2018 -- S 2011

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LC003575

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2018

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A N   A C T

RELATING TO STATE AFFAIRS AND GOVERNMENT - CARETAKER ASSISTANCE

AND RELIEF FOR ELDERLY (CARE)

     

     Introduced By: Senators Felag, Coyne, Seveney, Ciccone, and DiPalma

     Date Introduced: January 11, 2018

     Referred To: Senate Finance

     It is enacted by the General Assembly as follows:

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     SECTION 1. Title 42 of the General Laws entitled "STATE AFFAIRS AND

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GOVERNMENT" is hereby amended by adding thereto the following chapter:

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CHAPTER 66.12

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CARETAKER ASSISTANCE AND RELIEF FOR ELDERLY (CARE)

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     42-66.12-1. Legislative findings and purpose.

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     (a) The legislature finds that the state must improve accommodations for a broad range of

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home and community based long-term care options for Rhode Island's significant elderly

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population. The division of elderly affairs reports that according to 2006 census bureau figures

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the state had 194,533 residents age sixty (60) and older. This represented 18.2 percent (18.2%) of

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the population and ranked Rhode Island eighth in the nation in this category. As of July 1, 2016,

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the United States Census Bureau estimated that sixteen and one-half percent (16.5%) of the

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Rhode Island population were sixty-five (65) years of age or older.

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     (b) The legislature further finds that family caregivers constitute a major role in the state's

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health care system by regularly providing long-term care to the elderly. Caregiving for an elderly

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family member takes a toll on caregivers, and care recipients. Numerous studies show that

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caregivers report higher levels of psychological distress, and caring for elderly family members

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over extended periods of time can lead to chronic stress. In some instances, adult children may

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have to return home to live, and abandon careers in the process, in order to care for their parents

 

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at home, which is the only alternative to expensive institutional care. They often have to quit their

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jobs to stay home to care for their aging parents, which may result in financial disaster for the

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family and a loss of tax revenue for the state. While family caregivers play a critical role in

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helping others, it is imperative that family caregivers take care of themselves and have the

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necessary supports and services to sustain their own health as well as the health of the family

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member for which they are caring.

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     (c) The purpose of this act is to:

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     (1) Authorize the division of elderly affairs to establish the CARE program to assist

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Rhode Island family caregivers who are providing care for elders and to allow family caregivers

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to stay in the workforce;

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     (2) Provide a comprehensive program of assistance for Rhode Island elderly continuing

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to live at home; and

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     (3) Appropriate funds for the establishment and implementation of the CARE program.

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     42-66.12-2. Definitions.

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     (a) "Activities of daily living" means the following activities that individuals perform as a

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part of daily living: eating; dressing; bathing; toileting; transferring in and out of a bed or chair;

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and walking or moving about by other means within the home.

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     (b) "Adult day care" or "adult day health" means personal care for an individual in a

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supervised, protective, and congregate setting during some portion of a day.

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     (c) "Assisted transportation" means an individual who has difficulties, cognitive or

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physical in nature, and who needs assistance in using regular vehicular transportation.

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     (d) "Attendant care" means stand-by assistance, supervision, or cues, and may include

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other activities to help maintain the independence of an individual at home. Attendant care shall

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not include providing hands-on-the-body support, including but not limited to, weight-bearing

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assistance with transfers: washing; bathing; or grooming a participant's body; or guiding a

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participant's limbs or implements to assist with feeding or dressing.

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     (e) "Care coordination" means a person-centered, assessment-based, interdisciplinary

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approach to integrating health care and social support services that are tailored to an individual's

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needs and goals across all care services.

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     (f) "Case management" means assistance either in the form of access or care coordination

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in circumstances where an individual is experiencing diminished functioning capacities, personal

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conditions, or other characteristics that require the provision of services by formal service

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providers or family caregivers. Activities of case management may include assessing needs,

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developing care plans, authorizing and coordinating services among providers, and providing

 

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follow-up and reassessment, as required.

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     (g) "Chores" means activities such as heavy housework, yard work, or general home

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maintenance.

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     (h) "Coach" means an individual who:

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     (1) Helps the self-directing participant understand the program of self-directed supports;

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     (2) Develops and implements a spending plan to describe how the participant will spend

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the participant's budget; and

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     (3) Evaluates whether the self-direction program is meeting the participant's needs.

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     (i) "Family caregiver" means a spouse, adult child, other relative, partner, or friend who

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has a personal relationship with, and provides a broad range of unpaid assistance for, an adult age

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sixty (60) or older with a chronic or disabling condition.

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     (j) "Homemaking" means activities such as preparing meals, shopping for personal items,

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managing money, or performing light housework.

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     (k) "Instrumental activities of daily living" means the following instrumental activities

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that individuals perform as a part of daily living: preparing meals; shopping for personal items;

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medication management; managing money; using the telephone; performing light housework;

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performing heavy housework; and making use of available transportation.

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     (l) "CARE core services" means services consisting of:

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     (1) Adult day care;

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     (2) Attendant care;

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     (3) Case management;

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     (4) Chores;

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     (5) Homemaking;

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     (6) Nutrition and meal delivery;

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     (7) Personal care;

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     (8) Transportation; or

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     (9) Assisted transportation.

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     (m) "Nutrition and meal delivery" means the delivery of a meal to a qualified individual

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at the individual's place of residence.

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     (n) "Person-centered plan" means a plan developed by a qualified individual with the

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assistance of a coach that allows the qualified individual to establish goals, skills, and knowledge

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necessary to work toward the desired outcomes and lays out practical steps to the achievement of

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the goals; provided, that family members and friends may provide assistance in developing a

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qualified individual's plan if the qualified individual chooses to include them.

