ARTICLE 23 AS AMENDED

 

RELATING TO HUMAN SERVICES

 

     SECTION 1. Section 40-6-27 of the General Laws in Chapter 40-6 entitled "Public

Assistance Act" is hereby amended to read as follows:

 

     40-6-27. Supplemental security income. -- (a) (1) The director of the department is

hereby authorized to enter into agreements on behalf of the state with the secretary of the

Department of Health and Human Services or other appropriate federal officials, under the

supplementary and security income (SSI) program established by title XVI of the Social Security

Act, 42 U.S.C. section 1381 et seq., concerning the administration and determination of eligibility

for SSI benefits for residents of this state, except as otherwise provided in this section. The state's

monthly share of supplementary assistance to the supplementary security income program

effective January 1, 2009, shall be as follows:

     (i) Individual living alone: $39.92

     (ii) Individual living with others: $51.92

     (iii) Couple living alone: $79.38

     (iv) Couple living with others: $97.30

     (v) Individual living in state licensed assisted living residence: $538.00 332.00

     (vi) Individual living in state licensed supportive residential care settings that, depending

on the population served, meet the standards set by the department of human services in

conjunction with the department(s) of children, youth and families, elderly affairs and/or mental

health, retardation and hospitals behavioral healthcare, developmental disabilities and hospitals:

$300.00.

     Provided, however, that the department of human services shall by regulation reduce,

effective January 1, 2009, the state's monthly share of supplementary assistance to the

supplementary security income program for each of the above listed payment levels, by the same

value as the annual federal cost of living adjustment to be published by the federal social security

administration in October 2008 and becoming effective on January 1, 2009, as determined under

the provisions of title XVI of the federal social security act [42 U.S.C. section 1381 et seq.] and

provided further, that it is the intent of the general assembly that the January 1, 2009 reduction in

the state's monthly share shall not cause a reduction in the combined federal and state payment

level for each category of recipients in effect in the month of December 2008; provided further,

that the department of human services is authorized and directed to provide for payments to

recipients in accordance with the above directives beginning January 1, 2009.

     (2) As of July 1, 2010, state supplement payments shall not be federally administered and

shall be paid directly by the department of human services to the recipient.

     (3) Individuals living in institutions shall receive a twenty dollar ($20.00) per month

personal needs allowance from the state which shall be in addition to the personal needs

allowance allowed by the Social Security Act, 42 U.S.C. section 301 et seq.

     (4) Individuals living in state licensed supportive residential care settings and assisted

living residences who are receiving SSI shall be allowed to retain a minimum personal needs

allowance of fifty-five dollars ($55.00) per month from their SSI monthly benefit prior to

payment of any monthly fees.

     (5) To ensure that supportive residential care or an assisted living residence is a safe and

appropriate service setting, the department is authorized and directed to make a determination of

the medical need and whether a setting provides the appropriate services for those persons who:

      (i) Have applied for or are receiving SSI, and who apply for admission to supportive

residential care setting and assisted living residences on or after October 1, 1998; or

     (ii) Who are residing in supportive residential care settings and assisted living residences,

and who apply for or begin to receive SSI on or after October 1, 1998.

     (6) The process for determining medical need required by subsection (4) of this section

shall be developed by the office of health and human services in collaboration with the

departments of that office and shall be implemented in a manner that furthers the goals of

establishing a statewide coordinated long-term care entry system as required pursuant to the

Global Consumer Choice Compact Waiver.

     (7) To assure access to high quality coordinated services, the department is further

authorized and directed to establish rules specifying the payment certification standards that must

be met by those state licensed supportive residential care settings and assisted living residences

admitting or serving any persons eligible for state-funded supplementary assistance under this

section. Such payment certification standards shall define:

     (i) The scope and frequency of resident assessments, the development and

implementation of individualized service plans, staffing levels and qualifications, resident

monitoring, service coordination, safety risk management and disclosure, and any other related

areas;

     (ii) The procedures for determining whether the payment certifications standards have

been met; and

     (iii) The criteria and process for granting a one time, short-term good cause exemption

from the payment certification standards to a licensed supportive residential care setting or

assisted living residence that provides documented evidence indicating that meeting or failing to

meet said standards poses an undue hardship on any person eligible under this section who is a

prospective or current resident.

     (8) The payment certification standards required by this section shall be developed in

collaboration by the departments, under the direction of the executive office of health and human

services, so as to ensure that they comply with applicable licensure regulations either in effect or

in development. (b) The department is authorized and directed to provide additional assistance to

individuals eligible for SSI benefits for:

     (1) Moving costs or other expenses as a result of an emergency of a catastrophic nature

which is defined as a fire or natural disaster; and

     (2) Lost or stolen SSI benefit checks or proceeds of them; and

     (3) Assistance payments to SSI eligible individuals in need because of the application of

federal SSI regulations regarding estranged spouses; and the department shall provide such

assistance in a form and amount, which the department shall by regulation determine.

 

     SECTION 2. Section 40-8-4 of the General Laws in Chapter 40-8 entitled "Medical

Assistance" is hereby amended to read as follows:

 

     40-8-4. Direct vendor payment plan. -- (a) The department shall furnish medical care

benefits to eligible beneficiaries through a direct vendor payment plan. The plan shall include, but

need not be limited to, any or all of the following benefits, which benefits shall be contracted for

by the director:

      (1) Inpatient hospital services, other than services in a hospital, institution, or facility for

tuberculosis or mental diseases;

      (2) Nursing services for such period of time as the director shall authorize;

      (3) Visiting nurse service;

      (4) Drugs for consumption either by inpatients or by other persons for whom they are

prescribed by a licensed physician;

      (5) Dental services; and

      (6) Hospice care up to a maximum of two hundred and ten (210) days as a lifetime

benefit.

