2026 -- H 7361 SUBSTITUTE A

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LC004100/SUB A

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2026

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A N   A C T

RELATING TO BEHAVIORAL HEALTHCARE, DEVELOPMENTAL DISABILITIES AND

HOSPITALS -- QUALITY SELF-DIRECTED SUPPORTS ACT OF 2026

     Introduced By: Representatives Shanley, Slater, Solomon, Bennett, Craven, and Knight

     Date Introduced: January 28, 2026

     Referred To: House Labor

     It is enacted by the General Assembly as follows:

     SECTION 1. Title 40.1 of the General Laws entitled "BEHAVIORAL HEALTHCARE,

DEVELOPMENTAL DISABILITIES AND HOSPITALS" is hereby amended by adding thereto

the following chapter:

CHAPTER 22.2

QUALITY SELF-DIRECTED SUPPORTS ACT OF 2026

     40.1-22.2-1. Short title.

     This chapter shall be known and may be cited as the "Quality Self-Directed Supports Act

of 2026".

     40.1-22.2-2. Definitions.

     For the purposes of this chapter:

     (1) "Department" means the department of behavioral healthcare, developmental

disabilities and hospitals.

     (2) "Developmental disability organizations" or "DDOs" means an organization licensed

by the department to provide services to adults with disabilities.

     (3) "Director" means the director of the department of behavioral healthcare,

developmental disabilities and hospitals or the director's designees.

     (4) "Fiscal intermediary" means a third-party organization operating in accordance with

applicable federal and state requirements under contract with the state that is responsible for

performing payroll and other employment-related functions on behalf of a participant as set forth

in the implementing regulations for the self-directed supports program.

     (5) "Participant" means an adult who has a developmental disability as defined by § 40.1-

21-4.3(1) and has been determined by the state to be eligible for Medicaid-funded long-term

services and supports under the Medicaid state plan and/or the RI section 1115 waiver

demonstration and/or Medicaid authorities created in the future.

     (6) "Participant's representative" means a participant's legal guardian or a person who has

been designated by the participant or otherwise has the authority and responsibility to act on behalf

of a participant with respect to the provision of self-directed services, including the developmental

services subject to this chapter.

     (7) "Provider representative" means a provider organization that is certified as the exclusive

negotiating representative of self-directed direct support professionals as provided in § 40.1-22.3-

7.

     (8) "Secretary" means the secretary of the executive office of health and human services

(EOHHS).

     (9) "Self-directed direct support professional" means an individual selected by and working

under the direction of a self-directed supports participant or the participant's duly authorized

representative to provide self-directed personal care services to the participant in accordance with

a person-centered plan and the implementing regulations promulgated for the program by the

director. Self-directed direct support professional does not mean or include an employee of a DDO,

subject to the DDO's direction and control commensurate with DDO employee status.

     (10) "Self-directed personal care services" means home and community-based personal

care and in-home support services a participant is authorized to self-direct to meet their daily living

needs, function adequately at home, safely access the community, or other nonprofessional services

under the self-directed supports program or any similar program that may provide similar services

in the future under the Medicaid state plan, section 1115 demonstration waiver, or future Medicaid

authorities promulgated by the secretary or director.

     40.1-22.2-3. Scope of coverage.

     Self-directed direct support professionals may provide all self-directed personal care

services to the extent the applicable federal and state laws and rules and regulations allow.

     40.1-22.2-4. Use of employee workforce.

     (a) The state's ability to afford participants and participants' representatives who choose

not to employ a self-directed direct support professional, or are unable to do so, the option of

receiving personal care services through the employees of provider agencies, rather than through a

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self-directed direct support professional, shall not be restricted.

     (b) Nothing in this chapter shall restrict the state's ability to afford self-directed supports

participants with the freedom of choice guaranteed under Title XIX of the Social Security Act, 42

U.S.C. § 1396 et seq., to enter into service delivery agreements with any authorized Medicaid

provider.

     40.1-22.2-5. Duties of the department of behavioral healthcare, developmental

disabilities and hospitals.

     (a) Notwithstanding the state's obligations to meet and negotiate under chapter 7 of title 28

("labor relations act"), nothing in this chapter shall be construed to make self-directed direct support

professionals employees of the state for any purpose, including for the purposes of eligibility for

the state employee pension program or state employee health benefits.

