2019 -- H 5923

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LC002287

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2019

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A N   A C T

RELATING TO HUMAN SERVICES - QUALITY SELF-DIRECTED SERVICES

     

     Introduced By: Representative Christopher T. Millea

     Date Introduced: March 28, 2019

     Referred To: House Health, Education & Welfare

     It is enacted by the General Assembly as follows:

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     SECTION 1. Sections 40-8.14-1 and 40-8.14-4 of the General Laws in Chapter 40-8.14

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entitled "Quality Self-Directed Services" are hereby amended to read as follows:

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     40-8.14-1. Definitions.

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     For purposes of this section:

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     (1) "Activities of daily living" (ADL) means the routine activities that people tend to do

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every day without needing assistance. There are six (6) basic ADLs: eating, bathing, dressing,

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toileting, transferring (walking), and continence.

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     (2) "Applicant" means a person applying to the secretary for registration as an individual

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provider.

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     (3) "Bureau of criminal identification" means the bureau of criminal identification of the

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department of attorney general.

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     (2)(4) "Covered home- and community-based services (HCBS)" means any core,

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preventive, or specialized long-term-care services and supports available in a person's home or a

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community-based living arrangement that the state is authorized to provide under the Medicaid

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state plan, the Medicaid Section 1115 waiver, or any similar program.

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     (3)(5) "Direct-support services" means the range of home- and community-based services

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(HCBS) covered services that are identified in the Medicaid state plan, Rhode Island's § 1115

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waiver, or any similar program that may provide similar services in the future, and the rules and

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regulations promulgated by the executive office of health and human services (EOHHS) or a

 

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designated agency authorize individual home-care providers to provide. The direct-support

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services must be provided in accordance with applicable federal and state law, rules, and

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regulations and include, but are not limited to, personal care assistance, homemaker, and

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companion services that the state is authorized to provide under the Medicaid state plan, the

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Medicaid Section 1115 waiver, or any similar program in the future, including:

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     (i) Participant assistance with activities of daily living and instrumental activities of daily

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living as defined in this chapter;

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     (ii) Assistance with monitoring health status and physical condition;

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     (iii) Assistance with preparation and eating of meals (not the cost of the meal itself);

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     (iv) Assistance with housekeeping activities (bed making, dusting, vacuuming, laundry,

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grocery shopping, cleaning);

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     (v) Assistance with transferring, ambulation, and use of special mobility devices assisting

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the participant by directly providing or arranging transportation; and

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     (vi) Other similar, in-home, non-medical long-term services and supports provided to an

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elderly person or individual with a disability by an individual provider to meet the person's daily

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living needs and ensure that the person may adequately function in the person's home and have

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safe access to the community.

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     (4)(6) "Director" means the director of the Rhode Island department of administration.

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     (7) "Disqualifying information" means information produced by a national criminal

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records check pertaining to a conviction for the following crimes: murder, manslaughter, first

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degree sexual assault, second degree sexual assault, third degree sexual assault, assault on persons

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sixty (60) years of age or older, assault with intent to commit specified felonies (murder, robbery,

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rape, burglary, or the abominable and detestable crime against nature), felony assault, patient

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abuse, neglect or mistreatment of patients, first degree arson, robbery, felony drug offenses,

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larceny, abuse, neglect or exploitation of adults with severe impairments, fraud and false dealing,

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theft, embezzlement, false pretenses, misappropriation, impersonation and identity fraud,

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exploitation of elders, or felony banking law violations. For purposes of this subsection

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"conviction" means, in addition to judgments of conviction entered by a court subsequent to a

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finding of guilty or a plea of guilty, those instances where the defendant has entered a plea of

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nolo contendere and has received a sentence of probation and those instances where a defendant

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has entered into a deferred sentence agreement with the attorney general.

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     (5)(8) "Fiscal intermediary" means a third-party organization under contract with the

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EOHHS responsible for performing payroll and other employment-related functions on behalf of

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the participant.

 

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     (i) The fiscal intermediary shall:

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     (A) Be authorized by the secretary or a designated agency to receive and distribute

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support funds on behalf of a participant in accordance with the participant's service plan; and

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     (B) Act as a fiscal intermediary on behalf of a participant in compliance with all rules,

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regulations, and terms and conditions established by the secretary.

