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 service waiting lists.

The bill emphasizes a person-centered approach that promotes individual choice and self-determination, ensuring access to a variety of supportive services in community settings. It introduces provisions to enhance the capacity and quality of home- and community-based services, allows for the consolidation of existing services into a single system, establishes eligibility criteria, and mandates the development of payment methodologies to improve access to care. The executive office is authorized to implement a long-term-care-options counseling program and a statewide conflict-free case management network.

Additionally, the bill includes measures to increase wages for home-care workers and improve training for direct-care staff, addressing workforce challenges. It also establishes minimum Medicaid fee-for-service reimbursement rates for managed care provided by home care and hospice providers. The act will take effect upon passage.

Statutes affected:
5774: 40-8.9-9