     (b) The director has authority over the terms and conditions of self-directed direct support

professionals' employment, including compensation as required under § 40.1-22.2-6, payment,

benefit terms, provider qualification standards, other appropriate terms and conditions for the

workforce of self-directed direct support professionals without infringing on participants' or

participant representatives' rights and responsibilities to hire, direct, supervise, and/or terminate the

employment of their self-directed direct support professionals, and orientation, training, and the

operation of a registry as required under § 40.1-22.2-7.

     (c) The director's authority in subsection (b) of this section only applies to self-directed

personal care services and is subject to the state's obligation to meet and negotiate with a provider

representative pursuant to § 40.1-22.3-3.

     40.1-22.2-6. Wage ranges.

     (a) The state shall set wage ranges for all self-directed direct support professionals. All

self-directed personal care services performed by self-directed direct support professionals shall be

compensated at a wage that is within the range set by the director for the services; provided,

however, the participant may choose what wage to pay within the applicable range.

     (b) The wage range shall be the subject of collective bargaining as provided in this chapter.

However, such collective bargaining shall be related solely to self-directed personal care services.

All other self-directed services available to self-directed supports participants other than personal

care and in-home support services are excluded from collective bargaining.

     (c) The provisions of this section shall take effect upon the certification of a provider

representative as provided in § 40.1-22.3-13.

     40.1-22.2-7. Other duties of the director of behavioral healthcare, developmental

disabilities and hospitals.

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     (a) The director shall determine by rule or regulation that self-directed direct support

professionals selected by self-directed supports participants are required to complete an orientation,

pursuant to the director's authority under § 40.1-21-12. The director shall determine by rule or

regulation the specific types of education, experience, or training that shall be required for a self-

directed direct support professional to be included on a registry of persons qualified to be self-

directed direct support professionals. The provisions of this section shall be collectively bargained

with the provider representative.

     (1) Representatives of the provider representative shall be permitted to attend and present

information about the provider representative at educational and training programs presented by

the John E. Fogarty Institute of Rhode Island pursuant to § 40.1-21-6. The John E. Fogarty Institute

of Rhode Island shall provide the provider representative with a schedule of educational and

training programs at least two (2) weeks in advance. The provider representative shall be authorized

to provide self-directed direct support professionals with access to more training or education than

is minimally required by the director. Nothing in this chapter prohibits a self-directed supports

participant from requiring a self-directed direct support professional to complete more training or

education than is minimally required by the director.

     (b) The director shall maintain, either directly or through a contracted vendor, a registry

for self-directed direct support professionals pursuant to the authority provided under § 40.1-21-12

and shall collaborate with the provider representative to maintain this registry. This registry shall

be consolidated with the registry established for the personal choice program pursuant to § 40-8.15-

15.

     (c) The provisions of this section shall take effect upon the certification of a provider

representative as provided in § 40.1-22.3-13.

     40.1-22.2-8. Authority of the department of administration.

     In accordance with chapter 22.3 of this title, the director of the department of

administration shall have the authority to:

     (1) In coordination with the director, meet and negotiate with any provider representative

chosen pursuant to § 40.1-22.3-2(a);

     (2) In coordination with the director, negotiate over any of the topics in § 40.1-22.3-2(a)

and any other appropriate matters governing the workforce of self-directed direct support

professionals without infringing on participants' or their responsible parties' rights and

responsibilities to hire, direct, supervise, or terminate the employment of their self-directed direct

support professionals; and

     (3) In coordination with the director, execute a collective bargaining agreement, subject to

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any approval required under § 40.1-22.3-5.

     40.1-22.2-9. Severability.

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

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

of a court of competent jurisdiction, the remainder of this chapter shall remain in full force and

effect.

     40.1-22.2-10. Construction of chapter -- Participant and family protections.

     (a) Preservation of participant self-direction.

     (1) Nothing in this chapter shall be interpreted to alter, limit, or interfere with the rights of

participants in the self-directed supports program to exercise full control over their services and

supports.

