RELATING TO HUMAN SERVICES -- MEDICAL ASSISTANCE -- LONG-TERM CARE, SERVICE AND FINANCE REFORM -- ASSISTED LIVING SERVICES
Summary
H8406 amends Rhode Island’s Medical Assistance—Long-Term Care Service and Finance Reform law to address “bed hold” rules for Medicaid-assisted living residents. The bill provides that a licensed assisted living community is not required to keep a residential unit available for a Medicaid-eligible resident who is temporarily away for hospitalization or a skilled nursing facility stay beyond 10 days, unless the state provides a bed hold payment. If a longer hold is required, the executive office of health and human services (EOHHS) must pay the facility at a rate of at least 50% of the resident’s assessed Medicaid assisted living reimbursement rate.
The bill also sets an overall cap: assisted living communities cannot be required to maintain an unpaid bed hold for more than 45 days total, even if the resident is expected to return. Facilities may still voluntarily hold the unit longer or negotiate private payment arrangements with the resident or the resident’s representative. The bill applies only when the facility has written notice that the resident is reasonably expected to return, and it directs EOHHS to update regulations and seek any needed Medicaid state plan amendments or waivers. The effective date is upon passage, with application to absences on or after July 1, 2026.
Impact
This bill would change the obligations of licensed assisted living communities under Rhode Island Medicaid policy by limiting how long they must reserve a unit for an absent resident without compensation and by requiring state reimbursement for extended bed holds. It would affect EOHHS administration, assisted living providers, Medicaid-assisted living residents, and potentially Medicaid financing through state plan amendments or waivers. The bill also clarifies that unpaid bed-hold obligations cannot exceed 45 days, which could reduce provider financial exposure and alter discharge/return planning for residents.
Sentiment
The available record shows no committee transcript or vote history, so there is no documented floor or committee debate to gauge support or opposition. Based on the bill’s structure, the measure appears designed to balance resident continuity of care with provider reimbursement concerns, suggesting a policy approach aimed at making bed-hold requirements more financially sustainable for assisted living facilities. The caption and text indicate a practical administrative reform rather than a broadly controversial policy change.
Contention
The main point of potential contention is the allocation of cost for extended bed holds: assisted living providers may support the bill because it limits unpaid obligations, while Medicaid advocates or state budget officials may scrutinize the requirement that EOHHS fund bed holds at no less than 50% of the assessed reimbursement rate. Another possible issue is the 45-day cap, which could be viewed as too short by families or resident advocates who want more time for recovery and return planning. The bill also relies on regulatory changes and possible Medicaid waivers, which may raise implementation concerns.
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.
Authorizes an increase in resource eligibility limits for persons with long-term-care needs who reside at home and requires semi-annual reports from Medicaid certified assisted living facilities and adult day service providers to the EOHHS.
Authorizes an increase in resource eligibility limits for persons with long-term-care needs who reside at home and requires semi-annual reports from Medicaid certified assisted living facilities and adult day service providers to the EOHHS.
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.
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.
Authorizes office of health and human services (EOHHS) to establish coverage for obesity treatments, including medication. Office of health and human services would seek a 1115(a) waiver.
Increases individual, group, and Medicaid insurance rates of reimbursement for ambulance and wheelchair van services to be equal to reimbursement rates provided by Medicare for the same medical services.
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.