2012 -- H 7035

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LC00221

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STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2012

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A N A C T

RELATING TO BEHAVIORAL HEALTHCARE, DEVELOPMENTAL DISABILITIES AND

HOSPITALS - RIGHTS FOR PERSONS WITH DEVELOPMENTAL DISABILITIES

     Introduced By: Representatives Guthrie, Bennett, O`Grady, Johnston, and Phillips

     Date Introduced: January 05, 2012

     Referred To: House Finance

It is enacted by the General Assembly as follows:

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     SECTION 1. Section 40.1-11-4.3 of the General Laws in Chapter 40.1-11 entitled

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"Division of Developmental Disabilities" is hereby amended to read as follows:

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     40.1-21-4.3. Definitions. -- As used in this chapter and in chapter 22 of this title the

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words:

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      (1) "Ancillary services" means those services provided, and shall include, but not be

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limited to, transportation, housing, housing adaptation, personal attendant care, and homemaker

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services.

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      (2) "Case management" means the implementation of an individual's program by

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providing information, by referral to appropriate service providers, by procurement of services,

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and by the coordination of the necessary services.

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      (3) "Department" means the Rhode Island department of mental health, retardation, and

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hospitals.

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      (4) "Developmental services" means those services provided to developmentally

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disabled adults, and shall include, but not be limited to, habilitation and rehabilitation services,

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and day services.

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      (5) "Developmentally disabled adult" means a person, eighteen (18) years old or older

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and not under the jurisdiction of the department of children, youth, and families who is either a

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mentally retarded developmentally disabled adult or is a person with a severe, chronic disability

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which:

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      (i) Is attributable to a mental or physical impairment or combination of mental and

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physical impairments;

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      (ii) Is manifested before the person attains age twenty-two (22);

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      (iii) Is likely to continue indefinitely;

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      (iv) Results in substantial functional limitations in three (3) or more of the following

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areas of major life activity:

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      (A) Self care,

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      (B) Receptive and expressive language,

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      (C) Learning,

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      (D) Mobility,

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      (E) Self-direction,

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      (F) Capacity for independent living,

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      (G) Economic self-sufficiency; and

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      (v) Reflects the person's need for a combination and sequence of special,

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interdisciplinary, or generic care, treatment, or other services, which are of lifelong or extended

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duration and are individually planned and coordinated. For purposes of funding, it is understood

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that students enrolled in school will continue to receive education from their local education

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authority in accordance with section 16-24-1 et seq.

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      (6) "Diagnosis and evaluation" means a process to determine whether and to what extent

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an individual is developmentally disabled and a study of the individual's condition, situation, and

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needs which lead to a recommendation of what services, if any, would benefit the individual.

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      (7) "Individualized program plan" or "general service plan" means a plan, however

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named, which includes, but shall not be limited to, the following:

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      (i) An evaluation of the strengths, difficulties, needs, and goals of the individual;

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      (ii) A description of those services found to be necessary or appropriate to assist the

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individual in realizing his or her potential for self-sufficiency in major life activities;

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      (iii) A description of the agencies and/or individuals, which are proposed to provide each

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of the recommended services;

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      (iv) The intermediate and long-range objectives for the individual's development and

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habilitation;

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      (v) The expected duration for the provision of the services;

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      (vi) A description of the tests and other evaluative devices used and their results;

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      (vii) Proposed criteria for monitoring and evaluating the success of the services in

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meeting the individual's needs; and

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      (viii) The signatures of the preparers of the plan and the date.

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      The individual program plan shall indicate developmental, supportive, or ancillary

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services by function and frequency, the manner of subsidy and delivery and the categories of need

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for services such as transportation, job training, or occupation, housing, housing adaptation,

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personal attendant care, homemaker, or other services. This plan shall be reviewed at least

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annually; provided, however, that authorizations for services and funding issued prior to July 1,

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2011 are null and void. Authorizations will be paid at the rate effective in the quarter the service

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was provided.; provided, further, that the authorized rates for the period of October 1, 2011 to

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December 31, 2011, shall be the same as the rates in effect for the period of July 1, 2011 to

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September 30, 2011.

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      (8) "Mentally retarded developmentally disabled adult" means a person eighteen (18)

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years old or older and not under the jurisdiction of the department of children, youth, and

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families, with significant sub-average, general intellectual functioning two (2) standard deviations

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below the norm, existing concurrently with deficits in adaptive behavior and manifested during

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the developmental period. For purposes of funding, it is understood that students enrolled in

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school will continue to receive education from their local education authority in accordance with

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section 16-24-1 et seq.

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      (9) "Service broker" means that individual who assists in facilitating the connection

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between the developmentally disabled person and the services required by the individual program

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plan.

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      (10) "Subsidized access to service" means the provisions of financial resources through

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vouchers to a developmentally disabled person to enable the person to gain access to appropriate

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generic and/or special services as required by the individual program plan.

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      (11) "Supportive services" means those services provided to developmentally disabled

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adults, and shall include, but not be limited to, occupational therapy, physical therapy,

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psychological services, counseling, nursing services, and medical services.

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     SECTION 2. Section 40.1-26-2 of the General Laws in Chapter 40.1-26 entitled "Rights

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for Persons with Developmental Disabilities" is hereby amended to read as follows:

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     40.1-26-2. Definitions. -- As used in this chapter:

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      (1) "Advocate" means: (i) a legal guardian; or (ii) an individual acting on behalf of a

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person with a developmental disability in a manner clearly consistent with the interests of the

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person with a developmental disability and includes a family member, friend, or professional

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advocate. Whenever possible an advocate should be selected by the person with a disability.

