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art.011/6/011/5/011/4/011/3/011/2

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     ARTICLE 11 AS AMENDED

RELATING TO HEALTH AND HUMAN SERVICES

     SECTION 1. Title 23 of the General Laws entitled "HEALTH AND SAFETY" is hereby

amended by adding thereto the following chapter:

CHAPTER 17.29

PRIMARY CARE TRAINING SITES PROGRAM

     23-17.29-1. Short title.

     This chapter shall be known and may be cited as the "Primary Care Training Sites

Program".

     23-17.29-2. Definitions.

     As used in this chapter, the following words and phrases are construed as follows:

     (1) "Director" means the director of the department of health;

     (2) "Grant" means a sum awarded pursuant to a contract executed pursuant to § 23-17.29-

4;

     (3) "National Committee for Quality Assurance" or "NCQA" means the nonprofit

organization headquartered in the District of Columbia working to improve healthcare quality

through the administration of evidence-based standards, measures, programs and accreditation;

     (4) "Office" means the office of primary care training established pursuant to the provisions

of § 23-17.29-3;

     (5) "Patient-centered medical home" or "PCMH" means a model of healthcare that puts

patients at the forefront of care by providing team-based healthcare delivery led by a healthcare

provider to render comprehensive and continuous medical care to patients with a goal to obtain

maximal health outcomes;

     (6) "Primary care" means day-to-day healthcare provided by a healthcare professional.

Typically, the healthcare professional acts as the first contact and principal point of continuing care

for patients within a healthcare system, and coordinates other specialist care that the patient may

require; and

     (7) "Primary care site" means a site, location or medical practice that serves as the patient's

entry point into the healthcare system and acts as the continuing focal point for all required

healthcare services.

     23-17.29-3. Creation of office of primary care training -- Purpose.

     There is hereby authorized, created and established an office of primary care training

within the department of health. The purpose of the office shall be to:

     (1) Assist the director in developing an application and selection process for the awarding

     of grants pursuant to the provisions of this chapter;

     (2) Provide oversight of grant recipients;

     (3) Coordinate meetings and related logistics to implement the provisions of this chapter;

     (4) Assist applicants for grants to comply with the process to include providing information

and assistance in processing of grant awards;

     (5) Recommend acceptance or rejection of proposed contracts and grants to be approved

by the director in accordance with the provisions of § 42-11-11;

     (6) Coordinate with the approval of the director, and with the director of administration,

the approval of all contracts negotiated pursuant to the provisions of this chapter and the provisions

of § 42-11-11;

     (7) Establish evidence-based standards to measure the success and performance of all

recipients of grants provided pursuant to the provisions of this chapter; and

     (8) Perform all other duties as assigned by the director.

     The office of primary care training shall be staffed by the person or persons assigned by

the director.

     23-17.29-4. Contracts.

     In compliance with the provisions of § 42-11-11, the director shall have the authority to

enter into contracts, subject to appropriation, for medical education to be conducted at primary care

practice sites. Any contract entered into shall not exceed ninety thousand dollars ($90,000) per

primary care site contract recipient, per calendar year and shall contain, at a minimum, the

following terms, conditions and provisions:

     (1) The primary care site shall serve as an enhanced interdisciplinary clinical training site;

     (2) The primary care site shall have achieved and shall maintain NCQA PCMH distinction;

     (3) The primary care site shall provide integrated behavioral health services;

     (4) The primary care site shall provide an agreed curriculum of training for physicians,

nurse practitioners and physician assistants; and

     (5) Training shall include a minimum of five (5) hours didactic training and shall introduce

the trainees to the concept of PCMH and how the principles of the model have been operationalized

in the primary care delivery setting.

     23-17.29-5. Rules and regulations.

     The director shall promulgate rules and regulations to implement the provisions of this

chapter.

     23-17.29-6. Reports.

     The director shall report annually to the general assembly and the governor no later than

December 31 of each year on the status and progress of the primary care training sites program

established and administered pursuant to the provisions of this chapter.

     23-17.29-7. Severability.