     (2) Participants and their representatives shall retain all rights of self-direction under state

and federal law including, but not limited to, the authority to:

     (i) Hire, supervise, discipline, and terminate direct support professionals;

     (iii) Establish work schedules and approve hours worked;

     (iii) Assign job duties and tasks to be performed;

     (iv) Require or permit employee breaks;

     (v) Train direct support professionals in a manner determined by the participant or their

representative; and

     (vi) Direct the manner in which services are delivered within the participant's approved

service plan.

     (3) Nothing in this chapter shall authorize any labor organization, state agency, or third

party to make or influence individual care decisions for a participant.

     (b) Protection of family providers. Participants shall retain the right to hire parents, legal

guardians, family members, or other individuals of their choosing as paid direct support

professionals when permitted under federal waiver programs or state policy. Nothing in this chapter

shall restrict or limit that right.

     (c) Limitations on grievance procedures.

     (1) Any grievance, arbitration, or dispute resolution procedure established pursuant to a

collective bargaining agreement authorized under this chapter shall apply solely to matters

involving the state, its departments, or its fiscal intermediary.

     (2) No grievance, arbitration, or dispute resolution procedure shall be brought against or

imposed upon any participant, consumer employer, family member, or legal guardian participating

in the self-directed supports program.

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     (3) Participants shall not be considered employers for purposes of any grievance procedure

established under this chapter.

     (d) Protection of participant service budgets.

     (1) Nothing in this chapter or in any collective bargaining agreement entered into pursuant

to this chapter shall reduce, redirect, or otherwise diminish the individual service budgets of

participants receiving self-directed supports.

     (2) Any wage, benefit, or other economic improvement negotiated under this chapter shall

require additional state or Medicaid funding and shall not be implemented unless such funding is

provided. No such improvement shall be funded through reductions, reallocations, or redirection

of participant service budgets.

     (3) No wage or benefit increase negotiated pursuant to this chapter shall result in reduced

service hours, reduced eligibility for services, or reductions in participant budget allocations.

     (4) To the extent that wage increases are implemented through adjustments to participant-

specific reimbursement rates, each participant's annual self-directed program budget allocation

shall be increased by an equivalent percentage to ensure no reduction in authorized services.

     (5) Nothing in this chapter shall prohibit the state from establishing or funding separate,

supplemental funding mechanisms including, but not limited to, statewide benefit pools,

reimbursement funds, or training funds, for the purpose of supporting direct support professionals;

provided that, such mechanisms are funded in addition to, and do not supplant or diminish,

participant service budgets.

     (6) In the event that a participant's service budget is reduced, redirected, or otherwise

diminished in violation of this section, the state shall promptly restore the participant's budget and

make the participant whole for any loss of authorized services, including through retroactive

adjustments where necessary.

     (e) Participant and advocate input.

     (1) The state shall ensure a meaningful opportunity for participants receiving self-directed

services and their designated advocates to provide input during the collective bargaining process.

     (2) Such opportunity shall include, at a minimum:

     (i) The opportunity to submit comments and recommendations at clearly defined stages of

negotiations, including prior to the initial development of bargaining proposals and prior to the

finalization of any collective bargaining agreement, through accessible formats including, but not

limited to, written submissions, recorded audio or video submissions, or through a telephone hotline

or similar mechanism that allows individuals to leave recorded comments, or other methods that

ensure meaningful participation for individuals with disabilities;

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     (ii) At least one public meeting or listening session, with options for both in-person and

virtual participation to ensure accessibility, prior to the finalization of any collective bargaining

agreement; and

     (iii) Consideration of participant and advocate input in the development of bargaining

proposals.

     (3) Nothing in this section shall be construed to grant participants or advocates authority

to direct, approve, or reject the terms of a collective bargaining agreement.

     (f) Accessible education and training.

     (1) If direct support professionals elect to be represented by a labor organization pursuant

to this chapter, any education or training opportunities made available in connection with such

representation shall be structured in a manner that does not interfere with or replace training,

supervision, or service delivery as directed by the participant or their representative pursuant to the

participant's approved service plan.

     (2) Completion of any education or training provided through a labor organization, the

state, or any third party shall not satisfy, substitute for, or limit the authority of the participant or

their representative to require training of direct support professionals, and no direct support

professional shall decline or refuse participant-directed training on that basis.