      (b) For purposes of this chapter, the payment of federal Medicare premiums or other

health insurance premiums by the department on behalf of eligible beneficiaries in accordance

with the provisions of Title XIX of the federal Social Security Act, 42 U.S.C. section 1396 et

seq., shall be deemed to be a direct vendor payment.

      (c) With respect to medical care benefits furnished to eligible individuals under this

chapter or Title XIX of the federal Social Security Act, the department is authorized and directed

to impose:

      (i) Nominal co-payments or similar charges upon eligible individuals for non-emergency

services provided in a hospital emergency room; and

      (ii) Co-payments for prescription drugs in the amount of one dollar ($1.00) for generic

drug prescriptions and three dollars ($3.00) for brand name drug prescriptions in accordance with

the provisions of 42 U.S.C. section 1396, et seq.

      (d) The department is authorized and directed to promulgate rules and regulations to

impose such co-payments or charges and to provide that, with respect to subdivision (ii) above,

those regulations shall be effective upon filing.

     (e) No state agency shall pay a vendor for medical benefits provided to a recipient of

assistance under this chapter until and unless the vendor has submitted a claim for payment to a

commercial insurance plan, Medicare, and/or a Medicaid managed care plan, if applicable for that

recipient, in that order.

 

     SECTION 3. Sections 40-5.2-10 and 40-5.2-12 of the General Laws in Chapter 40-5.2

entitled "The Rhode Island Works Program" are hereby amended to read as follows:

 

     40-5.2-10. Necessary requirements and conditions. -- The following requirements and

conditions shall be necessary to establish eligibility for the program.

      (a) Citizenship, alienage and residency requirements.

      (1) A person shall be a resident of the State of Rhode Island.

      (2) Effective October 1, 2008 a person shall be a United States citizen, or shall meet the

alienage requirements established in section 402(b) of the Personal Responsibility and Work

Opportunity Reconciliation Act of 1996, PRWORA, Public Laws No. 104-193 and as that section

may hereafter be amended; a person who is not a United States citizen and does not meet the

alienage requirements established in PRWORA, as amended, is not eligible for cash assistance in

accordance with this chapter.

      (b) The family/assistance unit must meet any other requirements established by the

department of human services by rules and regulations adopted pursuant to the Administrative

Procedures Act, as necessary to promote the purpose and goals of this chapter.

      (c) Receipt of cash assistance is conditional upon compliance with all program

requirements.

      (d) All individuals domiciled in this state shall be exempt from the application of

subdivision 115(d)(1)(A) of Public Law 104-193, the Personal Responsibility and Work

Opportunity Reconciliation Act of 1996, PRWORA, which makes any individual ineligible for

certain state and federal assistance if that individual has been convicted under federal or state law

of any offense which is classified as a felony by the law of the jurisdiction and which has as an

element the possession, use, or distribution of a controlled substance as defined in section 102(6)

of the Controlled Substances Act (21 U.S.C. 802(6)).

      (e) Individual employment plan as a condition of eligibility.

      (1) Following receipt of an application, the department of human services shall assess

the financial conditions of the family, including the non-parent caretaker relative who is applying

for cash assistance for himself or herself as well as for the minor child(ren),in the context of an

eligibility determination. If a parent or non parent caretaker relative is unemployed or under-

employed, the department shall conduct an initial assessment, taking into account: (A) the

physical capacity, skills, education, work experience, health, safety, family responsibilities and

place of residence of the individual; and (B) the child care and supportive services required by the

applicant to avail himself or herself of employment opportunities and/or work readiness

programs.

      (2) On the basis of such assessment, the department of human services and the

department of labor and training, as appropriate, in consultation with the applicant, shall develop

an individual employment plan for the family which requires the individual to participate in the

intensive employment services provided by the department of labor and training. Intensive

employment services shall be defined as the work requirement activities in subsections 40-5.2-

12(g) and (i).

      (3) The director, or his/her designee, may assign a case manager to an

applicant/participant, as appropriate.

      (4) The department of labor and training and the department of human services in

conjunction with the participant shall develop a revised individual employment plan which shall

identify employment objectives, taking into consideration factors above, and shall include a

strategy for immediate employment and for preparing for, finding, and retaining employment

consistent, to the extent practicable, with the individual's career objectives.

      (5) The individual employment plan must include the provision for the participant to

engage in work requirements as outlined in section 40-5.2-12 of this chapter.

      (6) (A) The participant shall attend and participate immediately in intensive assessment

and employment services as the first step in the individual employment plan at the Rhode Island

department of labor and training, unless temporarily exempt from this requirement in accordance

with this chapter. Intensive assessment and employment services shall be defined as the work

requirement activities in subsections 40-5.2-12(g) and (i).

      (B) Parents under age twenty (20) without a high school diploma or General Equivalency

Diploma (GED) shall be referred to special teen parent programs which will provide intensive

services designed to assist teen parent to complete high school education or GED, and to continue

approved work plan activities in accord with Works program requirements.

      (7) The applicant shall become a participant in accordance with this chapter at the time

the individual employment plan is signed and entered into.

      (8) Applicants and participants of the Rhode Island Work Program shall agree to comply

with the terms of the individual employment plan, and shall cooperate fully with the steps

established in the individual employment plan, including the work requirements.

      (9) The department of human services has the authority under the chapter to require

attendance by the applicant/participant, either at the department of human services or at the

department of labor and training, at appointments deemed necessary for the purpose of having the

applicant enter into and become eligible for assistance through the Rhode Island Work Program.

Said appointments include, but are not limited to, the initial interview, orientation and

assessment; job readiness and job search. Attendance is required as a condition of eligibility for

cash assistance in accordance with rules and regulations established by the department.

