disabled Elderly Residents Who Need Nursing Facility Services › Section 40-8.6-3. - Report.

§ 40-8.6-3. Report.
The department shall issue an annual report to the long-term care coordinating council, the general assembly, the senate fiscal advisor, and the house fiscal advisor on the status of this program on or before April 15 of each year. The report shall include at least the number of people served and total expenditures to date.
History of Section.
P.L. 2003, ch. 376, art. 21, § 1; P.L. 2004, ch. 535, § 1; P.L. 2004, ch. 564, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.7 - Healthcare Assistance for Working People with Disabilities › Section 40-8.7-1. - Short title.

§ 40-8.7-1. Short title.
This chapter shall be known and may be cited as “The Sherlock Act” or “The Ticket to Work Program.”
History of Section.
P.L. 2004, ch. 343, § 1; P.L. 2004, ch. 354, § 1; P.L. 2023, ch. 79, art. 9, § 6, effective June 16, 2023.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.7 - Healthcare Assistance for Working People with Disabilities › Section 40-8.7-2. - Medicaid buy-in program.

§ 40-8.7-2. Medicaid buy-in program.
The executive office of health and human services is hereby authorized and directed to maintain a Medicaid buy-in program pursuant to the “Balanced Budget Act of 1997,” 42 U.S.C. § 1396a(a)(10)(A)(ii)(XIII), and the federal Ticket to Work and Work Incentives Improvement Act of 1999 (TWWIIA), Pub. L. No. 106-170.
History of Section.
P.L. 2004, ch. 343, § 1; P.L. 2004, ch. 354, § 1; P.L. 2023, ch. 79, art. 9, § 6, effective June 16, 2023.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.7 - Healthcare Assistance for Working People with Disabilities › Section 40-8.7-3. - Purpose.

§ 40-8.7-3. Purpose.
The purpose of the Medicaid buy-in program is to:
(1)
Enable individuals with disabilities to enter and reenter the work force as soon as possible;
(2)
Provide health care and employment support services to individuals with disabilities that will enable those individuals to reduce their dependency on cash benefit programs; and
(3)
Allow individuals with disabilities the option to purchase Medicaid coverage that is necessary to enable such individuals to obtain and/or maintain employment.
History of Section.
P.L. 2004, ch. 343, § 1; P.L. 2004, ch. 354, § 1; P.L. 2011, ch. 241, § 1; P.L. 2011, ch. 253, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.7 - Healthcare Assistance for Working People with Disabilities › Section 40-8.7-4. - Definitions.

§ 40-8.7-4. Definitions.
As used in this chapter, the term:
(1)
“Employed” means the individual with disabilities is engaged in a work effort that meets substantial and reasonable threshold criteria for hours of work, wages, or other measures, as defined by the department of human services and as permitted by federal law.
(2)
“Employment support services” means activities needed to sustain paid work including: benefits counseling; supervision; job coaching; vocational evaluation; case management; job development; customized employment; job training; transportation; training; tools; equipment; and technology, subject to Centers for Medicare and Medicaid Services approval.
(3)
“Individual with a disability” means a person who has been designated, but without regard to his or her ability to engage in substantial gainful activity, as specified in the Social Security Act, 42 U.S.C. § 423(d)(4), as a totally and permanently disabled individual by the Social Security Administration or the Rhode Island Medicaid program, pursuant to an application for benefits under Title II, Title XVI, or Title XIX of the Social Security Act, regardless of current receipt of cash benefits under the Social Security Act.
History of Section.
P.L. 2004, ch. 343, § 1; P.L. 2004, ch. 354, § 1; P.L. 2011, ch. 241, § 1; P.L. 2011, ch. 253, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.7 - Healthcare Assistance for Working People with Disabilities › Section 40-8.7-5. - Authorization for Medicaid buy-in program and personal care services.

§ 40-8.7-5. Authorization for Medicaid buy-in program and personal care services.
(a)
The department of human services is hereby authorized and directed to amend its Title XIX state plan to initiate a Medicaid buy-in program for employed individuals with disabilities.
(b)
The department of human services is hereby authorized and directed to amend its Title XIX state plan to initiate community choice first for personal care services, including through a home health agency and/or self-directed plan.
(c)
The department of human services is hereby authorized and directed to review and/or amend its Title XIX state plan to initiate the full scope of services authorized under § 1915(i) of the Social Security Act [42 U.S.C. § 1396n], for Medicaid buy-in participants who are eligible upon clinical assessment, subject to Centers for Medicare and Medicaid Services approval.
History of Section.
P.L. 2004, ch. 343, § 1; P.L. 2004, ch. 354, § 1; P.L. 2011, ch. 241, § 1; P.L. 2011, ch. 253, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.7 - Healthcare Assistance for Working People with Disabilities › Section 40-8.7-6. - Eligibility.