     If any provision of this chapter or any rule or regulation promulgated pursuant to the

provisions of this chapter, or its application to any person or circumstance, is held invalid by a court

of competent jurisdiction, the reminder of the chapter, rule or regulation and the application of the

provision to other persons or circumstances shall not be affected by its invalidity. The invalidity of

any section or sections or portion of any section or sections of this chapter shall not affect the

validity of the remainder of this chapter.

     SECTION 2. Sections 40-5.2-10, 40-5.2-11, and 40-5.2-12 of the General Laws in Chapter

40-5.2 entitled "The Rhode Island Works Program" are hereby amended to read as follows:

     40-5.2-10. Necessary requirements and conditions.

     The following requirements and conditions shall be necessary to establish eligibility for

the program.

     (a) Citizenship, alienage, and residency requirements.

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

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

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

Reconciliation Act of 1996, PRWORA, Pub. L. No. 104-193 and as that section may hereafter be

amended [8 U.S.C. § 1612]; a person who is not a United States citizen and does not meet the

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

accordance with this chapter.

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

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

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

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

requirements.

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

subdivision 115(d)(1)(A) of Pub. L. No. 104-193, the Personal Responsibility and Work

Opportunity Reconciliation Act of 1996, PRWORA [21 U.S.C. § 862a], 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 that is classified as a felony by the law of the jurisdiction

and that has as an element the possession, use, or distribution of a controlled substance as defined

in § 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 themself 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 themself of

employment opportunities and/or work readiness programs.

     (2) On the basis of this 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 that requires the individual to participate in the intensive

employment services. Intensive employment services shall be defined as the work requirement

activities in § 40-5.2-12(g) and (i).

     (3) The director, or the director’s 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 that 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 § 40-5.2-12.

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

employment services as the first step in the individual employment plan, 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 § 40-5.2-12(g) and (i).

     (ii) Parents under age twenty (20) without a high school diploma or general equivalency

diploma (GED) shall be referred to special teen-parent programs that will provide intensive services

designed to assist teen parents to complete high school education or GED, and to continue approved

work plan activities in accord with Rhode Island 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 works 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 works program.

The appointments include, but are not limited to: the initial interview, orientation and assessment;

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

in accordance with rules and regulations established by the department.

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

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

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

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

plan in accordance with department of human services 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

§ 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 five thousand dollars ($5,000).

     (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:

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

     (ii) 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;

     (iii) Real property that 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;

     (iv) 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 that the department determines are necessary for the family to earn a living;

     (v) 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 that

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;

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

limited value;

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

and funeral arrangements;

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

made to the family by reason of § 32 of the Internal Revenue Code of 1986, 26 U.S.C. § 32 (relating

to earned income tax credit), and any payment made to the family by an employer under § 3507 of

the Internal Revenue Code of 1986, 26 U.S.C. § 3507 [repealed] (relating to advance payment of

such earned income credit);

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

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

     (x) Any veteran’s disability pension benefits received as a result of any disability sustained

by the veteran while in the military service.

     (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

three hundred dollars ($300) five hundred and twenty-five dollars ($525) of gross earnings plus

fifty percent (50%) of the gross earnings of the family in excess of three hundred dollars ($300)

five hundred and twenty-five dollars ($525) earned during the month.

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

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

noncustodial 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) that are paid in any month by a noncustodial parent of a child;

     (ii) Earned income of any child;

     (iii) 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. § 1381 et seq.;

     (iv) 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;

     (v) 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 United States Commissioner of Education (or the Rhode Island council on

postsecondary education or the Rhode Island division of higher education assistance);

     (vi) Foster care payments;

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

organization;

     (viii) 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. § 5000 et seq.;

     (ix) Payments to volunteers under AmeriCorps VISTA as defined in the department’s rules

and regulations;

     (x) 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. § 1261 et seq., P.L. 93-134,

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

which are referred to in § 5 of P.L. 94-114, 25 U.S.C. § 459d, that became effective October 17,

1975;

     (xi) Refund from the federal and state earned income tax credit and any federal or state

child tax credits or rebates;

     (xii) 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;

     (xiii) The earned income of any adult family member who gains employment while an

active RI Works household member. This income is excluded for the first six (6) months of

employment in which the income is earned, or until the household’s total gross income exceeds

one hundred eighty-five percent (185%) of the federal poverty level, unless the household reaches

its sixty-month (60) time limit first;

     (xiv) Any veteran’s disability pension benefits received as a result of any disability

sustained by the veteran while in the military service.

