2018 -- H 7803

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LC004816

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2018

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A N   A C T

RELATING TO HUMAN SERVICES -- QUALITY SELF-DIRECTED SERVICES -- PUBLIC

OFFICERS AND EMPLOYEES -- INDIVIDUAL PROVIDERS OF DIRECT SUPPORT

SERVICES

     

     Introduced By: Representatives Blazejewski, Slater, Fogarty, Regunberg, and
Maldonado

     Date Introduced: February 28, 2018

     Referred To: House Finance

     It is enacted by the General Assembly as follows:

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     SECTION 1. Findings and declarations. The general assembly hereby finds and declares

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as follows:

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     (1) Ensuring that seniors and people with disabilities in Rhode Island have access to long-

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term services and supports in home and community based settings is an issue of statewide

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concern.

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     (2) It is in the best interest of the state to create a variety of home and community based

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service options in order to maximize consumer choice and provide the right care, in the right

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setting, at the right time, for individuals with long-term care service and supports needs.

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     (3) In 2015, seventy-seven percent (77%) of Medicaid spending for long-term services

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and supports for older adults and adults with physical disabilities in Rhode Island went to

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institutional care rather than home and community based care, compared with a national average

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of almost forty-four percent (44%) making Rhode Island one of the lease balanced states in the

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country.

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     (4) State efforts to give people more cost-effective choices of Medicaid-funded long-term

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services and supports would be greatly aided by offering an independent provider home care

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option for people with disabilities and seniors and implementing the proper infrastructure to

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support the program.

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     (5) The implementation of a successful individual provider home care option will rely on

 

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the ability to attract and maintain a robust, well qualified, adequately trained and compensated

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workforce to deliver high quality services and meet the increasing demand for these services due

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to the projected increase in the state's aging population.

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     SECTION 2. Title 36 of the General Laws entitled "PUBLIC OFFICERS AND

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

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CHAPTER 11.1

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INDIVIDUAL PROVIDERS OF DIRECT SUPPORT SERVICES

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     36-11.1-1. Definitions.

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     For the purposes of this chapter:

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     (1) "Direct support services" has the meaning given to it under § 40-8.14-1.

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     (2) "Individual provider" has the meaning given to it under § 40-8.14-1.

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     (3) "Participant" has the meaning given to it under § 40-8.14-1.

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     (4) "Participant's representative" has the meaning given to it under § 40-8.14-1.

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     36-11.1-2. Rights of individual providers and participants.

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     For the purposes of the Rhode Island state labor relations act, under chapter 11.1 of title

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36, individual providers shall be considered, by virtue of this chapter, employees within the

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meaning of § 28-7-3 and state employees within the meaning of § 36-11-1 employed by the

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director of human services or the director's representative. For purposes of this chapter, no

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individual provider shall be deemed excluded from the definition of "employee" under § 28-7-

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3(3)(ii) because they provide care to a family member or because they are in domestic service in a

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person’s home. This section does not require the treatment of individual providers as public

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employees for any other purpose. Individual providers are not state employees for purposes of

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chapter 31 of title 9 or any similar law. Chapter 11.1 of title 36 shall apply to individual providers

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except as otherwise provided in this chapter. Notwithstanding § 36-11-1.1, chapter 11.1 of title 36

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shall apply to individual providers regardless of part-time, full-time, casual, or seasonal

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employment status.

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     36-11.1-3. Scope of meet and negotiate obligation.

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     If an exclusive representative is certified pursuant to this chapter, the mutual rights and

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obligations of the state and an exclusive representative of individual providers to meet and

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negotiate regarding terms and conditions shall extend to the subjects covered under § 40-8.14-

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4(c), but shall not include those subjects reserved to participants or participants' representatives

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by § 36-11.1-4.

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     36-11.1-4. Rights of covered program participants.

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     No provision of any agreement reached between the state and any exclusive

 

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representative of individual providers, nor any arbitration award, shall interfere with the rights of

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participants or participants' representatives to select, hire, direct, supervise, and terminate the

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employment of their individual providers; to manage an individual service budget regarding the

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amounts and types of authorized goods or services received; or to receive direct support services

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from individual providers not referred to them through a state registry.

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     36-11.1-5. Legislative action on agreements.

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     Any agreement reached between the state and the exclusive representative of individual

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providers under chapter 11.1 of title 36 shall be submitted to the general assembly to be accepted

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or rejected in accordance with § 36-6-5.

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     36-11.1-6. Strikes prohibited.

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     Individual providers shall be subject to the prohibition on strikes applied to state

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employees under § 36-11-6.

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     36-11.1-7. Interest arbitration.

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     Individual providers shall be subject to the interest arbitration procedures applied to

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essential employees under §§ 36-11-7.1 through 36-11-11.

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     36-11.1-8. Appropriate unit.

