42-72-37. Family care community partnerships.

(a) As used in this section, "family care community partnership" (FCCP) means a specific,

community-based child abuse and neglect prevention service that an agency or entity provides to

children and families through a Medicaid certification, department license, or contract with the

department.

(b) There are hereby established five (5) FCCP catchment regions to serve residents of a

specific area within the state, as follows:

(1) West Urban Core: The cities of Providence and Cranston;

(2) East Urban Core: The cities of East Providence, Central Falls, and Pawtucket;

(3) East Bay: The towns of Barrington, Bristol, Jamestown, Little Compton, Middletown,

Portsmouth, Tiverton, and Warren, and the city of Newport;

(4) Washington and Kent Counties: The towns of Charlestown, Coventry, East Greenwich,

Exeter, Hopkinton, Narragansett, New Shoreham, North Kingstown, Richmond, South Kingstown,

West Greenwich, West Warwick, and Westerly, and the city of Warwick; and

(5) Northern Rhode Island: The towns of Burrillville, Cumberland, Foster, Glocester,

Johnston, Lincoln, North Providence, North Smithfield, Scituate, Smithfield, and the city of

Woonsocket.

(c) Exactly one FCCP Lead Agency shall be permitted to operate in each region set forth

in subsection (b) of this section.

SECTION 8. Rhode Island Medicaid Reform Act of 2008 Resolution.

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 §

5 42-12.4-1, et seq.; 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"; and

WHEREAS, In pursuit of a more cost-effective consumer choice system of care that is

fiscally sound and sustainable, the secretary requests legislative approval of the following proposals

to amend the demonstration; and

WHEREAS, Implementation of adjustments may require amendments to the Rhode

Island's Medicaid state plan and/or section 1115 waiver under the terms and conditions of the

demonstration. Further, adoption of new or amended rules, regulations and procedures may also be

required:

(a) Substance Abuse Residential Services Rates. The secretary of the executive office of

health and human services will pursue and implement any state plan amendments needed to

eliminate annual rate increases for substance abuse residential services.

(b) Assisted Living Tier C Rates. 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

increase Tier C Assisted Living reimbursement rates by 13 percent starting January 1, 2027

(c) Children's Services Rate Setting. 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 implement reimbursement rates resulting from the Children's Services Rate Setting

project.

(e) 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

starting April 1, 2027, to include, but not 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) Admission to a specialized nursing home is consistent with the least restrictive setting

requirement enunciated in the landmark U.S. Supreme Court case, Olmstead v. L.C (1999); and

(3) The individual 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 specialized nursing home.

(f) Glucagon-like Peptide-1 (GLP-1) Coverage. 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 remove coverage for GLP-1 medications, except if prescribed to treat type 2 diabetes.

(g) Targeted Case Management. 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

implement updates to Medicaid's authority to reimburse for the governmental provision of targeted

case management to Medicaid enrolled children and youth (up to 21 years old) by qualified staff at

the Department of Children, Youth and Families.

(h) Graduate Medical Education for Federally Qualified Health Centers. The executive

office of health and human services shall review and assess any Medicaid waiver or state plan

opportunities that support Rhode Island Federally Qualified Health Centers that operate, or

participate in the operation of, accredited primary care-focused physician residency programs. The

Secretary shall provide a report with options, recommendations, and estimated fiscal impact to the

General Assembly and Governor by November 1, 2026, for consideration in the FY 2028 enacted

budget.

(i) 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 increase resource limits

effective January 1, 2027, for Community Medicaid, long-term services and supports, and

medically needy beneficiaries to eight thousand dollars ($8,000) for an individual and twelve

thousand dollars ($12,000) for a couple.

