2024 -- S 2359

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LC004585

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2024

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A N   A C T

RELATING TO HEALTH AND SAFETY -- MATERNAL AND CHILD HEALTH SERVICES

FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS

     Introduced By: Senators Valverde, Murray, DiPalma, Pearson, Lawson, Lauria, DiMario,
Mack, Cano, and Bell

     Date Introduced: February 12, 2024

     Referred To: Senate Finance

     It is enacted by the General Assembly as follows:

     SECTION 1. The General Assembly hereby finds and declares the following:

     (1) The Rhode Island early intervention program, a program established under part C of

the federal Individuals with Disabilities Education Act and overseen and managed by the executive

office of health and human services, is a core component of the state’s commitment to ensuring

that families with infants and toddlers with or at substantial risk for developmental delays and

disabilities receive high-quality services as early as possible in order that children can develop to

their fullest potential and succeed in school and life.

      (2) According to the Center on the Developing Child at Harvard University, healthy

development in the early years (particularly birth to age three (3)) provides the building blocks for

educational achievement, economic productivity, responsible citizenship, and lifelong health.

Effective early intervention services help infants and toddlers make developmental progress and

can help them catch up with their peers. Research has shown that about one-third (1/3) of children

who receive early intervention services no longer had a developmental delay or special education

need in kindergarten.

     (3) In state fiscal year 2023, the Medicaid rates for early intervention were increased by

forty five percent (45%), the first rate increase since 2002. From 2002 through 2022, the average

Consumer Price Index for the Northeast increased by sixty one percent (61%).

     (4) Once a state participates in the early intervention program, it must assure that early

intervention will be available to every eligible child and its family.

     (5) Due to the twenty (20) year Medicaid rate freeze and a Medicaid rate cut in 2009, state-

certified early intervention programs experienced significant difficulties paying competitive wages

and benefits to attract and retain qualified staff. These staffing challenges became so severe that in

November 2021, the state established a waiting list for early intervention.

     (6) The Medicaid rate increase in state fiscal year 2023 has not been sufficient to attract

and retain enough qualified staff to meet federal timelines. Between June 2019 and June 2022, the

number of children receiving early intervention services in Rhode Island declined by nineteen

percent (19%). As of November 2023, there were seven hundred, sixteen (716) infants and toddlers

who had been waiting more than forty five (45) days for an evaluation, which is about thirty percent

(30%) of children enrolled in early intervention on a given day in 2019.

     SECTION 2. Section 23-13-22 of the General Laws in Chapter 23-13 entitled "Maternal

and Child Health Services for Children with Special Health Care Needs" is hereby amended to read

as follows:

     23-13-22. Early intervention program for developmentally disabled infants. Early

intervention program for infants and toddlers with developmental delays and/or disabilities.

     (a) The director of the department of human services shall ensure that all developmentally

disabled infants from birth to three (3) years of age shall be enrolled in the early intervention

program. The secretary of the executive office of health and human services (EOHHS) shall ensure

that all infants and toddlers with developmental delays and/or disabilities who are under the age of

three (3) are provided with early intervention services as required under Part C of the federal

Individuals with Disabilities Education Act (IDEA). Regulations governing the delivery of services

under this program, including eligibility criteria, shall be promulgated by the department of human

services executive office of health and human services, with the advice of the interagency

coordinating council; provided, however, that all regulations promulgated by the department of

health shall remain in full force and effect until the time they are replaced by regulations

promulgated by the department of human services. The regulations shall stipulate, at a minimum,

the following provisions that are consistent with the intent of this chapter:

     (1) The director secretary shall develop and maintain a procedure for the earliest possible

identification and efficient referral and evaluation of all children under age three (3) who may be

eligible for services under part C of IDEA and shall ensure Individualized Family Service Plans

are developed and IDEA services are provided in a timely fashion for eligible children

developmentally disabled infants;

     (2) The director shall ensure that every infant identified and referred to this program is

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enrolled as soon as possible after birth; and further, that for infants placed on a waiting list for

facility based group programming, an early intervention program shall be made available within a

thirty (30) day period from the time a need is identified in the individual program plan;

     (3) Unless parents refuse the service, the home visiting component of the program shall

commence as soon as the infant has been identified as having a possible developmental disability;

     (4)(2) Any parent(s) who is/are dissatisfied with decisions or termination of service or with

practices and procedures of a particular agency or the department of human services executive

office of health and human services shall notify the director of the department of human services

secretary of EOHHS in writing within thirty (30) calendar days and the complaint shall be reviewed

in accordance with department of health executive office of health and human services policy and

procedures, as amended, and the Administrative Procedures Act, chapter 35 of title 42.