      (10) As a condition of eligibility for assistance pursuant to this chapter, the

applicant/participant shall be obligated to keep appointments, attend orientation meetings at the

department of human services and/or the Rhode Island department of labor and training,

participate in any initial assessments or appraisals and comply with all the terms of the individual

employment plan in accordance with department of human service rules and regulations.

      (11) A participant, including a parent or non-parent caretaker relative included in the

cash assistance payment, shall not voluntarily quit a job or refuse a job unless there is good cause

as defined in this chapter or the department's rules and regulations.

      (12) A participant who voluntarily quits or refuses a job without good cause, as defined

in subsection 40-5.2-12(l), while receiving cash assistance in accordance with this chapter, shall

be sanctioned in accordance with rules and regulations promulgated by the department.

      (f) Resources.

      (1) The Family or assistance unit's countable resources shall be less than the allowable

resource limit established by the department in accordance with this chapter.

      (2) No family or assistance unit shall be eligible for assistance payments if the combined

value of its available resources (reduced by any obligations or debts with respect to such

resources) exceeds one thousand dollars ($1,000).

      (3) For purposes of this subsection, the following shall not be counted as resources of the

family/assistance unit in the determination of eligibility for the works program:

      (A) The home owned and occupied by a child, parent, relative or other individual;

      (B) Real property owned by a husband and wife as tenants by the entirety, if the property

is not the home of the family and if the spouse of the applicant refuses to sell his or her interest in

the property;

      (C) Real property which the family is making a good faith effort to dispose of, however,

any cash assistance payable to the family for any such period shall be conditioned upon such

disposal of the real property within six (6) months of the date of application and any payments of

assistance for that period shall (at the time of disposal) be considered overpayments to the extent

that they would not have occurred at the beginning of the period for which the payments were

made. All overpayments are debts subject to recovery in accordance with the provisions of the

chapter;

      (D) Income producing property other than real estate including, but not limited to,

equipment such as farm tools, carpenter's tools and vehicles used in the production of goods or

Services which the department determines are necessary for the family to earn a living;

      (E) One vehicle for each adult household member, but not to exceed two (2) vehicles per

household, and in addition, a vehicle used primarily for income producing purposes such as, but

not limited to, a taxi, truck or fishing boat; a vehicle used as a family's home; a vehicle which

annually produces income consistent with its fair market value, even if only used on a seasonal

basis; a vehicle necessary to transport a family member with a disability where the vehicle is

specially equipped to meet the specific needs of the person with a disability or if the vehicle is a

special type of vehicle that makes it possible to transport the person with a disability;

      (F) Household furnishings and appliances, clothing, personal effects and keepsakes of

limited value;

      (G) Burial plots (one for each child, relative, and other individual in the assistance unit),

and funeral arrangements;

      (H) For the month of receipt and the following month, any refund of federal income

taxes made to the family by reason of section 32 of the Internal Revenue Code of 1986, 26 U.S.C.

section 32 (relating to earned income tax credit), and any payment made to the family by an

employer under section 3507 of the Internal Revenue Code of 1986, 26 U.S.C. section 3507

(relating to advance payment of such earned income credit);

      (I) The resources of any family member receiving supplementary security income

assistance under the Social Security Act, 42 U.S.C. section 301 et seq.

      (g) Income.

      (1) Except as otherwise provided for herein, in determining eligibility for and the amount

of cash assistance to which a family is entitled under this chapter, the income of a family includes

all of the money, goods, and services received or actually available to any member of the family.

      (2) In determining the eligibility for and the amount of cash assistance to which a

family/assistance unit is entitled under this chapter, income in any month shall not include the

first one hundred seventy dollars ($170) of gross earnings plus fifty percent (50%) of the gross

earnings of the family in excess of one hundred seventy dollars ($170) earned during the month.

      (3) The income of a family shall not include:

      (A) The first fifty dollars ($50.00) in child support received in any month from each non-

custodial parent of a child plus any arrearages in child support (to the extent of the first fifty

dollars ($50.00) per month multiplied by the number of months in which the support has been in

arrears) which are paid in any month by a non-custodial parent of a child;

      (B) Earned income of any child;

      (C) Income received by a family member who is receiving supplemental security income

(SSI) assistance under Title XVI of the Social Security Act, 42 U.S.C. section 1381 et seq.;

      (D) The value of assistance provided by state or federal government or private agencies

to meet nutritional needs, including: value of USDA donated foods; value of supplemental food

assistance received under the Child Nutrition Act of 1966, as amended and the special food

service program for children under Title VII, nutrition program for the elderly, of the Older

Americans Act of 1965 as amended, and the value of food stamps;

      (E) Value of certain assistance provided to undergraduate students, including any grant

or loan for an undergraduate student for educational purposes made or insured under any loan

program administered by the U.S. Commissioner of Education (or the Rhode Island board of

governors for higher education or the Rhode Island higher educational assistance authority);

      (F) Foster Care Payments;

      (G) Home energy assistance funded by state or federal government or by a nonprofit

organization;

      (H) Payments for supportive services or reimbursement of out-of-pocket expenses made

to foster grandparents, senior health aides or senior companions and to persons serving in SCORE

and ACE and any other program under Title II and Title III of the Domestic Volunteer Service

Act of 1973, 42 U.S.C. section 5000 et seq.;

      (I) Payments to volunteers under AmeriCorps VISTA as defined in the department's

rules and regulations;

      (J) Certain payments to native Americans; payments distributed per capita to, or held in

trust for, members of any Indian Tribe under P.L. 92-254, 25 U.S.C. section 1261 et seq., P.L. 93-

134, 25 U.S.C. section 1401 et seq., or P.L. 94-540; receipts distributed to members of certain

Indian tribes which are referred to in section 5 of P.L. 94-114, 25 U.S.C. section 459d, that

became effective October 17, 1975;

      (K) Refund from the federal and state earned income tax credit;

      (L) The value of any state, local, or federal government rent or housing subsidy,

provided that this exclusion shall not limit the reduction in benefits provided for in the payment

standard section of this chapter.

