2022 -- H 7628

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LC005099

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2022

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A N   A C T

RELATING TO HEALTH AND SAFETY -- MATERNAL AND CHILD HEALTH SERVICES

FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS

     Introduced By: Representatives Giraldo, Williams, Morales, Alzate, Felix, Barros,
Amore, and Biah

     Date Introduced: March 02, 2022

     Referred To: House Finance

     It is enacted by the General Assembly as follows:

     SECTION 1. The General Assembly hereby finds and declares the following:

     (1) The Rhode Island early intervention program, overseen and managed by the executive

office of health and human services, is a core component of the state’s commitment to ensuring

that families with infants and toddlers with or at substantial risk for developmental delays and

disabilities receive high-quality services as early as possible so children can develop to their fullest

potential and succeed in school and life.

      (2) According to the Center on the Developing Child at Harvard University, healthy

development in the early years (particularly birth to age three (3)) provides the building blocks for

educational achievement, economic productivity, responsible citizenship, and lifelong health.

Effective early intervention services help infants and toddlers make developmental progress and

can help them catch up with their peers. Research has shown that about one-third (1/3) of children

who receive early intervention services no longer had a developmental delay or special education

need in kindergarten.

      (3) The Medicaid rates paid early intervention services have not been increased since 2002,

and, in fact, were cut in 2009. Inadequate funding has caused significant operating deficits for

Rhode Island’s certified early intervention providers and low wages and high turnover for early

intervention specialists.

      (4) Once a state participates in the early intervention program, it must assure that early

intervention will be available to every eligible child and its family.

     (5) Early intervention financing and staffing challenges have grown over time, and, as of

November 2021, the state established a waiting list for early intervention services, a public

education right established under Part C of the federal Individuals with Disabilities Education Act.

     (6) The Rhode Island first connections family home visiting program, overseen and

managed by the department of health, is a program designed to connect families with infants and

toddlers to services to address health and developmental challenges. First connections is Rhode

Island’s comprehensive system to identify, locate, and evaluate all infants and toddlers with

disabilities, required under the “child find” mandate in Part C of the federal Individuals with

Disabilities Education Act.

      (7) The Medicaid rates paid for first connections services have not increased since 2000.

Inadequate funding has resulted in an average operating loss for first connections programs of one

hundred thirty-six dollars and seventy cents ($136.70) per visit. Several agencies that operate first

connections programs have notified the state that they will not be able to continue providing

services in FY 2023 without a significant rate increase.

     (8) Each year, approximately sixty percent (60%) of babies born in Rhode Island are

referred to first connections and approximately thirty-seven percent (37%) receive first connections

services (at least one visit). Each year, over four thousand (4,000) infants and toddlers in Rhode

Island receive early intervention services, with approximately seven percent (7%) of the population

enrolled at any point in time.

     SECTION 2. Section 23-13-22 of the General Laws in Chapter 23-13 entitled "Maternal

and Child Health Services for Children with Special Health Care Needs" is hereby amended to read

as follows:

     23-13-22. Early intervention program for developmentally disabled infants. Early

intervention program for infants and toddlers with developmental delays and disabilities.

     (a) The director of the department of human services shall ensure that all developmentally

disabled infants from birth to three (3) years of age shall be enrolled in the early intervention

program. Regulations governing the delivery of services under this program, including eligibility

criteria, shall be promulgated by the department of human services, with the advice of the

interagency coordinating council; provided, however, that all regulations promulgated by the

department of health shall remain in full force and effect until the time they are replaced by

regulations promulgated by the department of human services. The regulations shall stipulate, at a

minimum, the following provisions that are consistent with the intent of this chapter:

     (1) The director shall develop and maintain a procedure for the earliest possible

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identification and efficient referral of all developmentally disabled infants;

     (2) The director shall ensure that every infant identified and referred to this program is

enrolled as soon as possible after birth; and further, that for infants placed on a waiting list for

facility based group programming, an early intervention program shall be made available within a

thirty (30) day period from the time a need is identified in the individual program plan;

     (3) Unless parents refuse the service, the home visiting component of the program shall

commence as soon as the infant has been identified as having a possible developmental disability;

     (4) Any parent(s) who is/are dissatisfied with decisions or termination of service or with

practices and procedures of a particular agency or the department of human services shall notify

the director of the department of human services in writing within thirty (30) calendar days and the

complaint shall be reviewed in accordance with department of health policy and procedures, as

amended, and the Administrative Procedures Act, chapter 35 of title 42.