§ 40-8.7-6. Eligibility.
(a)
To be eligible for benefits under the Medicaid buy-in program:
(1)
The person shall be an individual with disabilities as defined in § 40-8.7-4, but without regard to the person’s ability to engage in substantial gainful activity, as specified in the Social Security Act, 42 U.S.C. § 423(d)(4);
(2)
The person shall be employed as defined in § 40-8.7-4;
(3)
For the Sherlock Act Medicaid buy-in program the person’s net accountable income shall either not exceed two hundred fifty percent (250%) of the federal poverty level, taking into account the SSI program disregards and impairment-related work expenses as defined in 42 U.S.C. § 1396a(r)(2) or for the Ticket to Work Program buy-in program there are no income or asset limits to be considered as part of the eligibility determination;
(4)
A maximum of ten thousand dollars ($10,000) of available resources for an individual and twenty thousand dollars ($20,000) for a couple shall be disregarded as shall any additional resources held in a retirement account, in a medical savings account, or any other account, related to enhancing the independence of the individual and approved under rules to be adopted by the executive office for the Sherlock Act; there are no income or asset limits for the Ticket to Work Program; and
(5)
The person shall be a current medical assistance recipient under § 40-8.5-1 [CNIL] or § 40-8-3(5)(v) [MNIL]; or shall meet income, assets (except as modified by subsection (a)(4) of this section), and eligibility requirements for the medical assistance program under § 40-8.5-1 [CNIL] or § 40-8-3(5)(v) [MNIL], as such requirements are modified and extended by this chapter.
(b)
Appeals Process.
The director or designee shall review each application filed in accordance with regulations, and shall make a determination of whether the application will be approved and the extent of the benefits to be made available to the applicant, and shall, within thirty (30) days after the filing, notify the applicant, in writing, of the determination. If the application is rejected, the applicant shall be notified of the reason for the denial. The director may at any time reconsider any determination. Any applicant for or recipient of benefits aggrieved because of a decision, or delay in making a decision, shall be entitled to an appeal and shall be afforded reasonable notice and opportunity for a fair hearing conducted by the director, pursuant to chapter 8 of this title.
History of Section.
P.L. 2004, ch. 343, § 1; P.L. 2004, ch. 354, § 1; P.L. 2011, ch. 241, § 1; P.L. 2011, ch. 253, § 1; P.L. 2023, ch. 79, art. 9, § 6, effective June 16, 2023.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.7 - Healthcare Assistance for Working People with Disabilities › Section 40-8.7-7. - Premiums.

§ 40-8.7-7. Premiums.
(a)
The department of human services is authorized and directed to promulgate such rules to establish the monthly premium payments for employed individuals with disabilities who opt to participate directly in the Medicaid buy-in program. To participate in the Medicaid buy-in program, the employed individual with disabilities shall be required to make payment for coverage in accordance with a monthly payment or payment formula to be established by the department that shall count a portion of the individual’s or couple’s earned income on a sliding-scale basis, in accordance with rules to be established by the department.
(b)
The department is further authorized and directed to promulgate such rules to encourage businesses to hire individuals with disabilities, and to allow employed individuals with disabilities who have access to employer-based health insurance and who are determined eligible by the department pursuant to this chapter to coordinate health insurance coverage options.
(c)
The department of human services, in consultation with the health insurance commissioner, employer and disability advocacy organizations, shall, by June 30, 2012, investigate, develop, and promulgate rules that may:
(1)
Require enrollment in the employer-based health insurance plan as a condition of participation in the Medicaid buy-in program under this chapter, provided that enrollment in the employer-based health insurance plan is cost-effective and its benefits are comparable to the benefits provided by the Medicaid program. Enrollment of the individual and/or the family in the employer-based health insurance plan without regard to any enrollment season restrictions, subject to Centers for Medicare and Medicaid Services approval; or
(2)
Provide opportunities for employers to buy into the Medicaid Buy-in program, at the employer’s expense, where the employer’s premium contribution shall be no greater than the employer’s premiums in the existing employer-based health insurance or before September 30, 2012.
History of Section.
P.L. 2004, ch. 343, § 1; P.L. 2004, ch. 354, § 1; P.L. 2005, ch. 351, § 2; P.L. 2005, ch. 394, § 2; P.L. 2011, ch. 241, § 1; P.L. 2011, ch. 253, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.7 - Healthcare Assistance for Working People with Disabilities › Section 40-8.7-8. - Work-related protections.