      (4) The receipt of a lump sum of income shall affect participants for cash assistance in

accordance with rules and regulations promulgated by the department.

      (h) Time limit on the receipt of cash assistance.

      (1) No cash assistance shall be provided, pursuant to this chapter, to a family or

assistance unit which includes an adult member who has received cash assistance, either for

him/herself or on behalf of his/her children, for a total of twenty-four (24) months, (whether or

not consecutive) within any sixty (60) continuous months after July 1, 2008 to include any time

receiving any type of cash assistance in any other state or territory of the United States of

America as defined herein. Provided further, in no circumstances other than provided for in

section (3) below with respect to certain minor children, shall cash assistance be provided

pursuant to this chapter to a family or assistance unit which includes an adult member who has

received cash assistance for a total of a lifetime limit of forty-eight (48) months.

      (2) Cash benefits received by a minor dependent child shall not be counted toward their

lifetime time limit for receiving benefits under this chapter should that minor child apply for cash

benefits as an adult.

      (3) Certain minor children not subject to time limit. This section regarding the lifetime

time limit for the receipt of cash assistance, shall not apply only in the instances of a minor

child(ren) living with a parent who receives SSI benefits and a minor child(ren) living with a

responsible adult non-parent caretaker relative who is not in the case assistance payment.

      (4) Receipt of family cash assistance in any other state or territory of the United States of

America shall be determined by the department of human services and shall include family cash

assistance funded in whole or in part by Temporary Assistance for Needy Families (TANF) funds

[Title IV-A of the Federal Social Security Act 42 U.S.C. section 601 et seq.]and/or family cash

assistance provided under a program similar to the Rhode Island Families Work and Opportunity

Program or the federal TANF program.

      (5) (A) The department of human service shall mail a notice to each assistance unit when

the assistance unit has six (6) months of cash assistance remaining and each month thereafter

until the time limit has expired. The notice must be developed by the department of human

services and must contain information about the lifetime time limit. the number of months the

participant has remaining, the hardship extension policy, the availability of a post-employment-

and-closure bonus, and any other information pertinent to a family or an assistance unit nearing

either the twenty-four (24) month or forty-eight (48) month lifetime time limit.

      (B) For applicants who have less than six (6) months remaining in either the twenty-four

(24) month or forty-eight (48) month lifetime time limit because the family or assistance unit

previously received cash assistance in Rhode Island or in another state, the department shall

notify the applicant of the number of months remaining when the application is approved and

begin the process required in paragraph (A) above.

      (6) If a cash assistance recipient family closed pursuant to Rhode Island's Temporary

Assistance for Needy Families Program, (federal TANF described in Title IV A of the Federal

Social Security Act, 42 U.S.C. 601 et seq.) formerly entitled the Rhode Island Family

Independence Program, more specifically under subdivision 40-5.1-9(2)(c), due to sanction

because of failure to comply with the cash assistance program requirements; and that recipients

family received forty-eight (48) months of cash benefits in accordance with the Family

Independence Program, than that recipient family is not able to receive further cash assistance for

his/her family, under this chapter, except under hardship exceptions.

      (7) The months of state or federally funded cash assistance received by a recipient family

since May 1, 1997 under Rhode Island's Temporary Assistance for Needy Families Program,

(federal TANF described in Title IV A of the Federal Social Security Act, 42 U.S.C. section 601

et seq.) formerly entitled the Rhode Island Family Independence Program, shall be countable

toward the time limited cash assistance described in this chapter.

      (i) Time limit on the receipt of cash assistance.

      (1) (A) No cash assistance shall be provided, pursuant to this chapter, to a family

assistance unit in which an adult member has received cash assistance for a total of sixty (60)

months (whether or not consecutive) to include any time receiving any type of cash assistance in

any other state or territory of the United States as defined herein effective August 1, 2008.

Provided further, that no cash assistance shall be provided to a family in which an adult member

has received assistance for twenty-four (24) consecutive months unless the adult member has a

rehabilitation employment plan as provided in subsection 40-5.2-12(g)(5).

      (B) Effective August 1, 2008 no cash assistance shall be provided pursuant to this

chapter to a family in which a child has received cash assistance for a total of sixty (60) months

(whether or not consecutive) if the parent is ineligible for assistance under this chapter pursuant

to subdivision 40-5.2(a) (2) to include any time received any type of cash assistance in any other

state or territory of the United States as defined herein.

      (j) Hardship Exceptions.

      (1) The department may extend an assistance unit's or family's cash assistance beyond

the time limit, by reason of hardship; provided, however, that the number of such families to be

exempted by the department with respect to their time limit under this subsection shall not exceed

twenty percent (20%) of the average monthly number of families to which assistance is provided

for under this chapter in a fiscal year; provided, however, that to the extent now or hereafter

permitted by federal law, any waiver granted under section 40-5.2-35, for domestic violence,

shall not be counted in determining the twenty percent (20%) maximum under this section.

      (2) Parents who receive extensions to the time limit due to hardship must have and

comply with employment plans designed to remove or ameliorate the conditions that warranted

the extension.

      (k) Parents under eighteen (18) years of age.

      (1) A family consisting of a parent who is under the age of eighteen (18), and who has

never been married, and who has a child; or a family which consists of a woman under the age of

eighteen (18) who is at least six (6) months pregnant, shall be eligible for cash assistance only if

such family resides in the home of an adult parent, legal guardian or other adult relative. Such

assistance shall be provided to the adult parent, legal guardian, or other adult relative on behalf of

the individual and child unless otherwise authorized by the department.