     (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) On or after January 1, 2020, no cash assistance shall be provided, pursuant to this

chapter, to a family or assistance unit that includes an adult member who has received cash

assistance for a total of sixty (60) months (whether or not consecutive), to include any time

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

as defined herein. Provided further, in no circumstances other than provided for in subsection (h)(3)

with respect to certain minor children, shall cash assistance be provided pursuant to this chapter to

a family or assistance unit that includes an adult member who has received cash assistance for a

total of a lifetime limit of sixty (60) 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 cash assistance payment.

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

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

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

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

provided under a program similar to the Rhode Island families work and opportunity program or

the federal TANF program.

     (5)(i) The department of human services 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 the sixty-month (60)

lifetime time limit.

     (ii) For applicants who have less than six (6) months remaining in the sixty-month (60)

lifetime time limit because the family or assistance unit previously received cash assistance in

Rhode Island or in another state, the department shall notify the applicant of the number of months

remaining when the application is approved and begin the process required in subsection (h)(5)(i).

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

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

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

independence program, more specifically under § 40-5.1-9(2)(c) [repealed], due to sanction

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

family received sixty (60) months of cash benefits in accordance with the family independence

program, then that recipient family is not able to receive further cash assistance for his/her family,

under this chapter, except under hardship exceptions.

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

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

(federal TANF described in Title IV-A of the Federal Social Security Act, 42 U.S.C. § 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) No cash assistance shall be provided, pursuant to this chapter, to a family assistance

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

or not consecutive) to include any time receiving any type of cash assistance in any other state or

territory of the United States as defined herein effective August 1, 2008. Provided further, that no

cash assistance shall be provided to a family in which an adult member has received assistance for

twenty-four (24) consecutive months unless the adult member has a rehabilitation employment plan

as provided in § 40-5.2-12(g)(5).

     (2) 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 subsection

(a)(2) to include any time they received any type of cash assistance in any other state or territory

of the United States as defined herein.

     (j) Hardship exceptions.

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

time limit, by reason of hardship; provided, however, that the number of 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 § 40-5.2-34, 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 consisting of a person under the age of eighteen

(18) from onset of pregnancy shall be eligible for cash assistance only if the family resides in the

home of an adult parent, legal guardian, or other adult relative. The 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 a supervised supportive-living

arrangement to the extent available.

     (3) For purposes of this section, “supervised supportive-living arrangement” means an

arrangement that 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 that 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

that 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

rulemaking process, for refusing to comply with the requirements of subsections (l)(1) and (l)(2),

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. § 1396 et seq.

     40-5.2-11. Cash assistance.

     (a) A family or assistance unit found by the department to meet the eligibility criteria set

forth in this chapter shall be eligible to receive cash assistance as of the date a signed, written

application, signed under a penalty of perjury, is received by the department.

     (b) The family members or assistance unit shall be eligible for cash assistance for so long

as they continue to meet the eligibility criteria outlined in accordance with this chapter. Parents and

adult non-parent caretaker relatives receiving cash assistance shall be eligible so long as they meet

the terms and conditions of the work requirements of § 40-5.2-12. An adult caretaker relative shall

be eligible for assistance as a member of the assistance unit so long as he or she meets all the

eligibility requirements of this chapter.

     (c) The monthly amount of cash assistance shall be equal to the payment standard for the

family minus the countable income of the family in that month. The department is authorized to

reduce the amount of assistance in the month of application to reflect the number of the days

between the first day of the month and the effective date of the application.

     (d) A decision on the application for assistance shall be made or rejected by the department

no later than thirty (30) days following the date submitted and shall be effective as of the date of

application.

