To Amend the Medicaid Section 1115 Demonstration Waiver Requests and Renewals

WHEREAS, The General Assembly enacted Chapter 12.4 of Title 42 entitled “The Rhode Island Medicaid Reform Act of 2008”; and

WHEREAS, A legislative enactment is required pursuant to Rhode Island General Laws § 42-12.4-3; and

WHEREAS, Rhode Island General Laws § 42-7.2-5(3)(i) provides that the Secretary of the Executive Office of Health and Human Services is responsible for the review and coordination of any Medicaid section 1115 demonstration waiver requests and renewals as well as any initiatives and proposals requiring amendments to the Medicaid state plan or category II or III changes as described in the demonstration, “with potential to affect the scope, amount, or duration of publicly-funded health care services, provider payments or reimbursements, or access to or the availability of benefits and services provided by Rhode Island general and public laws”; now therefore be it

RESOLVED, That, in pursuit of a more cost-effective consumer choice system of care that is fiscally sound and sustainable and that reduces the number of days behaviorally complex patients spend in acute care facilities, the legislature approves the following proposal to amend the demonstration:

(x) Change to Rates for Nursing Facility Services. The secretary of the executive office of health and human services is authorized to pursue and implement any waiver amendments, state plan amendments, and/or changes to the applicable department’s rules, regulations, and procedures required to update the behavioral health per-diem add on program for particularly complex patients to include, but not be limited to, those who: (1) Require nursing home level of care and have complex needs that are barriers to placement in a traditional nursing home, and have a history of persistent, disruptive behaviors requiring moderate-to-frequent intervention; (2) Where admission to a nursing home is consistent with the least restrictive setting requirement enunciated in the landmark U.S. Supreme Court case, Olmstead v. L.C (1999); or (3) Must meet nursing facility level of care criteria and has been approved by BHDDH for specialized services through the BHDDH Level II PASRR determination process prior to admission to a nursing home certified by Medicaid to provide specialized and individualized services to these complex patients; and be it further

RESOLVED, That the Secretary of State be and hereby is authorized and directed to transmit duly certified copies of this resolution to the Governor of the State of Rhode Island, the Rhode Island Department of Health, and to the Rhode Island Executive Office of Health and Human Services.