 

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     (o) "Person-centered planning" means a process, directed by the participant, intended to

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identify the strengths, capacities, preferences, needs, and desired outcomes of the participant.

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     (p) "Personal care" means personal assistance, including hands-on-the-body support,

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stand-by assistance, supervision, or cues, to assist a participant with activities of daily living.

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     (q) "Qualified individual" means an individual who is sixty (60) years of age or older and

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homebound by reason of illness or incapacitating disability, or is otherwise isolated, and meets all

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the criteria to participate as a benefit recipient under the CARE program.

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     (r) "Transportation" means transportation from one location to another with a vehicle and

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does not include any other activity.

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     42-66.12-3. Caretaker assistance and relief for elderly (CARE) program.

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     (a) The division of elderly affairs within the department of human services shall establish

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the caretaker assistance and relief for elderly (CARE) program. The program shall provide

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additional assistance to qualified individuals who meet the requirements of this section.

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     (b) The program shall be coordinated and administered by the director of elderly affairs.

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     (c) The CARE program shall award a voucher of a maximum of seventy dollars ($70) per

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day to cover costs for the following services that would otherwise be performed by the qualified

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family caregiver for the care recipient:

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     (1) Transportation;

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     (2) Personal care services;

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     (3) Respite care;

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     (4) Adult day care; or

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     (5) Chores and homemaking services;

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     Provided that the voucher shall be issued directly to the service provider.

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     (d) The director may promulgate and adopt rules and regulations necessary to implement

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the purposes of this section.

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     (e) CARE services shall be delivered through two (2) distinct service options: traditional

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service delivery or qualified individual-directed services and support. Based on an individual

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support plan, each eligible participant may access CARE supports and services through

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traditional service delivery or participant-directed services and support; provided that:

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     (1) Traditional service delivery shall deliver to each participant one or more CARE core

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services to address the qualified individual's specific needs that have been identified through the

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division of elderly affairs process for person-centered planning; and

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     (2) Qualified individual-directed services and support shall address the qualified

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individual's specific needs that have been identified through the division of elderly affairs process

 

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for person-centered planning. Qualified individual-directed services and support shall be long-

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term services and supports that a qualified individual uses to maintain the qualified individual's

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independence in the community, in which the qualified individual determines what mix of

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services and support works best for the qualified individual. The qualified individual shall have

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decision-making authority over the qualified individual's budgeted dollar amount to purchase and

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manage the qualified individual's needed services and supports based on the qualified individual's

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person-centered plan. Qualified individual-directed services and support shall provide the

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qualified individual with a coach to assist the qualified individual with using the services and

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support in a manner that best supports the qualified individual's ability to maintain independence

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and enable a quality living experience in the community.

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     (f) To qualify for the CARE program, a qualified individual shall:

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     (1) Be a citizen of the United States or a qualified alien; provided, that for the purposes of

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this paragraph, "qualified alien" means a lawfully admitted permanent resident under the

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Immigration and Nationality Act;

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     (2) Be sixty (60) years of age or older;

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     (3) Not reside in a long-term care facility, such as an intermediate care facility, assisted

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living facility, skilled nursing facility, hospital, community care foster family home, adult

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residential care home, or expanded adult residential care home; and

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     (4) Have impairments of at least:

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     (i) Two (2) activities of daily living;

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     (ii) Two (2) instrumental activities of daily living;

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     (iii) One activity of daily living and one instrumental activity of daily living; or

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     (iv) Substantive cognitive impairment requiring substantial supervision because the

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individual behaves in a manner that poses a serious health or safety hazard to the individual or

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another person.

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     (g) The division of elderly affairs or other entity designated by the director of the division

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of elderly affairs shall conduct an intake and assessment of individuals seeking long-term services

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and supports to determine eligibility for the program. The intake and assessment shall include the

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following:

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     (1) A statewide uniform intake developed with and adopted by the director of the division

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of elderly affairs to preliminarily determine eligibility for public funded services and supports,

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including CARE services; and

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     (2) If warranted, a written assessment of the individual's eligibility to utilize statewide

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uniform comprehensive in-home care within ninety (90) days after written notice of the division

 

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of elderly affair's decision regarding eligibility for CARE services; provided that the director's

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decision shall be issued in writing and shall be final.

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     (h) Prior to termination of CARE services, service providers shall notify the division of

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elderly affairs of the date and reason for termination. Termination of CARE services may occur if

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the individual:

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     (1) Moves and the provider is unable to locate the individual;

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     (2) Is no longer a Rhode Island resident;

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     (3) Dies;

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     (4) No longer needs CARE services and supports;

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     (5) Is uncooperative with the service provider;

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     (6) Is non-compliant with the basic requirements of the program;

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     (7) Engages in behavior that threatens or demonstrates violence toward the service

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provider;

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     (8) Decides the individual no longer needs or wants a particular service;

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     (9) Uses comparable services from other programs; or

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     (10) Has a communicable disease that threatens the safety and welfare of the service

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provider.

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     (i) The division of elderly affairs shall record all consumer data, assessments, and service

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delivery within a statewide-consolidated database.

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     SECTION 2. This act shall take effect on July 1, 2018.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO STATE AFFAIRS AND GOVERNMENT - CARETAKER ASSISTANCE

AND RELIEF FOR ELDERLY (CARE)

***

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     This act would create the Caretaker Assistance and Relief for Elderly (CARE) program to

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be administered by the division of elderly affairs. CARE program services would provide

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payment of up to seventy dollars ($70) per day to cover costs for support services for qualified

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elderly receiving care from caregivers, thereby allowing family members to work or pursue other

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individual or family needs.

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     This act would take effect on July 1, 2018.

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