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     The only appropriate unit for individual providers shall be a statewide unit of all

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individual providers. The unit shall be treated as an appropriate unit under § 28-7-15. Individual

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providers who are related to their participant or their participant's representative shall not for such

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reason be excluded from the appropriate unit.

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     36-11.1-9. List access.

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     Beginning October 1, 2018, upon a showing made to the chairperson of the labor

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relations board by any employee organization wishing to represent the appropriate unit of

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individual providers that at least fifty (50) individual providers support such representation, the

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chairperson of the labor relations board shall provide to such organization within seven (7) days

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the most recent list of individual providers compiled under § 40-8.14-4(f), and three (3)

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subsequent monthly lists upon request. The chairperson of the labor relations board shall provide

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lists compiled under § 40-8.14-4(f), upon request, to any exclusive representative of individual

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providers. To facilitate operation of this chapter, the director of the department of human services

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shall provide all lists to the chairperson of the labor relations board, upon the request of the

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chairperson of the labor relations board.

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     36-11.1-10. Representation and election.

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     Beginning January 1, 2019, any employee organization that desires to represent the

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appropriate unit of individual providers may seek exclusive representative status pursuant to an

 

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election conducted pursuant to §§ 28-7-14 through 28-7-19. Certification elections for individual

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providers shall be conducted by mail ballot, and such election shall be conducted upon an

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appropriate petition stating that among individual providers who have been paid for providing

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direct support services to participants within the previous twelve (12) months, a number of

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individual providers equal to at least thirty percent (30%) of those eligible to vote desire to be

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represented by the petitioner. The individual providers eligible to vote in any such election shall

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be those individual providers on the monthly list of individual providers compiled under § 40-

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8.14-4(f), most recently preceding the filing of the election petition. Except as otherwise

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provided, elections under this section shall be conducted in accordance with §§ 28-7-14 through

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28-7-19.

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     SECTION 3. Title 40 of the General Laws entitled "HUMAN SERVICES" is hereby

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amended by adding thereto the following chapter:

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CHAPTER 8.14

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QUALITY SELF-DIRECTED SERVICES

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     40-8.14-1. Definitions.

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     For purposes of this chapter:

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     (1) "Activities of daily living" means everyday routines generally involving functional

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mobility and personal care, such as bathing, dressing, eating, toileting, mobility and transfer.

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     (2) "Covered program" means a program to provide direct support services funded in

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whole or in part by the state of Rhode Island, including the state's Comprehensive § 1115 Waiver

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Demonstration, integrated care initiative, personal assistance services and supports program,

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family-directed respite programs for adults and children, Rhode to Home, and any and all waiver

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programs established pursuant to home and community-based service waivers authorized under §

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1915(c) (42 U.S.C. § 1396 n) or § 1115 (42 U.S.C. § 1315) of the federal Social Security Act, and

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Rhode Island general laws, including, but not limited to, chapters 8, 8.1, 8.7, 8.9, and 8.10 of title

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40, and any plan or program developed pursuant to the executive office of health and human

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services’ authority under §§ 40-8-17 and 40-8.9-9(d); and any similar program that may provide

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similar services in the future.

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     (3) "Direct support services" means personal care assistance, homemaker, and companion

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services covered by medical assistance, 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, however not including the cost of

 

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meals;

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     (iv) Assistance with housekeeping activities to include, but not be limited to, bed making,

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dusting vacuuming, laundry, grocery shopping ,and cleaning;

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     (v) Assistance with ambulation; use of special mobility devices and directly providing or

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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 person with a disability by their caretaker or direct support service provider to

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meet such participant's daily living needs and ensure that such participant may adequately

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function in the participant's home and have safe access to the community.

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     (4) "Director" means the director of the department of human services.

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

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direction of a participant in a covered program, or a participant's representative, to provide direct

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support services to the participant, but does not include an employee of a provider agency, subject

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to the agency's direction and control commensurate with agency employee status or an individual

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providing services to a participant electing the personal choice option in any program.

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     (6) "Instrumental activities of daily living" means the activities often performed by a

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person who is living independently in a community setting during the course of a normal day,

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such as managing money, shopping, telephone use, travel in community, housekeeping, and

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preparing meals.

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     (7) "Participant" means a person who receives direct support services through a covered

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program.

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     (8) "Participant's representative" means a participant's legal guardian or an individual

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

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provision of direct support services through a covered program.

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     40-8.14-2. Operations of covered programs.

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     All covered programs shall operate consistent with this chapter, including by allowing

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participants and participants' representatives within the programs to elect the option of receiving

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services through individual providers as defined in § 40-8.14-1, notwithstanding any inconsistent

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provisions of any Medicaid state plan or program developed pursuant to the executive office of

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health and human services' authority under §§ 40-8-17 and 40-8.9-9(d); or any other similar

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statutes or regulations.

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     40-8.14-3. Optional service providers.

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     The requirement under § 40-8.14-2 shall not restrict the state's ability to allow

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participants and participants' representatives within the covered programs to choose not to

 

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employ an individual provider, and instead elect the option of receiving direct support services

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through a personal choice option or through the employees of provider agencies.