     (5)(3) An early intervention program for purposes of this section shall mean a

comprehensive array of educational, developmental, health, and social services provided on a

calendar year basis to eligible infants, children, and their families as specified in program

regulations.

     (b) Within ninety (90) days after October 1, 2004, an evaluation plan describing outcome

measures that document the program’s successes and shortcomings from the previous fiscal year

shall be submitted to the speaker of the house of representatives, the president of the senate, and

the house oversight committee, and the governor, and the interagency coordinating council.

Development of the plan shall be made in consultation with the entities with expertise in this area

and the interagency coordinating council. The plan shall include a memorandum of understanding

between the department of health, department of human services, and the department of elementary

and secondary education that demonstrates coordination and continuity of early intervention

services among these departments.

     (c) Within six (6) months after January 1, 2005 where prescribed outcomes documented in

the evaluation plan have not been accomplished the responsible agencies shall submit written

explanations for the shortfalls, together with their proposed remedies. The report shall also include

evaluation of the progress of the coordination efforts between the department of health and the

department of human services and the department of elementary and secondary education and the

interagency coordinating council and shall include any recommendations regarding modifications

of the reimbursement mechanisms of this chapter.

     (d) Within twelve (12) months after August 1, 2005 a final report shall include the progress

of the coordination efforts between the department of health and the department of human services

and department of elementary and secondary education, interagency coordinating council and shall

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include any recommendations regarding modifications to the comprehensive array of educational,

developmental, health, and social services provided on a calendar year basis to eligible infants,

children, and their families as specified in an early intervention system.

     (e) All reports or documents required to be produced pursuant to 20 U.S.C. § 1471 et seq.,

shall be submitted to the speaker of the house, president of the senate, and the chairpersons of the

appropriate house of representatives, and senate oversight committees, and the governor and the

interagency coordinating council. Adherence to such plans and reporting requirements, and budgets

and the timely achievement of goals contained therein shall be considered by the oversight

committees of the house of representatives and senate, among other relevant factors, in determining

appropriations or other systemic changes.

     (f) The executive office of health and human services shall:

     (1) Pursue a Medicaid state plan amendment and allocate sufficient state general revenue

to increase Medicaid payment rates for early intervention services by twenty-five percent (25%) on

or before October 1, 2024, to ensure rates enable early intervention service providers to cover the

costs of adequately staffing the program with qualified service coordinators, early educators, and

licensed professionals to deliver all services required under Part C of the Individuals with

Disabilities Education Act. Staffing costs shall include competitive wages that are at or above the

median wage for the profession based on the most recent occupational wage estimates for Rhode

Island from the U.S. Bureau of Labor Statistics.

     (2) Annually, on or before July 1 of each year beginning July 1, 2025, the Medicaid

payment rates for early intervention shall be adjusted to reflect increases in program operating

costs, based on the Consumer Price Index calculated by the U.S. Bureau of Labor Statistics.

      SECTION 3. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO HEALTH AND SAFETY -- MATERNAL AND CHILD HEALTH SERVICES

FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS

***

     This act would direct the executive office of health and human services (EOHHS) to

increase Medicaid rates for the early intervention programs allowing for payment of competitive

wages for qualified professionals. This act would further change the title of the section from early

intervention program for developmentally disabled infants to early intervention program for infants

and toddlers with developmental delays and/or disabilities and update the basic program

requirements and name of the state agency responsible for the program to be the executive office

of health and human services (EOHHS) which has been overseeing the early intervention program

under Part C of the federal Individuals with Disabilities Act.

     This act would take effect upon passage.

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