§ 40-8.7-8. Work-related protections.
(a)
Medicaid buy-in participants shall continue on the Medicaid buy-in program for up to four (4) months after loss of employment due to a medical condition. If the loss of employment is not due to a medical condition, the individual may continue to be eligible for up to four (4) months, but must pay a monthly premium equal to their monthly-unearned income in excess of the medically needy income limit.
(b)
Medicaid buy-in participants who return to other Medicaid eligibility categories shall have their accrued savings in a retirement account and/or a medical savings account excluded from countable assets.
(c)
The department shall promulgate rules or regulations necessary to institute the work-related protections of this section.
History of Section.
P.L. 2004, ch. 343, § 1; P.L. 2004, ch. 354, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.8 - Program of All-Inclusive Care for the Elderly › Section 40-8.8-1. - Short title.

§ 40-8.8-1. Short title.
This chapter shall be known and may be cited as the “Program of All-Inclusive Care for the Elderly.”
History of Section.
P.L. 2005, ch. 110, § 1; P.L. 2005, ch. 114, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.8 - Program of All-Inclusive Care for the Elderly › Section 40-8.8-2. - Program of all-inclusive care for the elderly.

§ 40-8.8-2. Program of all-inclusive care for the elderly.
The department of human services is hereby authorized to elect a program of all-inclusive care for the elderly as an optional Medicaid benefit, pursuant to § 1905(a)(26) of the Social Security Act [42 U.S.C. § 1396d(a)(26)], as added by § 4802(a)(1) of the Balanced Budget Act of 1997.
History of Section.
P.L. 2005, ch. 110, § 1; P.L. 2005, ch. 114, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.8 - Program of All-Inclusive Care for the Elderly › Section 40-8.8-3. - Purpose.

§ 40-8.8-3. Purpose.
The purpose of the program of all-inclusive care for the elderly is to offer an alternative to nursing home care for frail elders. The program of all-inclusive care for the elderly is a pre-paid, capitated program of managed care service delivery for beneficiaries who meet special eligibility requirements, including being eligible for nursing home placement, and who elect to enroll. The model of care includes as core services the provision of adult day health care and multidisciplinary team case management, through which access to and allocation of all health services are coordinated.
History of Section.
P.L. 2005, ch. 110, § 1; P.L. 2005, ch. 114, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.8 - Program of All-Inclusive Care for the Elderly › Section 40-8.8-4. - Definition.

§ 40-8.8-4. Definition.
As used in this chapter, the term “Program of all-inclusive care for the elderly” shall mean a program of services coordinated for the eligible population by an organization approved by the United States Department of Health and Human Services for these purposes. The program of services include at minimum the following benefit package: multidisciplinary assessment and treatment planning; primary care services including physician and nursing services; social work services; restorative therapies; personal care and supportive services; nutritional counseling; recreational therapy; transportation; meals; medical specialty services; laboratory tests; drugs and biologicals; prosthetics and durable medical equipment; acute inpatient care, ambulance and emergency care; and nursing facility care.
History of Section.
P.L. 2005, ch. 110, § 1; P.L. 2005, ch. 114, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.8 - Program of All-Inclusive Care for the Elderly › Section 40-8.8-5. - Authorization for program of all-inclusive care for the elderly.

§ 40-8.8-5. Authorization for program of all-inclusive care for the elderly.
The department of human services is hereby authorized and directed to amend its Title XIX state plan to initiate a program of all-inclusive care for the elderly.
History of Section.
P.L. 2005, ch. 110, § 1; P.L. 2005, ch. 114, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.8 - Program of All-Inclusive Care for the Elderly › Section 40-8.8-6. - Eligibility.

§ 40-8.8-6. Eligibility.
To be eligible for benefits under the program of all-inclusive care for the elderly:
(1)
The person shall meet the eligibility criteria for both the Rhode Island medical assistance program and for the federal Medicare program; and
(2)
The person shall meet the eligibility criteria for the program of all-inclusive care for the elderly as established by the United States Department of Health and Human Services and the state department of human services, including, but not limited to:
(i)
Being at least fifty-five (55) years old;
(ii)
Residing in the program of all-inclusive care for the elderly service area; and
(iii)
Being certified as eligible for nursing home care by the state department of human services.
History of Section.
P.L. 2005, ch. 110, § 1; P.L. 2005, ch. 114, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.8 - Program of All-Inclusive Care for the Elderly › Section 40-8.8-7. - Regulations and commencement of program.