     (3) Any education, training, orientation, or informational program established pursuant to

this chapter shall be designed to ensure full accessibility for participants, families, and direct

support professionals.

     (4) To remove barriers to participation, such programs shall be made available through

remote or virtual formats whenever feasible, including online or other distance-learning options.

Participation in education or training programs shall not require in-person attendance if a remote

option is available.

     (5) The state shall ensure that training requirements associated with this chapter do not

create transportation, health, supervision, or caregiving barriers for participants or their families.

     (g) Employee choice regarding representation.

     (1) Nothing in this chapter shall be interpreted to require any direct support professional to

join or support a labor organization.

     (2) Direct support professionals shall retain the right to determine, through a democratic

process conducted pursuant to applicable state labor law, whether to be represented by a labor

organization for purposes of collective bargaining.

     (3) A labor organization may be recognized as the representative of direct support

professionals only through the certification procedures established under state labor law.

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     (4) Nothing in this chapter shall interfere with the rights of workers to support, oppose, or

refrain from supporting a labor organization.

     (h) Compliance with federal disability law. Nothing in this chapter shall be interpreted or

implemented in a manner that conflicts with or violates the rights of individuals with disabilities

under the Americans with Disabilities Act, the Rehabilitation Act of 1973, or any other applicable

federal or state disability rights law.

     (i) Protection of Medicaid waiver and person-centered planning rights.

     (1) Nothing in this chapter shall be interpreted to alter, limit, or conflict with the rights of

participants under:

     (i) Medicaid Home and Community-Based Services waiver programs;

     (ii) Federal person-centered planning requirements; or

     (iii) Participant-directed service models recognized under federal Medicaid law.

     (2) The provisions of this chapter shall be implemented in a manner that preserves

participant autonomy, independence, and the principles of self-direction.

     (j) Participants not considered employers.

     (1) Notwithstanding any provision of this chapter to the contrary, participants, consumer

employers, family members, and legal guardians receiving or administering self-directed supports

shall not be considered employers for purposes of collective bargaining under this chapter.

     (2) Any collective bargaining authorized by this chapter shall occur solely between the

labor organization and the state.

     (k) Self-direction takes precedence. Notwithstanding any provision of this chapter to the

contrary, if any provision of this chapter or any collective bargaining agreement entered into

pursuant to this chapter conflicts with the rights of participants to self-direct their services under

state or federal law, the rights of participants to self-direct their services shall prevail.

     SECTION 2. Title 40.1 of the General Laws entitled "BEHAVIORAL HEALTHCARE,

DEVELOPMENTAL DISABILITIES AND HOSPITALS" is hereby amended by adding thereto

the following chapter:

CHAPTER 22.3

SELF-DIRECTED DIRECT SUPPORT PROFESSIONALS

     40.1-22.3-1. Definitions.

     For the purposes of this chapter:

     (1) "Department" means the department of behavioral healthcare, developmental

disabilities and hospitals.

     (2) "Developmental disability organizations" or "DDOs" means an organization licensed

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by the department to provide services to adults with disabilities.

     (3) "Director" means the director of the department of behavioral healthcare,

developmental disabilities and hospitals or the director's designees.

     (4) "Fiscal intermediary" means a third-party organization operating in accordance with

applicable federal and state requirements under contract with the state that is responsible for

performing payroll and other employment-related functions on behalf of a participant as set forth

in the implementing regulations for the self-directed supports program.

     (5) "Participant" means an adult who has a developmental disability as defined by § 40.1-

21-4.3(1) and has been determined by the state to be eligible for Medicaid-funded long-term

services and supports under the Medicaid state plan and/or the RI section 1115 waiver

demonstration and/or Medicaid authorities created in the future.

     (6) "Participant's representative" means a participant's legal guardian or a person who has

been designated by the participant or otherwise has the authority and responsibility to act on behalf

of a participant with respect to the provision of self-directed services, including the developmental

services subject to this chapter.

     (7) "Provider representative" means a provider organization that is certified as the exclusive

negotiating representative of self-directed direct support professionals as provided in § 40.1-22.3-

7.

     (8) "Secretary" means the secretary of the executive office of health and human services

(EOHHS).