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     (ii) The fiscal intermediary shall not make any decisions regarding hiring, supervising, or

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firing individual providers.

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     (6)(9) "Individual provider" means an individual selected by and working under the

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direction of a Medicaid LTSS beneficiary or the beneficiary's duly authorized representative to

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provide direct-support services to the participant in accordance with the beneficiary's service

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plan, but does not include an employee of a provider agency, subject to the agency's direction and

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control commensurate with agency employee status or an individual providing services to a

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participant electing the personal choice option in any program.

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     (7)(10) "Instrumental activities of daily living" means the skills a person needs to live

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safely and successfully in a residential setting of choice without outside supports. These skills

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include, but are not limited to, using the telephone, traveling, shopping, preparing meals, doing

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housework, taking medications properly, and managing money.

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     (8)(11) "Medicaid LTSS beneficiary" means a person who has been determined by the

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state to obtain Medicaid-funded long-term services and supports.

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     (9)(12) "Participant" means a Medicaid LTSS beneficiary who receives direct-support

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services from an individual provider.

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     (10)(13) "Participant's representative" means a participant's legal guardian or an

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individual having the authority and responsibility to act on behalf of a participant with respect to

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the provision of direct-support services.

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     (11)(14) "Provider representative" means a provider organization that is certified as the

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exclusive negotiating representative of individual providers as provided in § 40-8.15-7.

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     (12)(15) "secretary Secretary" means the secretary of the Rhode Island executive office

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of health and human services (EOHHS).

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     40-8.14-4. Duties of the executive office for health and human services.

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     (a) The secretary shall afford to all Medicaid LTSS beneficiaries who receive authorized

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HCBS-covered services in accordance with a service plan the option of employing an individual

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provider to provide direct-support services.

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     (b) The secretary shall modify program operations as necessary to ensure implementation

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of the individual provider model and to ensure all relevant vendors assist and cooperate as

 

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needed, including managed care organizations and providers of fiscal support, fiscal intermediary,

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financial management, or similar services to provide support to participants and participants'

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representatives with regard to employing individual providers, and otherwise fulfill the

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requirements of this section, including the provisions of subsection (f) of this section.

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     (c) The secretary shall have the authority to:

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     (1) Establish reimbursement rates for all individual providers, in accordance with chapter

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8.15 of this title, provided that these rates may permit individual provider variations based on

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traditional and relevant factors otherwise permitted by law; provided, however, that

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reimbursement rates shall be required to be approved by the general assembly;

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     (2) Ensure delivery of required orientation programs for individual providers;

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     (3) Implement training and educational opportunities negotiated in accordance with

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chapter 8.15 of this title for individual providers, as well as for participants and participants'

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representatives who receive services from individual providers, including opportunities for

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individual providers to obtain certification documenting additional training and experience in

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areas of specialization; provided, however, that individual providers providing homemaking

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services shall undergo training at least equivalent to the training requirements for homemakers

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required by 216 RICR 40-10-17.5.3(K); provided further that individual providers performing the

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duties of a nursing assistant shall be licensed as a nursing assistant in accordance with chapter

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17.9 of title 23.

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     (4) In collaboration with the provider representative, provide for the maintenance of a

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public registry of individuals who have consented to be included to:

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     (i) Allow for routine, emergency, and respite referrals of qualified individual providers

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who have consented to be included in the registry to participants and participants' representatives;

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     (ii) Enable participants and participants' representatives to gain improved access to, and

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choice among, prospective individual providers, including by having access to information about

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individual providers' training, educational background, work experience, national criminal

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background check results, and availability for hire;

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     (5) Establish provider qualification standards for individual providers, including

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undergoing a national criminal background check and behavior that would disqualify someone as

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an individual provider in accordance with the provisions of this chapter;

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     (6) Establish other appropriate terms and conditions for the workforce of individual

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providers without infringing on participants' or their responsible parties' rights and responsibilities

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to hire, direct, supervise, or terminate the employment of their individual providers;

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     (7) Establish policies and procedures for individual providers to be supervised by a

 

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professional (registered) nurse;

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     (7)(8) Establish an advisory board for participants, their representatives, and advocates, to

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communicate directly with the secretary about the provision of quality, direct-support services.