     (e) The payment standard is equal to the sum of the following: four hundred twenty-five

dollars ($425) five hundred ten dollars ($510) (three hundred sixty dollars ($360) (four hundred

forty-five dollars ($445) for a family residing in subsidized housing) for the first person; one

hundred fifty-nine dollars ($159) one hundred ninety-one dollars ($191) for the second person; one

hundred thirty-seven dollars ($137) one hundred sixty-four dollars ($164) for the third person; and

one hundred four dollars ($104) one hundred twenty-five dollars ($125) for each additional person.

     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 § 40-5.2-10(e).

     (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-parent (2) 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, the individual 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 that 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 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:

     (i) Unsubsidized employment;

     (ii) Subsidized private-sector employment;

     (iii) Subsidized public-sector employment;

     (iv) Work experience;

     (v) On-the-job training;

     (vi) Job search and job readiness;

     (vii) Community service programs;

     (viii) Vocational educational training not to exceed twelve (12) months; provided,

however, that a participant who successfully completes their first year of education at the

community college of Rhode Island may participate in vocational education training for an

additional twelve (12) months;

     (ix) Providing childcare services to another participant parent who is participating in an

approved community service program; and

     (x) Adult education in an intensive work-readiness program.

     (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-hour (30) requirement:

     (i) Job skills training directly related to employment;

     (ii) Education directly related to employment; and

     (iii) 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 of 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 or her required minimum hours per week in core activities if actual

participation falls short of his or 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 rehabilitation services that 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 (g) 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 (12) 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 that 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 (2) parents, one or both parents are required, and shall be

engaged in, work activities as defined below, for an individual or combined total of 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 as the first step in the individual employment plan.

Two-parent work requirements shall be defined as the following:

     (i) Unsubsidized employment;

     (ii) Subsidized private-sector employment;

     (iii) Subsidized public-sector employment;

     (iv) Work experience;

     (v) On-the-job training;

     (vi) Job search and job readiness;

     (vii) Community service program;

     (viii) Vocational educational training not to exceed twelve (12) months; provided,

however, that a participant who successfully completes their first year of education at the

community college of Rhode Island may participate in vocational education training for an

additional twelve (12) months;

     (ix) The provision of childcare services to a participant individual who is participating in a

community service program; and

     (x) Adult education in an intensive work-readiness program.

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

participation:

     (i) Job skills training directly related to employment;

     (ii) Education directly related to employment; and

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

certificate of general equivalence.

     (3) A family with two (2) 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 or her required minimum hours per week.

     (4) If the family receives childcare 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 subsection (i)(1).

     Above fifty (50) hours per week, the three (3) activities listed in subsection (i)(2) may also

count as participation.

     (6) A family with two (2) 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 (i) 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. The reduction in cash assistance shall not exceed the share of the payment made to the

participant, i.e., the amount paid in addition to the payment for the dependent children. 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: (i) Enters

into an individual employment plan or rehabilitation plan and demonstrates compliance with the

terms thereof; or (ii) 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 or 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: (i) Enter into an individual employment or

rehabilitation plan as applicable, and demonstrate compliance with the terms thereof, or (ii)

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)(3) 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)(4) Participants whose cases had closed in sanction status pursuant to Rhode Island’s

prior Temporary Assistance for Needy Families Program (federal TANF described in Title IV-A

of the federal Social Security Act, 42 U.S.C. § 601 et seq.), the family independence program, more

specifically, § 40-5.1-9(2)(c) [repealed], due to failure to comply with the cash assistance program

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

of closure, and who reapply for cash assistance under the Rhode Island works program, must

demonstrate full compliance, as defined by the department in its rules and regulations, before they

shall be eligible for cash assistance pursuant to this chapter.

     (l) Good cause. Good cause for failing to meet any program requirements including leaving

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

regulations promulgated by the department of human services.

     SECTION 3. Section 40-5.2-20 of the General Laws in Chapter 40-5.2 entitled "The Rhode

Island Works Program" is hereby amended to read as follows:

     40-5.2-20. Childcare assistance — Families or assistance units eligible.

