2018 -- S 2543 SUBSTITUTE A

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LC004633/SUB A

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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 BEHAVIORAL HEALTHCARE, DEVELOPMENTAL DISABILITIES AND

HOSPITALS - DIVISION OF DEVELOPMENTAL DISABILITIES

     Introduced By: Senators DiPalma, Conley, Miller, and Nesselbush

     Date Introduced: March 01, 2018

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

     SECTION 1. Section 40.1-21-4.3 of the General Laws in Chapter 40.1-21 entitled

"Division of Developmental Disabilities" is hereby amended to read as follows:

     40.1-21-4.3. Definitions.

     As used in this chapter and in chapter 22 of this title the words:

     (1) "Ancillary services" means those services provided, and shall include, but not be

limited to, transportation, housing, housing adaptation, personal attendant care, and homemaker

services.

     (2) "Case management" means the implementation of an individual's program by

providing information, by referral to appropriate service providers, by procurement of services,

and by the coordination of the necessary services.

     (3) "Department" means the Rhode Island department of behavioral healthcare,

developmental disabilities and hospitals (BHDDH).

     (4) "Developmental services" means those services provided to developmentally disabled

adults, and shall include, but not be limited to, habilitation and rehabilitation services, and day

services.

     (5) "Developmentally disabled adult" means a person, eighteen (18) years old or older

and not under the jurisdiction of the department of children, youth and families who is either a

mentally retarded developmentally disabled adult or is a person with a severe, chronic disability

which:

     (i) Is attributable to a mental or physical impairment or combination of mental and

physical impairments;

     (ii) Is manifested before the person attains age twenty-two (22);

     (iii) Is likely to continue indefinitely;

     (iv) Results in substantial functional limitations in three (3) or more of the following

areas of major life activity:

     (A) Self care,

     (B) Receptive and expressive language,

     (C) Learning,

     (D) Mobility,

     (E) Self-direction,

     (F) Capacity for independent living,

     (G) Economic self-sufficiency; and

     (v) Reflects the person's need for a combination and sequence of special,

interdisciplinary, or generic care, treatment, or other services, which are of lifelong or extended

duration and are individually planned and coordinated. For purposes of funding, it is understood

that students enrolled in school will continue to receive education from their local education

authority in accordance with § 16-24-1 et seq.

     (6) "Diagnosis and evaluation" means a process to determine whether and to what extent

an individual is developmentally disabled and a study of the individual's condition, situation, and

needs which lead to a recommendation of what services, if any, would benefit the individual.

     (7) "Individualized program plan" or "general service plan" means a plan, however

named, which includes, but shall not be limited to, the following:

     (i) An evaluation of the strengths, difficulties, needs, and goals of the individual;

     (ii) A description of those services found to be necessary or appropriate to assist the

individual in realizing his or her potential for self-sufficiency in major life activities;

     (iii) A description of the agencies and/or individuals, which are proposed to provide each

of the recommended services;

     (iv) The intermediate and long-range objectives for the individual's development and

habilitation;

     (v) The expected duration for the provision of the services;

     (vi) A description of the tests and other evaluative devices used and their results;

     (vii) Proposed criteria for monitoring and evaluating the success of the services in

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meeting the individual's needs; and

     (viii) The signatures of the preparers of the plan and the date.

     The individual program plan shall indicate developmental, supportive, or ancillary

services by function and frequency, the manner of subsidy and delivery and the categories of need

for services such as transportation, job training, or occupation, housing, housing adaptation,

personal attendant care, homemaker, or other services. This plan shall be reviewed at least

annually; provided, however, that authorizations for services and funding issued prior to July 1,

2011 are null and void. Authorizations will be paid at the rate effective in the quarter the service

was provided. As set out by the Centers for Medicare and Medicaid services (CMS) and home

and community-based requirements for person-centered planning, individuals shall be able to

utilize their allocated funding consistent with their stated goals and plan of care in accordance

with quarterly allocations. Authorizations for services and related funding issued on or after

October 1, 2018, shall be authorized annually with a quarterly allocation identified for each

participant. The department shall release quarterly allocations in an amount not to exceed a

participant's quarterly funding level package. Any changes to rates during a fiscal year require a

forty-five (45) day written notice to the participant and service provider. Notwithstanding the

issuance of annual funding authorizations, the department is not restricted from other statutory

rights granted the department.

     (8) "Mentally retarded developmentally disabled adult" means a person eighteen (18)

years old or older and not under the jurisdiction of the department of children, youth and

families, with significant sub-average, general intellectual functioning two (2) standard deviations

below the norm, existing concurrently with deficits in adaptive behavior and manifested during

the developmental period. For purposes of funding, it is understood that students enrolled in

school will continue to receive education from their local education authority in accordance with

§ 16-24-1 et seq.

     (9) "Service broker" means that individual who assists in facilitating the connection

between the developmentally disabled person and the services required by the individual program

plan.

     (10) "Subsidized access to service" means the provisions of financial resources through

vouchers to a developmentally disabled person to enable the person to gain access to appropriate

generic and/or special services as required by the individual program plan.

