H8337 amends Rhode Island’s Medicaid nursing facility reimbursement law in Chapter 40-8, which governs medical assistance payments to nursing homes. The bill directs the Executive Office of Health and Human Services to review and potentially modify the current cost-based reimbursement system for nursing facilities and other long-term care providers, with the goal of moving toward a price-based methodology. In doing so, the office would be required to account for resident acuity, Medicaid occupancy, direct-care and indirect-care costs, fair-rental value, pass-through payments, and annual inflation adjustments.
The bill also adds a specific requirement that, beginning with rate reviews tied to October 2027, the state consider increases in direct and indirect costs using the most recent finalized year of each facility’s cost report. The bill retains and references existing statutory provisions on staffing-related rate adjustments, wage pass-through requirements, reporting, audits, and clawbacks for noncompliance, while preserving the transition framework intended to soften the impact of reimbursement changes on individual facilities. It takes effect upon passage.
Impact
If enacted, H8337 would change how Rhode Island calculates Medicaid reimbursement for nursing facilities by requiring the state to incorporate a new cost-review element tied to the most recent finalized cost-report year and by authorizing continued movement from a cost-based to a price-based payment model. The bill would affect the Executive Office of Health and Human Services, nursing facilities licensed in Rhode Island, and Medicaid-eligible residents whose care is financed through Title XIX. It would not create a new program, but would modify the state’s existing nursing home rate-setting and reimbursement rules under the Medical Assistance chapter.
Sentiment
The bill appears generally supportive of nursing facility reimbursement reform and is framed as a technical but meaningful update to Medicaid payment methodology. Because there are no recorded committee transcripts or votes in the provided materials, there is no documented floor or committee debate to indicate opposition or support beyond the bill’s stated purpose. The caption and explanatory language suggest the measure is intended to help the state better account for nursing facility cost changes over time.
Contention
The main policy issue embedded in the bill is how Rhode Island should balance adequate Medicaid payments to nursing facilities against state budget control and accountability. Potential points of contention include the shift from a cost-based to a price-based methodology, the timing and use of cost-report data beginning in October 2027, and the continued use of staffing-related payment adjustments, reporting requirements, audits, and clawbacks. Nursing facilities may favor more predictable and higher reimbursement, while state budget officials or advocates for fiscal restraint may scrutinize the cost implications of the revised rate-setting approach.
Requires the executive office of health and human services to increase Medicaid payment rates for primary care services furnished by primary care providers to be commensurate with Medicare rates.
Raises the per diem rate by thirteen percent (13%) for Medicaid reimbursement for Tier C services provide by assisted living residence beginning January 1, 2026.
Establishes Medicaid fee-for-service reimbursement rates set by the general assembly as the rate floor for Medicaid managed care by home care, home nursing care and hospice providers licensed by the DOH and continue the EEOHH.
Establishes Medicaid fee-for-service reimbursement rates set by the general assembly as the rate floor for Medicaid managed care by home care, home nursing care and hospice providers licensed by the DOH and continue the EEOHH.
Requires the executive office of health and human services to apply to the Centers for Medicare and Medicaid Services for a state plan amendment for reimbursement for health services in a school.
Requires the executive office of health and human services to apply to the Centers for Medicare and Medicaid Services for a state plan amendment for reimbursement for health services in a school.