The bill amends Section 40-8.9-9 of the General Laws to establish a long-term-care rebalancing system reform goal. It mandates that all Medicaid programs operated by the executive office of health and human services, its subordinate agencies, contractors, and all commercial lines within health insurance companies contracted with the Medicaid program shall not reimburse home care providers, home nursing care providers, and hospice providers less than fee-for-service rates.

The executive office of health and human services is responsible for applying for necessary waivers and amendments to implement this plan, which includes annual reporting on funding distribution between institutional and community care, as well as waiting lists for services. The bill emphasizes a person-centered approach that promotes individual choice and self-determination, ensuring access to a range of supportive services in community settings.

Additionally, the bill introduces provisions to enhance the capacity and quality of home- and community-based services, including the consolidation of existing services into a single system, establishing eligibility criteria, and developing payment methodologies to improve access to care. It mandates the implementation of a long-term-care-options counseling program and a statewide conflict-free case management network. The bill also addresses workforce challenges by increasing wages for home-care workers and enhancing training for direct-care staff.

Key reforms must be implemented by January 1, 2016, including establishing adult day services level of need criteria and an acuity-based, tiered-payment methodology. The act will take effect upon passage.

Statutes affected:
255: 40-8.9-9