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     (i) The board shall consist of thirteen (13) members:

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     (A) One of whom shall be the secretary of the executive office of health and human

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services, or a designee, who shall serve as chair;

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     (B) Six (6) of whom shall be consumers of the individual provider model, two (2) to be

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appointed by the governor, two (2) to be appointed by the president of the senate, and two (2) to

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be appointed by the speaker of the house;

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     (C) Three (3) of whom shall be representatives from statewide independent living

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centers, one to be appointed by the governor, one to be appointed by the president of the senate,

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and one to be appointed by the speaker of the house;

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     (D) Three of whom shall be from a 501(c)(3) statewide senior advocacy organization, one

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to be appointed by the governor, one to be appointed by the president of the senate, and one to be

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appointed by the speaker of the house;

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     (ii) The board members shall be appointed for three-year (3) terms.

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     (iii) The board shall advise the secretary, or a designee, regarding issues relating to the

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quality, access, and consumer autonomy offered through the individual provider model; and

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     (8)(9) Contract with a fiscal intermediary service for the operations of the individual

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provider model.

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     (d) The secretary's authority in this section shall be subject to the state's obligations to

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meet and negotiate under § 40-8.15-3 and chapter 7 of title 28, as modified and made applicable

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to individual providers under § 40-8.15-3, and to agreements with any exclusive representative of

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individual providers, as authorized by § 40-8.15-3. Except to the extent otherwise provided by

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law, the secretary shall not undertake activities in subsections (c)(3) and (c)(4) of this section,

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prior to October 1, 2019, unless included in a negotiated agreement and an appropriation has been

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provided by the legislature to the secretary.

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     (e) The secretary shall cooperate in the implementation of chapter 8.15 of this title with

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all other relevant state departments and agencies. Any entity providing relevant services,

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including, but not limited to, providers of fiscal support, fiscal intermediary, financial

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management, or similar services to provide support to participants and participants'

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representatives with regard to employing individual providers shall assist and cooperate with the

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secretary in the operations of this section, including with respect to the secretary's obligations

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under subsections (b) and (f).

 

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     (f) The secretary, or a designee, shall, no later than October 1, 2019, and then quarterly

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thereafter, in accordance with rules and regulations promulgated by EOHHS, compile and

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maintain a list of the names and addresses of all individual providers who have been paid for

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providing direct-support services to participants within the previous six (6) months. The list shall

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not include the name of any participant, or indicate that an individual provider is a relative of a

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participant or has the same address as a participant. The secretary, or a designee agency, shall

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share the lists with others as needed for the state to meet its obligations under this chapter and

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chapter 8.15 of this title. This sharing shall not include access to private data on participants or

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participants' representatives. Nothing in this section or chapter 8.15 of this title shall alter the

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access rights of other private parties to data on individual providers.

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     (g) The secretary shall immediately commence all necessary steps to ensure that direct-

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support services are offered in conformity with this section; to gather all information that may be

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needed for promptly compiling lists required under this section, including information from

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current vendors; and to complete any required modifications to currently providing direct-support

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services by October 1, 2019.

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     SECTION 2. Chapter 40-8.14 of the General Laws entitled "Quality Self-Directed

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Services" is hereby amended by adding thereto the following section:

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     40-8.14-7. Rights of participants.

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     The secretary shall develop a written list of rights to be distributed to the participant

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within five (5) calendar days of the initiation of services to the participant and thereafter, on an

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annual basis. These rights include:

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     (1) The participant's right to be free from verbal, physical and psychological abuse and to

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be treated with dignity;

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     (2) The participant's right to temporarily or permanently suspend, terminate, or add the

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provision of any services stated in the service plan;

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     (3) The participant's right to have property treated with respect;

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     (4) The participant's right to voice grievances regarding services furnished or regarding

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the lack of respect for property by anyone who is furnishing services and that the participant shall

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not be subject to discrimination or reprisal for doing so;

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     (5) A statement that it is not within the scope of the services to manage the medical and

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health conditions of the participants; and

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     (6) The procedure and contact information to file a complaint with the secretary.