     (a) The department shall provide appropriate child care to every participant who is eligible

for cash assistance and who requires child care in order to meet the work requirements in

accordance with this chapter.

     (b) Low-income child care. The department shall provide child care to all other working

families with incomes at or below two hundred percent (200%) two hundred sixty-one percent

(261%) of the federal poverty level if, and to the extent, these other families require child care in

order to work at paid employment as defined in the department’s rules and regulations. The

department shall also provide child care to families with incomes below two hundred two hundred

sixty-one percent (200%) (261%) of the federal poverty level if, and to the extent, these families

require child care to participate on a short-term basis, as defined in the department’s rules and

regulations, in training, apprenticeship, internship, on-the-job training, work experience, work

immersion, or other job-readiness/job-attachment program sponsored or funded by the human

resource investment council (governor’s workforce board) or state agencies that are part of the

coordinated program system pursuant to § 42-102-11. Effective from January 1, 2021, through June

30, 2022, the department shall also provide childcare assistance to families with incomes below

one hundred eighty percent (180%) of the federal poverty level when such assistance is necessary

for a member of these families to enroll or maintain enrollment in a Rhode Island public institution

of higher education provided that eligibility to receive funding is capped when expenditures reach

$200,000 for this provision. Effective July 1, 2022 through December 31, 2024, the department

shall also provide childcare assistance to families with incomes below two hundred percent (200%)

of the federal poverty level when such assistance is necessary for a member of these families to

enroll or maintain enrollment in a Rhode Island public institution of higher education. Effective

January 1, 2025, the department shall also provide childcare assistance to families with incomes

below two hundred sixty-one percent (261%) of the federal poverty level when such assistance is

necessary for a member of these families to enroll or maintain enrollment in a Rhode Island public

institution of higher education.

     (c) No family/assistance unit shall be eligible for childcare assistance under this chapter if

the combined value of its liquid resources exceeds one million dollars ($1,000,000), which

corresponds to the amount permitted by the federal government under the state plan and set forth

in the administrative rulemaking process by the department. Liquid resources are defined as any

interest(s) in property in the form of cash or other financial instruments or accounts that are readily

convertible to cash or cash equivalents. These include, but are not limited to: cash, bank, credit

union, or other financial institution savings, checking, and money market accounts; certificates of

deposit or other time deposits; stocks; bonds; mutual funds; and other similar financial instruments

or accounts. These do not include educational savings accounts, plans, or programs; retirement

accounts, plans, or programs; or accounts held jointly with another adult, not including a spouse.

The department is authorized to promulgate rules and regulations to determine the ownership and

source of the funds in the joint account.

     (d) As a condition of eligibility for childcare assistance under this chapter, the parent or

caretaker relative of the family must consent to, and must cooperate with, the department in

establishing paternity, and in establishing and/or enforcing child support and medical support

orders for any children in the family receiving appropriate child care under this section in

accordance with the applicable sections of title 15, as amended, unless the parent or caretaker

relative is found to have good cause for refusing to comply with the requirements of this subsection.

     (e) For purposes of this section, “appropriate child care” means child care, including infant,

toddler, preschool, nursery school, and school-age, that is provided by a person or organization

qualified, approved, and authorized to provide the care by the state agency or agencies designated

to make the determinations in accordance with the provisions set forth herein.

     (f)(1) Families with incomes below one hundred percent (100%) of the applicable federal

poverty level guidelines shall be provided with free child care. Families with incomes greater than

one hundred percent (100%) and less than two hundred percent (200%) of the applicable federal

poverty guideline shall be required to pay for some portion of the child care they receive, according

to a sliding-fee scale adopted by the department in the department’s rules, not to exceed seven

percent (7%) of income as defined in subsection (h) of this section.

     (2) Families who are receiving childcare assistance and who become ineligible for

childcare assistance as a result of their incomes exceeding two hundred percent (200%) two

hundred sixty-one percent (261%) of the applicable federal poverty guidelines shall continue to be

eligible for childcare assistance until their incomes exceed three hundred percent (300%) of the

applicable federal poverty guidelines. To be eligible, the families must continue to pay for some

portion of the child care they receive, as indicated in a sliding-fee scale adopted in the department’s

rules, not to exceed seven percent (7%) of income as defined in subsection (h) of this section, and

in accordance with all other eligibility standards.

