The bill amends Section 40-8.9-9 of the General Laws in Chapter 40-8.9, establishing a new mandate for the executive office of health and human services to allocate at least fifty percent of Medicaid long-term care funding for individuals aged sixty-five and over, as well as adults with disabilities, towards home- and community-based care. This legislation emphasizes person-centered care and individual choice, ensuring that individuals with severe disabilities have access to a variety of supportive services in community settings. The executive office is also required to provide annual reports on the funding distribution between institutional and community-based care, along with current and projected waiting lists for these services. The bill introduces a tiered eligibility criterion for long-term care services, allowing for stricter admission criteria for institutional care compared to home- and community-based services, and mandates access to the highest level of care for individuals who experience a failed community placement.

Furthermore, the bill seeks to reform payment methodologies to enhance access to various home- and community-based services, including homemaker and personal care, assisted living, and adult day services. It includes provisions for a one-time increase in base-payment rates for home-care service providers and mandates annual inflation adjustments starting July 1, 2019. The bill also introduces a payment methodology change for FY 2022, which includes a shift differential modifier and a behavioral healthcare enhancement for providers with certified direct-care workers. Additionally, it establishes a long-term-care-options counseling program and a statewide conflict-free case management network by January 1, 2024. The legislation aims to improve access to long-term care services while ensuring compliance with federal requirements, with specific insertions regarding payment adjustments and compliance requirements, although the exact deletions from current law are not detailed in the provided text.

Statutes affected:
6289: 40-8.9-9