     (5) An early intervention program for purposes of this section shall mean a comprehensive

array of educational, developmental, health, and social services provided on a calendar year basis

to eligible infants, children, and their families as specified in program regulations.

     (b) Within ninety (90) days after October 1, 2004, an evaluation plan describing outcome

measures that document the program's successes and shortcomings from the previous fiscal year

shall be submitted to the speaker of the house of representatives, the president of the senate and the

house oversight committee and the governor and the interagency coordinating council.

Development of the plan shall be made in consultation with the entities with expertise in this area

and the interagency coordinating council. The plan shall include a memorandum of understanding

between the department of health, department of human services and the department of elementary

and secondary education that demonstrates coordination and continuity of early intervention

services among these departments.

     (c) Within six (6) months after January 1, 2005 where prescribed outcomes documented in

the evaluation plan have not been accomplished the responsible agencies shall submit written

explanations for the shortfalls, together with their proposed remedies. The report shall also include

evaluation of the progress of the coordination efforts between the department of health and the

department of human services and the department of elementary and secondary education and the

interagency coordinating council and shall include any recommendations regarding modifications

of the reimbursement mechanisms of this chapter.

     (d) Within twelve (12) months after August 1, 2005 a final report shall include the progress

of the coordination efforts between the department of health and the department of human services

and department of elementary and secondary education, interagency coordinating council and shall

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include any recommendations regarding modifications to the comprehensive array of educational,

developmental, health and social services provided on a calendar year basis to eligible infants,

children and their families as specified in an early intervention system.

     (e) All reports or documents required to be produced pursuant to 20 U.S.C. § 1471 et seq.,

shall be submitted to the speaker of the house, president of the senate and the chairpersons of the

appropriate house of representatives and senate oversight committees and the governor and the

interagency coordinating council. Adherence to such plans and reporting requirements, and budgets

and the timely achievement of goals contained therein shall be considered by the oversight

committees of the house of representatives and senate, among other relevant factors, in determining

appropriations or other systemic changes.

     (f) The executive office of health and human services shall:

     (1) Pursue a Medicaid state plan amendment and allocate sufficient state general revenue

(estimated at four million dollars ($4,000,000)) to increase Medicaid payment rates for early

intervention services by seventy percent (70%) on or before October 1, 2022 to ensure rates enable

early intervention service providers to cover the costs of adequately staffing the program with

qualified service coordinators, early educators, and licensed professionals to deliver all services

required under Part C of the Individuals with Disabilities Education Act. Staffing costs shall include

competitive wages that are at or above the median wage for the profession based on the most recent

occupational wage estimates for Rhode Island from the U.S. Bureau of Labor Statistics.

     (2) Pursue a Medicaid state plan amendment and allocate sufficient state general revenue

(estimated at five hundred twenty thousand dollars ($520,000)) to increase Medicaid payment rates

for the first connections program by one hundred twenty-three percent (123%) on or before October

1, 2022 to ensure rates enable first connections service providers to cover the costs of adequately

staffing the program with qualified nurses, social workers and community health workers to

identify, locate, and connect families who have infants and toddlers facing developmental

challenges to the early intervention program and other services. Staffing costs shall include

competitive wages that are at or above the median wage for the profession based on the most recent

occupational wage estimates for Rhode Island from the U.S. Bureau of Labor Statistics.

     (3) Annually, on or before July 1 of each year beginning July 1, 2023, the Medicaid

payment rates for early intervention and first connections services shall be adjusted to reflect

increases in program operating costs, based on the Consumer Price Index calculated by the U.S.

Bureau of Labor Statistics.

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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 HEALTH AND SAFETY -- MATERNAL AND CHILD HEALTH SERVICES

FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS

***

     This act would direct the executive office of health and human services to increase

Medicaid rates for the early intervention and first connections programs allowing for payment of

competitive wages for qualified professionals. This act would further change the title of the section

from early intervention program for developmentally disabled infants to early intervention program

for infants and toddlers with developmental delays and disabilities.

     This act would take effect upon passage.

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