      (2) This subsection shall not apply if the minor parent or pregnant minor has no parent,

legal guardian or other adult relative who is living and/or whose whereabouts are unknown; or the

department determines that the physical or emotional health or safety of the minor parent, or his

or her child, or the pregnant minor, would be jeopardized if he or she was required to live in the

same residence as his or her parent, legal guardian or other adult relative (refusal of a parent,

legal guardian or other adult relative to allow the minor parent or his or her child, or a pregnant

minor, to live in his or her home shall constitute a presumption that the health or safety would be

so jeopardized); or the minor parent or pregnant minor has lived apart from his or her own parent

or legal guardian for a period of at least one year before either the birth of any child to a minor

parent or the onset of the pregnant minor's pregnancy; or there is good cause, under departmental

regulations, for waiving the subsection; and the individual resides in supervised supportive living

arrangement to the extent available.

      (3) For purposes of this section "supervised supportive living arrangement" means an

arrangement which requires minor parents to enroll and make satisfactory progress in a program

leading to a high school diploma or a general education development certificate, and requires

minor parents to participate in the adolescent parenting program designated by the department, to

the extent the program is available; and provides rules and regulations which ensure regular adult

supervision.

      (l) Assignment and Cooperation. - As a condition of eligibility for cash and medical

assistance under this chapter, each adult member, parent or caretaker relative of the

family/assistance unit must:

      (1) Assign to the state any rights to support for children within the family from any

person which the family member has at the time the assignment is executed or may have while

receiving assistance under this chapter;

      (2) Consent to and cooperate with the state in establishing the paternity and in

establishing and/or enforcing child support and medical support orders for all children in the

family or assistance unit in accordance with Title 15 of the general laws, as amended, unless the

parent or caretaker relative is found to have good cause for refusing to comply with the

requirements of this subsection.

      (3) Absent good cause, as defined by the department of human services through the rule

making process, for refusing to comply with the requirements of (1) and (2) above, cash

assistance to the family shall be reduced by twenty-five percent (25%) until the adult member of

the family who has refused to comply with the requirements of this subsection consents to and

cooperates with the state in accordance with the requirements of this subsection.

      (4) As a condition of eligibility for cash and medical assistance under this chapter, each

adult member, parent or caretaker relative of the family/assistance unit must consent to and

cooperate with the state in identifying and providing information to assist the state in pursuing

any third-party who may be liable to pay for care and services under Title XIX of the Social

Security Act, 42 U.S.C. section 1396 et seq.

 

     40-5.2-12. Work requirements for receipt of cash assistance. -- (a) The department of

human services and the department of labor and training shall assess the applicant/parent or non-

parent caretaker relative's work experience, educational and vocational abilities, and the

department together with the parent shall develop and enter into a mandatory individual

employment plan in accordance with subsection 40-5.2-10(e) of this chapter.

      (b) In the case of a family including two (2) parents, at least one of the parents shall be

required to participate in an employment plan leading to full-time employment. The department

may also require the second parent in a two (2) parent household to develop an employment plan

if and when the youngest child reaches six (6) years of age or older.

      (c) The written individual employment plan shall specify, at minimum, the immediate

steps necessary to support a goal of long-term economic independence.

      (d) All applicants and participants in the Rhode Island Works employment program must

attend and participate in required appointments, employment plan development, and employment-

related activities, unless temporarily exempt for reasons specified in this chapter.

      (e) A recipient/participant temporarily exempted from the work requirements may

participate in an individual employment plan on a voluntary basis, however, remains subject to

the same program compliance requirements as a participant without a temporary exemption.

      (f) The individual employment plan shall specify the participant's work activity(ies) and

the supportive services which will be provided by the department to enable the participant to

engage in the work activity(ies).

      (g) Work Requirements for single parent families. - In single parent households, the

participant parent or non-parent caretaker relative in the cash assistance payment, shall participate

as a condition of eligibility, for a minimum of twenty (20) hours per week if the youngest child in

the home is under the age of six (6), and for a minimum of thirty (30) hours per week if the

youngest child in the home is six (6) years of age or older, in one or more of their required work

activities, as appropriate, in order to help the parent obtain stable full-time paid employment, as

determined by the department of human services and the department of labor and training;

provided, however, that he or she shall begin with intensive employment services through the

department of labor and training as the first step in the individual employment plan. Required

work activities are as follows:

      (1) At least twenty (20) hours per week must come from participation in one or more of

the following ten (10) work activities:

      (A) Unsubsidized employment;

      (B) Subsidized private sector employment;

      (C) Subsidized public sector employment;

      (D) Work experience;

      (E) On the Job Training;

      (F) Job search and job readiness;

      (G) Community service programs;

      (H) Vocational educational training not to exceed twelve (12) months;

      (I) Providing child care services to another participant parent who is participating in an

approved community service program;

      (J) Adult education in an intensive work readiness program not to exceed six (6) months.

      (2) Above twenty (20) hours per week, the parent may participate in one or more of the

following three (3) activities in order to satisfy a thirty (30) hour requirement:

      (A) Job skills training directly related to employment;

      (B) Education directly related to employment; and,

      (C) Satisfactory attendance at a secondary school or in a course of study leading to a

certificate of general equivalence if it is a teen parent under the age twenty (20) who is without a

high school diploma or General Equivalence Diploma (GED);

      (3) In the case of a parent under the age of twenty (20), attendance at a secondary school

or the equivalent during the month or twenty (20) hours per week on average for the month in

education directly related to employment will be counted as engaged in work.

      (4) A parent who participates in a work experience or community service program for

the maximum number of hours per week allowable by the Fair Labor Standards Act (FLSA) is

deemed to have participated in his/her required minimum hours per week in core activities if

actual participation falls short of his/her required minimum hours per week.