     (9) "Self-directed direct support professional" means an individual selected by and working

under the direction of a self-directed supports participant or the participant's duly authorized

representative to provide self-directed personal care services to the participant in accordance with

a person-centered plan and the implementing regulations promulgated for the program by the

director of behavioral healthcare, developmental disabilities and hospitals. Self-directed direct

support professional does not mean or include an employee of a DDO, subject to the DDO's

direction and control commensurate with DDO employee status.

     (10) "Self-directed personal care services" means home and community-based personal

care and in-home support services a participant is authorized to self-direct to meet their daily living

needs, function adequately at home, safely access the community, or other nonprofessional services

under the self-directed supports program or any similar program that may provide similar services

in the future under the Medicaid state plan, section 1115 demonstration waiver, or future Medicaid

authorities promulgated by the secretary or director.

     40.1-22.3-2. Right of self-directed support professionals to choose provider

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representative -- Subject of negotiation.

     (a) Self-directed direct support professionals may, in accordance with the procedures set

forth in § 40.1-22.3-7, choose a provider organization to be their provider representative and to

negotiate with the state, over the terms and conditions of self-directed direct support professionals'

participation in providing direct-support services including, but not limited to:

     (1) Training and professional development opportunities;

     (2) Improving the recruitment and retention of qualified self-directed direct support

professionals;

     (3) Reimbursement rates, wages, and other economic matters;

     (4) Benefits;

     (5) Payment procedures;

     (6) Provider qualification standards; and

     (7) A grievance resolution process.

     (b) Nothing in this chapter or in chapter 22.2 of this title shall interfere with the regulatory

authority of the department of health (DOH) over self-directed direct support professionals

licensing. Self-directed direct support professional licensing shall be excluded from and not subject

to the negotiation process recognized and described in this section.

     (c) Notwithstanding the provisions of this section, self-directed direct support professionals

shall operate in conformance with the relevant sections of the general laws applicable thereto and

regulations promulgated by the state.

     40.1-22.3-3. Good faith negotiations.

     It shall be the obligation of the director of the department of administration, or designee,

to meet and negotiate in good faith with the provider representative within thirty (30) days after

receipt of written notice from the provider representative of the request for a meeting for bargaining

purposes. This obligation shall include the duty to cause any agreement resulting from the

negotiations to be reduced to a written contract.

     40.1-22.3-4. Unresolved issues - Impasses procedures.

     In the event that the provider representative and the director, or designee, are unable to

reach an agreement on a contract, or reach an impasse in negotiations, the procedures of §§ 36-11-

7.1 through 36-11-11 shall be followed.

     40.1-22.3-5. Economic aspects of contract subject to legislative appropriation.

     Any aspects of a contract requiring appropriation by the federal government, the general

assembly, or revisions to statutes and regulations shall be subject to passage of those appropriations

and any necessary statutory and regulatory revisions.

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     40.1-22.3-6. Duty to represent all self-directed direct support professionals fairly –

Deduction of membership dues and other voluntary deductions.

     (a) A provider organization certified as the provider representative shall represent all self-

directed direct support professionals in the state fairly and without discrimination, without regard

to whether or not the self-directed direct support professional is a member of the provider

organization.

     (b) Each self-directed direct support professional may choose whether to be a member of

the provider organization. The state, or its designee, shall deduct from payments to self-directed

direct support professionals membership dues for self-directed direct support professionals who

elect to become members and authorize the deduction of membership dues, and any other voluntary

deductions authorized by self-directed direct support professionals.

     40.1-22.3-7. Certification and decertification of provider organization.

     (a) Petitions to certify a provider organization to serve as the provider representative of

self-directed direct support professionals; petitions to intervene in such an election; and any other

petitions for investigation of controversies as to representation may be filed with and acted upon

by the labor relations board in accordance with the provisions of chapter 7 of title 28 ("labor

relations act") and the board's rules and regulations; provided that, any valid petition as to whether

self-directed direct support professionals wish to certify or decertify a provider representative shall

be resolved by a secret ballot election among self-directed direct support professionals.

     (b) The only appropriate unit shall consist of all self-directed direct support professionals

in the state.