     (g) In determining the type of child care to be provided to a family, the department shall

take into account the cost of available childcare options; the suitability of the type of care available

for the child; and the parent’s preference as to the type of child care.

     (h) For purposes of this section, “income” for families receiving cash assistance under §

40-5.2-11 means gross, earned income and unearned income, subject to the income exclusions in

§§ 40-5.2-10(g)(2) and 40-5.2-10(g)(3), and income for other families shall mean gross, earned and

unearned income as determined by departmental regulations.

     (i) The caseload estimating conference established by chapter 17 of title 35 shall forecast

the expenditures for child care in accordance with the provisions of § 35-17-1.

     (j) In determining eligibility for childcare assistance for children of members of reserve

components called to active duty during a time of conflict, the department shall freeze the family

composition and the family income of the reserve component member as it was in the month prior

to the month of leaving for active duty. This shall continue until the individual is officially

discharged from active duty.

     (k) Effective from August 1, 2023, through July 31, 2024 2025, the department shall

provide funding for child care for eligible childcare educators, and childcare staff, who work at

least twenty (20) hours a week in licensed childcare centers and licensed family childcare homes

as defined in the department’s rules and regulations. Eligibility is limited to qualifying childcare

educators and childcare staff with family incomes up to three hundred percent (300%) of the

applicable federal poverty guidelines and will have no copayments. Qualifying participants may

select the childcare center or family childcare home for their children. The department shall

promulgate regulations necessary to implement this section, and will collect applicant and

participant data to report estimated demand for state-funded child care for eligible childcare

educators and childcare staff. The report shall be due to the governor and the general assembly by

November 1, 2024.

     SECTION 4. Section 40-6.2-1.1 of the General Laws in Chapter 40-6.2 entitled "Child

Care — State Subsidies" is hereby amended to read as follows:

     40-6.2-1.1. Rates established.

     (a) Through June 30, 2015, subject to the payment limitations in subsection (c), the

maximum reimbursement rates to be paid by the departments of human services and children, youth

and families for licensed childcare centers and licensed family childcare providers shall be based

on the following schedule of the 75th percentile of the 2002 weekly market rates adjusted for the

average of the 75th percentile of the 2002 and the 2004 weekly market rates:

Licensed Childcare Centers 75th Percentile of Weekly

Market Rate

Infant $182.00

Preschool $150.00

School-Age $135.00

Licensed Family Childcare 75th Percentile of Weekly

Providers Market Rate

Infant $150.00

Preschool $150.00

School-Age $135.00

     Effective July 1, 2015, subject to the payment limitations in subsection (c), the maximum

reimbursement rates to be paid by the departments of human services and children, youth and

families for licensed childcare centers and licensed family childcare providers shall be based on the

above schedule of the 75th percentile of the 2002 weekly market rates adjusted for the average of

the 75th percentile of the 2002 and the 2004 weekly market rates. These rates shall be increased by

ten dollars ($10.00) per week for infant/toddler care provided by licensed family childcare

providers and license-exempt providers and then the rates for all providers for all age groups shall

be increased by three percent (3%). For the fiscal year ending June 30, 2018, licensed childcare

centers shall be reimbursed a maximum weekly rate of one hundred ninety-three dollars and sixty-

four cents ($193.64) for infant/toddler care and one hundred sixty-one dollars and seventy-one

cents ($161.71) for preschool-age children.

     (b) Effective July l, 2018, subject to the payment limitations in subsection (c), the

maximum infant/toddler and preschool-age reimbursement rates to be paid by the departments of

human services and children, youth and families for licensed childcare centers shall be

implemented in a tiered manner, reflective of the quality rating the provider has achieved within

the state’s quality rating system outlined in § 42-12-23.1.