§ 40-8.8-7. Regulations and commencement of program.
(a)
The department of human services shall submit the Medicaid state plan amendment and promulgate any rules or regulations necessary to implement the provisions of this chapter, contingent upon, and immediately following, federal approval of any program of all-inclusive care of the elderly.
(b)
Contingent upon completion of the Medicaid state plan amendment process, and the appropriation of necessary funding to implement the program, the program of all-inclusive care for the elderly shall commence on July 1, 2005.
(c)
Each hospital licensed in this state under chapter 17 of title 23 must accept as payment in full for providing professional component, technical component, or globally billed services to a person enrolled in a program of all-inclusive care for the elderly no more than one hundred percent (100%) of what Medicare would pay the hospital for providing the same services.
(d)
A hospital-owned or controlled professional practice or affiliate thereof must accept as payment in full for providing professional services to a person enrolled in a program of all-inclusive care for the elderly no more than one hundred percent (100%) of what Medicare would pay the relevant professional for providing the same services.
(e)
For purposes of subsection (d):
(1)
A “hospital-owned or controlled professional practice” means a practitioner’s (physician, dentist, or other healthcare provider) office or group of practitioners’ offices (whether organized as a nonprofit corporation, professional service corporation, partnership, organization, or association) that is directly or indirectly owned or controlled by a hospital licensed under chapter 17 of title 23, or is directly or indirectly owned or controlled by an affiliate of such a hospital; and
(2)
An “affiliate” means an entity that is controlled by, in control of, or in common control with, another entity.
History of Section.
P.L. 2005, ch. 110, § 1; P.L. 2005, ch. 114, § 1; P.L. 2022, ch. 435, § 1, effective June 30, 2022; P.L. 2022, ch. 436, § 1, effective June 30, 2022.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.9 - Medical Assistance — Long-Term Care Service and Finance Reform › Section 40-8.9-1. - Findings.

§ 40-8.9-1. Findings.
(a)
The number of Rhode Islanders in need of long-term-care services continues to rise substantially, and the quality of life of these Rhode Islanders is determined by the capacity of the state to ensure equitable access to the full array of services and supports required to meet their healthcare needs and maintain their independence.
(b)
It is in the interest of all Rhode Islanders to endorse and fund statewide efforts to build a fiscally sound, dynamic, and resilient long-term-care system that fosters: consumer independence and choice; the delivery of high-quality, coordinated services; the financial integrity of all participants-purchasers, payers, providers, and consumers; and the responsible and efficient allocation of all available public and private resources, including preservation of federal financial participation.
(c)
It is in the interest of all Rhode Islanders to assure that rates paid for community-based long-term-care services are adequate to assure high quality and support workforce recruitment and retention.
(d)
It is in the interest of all Rhode Islanders to improve consumers’ access information regarding community-based alternatives to institutional settings of care.
(e)
It is in the best interest of all Rhode Islanders to maintain a person-centered, quality driven, and conflict-free system of publicly financed long-term services and supports that is responsive to the goals and preferences of those served.
History of Section.
P.L. 2006, ch. 263, § 1; P.L. 2006, ch. 286, § 1; P.L. 2023, ch. 79, art. 9, § 7, effective June 16, 2023.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.9 - Medical Assistance — Long-Term Care Service and Finance Reform › Section 40-8.9-2. - System reform and rebalancing goal.

§ 40-8.9-2. System reform and rebalancing goal.
On or before July 1, 2007, the department of human services shall begin to implement a model system for integrated long-term care, that expands the capacity of the long-term-care system as a whole to support consumer choice and independence; enables consumers to access coordinated services; ensures quality outcomes through certification standards, performance measures, and incentives and rewards that promote service excellence and generates the information consumers need to make reasoned choices about their health care; and improves the system’s overall stability by reinvesting the benefits that accrue from the more efficient utilization of services to enhance the capacity of each of its component parts. Attaining systemwide reform of the magnitude set forth herein will require rebalancing the system by making significant changes in the organization, financing, and delivery of services that must be implemented incrementally.
History of Section.
P.L. 2006, ch. 263, § 1; P.L. 2006, ch. 286, § 1; P.L. 2009, ch. 223, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.9 - Medical Assistance — Long-Term Care Service and Finance Reform › Section 40-8.9-3. - Least-restrictive setting requirement.