(i) (j) Federal Financing Opportunities. The executive office of health and human services

proposes that it shall review Medicaid requirements and opportunities under the U.S. Patient

Protection and Affordable Care Act of 2010 (PPACA) and various other recently enacted federal

laws and pursue any changes in the Rhode Island Medicaid program that promote, increase and

enhance service quality, access and cost-effectiveness that may require a Medicaid state plan

amendment or amendment under the terms and conditions of Rhode Island's section 1115 waiver,

its successor, or any extension thereof. Any such actions by the executive office of health and

human services shall not have an adverse impact on beneficiaries or cause there to be an increase

in expenditures beyond the amount appropriated for state fiscal year 2027; now, therefore be it

RESOLVED, That the General Assembly hereby approves the above-referenced proposals;

and be it further

RESOLVED, That 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 approved herein and as

authorized by chapter 12.4 of title 42; and be it further

SECTION 9. Joint Resolution. AUTHORIZING THE SECRETARY OF THE

EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES TO CONTINUE AND

EXPAND AN ACUTE HOSPITAL CARE AT HOME PROGRAM

WHEREAS, The State of Rhode Island has received a multi-hundred-million-dollar,

multiyear award from the Centers for Medicare and Medicaid Services called The Rural Health

Transformation Program (RHTP); and

WHEREAS, RHTP strongly favors and funds states that have hospitals that participate in

the Centers for Medicare and Medicaid Services Acute Hospital Care at Home initiative, the

services of which are often called hospital at home programs; and

WHEREAS, Hospital at home models have shown over decades that advanced care at

home can be a safe, effective way to provide care to patients that is associated with lower costs and

better patient outcomes and satisfaction compared with inpatient hospitalization; and

WHEREAS, The hospital at home model is an important component of the shift away from

institutionalized care and has been successful in allowing patients with particular conditions to

remain in their homes and avoid risks associated with inpatient admission and care; and

WHEREAS, The Centers for Medicare and Medicaid Services has extended the Acute

Hospital Care at Home initiative through September 30, 2030, via the Consolidated Appropriations

Act; and

WHEREAS, The Acute Hospital Care at Home initiative applies to Medicare beneficiaries,

but can be extended to Medicaid beneficiaries if states choose to cover such services; and

WHEREAS, The State of Rhode Island wishes to extend the Acute Hospital Care at Home

initiative benefits to both traditional and managed Medicaid enrollees;

NOW, THEREFORE BE IT RESOLVED,

(1) Notwithstanding any provision of law to the contrary, the Executive Office of Health

and Human Services shall establish and maintain a program to cover hospital at home services for

all eligible medical assistance enrollees and managed Medicaid enrollees. The program shall be

established and maintained in a manner that is consistent with the provisions of the Acute Hospital

Care at Home initiative, as authorized by the federal Centers for Medicare and Medicaid Services.

(2) Any Rhode Island licensed hospital in receipt of a waiver to operate, or otherwise

approved to participate in the Centers for Medicare and Medicaid Services Acute Hospital Care at

Home initiative, shall be permitted to operate or to continue to operate its program in the manner

permitted under federal law.

(3) For as long the Acute Hospital Care at Home initiative, or a successor, remains in effect,

the Rhode Island Medical Assistance program, including managed Medicaid plans, shall provide

coverage and payment for acute hospital care services delivered to a covered person through the

program established pursuant to this resolution, on the same basis as when services are delivered

within the facilities of a hospital. Reimbursement payments under this section shall be provided to

the hospital, facility, or organization providing the services or the individual practitioner who

delivered the reimbursable services, or to the agency, facility, or organization that employs or

contracts with the individual practitioner who delivered the reimbursable services, as appropriate,

at a rate no higher than the payer's then applicable reimbursement rates for the same service in the

same hospital.

(4) The program shall not utilize more stringent utilization management criteria than apply

when those services are provided within the facilities of a hospital.

(5) The Secretary of the Executive Office of Health and Human Services shall apply for

any State plan amendments or waivers as may be necessary to implement the provisions of this

resolution and to secure federal financial participation for State Medicaid expenditures under the

federal Medicaid program.

(6) The Secretary of the Executive Office of Health and Human Services shall adopt rules

and regulations, in accordance with the Administrative Procedure Act, if necessary, to effectuate

the provisions of this resolution; and be it further

RESOLVED, The Secretary of the Executive Office of Health and Human Services shall

provide a report to the Governor and the General Assembly regarding the cost of the program.

SECTION 10. Sections 8 and 9 of this article shall take effect on July 1, 2026. Sections 2,

4 and 5 shall take effect on January 1, 2027. The remainder of the article shall take effect upon

passage