      (5) A parent who has been determined to have a physical or mental impairment affecting

employment but who has not been found eligible for Social Security Disability Benefits or

Supplemental Security Income must participate in his or her rehabilitation employment plan as

developed with the Office of Rehabilitative Services which leads to employment and/or to receipt

of disability benefits through the Social Security Administration.

      (6) A required work activity may be any other work activity permissible under federal

TANF provisions or state defined Rhode Island Works Program activity, including up to ten (10)

hours of activities required by a parent's department of children, youth and families service plan.

      (h) Exemptions from Work Requirements for the single parent family. - Work

Requirements outlined in subsection 40-5.2-12(g) above shall not apply to a single parent if (and

for so long as) the department finds that he or she is:

      (1) Caring for a child below the age of one, provided, however that a parent may opt for

the deferral from an individual employment plan for a maximum of twelve (12) months during

the twenty-four (24) months of eligibility for cash assistance, and provided further that a minor

parent without a high school diploma or the equivalent, and who is not married, shall not be

exempt for more than twelve weeks from the birth of the child;

      (2) Caring for a disabled family member, who resides in the home and requires full time

care;

      (3) A recipient of Social Security Disability benefits or Supplemental Security Income or

other disability benefits which have the same standard of disability as defined by the Social

Security Administration;

      (4) An individual receiving assistance who is a victim of domestic violence as

determined by the department in accordance with rules and regulations;

      (5) An applicant for assistance in her third trimester or a pregnant woman in her third

trimester who is a recipient of assistance and has medical documentation that she cannot work;

      (6) An individual otherwise exempt by the department as defined in rules and regulations

promulgated by the department.

      (i) Work Requirement for two parent families.

      (1) In families consisting of two parents, one parent is required and shall be engaged in

work activities as defined below, for at least thirty-five (35) hours per week during the month, not

fewer than thirty (30) hours per week of which are attributable to one or more of the following

listed work activities, provided, however, that he or she shall begin with intensive employment

services through the department of labor and training as the first step in the Individual

Employment Plan. Two parent work requirements shall be defined as the following:

      (A) Unsubsidized employment;

      (B) Subsidized private sector employment;

      (C) Subsidized public-sector employment;

      (D) Work experience;

      (E) On-the-job training;

      (F) Job search and job readiness;

      (G) Community service program;

      (H) Vocational educational training not to exceed twelve (12) months;

      (I) The provision of child care services to a participant individual who is participating in

a community service program;

      (J) Adult education in an intensive work readiness program not to exceed six (6) months.

      (2) Above thirty (30) hours per week, the following three (3) activities may also count

for participation:

      (A) Job skills training directly related to employment;

      (B) Education directly related to employment; and

      (C) Satisfactory attendance at secondary school or in a course of study leading to a

certificate of general equivalence.

      (3) A family with two parents in which one or both parents participate in a work

experience or community service program shall be deemed to have participated in core work

activities for the maximum number of hours per week allowable by the Fair Labor Standards Act

(FLSA) if actual participation falls short of his/her required minimum hours per week.

      (4) If the family receives child care assistance and an adult in the family is not disabled

or caring for a severely disabled child, then the work-eligible individuals must be participating in

work activities for an average of at least fifty-five (55) hours per week to count as a two-parent

family engaged in work for the month.

      (5) At least fifty (50) of the fifty-five (55) hours per week must come from participation

in the activities listed in subdivision 40-5.1-12(i)(1).

      Above fifty (50) hours per week, the three (3) activities listed in subdivision 40-5.1-(i)(2)

may also count as participation.

      (6) A family with two parents receiving child care in which one or both parents

participate in a work experience or community service program for the maximum number of

hours per week allowable by the Fair Labor Standards Act (FLSA) will be considered to have met

their required core hours if actual participation falls short of the required minimum hours per

week. For families that need additional hours beyond the core activity requirement, these hours

must be satisfied in some other TANF work activity.

      (j) Exemptions from work requirements for two parent families. - Work requirements

outlined in subsection 40-5.2-12(i) above shall not apply to two parent families if (and for so long

as) the department finds that:

      (1) Both parents receive Supplemental Security Income (SSI);

      (2) One parent receives SSI, and the other parent is caring for a disabled family member

who resides in the home, and who requires full time care; or

      (3) The parents are otherwise exempt by the department as defined in rules and

regulations.

      (k) Failure to comply with work requirements. Sanctions and Terminations.

      (1) The cash assistance to which an otherwise eligible family/assistance unit is entitled

under this chapter, shall be reduced for three (3) months, whether or not consecutive, in

accordance with rules and regulations promulgated by the department, whenever any participant,

without good cause, as defined by the department in its rules and regulations, has failed to enter

into an individual employment plan; has failed to attend a required appointment; has refused or

quit employment; or has failed to comply with any other requirements for the receipt of cash

assistance under this chapter. If the family's benefit has been reduced, benefits shall be restored to

the full amount beginning with the initial payment made on the first of the month following the

month in which the parent: (1) enters into an individual employment plan or rehabilitation plan

and demonstrates compliance with the terms thereof; or (2) demonstrates compliance with the

terms of his or her existing individual employment plan or rehabilitation plan, as such plan may

be amended by agreement of the parent and the department.

      (2) In the case where appropriate child care has been made available in accordance with

this chapter, a participant's failure, without good cause, to accept a bona fide offer of work,

including full-time, part-time and/or temporary employment, or unpaid work experience or

community service, shall be deemed a failure to comply with the work requirements of this

section and shall result in reduction or termination of cash assistance, as defined by the

department in rules and regulations duly promulgated.

