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
(2) Effective October
1, 2008 a person shall be a
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
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
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
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
governors for higher education or the
(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
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
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
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
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
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
(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
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
(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
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
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.