§ 40-8.9-3. Least-restrictive setting requirement.
The executive office of health and human services (executive office) is directed to recommend the allocation of existing Medicaid resources as needed to ensure that those in need of long-term-care and support services receive them in the least-restrictive setting appropriate to their needs and preferences. The executive office is hereby authorized to utilize screening criteria to avoid unnecessary institutionalization of persons during the full eligibility-determination process for Medicaid community-based care.
History of Section.
P.L. 2006, ch. 263, § 1; P.L. 2006, ch. 286, § 1; P.L. 2007, ch. 73, art. 14, § 1; P.L. 2016, ch. 142, art. 7, § 5.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.9 - Medical Assistance — Long-Term Care Service and Finance Reform › Section 40-8.9-4. - Unified long-term care budget.

§ 40-8.9-4. Unified long-term care budget.
Beginning on July 1, 2007, a unified long-term-care budget shall combine in a single, line-item appropriation within the executive office of health and human services (executive office), annual executive office Medicaid appropriations for nursing facility and community-based, long-term-care services for elderly sixty-five (65) years and older and younger persons at risk of nursing home admissions (including adult day care, home health, PACE, and personal care in assisted-living settings). Beginning on July 1, 2007, the total system savings attributable to the value of the reduction in nursing home days including hospice nursing home days paid for by Medicaid shall be allocated in the budget enacted by the general assembly for the ensuing fiscal year for the express purpose of promoting and strengthening community-based alternatives; provided, further, beginning July 1, 2009, said savings shall be allocated within the budgets of the executive office and, as appropriate, the department of human services, office of healthy aging. The allocation shall include, but not be limited to, funds to support an ongoing, statewide community education and outreach program to provide the public with information on home and community services and the establishment of presumptive eligibility criteria for the purposes of accessing home and community care. The home- and community-care service presumptive eligibility criteria shall be developed through rule or regulation on or before September 30, 2007. The allocation may also be used to fund home and community services provided by the office of healthy aging for persons eligible for Medicaid long-term care, and the co-pay program administered pursuant to chapter 66.3 of title 42. Any monies in the allocation that remain unexpended in a fiscal year shall be carried forward to the next fiscal year for the express purpose of strengthening community-based alternatives.
The caseload estimating conference pursuant to § 35-17-1 shall determine the amount of general revenues to be added to the current service estimate of community-based, long-term-care services for elderly sixty-five (65) and older and younger persons at risk of nursing home admissions for the ensuing budget year by multiplying the combined, cost per day of nursing home and hospice nursing home days estimated at the caseload conference for that year by the reduction in nursing home and hospice nursing home days from those in the second fiscal year prior to the current fiscal year to those in the first fiscal year prior to the current fiscal year.
History of Section.
P.L. 2006, ch. 263, § 1; P.L. 2006, ch. 286, § 1; P.L. 2007, ch. 73, art. 14, § 1; P.L. 2007, ch. 128, § 1; P.L. 2007, ch. 186, § 1; P.L. 2009, ch. 68, art. 5, § 8; P.L. 2009, ch. 223, § 1; P.L. 2016, ch. 142, art. 7, § 5.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.9 - Medical Assistance — Long-Term Care Service and Finance Reform › Section 40-8.9-5. - Administration and regulations.

§ 40-8.9-5. Administration and regulations.
The single state agency designated to administer the Rhode Island Medicaid program is hereby directed and authorized to develop and submit any requests for waivers, demonstration projects, grants and state plan amendments or regulations that may be considered necessary and appropriate to support the general purposes and specific requirements of this statute. The requests shall be made in consultation with any affected departments and, to the extent feasible, any consumer group, advisory body, or other entity designated for such purposes.
History of Section.
P.L. 2006, ch. 263, § 1; P.L. 2006, ch. 286, § 1; P.L. 2007, ch. 73, art. 14, § 1; P.L. 2009, ch. 223, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.9 - Medical Assistance — Long-Term Care Service and Finance Reform › Section 40-8.9-6. - Recognizing long-term reform performance — Reporting.