      (3) If the family/assistance unit's benefit has been reduced for a total of three (3) months,

whether or not consecutive in accordance with this section due to the failure by one or more

parents to enter into an individual employment plan or failure to comply with the terms of his of

her individual employment plan, or the failure to comply with the requirements of this chapter,

cash assistance to the entire family shall end. The family/assistance unit may reapply for benefits,

and the benefits shall be restored to the family/assistance unit in the full amount the

family/assistance unit is otherwise eligible for under this chapter beginning on the first of the

month following the month in which all parents in the family/assistance unit who are subject to

the employment or rehabilitation plan requirements under this chapter: (A) enter into an

individual employment or rehabilitation plan as applicable, and demonstrate compliance with the

terms thereof, or (B) demonstrate compliance with the terms of the parent's individual

employment or rehabilitation employment plan in effect at the time of termination of benefits, as

such plan may be amended by agreement of the parent and the department.

      (4) Up to ten (10) days following a notice of adverse action to reduce or terminate

benefits under this subsection, the client may request the opportunity to meet with a social worker

to identify the reasons for non-compliance, establish good cause and seek to resolve any issues

that have prevented the parent from complying with the employment plan requirements.

      (5) Participants whose cases had closed in sanction status pursuant to Rhode Island's

prior Temporary Assistance for Needy Families Program,(federal TANF described in Title IVA

of the federal Social Security Act, 42 U.S.C. section 601 et seq.), the Family Independence

Program, more specifically, subdivision 40-5.1-9(2)(c), due to failure to comply with the cash

assistance program requirements, but who had received less than forty-eight (48) months of cash

assistance at the time of closure, and who reapply for cash assistance under the Rhode Island

Works Program, must demonstrate full compliance, as defined by the department in its rules and

regulations, before they shall be eligible for cash assistance pursuant to this chapter.

      (l) Good Cause. - Good Cause for failing to meet any program requirements including

leaving employment, and failure to fulfill documentation requirements, shall be outlined in rules

and regulations promulgated by the department of human services.

 

      SECTION 4. Sections 42-66.2-2, 42-66.2-4, 42-66.2-5, 42-66.2-6 and 42-66.2-7 of the

General Laws in Chapter 42-66.2 entitled "Pharmaceutical Assistance to the Elderly Act" are

hereby amended to read as follows:

 

     42-66.2-2. Program established. -- There is established a program for pharmaceutical

assistance to the elderly. The intent of the This program is to be the payer of last resort and is

limited to eligible persons and eligible drugs.

 

     42-66.2-4. Amount of payment. (a) The state shall pay the percentage rate of the

maximum allowable amount per prescription as formulated in the contract, as of the date of

purchase of the drug, between the contractor and participating pharmacies in accordance with the

income eligibility and co-payment shares reimburse the consumer up to the percentage rate of the

maximum allowable amount per prescription as set forth in section 42-66.2-5 as of the date of

purchase of the drug, in accordance with the income eligibility and co-payment shares set forth in

section 42-66.2-5. The rebates generated pursuant to section 42-66.2-10 shall be used to offset the

state's payment. The pharmacy shall collect from the consumer the percentage rate of the

maximum allowable amount per prescription as formulated in the contract, as of the date of the

purchase of the eligible drug or additional drug, between the contractor and participating

pharmacies in accordance with the income eligibility and co-payment shares set forth in section

42-66.2-5.

     (b) Reimbursement payment will be made to consumers no less than quarterly.

     (c) The director is authorized and directed to promulgate rules relating to the process by

which consumers submit claims for reimbursement including what documentation must be

provided by the consumer.

 

     42-66.2-5. Persons eligible. -- (a) Persons eligible for assistance under the provisions of

this chapter include any resident of the state who is at least sixty-five (65) years of age or at least

fifty-five (55) years of age and receiving social security disability benefits. State and consumer

co-payment shares for these persons shall be determined as follows:

      (1) For unmarried persons or married persons living separate and apart whose income for

the calendar year immediately preceding the year in which assistance is sought is:

      (i) Less than nineteen thousand three hundred forty-one dollars ($19,341) the state shall

provide reimbursement such that the consumer shall pay no more than forty percent (40%) pay

sixty percent (60%) of the cost of the prescriptions and the consumer shall pay forty percent

(40%) of the cost of the prescriptions.

      (ii) More than nineteen thousand three hundred forty-one dollars ($19,341) and less than,

twenty-four thousand two hundred and eighty dollars ($24,280) the state shall provide

reimbursement such that pay thirty percent (30%) of the cost of the prescriptions and the

consumer shall pay no more than seventy percent (70%) of the cost of the prescriptions; and

      (iii) More than twenty-four thousand two hundred and eighty dollars ($24,280) and less

than forty-two thousand four hundred and ninety-three dollars ($42,493), the state shall provide

reimbursement such that pay fifteen percent (15%) of the cost of prescriptions and the consumer

shall pay no more than eighty-five percent (85%) of the cost of prescriptions.

      (2) For married persons whose income for the calendar year immediately preceding the

year in which assistance is sought hereunder when combined with any income of the person's

spouse in the same year is:

      (i) Twenty-four thousand one hundred and seventy-nine dollars ($24,179) or less, the

state shall pay sixty percent (60%) of the cost of the prescriptions and provide reimbursement

such that the consumer shall pay no more than forty percent (40%) of the cost of the

prescriptions;

      (ii) More than twenty-four thousand one hundred and seventy-nine dollars ($24,179) and

less than thirty thousand three hundred and fifty-two dollars ($30,352), the state shall pay thirty

percent (30%) of the cost of the prescriptions and provide reimbursement such that the consumer

shall pay no more than seventy percent (70%) of the cost of prescriptions; and

      (iii) More than thirty thousand three hundred and fifty-two dollars ($30,352) and less

than forty-eight thousand five hundred and sixty-three dollars ($48,563), the state shall pay

fifteen percent (15%) of the cost of prescriptions and provide reimbursement such that the

consumer shall pay no more than eighty-five percent (85%) of the cost of prescriptions.