     (c) For purposes of this section, no self-directed direct support professional shall be deemed

excluded from the bargaining unit under § 28–7–3(3)(ii) because they provide care to a family

member or because they are in domestic service in a person's home.

     (d) The cost of any certification election held under this section shall be split equally among

all the provider organizations that appear on the ballot.

     40.1-22.3-8. Unfair practices.

     It shall be unlawful for the state to perform any of the acts made unlawful under § 28–7–

13. It shall be unlawful for the provider representative to perform any of the acts made unlawful

under § 28–7–13.1. Any alleged violation of this provision may be filed with the labor relations

board as an unfair labor practice and considered and ruled upon in accordance with chapter 7 of

title 28 ("labor relations act") and the board's rules and regulations.

     40.1-22.3-9. Right of families to select, direct and terminate self-directed direct

support professionals.

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     Nothing in this chapter shall be construed to alter the rights of families to select, direct, and

terminate the services of self-directed direct support professionals.

     40.1-22.3-10. Strikes not authorized.

     Self-directed direct support professionals shall not engage in any strike or other collective

cessation of the delivery of direct-support services.

     40.1-22.3-11. State action exemption.

     The state action exemption to the application of state and federal antitrust laws is applicable

to the activities of self-directed direct support professionals and their provider representative

authorized under this chapter.

     40.1-22.3-12. Implementation.

     (a) Within ninety (90) days of the effective date of this chapter, any provider organization

that has previously been certified to serve as the provider representative of individual providers

pursuant to § 40-8.15-7 shall be furnished by the director with contact information for every person

providing self-directed personal care services under the self-directed supports program. The

director shall provide any such provider organization with updated contact information every sixty

(60) days thereafter.

     (b) The labor relations board shall hold an election to determine whether a provider

organization shall be certified as the provider representative for the bargaining unit of self-directed

direct support professionals upon a ten percent (10%) showing of interest. All persons who are

providing self-directed services under the self-directed supports program shall be considered part

of the bargaining unit for purposes of the showing of interest and shall be eligible to vote in the

certification election. If a majority of those casting ballots vote to be represented by that provider

organization, then the provider organization shall be certified as the provider representative to

negotiate with the state over the terms and conditions of self-directed direct support professionals'

participation in providing self-directed personal care services for all self-directed direct support

professionals in the state. The provisions of this chapter shall otherwise apply.

     (c) Nothing in this chapter shall be construed to alter or limit the rights of participants and

their representative to select, direct, and terminate the services of self-directed direct support

professionals or to determine self-directed direct support professionals' wages within a range set by

the director, or to alter or limit the director's authority to administer the self-directed supports

program including to adopt rules and regulations and operate the program, to determine participant

budgets, to determine eligibility, or to authorize services, except as specifically set forth in this

chapter.

     (d) No provision of any agreement or award resulting from collective bargaining and

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negotiations under this chapter shall provide for a reduction in Medicaid federal financial

participation under Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq., nor shall any

provision of any agreement or award provide for a reduction in the self-directed personal care

services for eligible self-directed supports participants. Any provision in any agreement or award

that would require an additional appropriation in order to maintain the levels of services provided

by existing appropriations shall be subject to the annual budget process.

     40.1-22.3-13. Severability.

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

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

of a court of competent jurisdiction, the remainder of this chapter shall remain in full force and

effect.

     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 BEHAVIORAL HEALTHCARE, DEVELOPMENTAL DISABILITIES AND

HOSPITALS -- QUALITY SELF-DIRECTED SUPPORTS ACT OF 2026

***

     This act would ensure that more developmentally disabled adults can self-direct the care

they need and want, by incorporating collective bargaining rights into the self-directed supports

program to enhance service access, increase the availability of education and training options and

improve the recruitment and retention of the individuals selected by participants as direct support

professionals. This act does not alter or limit the authority of the director of behavioral healthcare,

developmental disabilities and hospitals to administrator the self-directed supports program,

enforce existing rules, regulations and procedures, or adopt amended rules, regulations and

procedures for operating the program. This act further does not alter or limit the rights of

participants and their representatives to select, direct and terminate the services of self-directed

direct support professionals or to determine the wages of self-directed direct support professionals

within the range set by the director.

     This act would take effect upon passage.

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