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      (2) "Agency" means any person or organization which provides day program services,

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residential services, support services or advocacy services for persons with developmental

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disabilities, and which is licensed by the department of mental health, retardation, and hospitals

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pursuant to section 40.1-24-1 et seq.

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      (3) "Applicant" means any person with a developmental disability who has applied for

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services from the division of developmental disabilities and/or any agency licensed by the

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department of mental health, retardation, and hospitals pursuant to section 40.1-24-1 et seq.

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      (4) "Aversive interventions" means a class of stimuli that are followed by escape or

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avoidance response.

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      (5) "Behavioral Treatment Intervention" means any intervention or treatment to develop

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or strengthen adaptive appropriate behaviors through the application of behavioral interventions

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and to simultaneously reduce the frequency of maladaptive or inappropriate behaviors. Behavior

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interventions encompass interventions, which refer to purposeful, clinical manipulation of

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behavior.

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      (6) "Competent" means the ability to understand the likely risks and benefits of a

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procedure or plan when the risks and benefits are presented to the participant in a manner most

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likely to be understood by the participant in light of his or her cognitive abilities and learning

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style.

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      (7) "Department" means the department of mental health, retardation, and hospitals.

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      (8) "Developmental disability" means a severe chronic disability which is attributable to

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a mental or physical impairment or combination of impairments; is manifested before the person

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attains age twenty-two (22); is likely to continue indefinitely; results in substantial functional

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limitations in three (3) or more of the following areas of major life activity: self-care, receptive

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and expressive language, learning, mobility, self-direction, capacity for independent living,

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economic self-sufficiency; and reflects the person's need for a combination and sequence of

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special, interdisciplinary or generic care, treatment, or other services which are of life long or

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extended duration and are individually planned and coordinated.

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      (9) "Individualized plan" means the personalized document which describes an

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individualized profile of the participant highlighting his or her capabilities, preferences and

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interests. The plan describes specific supports in the areas of vocational, social, medical,

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supported living, and rehabilitation required to meet the specific needs of the participant. The

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plan includes quality indicators that demonstrate the plan has met the expectations of the

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participant and the participant is satisfied with the support services he or she is receiving;

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provided, however, that authorizations for services and funding issued prior to July 1, 2011 are

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null and void. Authorizations for services will be paid at the rate effective when in the quarter the

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service was provided.; provided, further, that the authorized rates for the period of October 1,

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2011 to December 31, 2011, shall be the same as the rates in effect for the period of July 1, 2011

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to September 30, 2011.

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      (10) "Participant" means any person eighteen (18) years or older, with a developmental

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disability who receives services from the division of developmental disabilities and/or an agency

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licensed by the department of mental health, retardation, and hospitals.

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      (11) "Relative" means a member of the participant's or applicant's family who has been

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actively involved in the participant's or applicant's life, has an ongoing relationship with the

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participant or applicant, and is supportive in a manner clearly consistent with the best interests of

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the participant or applicant.

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      (12) "Seclusion" means placing a participant alone in a locked room without supervision.

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      (13) "Serious incidents" means any situation involving a person with developmental

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disabilities in which the person:

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      (i) Has sustained an injury, which requires medical care or treatment beyond routine first

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aid;

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      (ii) Has been missing;

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      (iii) Has died;

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      (iv) Has been involved in a criminal act;

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      (v) Has been subject to a medication error.

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     SECTION 3. Section 40-6-27 of the General Laws in Chapter 40-6 entitled "Public

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Assistance Act" is hereby amended to read as follows:

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

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

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

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

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

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

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monthly share of supplementary assistance to the supplementary security income program

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effective January 1, 2009, shall be as follows:

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      (i) Individual living alone:
$39.92

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     (ii) Individual living with others:
$51.92

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     (iii) Couple living alone:
$79.38

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     (iv) Couple living with others:
$97.30

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

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

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

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

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

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$300.00.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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payment of any monthly fees.

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

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

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

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

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care setting and assisted living residences on or after October 1, 1998; or (ii) Who are residing in

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supportive residential care settings and assisted living residences, and who apply for or begin to

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receive SSI on or after October 1, 1998.

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

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

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

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

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Global Consumer Choice Compact Waiver.

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

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

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

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

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section. Such payment certification standards shall define:

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

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

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

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areas;

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

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been met; and

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

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

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

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

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prospective or current resident.

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

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

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

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in development.

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

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individuals eligible for SSI benefits for:

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

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which is defined as a fire or natural disaster; and

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

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

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

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

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     SECTION 4. There is hereby appropriated, out of any money in the treasury not

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otherwise appropriated for the fiscal year 2011-2012, the sum of $15,000,000 for services for the

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developmentally disabled at the rates and amounts provided for in this act, and the state controller

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is hereby authorized and directed to draw his or her orders upon the general treasurer for payment

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of said sum, or so much thereof as may be from time to time required, upon receipt by him or her

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of properly authenticated vouchers in accordance with the rates and amounts provided for in this

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act.

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     SECTION 5. This act shall take effect upon passage.

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LC00221

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N A C T

RELATING TO BEHAVIORAL HEALTHCARE, DEVELOPMENTAL DISABILITIES AND

HOSPITALS - RIGHTS FOR PERSONS WITH DEVELOPMENTAL DISABILITIES

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     This act would restore the budget cut made to the developmental disabilities assisted

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living fund.

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     This act would take effect upon passage.

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LC00221

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