     (1) For infant/toddler child care, tier one shall be reimbursed two and one-half percent

(2.5%) above the FY 2018 weekly amount, tier two shall be reimbursed five percent (5%) above

the FY 2018 weekly amount, tier three shall be reimbursed thirteen percent (13%) above the FY

2018 weekly amount, tier four shall be reimbursed twenty percent (20%) above the FY 2018 weekly

amount, and tier five shall be reimbursed thirty-three percent (33%) above the FY 2018 weekly

amount.

     (2) For preschool reimbursement rates, tier one shall be reimbursed two and one-half

(2.5%) percent above the FY 2018 weekly amount, tier two shall be reimbursed five percent (5%)

above the FY 2018 weekly amount, tier three shall be reimbursed ten percent (10%) above the FY

2018 weekly amount, tier four shall be reimbursed thirteen percent (13%) above the FY 2018

weekly amount, and tier five shall be reimbursed twenty-one percent (21%) above the FY 2018

weekly amount.

     (c) [Deleted by P.L. 2019, ch. 88, art. 13, § 4.]

     (d) By June 30, 2004, and biennially through June 30, 2014, the department of labor and

training shall conduct an independent survey or certify an independent survey of the then-current

weekly market rates for child care in Rhode Island and shall forward the weekly market rate survey

to the department of human services. The next survey shall be conducted by June 30, 2016, and

triennially thereafter. The departments of human services and labor and training will jointly

determine the survey criteria including, but not limited to, rate categories and sub-categories.

     (e) In order to expand the accessibility and availability of quality child care, the department

of human services is authorized to establish, by regulation, alternative or incentive rates of

reimbursement for quality enhancements, innovative or specialized child care, and alternative

methodologies of childcare delivery, including nontraditional delivery systems and collaborations.

     (f) Effective January 1, 2007, all childcare providers have the option to be paid every two

(2) weeks and have the option of automatic direct deposit and/or electronic funds transfer of

reimbursement payments.

     (g) Effective July 1, 2019, the maximum infant/toddler reimbursement rates to be paid by

the departments of human services and children, youth and families for licensed family childcare

providers shall be implemented in a tiered manner, reflective of the quality rating the provider has

achieved within the state’s quality rating system outlined in § 42-12-23.1. Tier one shall be

reimbursed two percent (2%) above the prevailing base rate for step 1 and step 2 providers, three

percent (3%) above prevailing base rate for step 3 providers, and four percent (4%) above the

prevailing base rate for step 4 providers; tier two shall be reimbursed five percent (5%) above the

prevailing base rate; tier three shall be reimbursed eleven percent (11%) above the prevailing base

rate; tier four shall be reimbursed fourteen percent (14%) above the prevailing base rate; and tier

five shall be reimbursed twenty-three percent (23%) above the prevailing base rate.

     (h) Through December 31, 2021, the maximum reimbursement rates paid by the

departments of human services, and children, youth and families to licensed childcare centers shall

be consistent with the enhanced emergency rates provided as of June 1, 2021, as follows:

      Tier 1 Tier 2 Tier 3 Tier 4 Tier 5

     Infant/Toddler $257.54 $257.54 $257.54 $257.54 $273.00

     Preschool Age $195.67 $195.67 $195.67 $195.67 $260.00

     School Age $200.00 $200.00 $200.00 $200.00 $245.00

     The maximum reimbursement rates paid by the departments of human services, and

children, youth and families to licensed family childcare providers shall be consistent with the

enhanced emergency rates provided as of June 1, 2021, as follows:

      Tier 1 Tier 2 Tier 3 Tier 4 Tier 5

     Infant/Toddler $224.43 $224.43 $224.43 $224.43 $224.43

     Preschool Age $171.45 $171.45 $171.45 $171.45 $171.45

     School Age $162.30 $162.30 $162.30 $162.30 $162.30

     (i) Effective January 1, 2022, the maximum reimbursement rates to be paid by the

departments of human services and children, youth and families for licensed childcare centers shall

be implemented in a tiered manner, reflective of the quality rating the provider has achieved within

the state’s quality rating system outlined in § 42-12-23.1. Maximum weekly rates shall be

reimbursed as follows:

     Licensed Childcare Centers

Tier One Tier Two Tier Three Tier Four Tier Five

     Infant/Toddler $236.36 $244.88 $257.15 $268.74 $284.39

     Preschool $207.51 $212.27 $218.45 $223.50 $231.39

     School-Age $180.38 $182.77 $185.17 $187.57 $189.97

     The maximum reimbursement rates for licensed family childcare providers paid by the

departments of human services, and children, youth and families is determined through collective

bargaining. The maximum reimbursement rates for infant/toddler and preschool age children paid

to licensed family childcare providers by both departments is implemented in a tiered manner that

reflects the quality rating the provider has achieved in accordance with § 42-12-23.1.

     (j) Effective July 1, 2022, the maximum reimbursement rates to be paid by the departments

of human services and children, youth and families for licensed childcare centers shall be

implemented in a tiered manner, reflective of the quality rating the provider has achieved within

the state’s quality rating system outlined in § 42-12-23.1. Maximum weekly rates shall be

reimbursed as follows:

     Licensed Childcare Centers

Tier One Tier Two Tier Three Tier Four Tier Five

Infant/Toddler $265 $270 $282 $289 $300

Infant/Toddler

Preschool $225 $235 $243 $250 $260

School-Age $200 $205 $220 $238 $250

     (k) Effective July 1, 2024, the maximum reimbursement rates to be paid by the departments

of human services and children, youth and families for licensed childcare centers shall be

implemented in a tiered manner, reflective of the quality rating the provider has achieved within

the state’s quality rating system outlined in § 42-12-23.1. Maximum weekly rates shall be

reimbursed as follows:

     Licensed Childcare Centers

Tier One Tier Two Tier Three Tier Four Tier Five

Infant/Toddler $278 $284 $296 $303 $315

Preschool $236 $247 $255 $263 $273

School-Age $210 $215 $231 $250 $263

     SECTION 5. Title 42 of the General Laws entitled "STATE AFFAIRS AND

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

CHAPTER 166

THE LADDERS TO LICENSURE PROGRAM

     42-166-1. The ladders to licensure grant program.

     The executive office of health and human services is hereby directed to establish the ladders

to licensure grant program, a public-private partnership to:

     (1) Increase the number of licensed health professionals;

     (2) Increase racial, ethnic, cultural and linguistic diversity of health professionals;

     (3) Provide academic, financial and wrap around supports to enable working adults to

obtain health professional higher education degrees and license;

     (4) Leverage employer support for academic, financial and wraparound supports;

     (5) Align with existing state workforce and higher education initiatives;

     (6) Develop and implement career ladders with tiered training and education requirements

and corresponding salary increases;

     (7) Develop and implement interscholastic and interdepartmental agreements that accept

prior learning, credentials, work experience, and academic credits towards requirement for higher

education health professional degrees;

     (8) Establish policies and initiatives to counter systemic racism and other institutional

barriers to participation and advancement of underrepresented populations;

     (9) Establish policies and initiatives that provide flexible scheduling of work hours and/or

academic programs to reduce barriers to participation; and

     (10) Identify state policy barriers to entry and advancement in the field.

     42-166-2. Use of appropriated funds.

     Any appropriated funds shall be used to provide grants to three (3) or four (4) grantee

partnerships, consisting of multiple private sector health and human services employer

organizations and education grantee partnerships (with at least one focused on behavioral health

and one focused on nursing). Employers will be required to contribute a twenty-five percent (25%)

in-kind match and a ten percent (10%) cash match.

     42-166-3. Oversight.

     The executive office of health and human services shall collaborate and coordinate with

the department of labor and training and the office of the postsecondary commissioner in the

development, implementation and oversight of the program.

     42-166-4. Reporting.

     The executive office of health and human services shall provide quarterly reports to the

speaker of the house of representatives and senate president documenting the progress of the

implementation of the program.

     SECTION 6. Section 3 of this article shall take effect January 1, 2025, except for the

provisions of § 40-5.2-20(k) which shall take effect July 1, 2024. The remainder of this article shall

take effect July 1, 2024.