      (3) Eligibility may also be determined by using income data for the ninety (90) days

prior to application for benefits and projecting that income on an annual basis. The income levels

shall not include those sums of money expended for medical and pharmaceutical that exceed

three percent (3%) of the applicant's annual income or three percent (3%) of the applicant's

preceding ninety (90) day income computed on an annual basis.

      (4) For persons on social security disability benefits who are: (i) unmarried or married

and living separate and apart with income for the calendar year immediately preceding the year in

which assistance is sought that is less than forty-two thousand four hundred and ninety-three

dollars ($42,493); or (ii) married with income that is less than forty-eight thousand five hundred

and sixty-three dollars ($48,563) the state shall pay fifteen percent (15%) of the cost of

prescriptions and provide reimbursement such that the consumer shall pay no more than eighty-

five percent (85%) of the cost.

      (b) On July 1 of each year, the maximum amount of allowable income for both

unmarried and married residents set forth in subsection (a) shall be increased by a percentage

equal to the percentage of the cost of living adjustment provided for social security recipients.

      (c) No person whose prescription drug expenses are paid or reimbursable, either in

whole or in part, by any other plan of assistance or insurance is eligible for assistance under this

section, until the person's prescription drug coverage for a specific covered prescription

medication is exhausted or the specific prescription medication is not covered by the plan during

a benefit year, and as provided in subsection (d).

      (d)(c) The fact that some of a person's prescription drug expenses are paid or

reimbursable either in whole or in part, under the provisions of the federal Medicare program

shall not disqualify that person, if he or she is otherwise eligible, to receive assistance under this

chapter, provided that if the federal share equals or exceeds sixty percent (60%) of the cost the

state shall make no payment. In those cases, the state shall pay the eligible percentage of the cost

of those prescriptions for qualified drugs for which no payment or reimbursement is made by the

federal government.

      (e) Eligibility for receipt of any other benefit under any other provisions of the Rhode

Island general laws as a result of eligibility for the pharmaceutical assistance program authorized

under this section shall be limited to those persons whose income qualify them for a sixty percent

(60%) state co-payment share of the cost of prescriptions.

      (f)(d) For all additional drugs, the consumer shall pay one hundred percent (100%) of the

cost of prescriptions as set forth in section 42-66.2-4.

      (g)(e) To promote coordination of benefits between the pharmaceutical assistance

program created under this chapter and the Medicare Part D prescription drug program created in

the federal Medicare Prescription Drug, Improvement and Modernization Act of 2003, RIPAE

enrollees must apply for and enroll in the Medicare Part D prescription drug program.

 

     42-66.2-6. Responsibilities of department of elderly affairs. -- (a) Determination of

eligibility. - The department shall adopt regulations relating to the determination of eligibility of

prospective consumers and the determination and elimination of program abuse. The department

has the power to declare ineligible any consumer who abuses or misuses the established

prescription plan. The department has the power to investigate cases of suspected provider or

consumer fraud.

      (b) Rebates for expenses prohibited. - (1) A system of rebates or reimbursements to the

consumer for pharmaceutical expenses shall be prohibited.

      (2) Subdivision (1) shall not be interpreted to exclude other consumers not participating

in the pharmaceutical assistance to the elderly program from receiving financial offers or

redeemable coupons that are available to only those who have paid for the service or product

through direct cash payment, insurance premiums, or cost sharing with an employer.

      (c)(b) Program criteria. - The program includes the following criteria:

      (1) Collection of the co-payment by pharmacies is mandatory;

      (2)(1) Senior citizens participating in the program are not required to maintain records of

each transaction but shall sign a receipt for eligible and additional drugs; as specified by the

director in accordance with subsection 42-66.2-4(c);

      (3) (i) A system of rebates or reimbursements to the consumer for pharmaceutical

expenses is prohibited;

      (ii) This subdivision shall not be interpreted to exclude other consumers from receiving

financial offers or redeemable coupons that are available to only those who have paid for the

service or product through direct cash payment, insurance premiums, or cost sharing with an

employer.

      (4)(2) Prescription benefits for any single prescription may be dispensed in the amounts

authorized by the physician, and agreed to by the consumer, up to a maximum of a one hundred

(100) day supply or two hundred (200) doses, whichever is less and/or a one hundred (100) day

supply or one quart of liquid, whichever is less; provided, however, that disposable insulin

syringes are dispersed in a quantity of one hundred (100);

      (5)(3) Experimental drugs are excluded from the program;

      (6)(4) A system of mail order delivery for prescriptions is allowed under this program;

and

      (7)(5) Eligible and additional drugs must be dispensed within one year of the original

prescription order.

      (d) The director shall issue an eligibility card containing a program ID number and the

time period for which the card is valid.

      (e)(c) The director shall provide a mechanism, within the department, to handle all

public inquiries concerning the program.

      (f)(d) The director shall establish a process, in accordance with the Administrative

Procedures Act, chapter 35 of this title, to provide an appeals hearing on the determination of

eligibility.

      (g)(e) The director shall forward to the contractor a list of all eligible consumers.

      (h)(f) Expenditures for multiple sclerosis drugs shall not exceed thirty thousand dollars

($30,000).

      (i)(g) Generic drug substitution is mandatory when there is an available generic drug

equivalent.

 

     42-66.2-7. Contract. -- (a) The director is authorized and shall to enter into a contract

with the contractor for the effective administrative support of this program.

      (b) A competitive bid and contract award shall occur in accordance with the state

Medicaid authority's competitive bid process and cycle.

 

     SECTION 5. Section 1 shall take effect as of October 1, 2011. The remainder of the

     Article shall take effect upon passage.