     (11) "Supportive services" means those services provided to developmentally disabled

adults, and shall include, but not be limited to, occupational therapy, physical therapy,

psychological services, counseling, nursing services, and medical services.

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     SECTION 2. Section 40.1-26-2 of the General Laws in Chapter 40.1-26 entitled "Rights

for Persons with Developmental Disabilities" is hereby amended to read as follows:

     40.1-26-2. Definitions.

     As used in this chapter:

     (1) "Advocate" means: (i) a legal guardian; or (ii) an individual acting on behalf of a

person with a developmental disability in a manner clearly consistent with the interests of the

person with a developmental disability and includes a family member, friend, or professional

advocate. Whenever possible an advocate should be selected by the person with a disability.

     (2) "Agency" means any person or organization which provides day program services,

residential services, support services or advocacy services for persons with developmental

disabilities, and which is licensed by the department of behavioral healthcare, developmental

disabilities and hospitals pursuant to § 40.1-24-1 et seq.

     (3) "Applicant" means any person with a developmental disability who has applied for

services from the division of developmental disabilities and/or any agency licensed by the

department of behavioral healthcare, developmental disabilities and hospitals pursuant to § 40.1-

24-1 et seq.

     (4) "Aversive interventions" means a class of stimuli that are followed by escape or

avoidance response.

     (5) "Behavioral treatment intervention" means any intervention or treatment to develop or

strengthen adaptive appropriate behaviors through the application of behavioral interventions and

to simultaneously reduce the frequency of maladaptive or inappropriate behaviors. Behavior

interventions encompass interventions, which refer to purposeful, clinical manipulation of

behavior.

     (6) "Competent" means the ability to understand the likely risks and benefits of a

procedure or plan when the risks and benefits are presented to the participant in a manner most

likely to be understood by the participant in light of his or her cognitive abilities and learning

style.

     (7) "Department" means the department of behavioral healthcare, developmental

disabilities and hospitals (BHDDH).

     (8) "Developmental disability" means a severe chronic disability which is attributable to a

mental or physical impairment or combination of impairments; is manifested before the person

attains age twenty-two (22); is likely to continue indefinitely; results in substantial functional

limitations in three (3) or more of the following areas of major life activity: self-care, receptive

and expressive language, learning, mobility, self-direction, capacity for independent living,

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economic self-sufficiency; and reflects the person's need for a combination and sequence of

special, interdisciplinary or generic care, treatment, or other services which are of life long or

extended duration and are individually planned and coordinated.

     (9) "Individualized plan" means the personalized document which describes an

individualized profile of the participant highlighting his or her capabilities, preferences and

interests. The plan describes specific supports in the areas of vocational, social, medical,

supported living, and rehabilitation required to meet the specific needs of the participant. The

plan includes quality indicators that demonstrate the plan has met the expectations of the

participant and the participant is satisfied with the support services he or she is receiving;

provided, however, that authorizations for services and funding issued prior to July 1, 2011 are

null and void. Authorizations for services will be paid at the rate effective when in the quarter the

service was provided. As set out by the Centers for Medicare and Medicaid services (CMS) and

home and community-based requirements for person-centered planning, individuals shall be able

to utilize their allocated funding consistent with their stated goals and plan of care in accordance

with quarterly allocations. Authorizations for services and related funding issued on or after

October 1, 2018, shall be authorized annually with a quarterly allocation identified for each

participant. The department shall release quarterly allocations in an amount not to exceed a

participant's quarterly funding level package. Any changes to rates during a fiscal year require a

forty-five (45) day written notice to the participant and service provider. Notwithstanding the

issuance of annual funding authorizations, the department is not restricted from other statutory

rights granted the department.

     (10) "Participant" means any person eighteen (18) years or older, with a developmental

disability who receives services from the division of developmental disabilities and/or an agency

licensed by the department of behavioral healthcare, developmental disabilities and hospitals.

     (11) "Relative" means a member of the participant's or applicant's family who has been

actively involved in the participant's or applicant's life, has an ongoing relationship with the

participant or applicant, and is supportive in a manner clearly consistent with the best interests of

the participant or applicant.

     (12) "Seclusion" means placing a participant alone in a locked room without supervision.

     (13) "Serious incidents" means any situation involving a person with developmental

disabilities in which the person:

     (i) Has sustained an injury, which requires medical care or treatment beyond routine first

aid;

     (ii) Has been missing;

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     (iii) Has died;

     (iv) Has been involved in a criminal act;

     (v) Has been subject to a medication error.

     SECTION 3. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO BEHAVIORAL HEALTHCARE, DEVELOPMENTAL DISABILITIES AND

HOSPITALS - DIVISION OF DEVELOPMENTAL DISABILITIES

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     This act would provide for authorizations for services to developmentally disabled adults

issued on or after October 1, 2018, be developed on an annual basis with funding for these

services to be issued on an annual basis.

     This act would take effect upon passage.

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