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 is responsible for adopting the rate percentage increase applicable to these services based on a rate review report conducted by the office of the health insurance commissioner.

The legislation includes provisions for rate adjustments, including an increase in the existing shift differential modifier and overtime rate, effective July 1, 2026. The new rates will be competitive with those set in Massachusetts and Connecticut and will apply to personal care, combined personal care/homemaker, and private duty nursing for overnight, weekend, and holiday shifts. Additionally, the bill requires compliance with federal regulations regarding reimbursement for all time and travel costs attributed to direct care employees providing care to Medicaid beneficiaries.

The bill also establishes a ten percent enhancement rate for providers sending direct care employees to Medicaid beneficiaries residing in low-density population communities, defined as those with a population density of under one thousand and a population size of under twenty-five thousand. Furthermore, it allows the Rhode Island Partnership for Home Care, with oversight from the Executive Office of Health and Human Services, to coordinate behavioral health training for licensed nurse assistants and homemakers delivering paraprofessional care services to Medicaid home care beneficiaries.

The act reduces administrative burdens on Medicaid-contracted home care providers by eliminating a statutory reporting requirement that is no longer relevant. It emphasizes a person-centered approach, promoting individual choice and access to supportive services in community settings, thereby reducing reliance on institutional care. The bill takes effect upon passage.

Statutes affected:
2363: 40-8.9-9