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     40-8.14-8. Complaint process.

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     The secretary shall establish a process for participants to file complaints regarding the

 

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provision of services by individual providers in the quality self-directed services program. The

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secretary shall investigate complaints made by a participant, the participant's family, or the

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participant's representative regarding services that are or have failed to be furnished or lack of

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respect for the participant's property by the individual provider. The secretary shall document the

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existence of the complaint and resolution of the complaint.

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     40-8.14-9. National criminal records check.

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     (a) Any person seeking to become an individual provider shall undergo a national

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criminal records check to be initiated prior to applying for registration.

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     (b) The applicant shall apply to the bureau of criminal identification for a national

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criminal records check that shall be supported by fingerprints submitted to the Federal Bureau of

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Investigation ("FBI").

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     (1) Upon the discovery of any disqualifying information, the bureau of criminal

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identification shall inform the applicant, in writing, of the nature of the disqualifying information;

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and, without disclosing the nature of the disqualifying information, will notify the secretary, in

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writing, that disqualifying information has been discovered. The secretary may not deny

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registration based on the existence of disqualifying information. However, the secretary shall

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alert the hiring participant that disqualifying information has been discovered on a registrant's

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national criminal records check. The registrant, on whom disqualifying information has been

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found may provide the participant a copy of the national criminal records check. The participant

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shall make a judgment regarding the employment or continued employment of a registrant.

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     (2) In those situations in which no disqualifying information has been found, the bureau

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of criminal identification shall inform the applicant and the secretary, in writing.

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     (c) It shall be the responsibility of the applicant to pay for the national criminal records

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check.

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     40-8.14-10. Denial, suspension, or revocation of individual provider registration.

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     The secretary, after notice and opportunity for a hearing to the applicant or individual

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provider, is authorized to deny, suspend, or revoke a registration in any case in which it finds that

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there has been failure to comply with the requirements under this chapter and the rules and

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regulations promulgated thereto or the individual provider has been convicted of an offense that is

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considered disqualifying information. The notice shall be effected by registered or certified mail

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or by personal service, setting forth the particular reasons for the proposed action and fixing a

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date not less than thirty (30) days from the date of the mailing or service, at which time the

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applicant or individual provider shall be given an opportunity for a prompt and fair hearing. On

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the basis of the hearing, or upon the failure of the applicant or individual provider to appear, the

 

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secretary shall make a determination specifying its findings of fact and conclusions of law. A

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copy of the determination shall be sent by registered or certified mail or served personally upon

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the applicant or individual provider. The decision denying, suspending, or revoking the

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registration shall become final thirty (30) days after it is so mailed or served, unless the applicant

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or individual provider, within the thirty (30) day period, appeals the decision pursuant to § 42-35-

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15. The procedure governing hearings authorized by this section shall be in accordance with §§

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42-35-9 and 42-35-13 as stipulated in § 42-35-14. A full and complete record shall be kept of all

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proceedings, and all testimony shall be reported but need not be transcribed unless the decision is

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appealed pursuant to § 42-35-15. A copy or copies of the transcript may be obtained by an

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interested party on payment of the cost of preparing the copy or copies. Witnesses may be

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subpoenaed by either party.

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     40-8.14-11. Judicial review of certificate of registration action.

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     Any person who has exhausted all administrative remedies available to them within the

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secretariat, and who is aggrieved by a final decision of the secretary, is entitled to judicial review

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in accordance with the provisions of §§ 42-35-15 and 42-35-16.

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     40-8.14-12. Immunity from liability.

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     No person who disqualifies an individual from employment or continued employment

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within thirty (30) days of receipt of a letter containing disqualifying information or of a national

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criminal records check relating to that information shall be liable for civil damages or subject to

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any claim, cause of action, or proceeding of any nature as a result of the disqualification.

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     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 HUMAN SERVICES - QUALITY SELF-DIRECTED SERVICES

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     This act would establish minimum qualifications for providers of covered home- and

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community-based services and direct-support services and would grant certain rights, and a

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complaint process, to participants who receive direct-support services.

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     This act would take effect upon passage.

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