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

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     (a) The director shall allow to all participants within a covered program the option of

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employing an individual provider to provide direct support services.

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     (b) The director shall ensure that all employment of individual providers is in conformity

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with this chapter and chapter 11.1 of title 36, to include modification of program operations as

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necessary to ensure proper classification of individual providers, and to require that all relevant

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vendors within covered programs assist and cooperate as needed, including managed care

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organizations and providers of fiscal support, fiscal intermediary, financial management, or

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similar services to provide support to participants and participants' representatives with regard to

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employing individual providers, and to otherwise fulfill the requirements of this chapter.

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     (c) The director shall:

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     (1) Establish for all individual providers' compensation rates, payment terms and

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practices, and any benefit terms; provided that these rates and terms may permit individual

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provider variations based on traditional and relevant factors otherwise permitted by law;

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     (2) Provide for required orientation programs within three (3) months of hire for

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individual providers newly hired on or after October 1, 2018, regarding their employment within

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the covered programs through which they provide services;

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     (3) Have the authority to provide for relevant training and educational opportunities for

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individual providers, as well as for participants and participants' representatives who receive

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services from individual providers, including opportunities for individual providers to obtain

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certification documenting additional training and experience in areas of specialization;

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     (4) Have the authority to provide for the maintenance of a public registry of individuals

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who have consented to be included to:

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     (i) Provide routine, emergency, and respite referrals of qualified individual providers who

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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, and availability for hire;

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     (iii) Provide for appropriate employment opportunities for individual providers and a

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means by which they may more easily remain available to provide services to participants within

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covered programs;

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     (5) Establish provider qualification standards for the workforce of individual providers,

 

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including behavior that would disqualify someone from providing services as an individual

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provider;

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     (6) Establish other appropriate terms and conditions of employment governing the

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workforce of individual providers without infringing on participants' or their responsible parties'

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rights and responsibilities to hire, direct, supervise, and/or terminate the employment of their

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individual providers; and

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

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communicate directly with the director about the provision of quality direct support services in

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covered programs.

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     (d) The director's authority over terms and conditions of individual providers'

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employment, including compensation, payment, and benefit terms, employment opportunities

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within covered programs, individual provider orientation, training, and education opportunities,

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and the operation of public registries shall be subject to the state's obligations to meet and

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negotiate under chapters 11 of title 36 and 7 of title 28, as modified and made applicable to

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individual providers under chapter 11.1 of title 36, and to agreements with any exclusive

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representative of individual providers, as authorized by chapters 11 of title 36 and 7 of title 28, as

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modified and made applicable to individual providers under chapter 11.1 of title 36. Except to the

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extent otherwise provided by law, the director shall not undertake activities in subsections (c)(3)

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and (c)(4) of this section, prior to October 1, 2018, unless included in a negotiated agreement and

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an appropriation has been provided by the legislature to the director.

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     (e) The director shall cooperate in the implementation of chapter 11.1 of title 36 with all

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other relevant state departments and agencies. Any entity providing relevant services within

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covered programs, including 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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director of the department of human services in the operations of this section, including with

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respect to the director's obligations under subsections (b) and (f) of this section.

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     (f) The director shall, no later than October 1, 2018, and then monthly thereafter, compile

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and 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 shall share the lists with others

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as needed for the state to meet its obligations under chapters 11 of title 36 and 7 of title 28 as

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modified and made applicable to individual providers under chapter 11.1 of title 36, and to

 

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facilitate the representational processes under §§ 36-11.1-9 and 36-11.1-10. This shall not include

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access to private data on participants or participants' representatives. Nothing in this section or

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chapter 11.1 of tile 36 shall alter the access rights of other private parties to data on individual

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providers.

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     (g) The director shall immediately commence all necessary steps to ensure that services

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offered under all covered programs are offered in conformity with this chapter, to gather all

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information that may be needed for promptly compiling lists required under this chapter,

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including information from current vendors within covered programs, and to complete any

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required modifications to currently operating covered programs by October 1, 2018.

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     40-8.14-5. Severability.

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     Should any part of this act be declared invalid or unenforceable, or the enforcement or

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compliance with it is suspended, restrained, or barred, either by the state or by the final judgment

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of a court of competent jurisdiction, the remainder of this act shall remain in full force and effect.

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     SECTION 4. 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 -- PUBLIC

OFFICERS AND EMPLOYEES -- INDIVIDUAL PROVIDERS OF DIRECT SUPPORT

SERVICES

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     This act would enable the creation of a public registry of home health aides giving

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seniors and individuals living with disabilities another choice when accessing long-term care

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options. The act would also provide that the state would set wage rates and qualification standards

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for home health aides on the registry. The act would further provide that these home health aides

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would have the right to choose to form a union through an election.

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     This act would take effect upon passage.

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