Title 40, Title 40 Services

(a) The comprehensive assessment required in § 40-8.10-4(b) as part of Medicaid long-term service reform shall also include a caregiver assessment whenever the plan of care depends on a family caregiver for providing assistance with activities of daily-living or instrumental acti…

Pursuant to § 42-12.3-2, it is the intent of the general assembly to create access to comprehensive health care for uninsured Rhode Islanders. The Rhode Island Medicaid program has become an important source of insurance coverage for low-income pregnant women, families with child…

(a) Medicaid coverage for nonpregnant adults without children. There is hereby established, effective January 1, 2014, a category of Medicaid eligibility pursuant to Title XIX of the Social Security Act, as amended by the U.S. Patient Protection and Affordable Care Act (ACA) of 2…

(a) The executive office of health and human services is directed to amend its rules and regulations to implement a premium assistance program for adults with dependent children, enrolled in the state’s health-benefits exchange, whose annual income and resources meet the guidelin…

For purposes of this section the following terms shall have the meanings indicated: (1) “Beneficiary” means an individual who is eligible for medical assistance under the Rhode Island Medicaid state plan established in accordance with 42 U.S.C. § 1396, and includes individuals wh…

In the event that a beneficiary: (1) Has been determined to meet level-of-care requirements for nursing facility coverage as of the date of his or her enrollment in a managed care organization; or (2) Has been determined to meet level of care requirements for nursing facility cov…

EOHHS shall report to the general assembly and shall make available to interested persons a separate accounting of state expenditures for long-term-care supports and services under any managed long-term-care arrangement, specifically and separately identifying expenditures for ho…

Any managed long-term-care arrangement shall offer beneficiaries the option to decline participation and remain in traditional Medicaid and, if a duals demonstration project, traditional Medicare. Beneficiaries must be provided with sufficient information to make an informed choi…

EOHHS shall designate an ombudsperson to advocate for beneficiaries enrolled in a managed long-term-care arrangement. The ombudsperson shall advocate for beneficiaries through complaint and appeal processes and ensure that necessary healthcare services are provided. At the time o…

EOHHS shall designate an individual, not employed by or otherwise under contract with a participating managed care organization, who shall act as liaison between healthcare providers and managed care organizations, for the purpose of facilitating communications and ensuring that …

(a) To the extent that financial savings are a goal under any managed long-term-care arrangement, it is the intent of the legislature to achieve savings through administrative efficiencies, care coordination, improvements in care outcomes and in a way that encourages the highest …

In order to encourage quality improvement and promote appropriate utilization incentives for providers in a managed long-term-care arrangement, a managed care organization may use incentive or bonus payment programs that are in addition to the rates identified in § 40-8.13-5.

A managed care organization must contract with and cover services furnished by any nursing facility licensed under chapter 17 of title 23 and certified by CMS that provides Medicaid-covered nursing facility services pursuant to a provider agreement with the state, provided that t…

A managed long-term-care arrangement must require that all participating managed care organizations use only the EOHHS level-of-care tool in determining coverage of long-term-care supports and services for beneficiaries. EOHHS may amend the level-of-care tool provided that any ch…

No managed care organization acting under a managed long-term-care arrangement may require a provider to change a plan of care if the provider reasonably believes that such an action would conflict with the provider’s responsibility to develop an appropriate care plan under state…

For purposes of this chapter: (1) “Director” means the director of the Rhode Island department of administration. (2) “Executive office of health and human services (EOHHS)” means the agency in the executive branch of state government that is designated as the Medicaid single sta…

Individual providers may provide all authorized HCBS-covered services in accordance with the participant’s service plan at home and other Medicaid certified settings, to the extent the applicable federal and state laws and rules and regulations allow.

The requirement under § 40-8.14-2 shall not restrict the state’s ability to afford participants and participants’ representatives who choose not to employ an individual provider, or are unable to do so, the option of receiving personal care services through the employees of provi…

(a) The secretary shall afford to all Medicaid LTSS beneficiaries who receive authorized HCBS-covered services in accordance with a service plan the option of employing an individual provider to provide direct-support services. (b) The secretary shall modify program operations as…

In accordance with chapter 8.15 of this title, the director shall have the authority to: (1) Meet and negotiate with any provider representative chosen pursuant to § 40-8.15-2(a); (2) In coordination with the secretary, negotiate over any of the topics in § 40-8.14-4(c) and any o…

Should any part of this chapter be declared invalid or unenforceable, or the enforcement or compliance with it is suspended, restrained, or barred, either by the state or by the final judgment of a court of competent jurisdiction, the remainder of this chapter shall remain in ful…

For the purposes of this chapter: (1) “Direct-support services” has the meaning given to it under § 40-8.14-1. (2) “Director” has the meaning given to it under § 40-8.14-1. (3) “Individual provider” has the meaning given to it under § 40-8.14-1. (4) “Participant” has the meaning …

Nothing in this chapter shall be construed to alter the rights of families to select, direct, and terminate the services of individual providers.

Individual providers shall not engage in any strike or other collective cessation of the delivery of direct-support services.

The state action exemption to the application of state and federal antitrust laws is applicable to the activities of individual providers and their provider representative authorized under this chapter.

Should any part of this chapter be declared invalid or unenforceable, or the enforcement or compliance with it is suspended, restrained, or barred, either by the state or by the final judgment of a court of competent jurisdiction, the remainder of this chapter shall remain in ful…

(a) The state shall set wage ranges for all individual providers. All self-directed personal care services performed by individual providers must be compensated at a wage that is within the range set by the secretary for the services provided, but the participant may choose what …

(a)(1) The secretary shall determine by regulation whether and to what extent individual providers selected by personal choice participants to provide self-directed personal care are required to complete an orientation, pursuant to the secretary’s authority under § 40-8.14-4(c)(2…

(a) For purposes of this section, the independent provider (IP) program and the personal choice program shall have the meanings that were set forth in 210-RICR-50-10-2.2(A)(1) and (A)(2) as of the effective date of the personal choice in self-directed personal care services act o…

(a) Individual providers may, in accordance with the procedures set forth in § 40-8.15-7, choose a provider organization to be their provider representative and to negotiate with the state, over the terms and conditions of individual providers’ participation in providing direct-s…

It shall be the obligation of the director, or a designee, to meet and negotiate in good faith with the provider representative within thirty (30) days after receipt of written notice from the provider representative of the request for a meeting for bargaining purposes. This obli…

In the event that the provider representative and the director, or a designee, are unable to reach an agreement on a contract, or reach an impasse in negotiations, the procedures of §§ 36-11-7.1 through 36-11-11 shall be followed.

Any aspects of a contract requiring appropriation by the federal government, the general assembly, or revisions to statutes or regulations shall be subject to passage of those appropriations and any necessary statutory and regulatory revisions.

(a) A provider organization certified as the provider representative shall represent all individual providers in the state fairly and without discrimination, without regard to whether or not the individual provider is a member of the provider organization. (b) Each individual pro…

(a) Petitions to certify a provider organization to serve as the provider representative of individual providers; petitions to intervene in such an election; and any other petitions for investigation of controversies as to representation may be filed with and acted upon by the la…

It shall be unlawful for the state to do any of the acts made unlawful under § 28-7-13. It shall be unlawful for the provider representative to do any of the acts made unlawful under § 28-7-13.1. Any alleged violation of this provision may be filed with the labor relations board …

(a) The secretary has authority over the terms and conditions of individual providers’ employment, including compensation as required under § 40-8.15-14, payment, benefit terms, provider qualification standards, other appropriate terms and conditions for the workforce of individu…