§ 40-8.9-6. Recognizing long-term reform performance — Reporting.
(a)
Annual performance reports showing progress in long-term-care system reform and rebalancing shall be submitted by April 1 of each year by the executive office of health and human services to the finance committees of both the senate and the house of representatives and the long-term care coordinating council and shall include:
(1)
The number of Medicaid-eligible persons aged sixty-five (65) years and over and adults with disabilities served in nursing facilities;
(2)
The number of Medicaid-eligible persons aged sixty-five (65) years and over and adults with disabilities transitioned from nursing homes to Medicaid-supported home- and community-based care;
(3)
The number of persons aged sixty-five (65) years and over and adults with disabilities served in Medicaid and office of healthy aging home and community care, to include home care, adult day services, assisted living, the personal choice program, the program of all-inclusive care of the elderly (PACE) and shared living;
(4)
The dollar amounts and percent of expenditures spent on nursing facility care and home- and community-based care for those aged sixty-five (65) years and over and adults with disabilities and the average cost of care for nursing facility care and home- and community-based care;
(5)
The amount of savings attributed to the value of the reduction in nursing home days, including hospice nursing home days paid for by Medicaid in accordance with § 40-8.9-4, and how the savings, if any, are allocated in the current fiscal year and in the proposed budget for the ensuing fiscal year to promote and strengthen community-based alternatives; and
(6)
Estimates of the continued investments necessary to provide stability to the existing system and establish the infrastructure and programs required to achieve systemwide reform and the targeted goal of spending fifty percent (50%) of Medicaid long-term-care dollars on nursing facility care and fifty percent (50%) on home- and community-based services.
(b)
Beginning in 2019, to measure and show progress in achieving the state’s goals for long-term services and supports reform, the executive office of health and human services shall develop and make public on its website a long-term services and supports performance scorecard based on the measures detailed in subsections (a)(1) through (a)(5) of this section showing data for the most recent four-year (4) period.
History of Section.
P.L. 2006, ch. 263, § 1; P.L. 2006, ch. 286, § 1; P.L. 2009, ch. 223, § 1; P.L. 2010, ch. 239, § 5; P.L. 2016, ch. 142, art. 7, § 5; P.L. 2018, ch. 148, § 1; P.L. 2018, ch. 255, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.9 - Medical Assistance — Long-Term Care Service and Finance Reform › Section 40-8.9-7. - Rate reform.

§ 40-8.9-7. Rate reform.
The executive office of health and human services shall design, and require to be submitted by all service providers, cost reports for all community-based, long-term services, including patient liability owed and collected.
History of Section.
P.L. 2006, ch. 263, § 1; P.L. 2006, ch. 286, § 1; P.L. 2016, ch. 142, art. 7, § 5.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.9 - Medical Assistance — Long-Term Care Service and Finance Reform › Section 40-8.9-8. - System screening.

§ 40-8.9-8. System screening.
The executive office of health and human services shall develop and implement a screening strategy for the purpose of identifying entrants to the publicly financed, long-term-care system prior to application for eligibility as well as defining their potential service needs.
History of Section.
P.L. 2006, ch. 263, § 1; P.L. 2006, ch. 286, § 1; P.L. 2016, ch. 142, art. 7, § 5.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.10 - Long-Term Care Service Reform for Medicaid Eligible Individuals › Section 40-8.10-1. - Purpose.

§ 40-8.10-1. Purpose.
In order to ensure that all Medicaid recipients eligible for long-term care have access to the full continuum of services they need, the secretary of the executive office of health and human services, in collaboration with the directors of EOHHS departments, shall offer eligible Medicaid recipients the full range of services as allowed under the terms and conditions of the Rhode Island Medicaid section 1115 demonstration waiver, including institutional services and the home- and community-based services provided for under the previous Medicaid section 1915(c) waivers, as well as additional services for medication management, transition services, and other authorized services as defined in this chapter, in order to meet the individual needs of the Medicaid recipient.
History of Section.
P.L. 2009, ch. 68, art. 23, § 9; P.L. 2015, ch. 141, art. 5, § 17.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.10 - Long-Term Care Service Reform for Medicaid Eligible Individuals › Section 40-8.10-2. - Definitions.

§ 40-8.10-2. Definitions.
As used in this chapter:
(1)
“Core services” mean homemaker services, environmental modifications (home accessibility adaptations, special medical equipment (minor assistive devices), meals on wheels (home delivered meals), personal emergency response (PERS), licensed practical nurse services, community transition services, residential supports, day supports, supported employment, supported living arrangements, private duty nursing, supports for consumer direction (supports facilitation), participant directed goods and services, case management, senior companion services, assisted living, personal care assistance services and respite.
(2)
“Preventive services” mean homemaker services, minor environmental modifications, physical therapy evaluation and services, and respite services.
History of Section.
P.L. 2009, ch. 68, art. 23, § 9.