reglab/statecodes huggingface dataset:
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 50 - Medicaid Long-Term Services and Supports › Subchapter 05 - Institutionally Based LTSS › Part 2 - Uniform Accountability Procedures for Title XIX Resident Personal Needs Funds in Community Nursing Facilities, ICF/DD Facilities, and Assisted Living Residences › Section 210-RICR-50-05-2.4 - Personal Needs Funds - Requirements

Current through June 14, 2024
A. The
				  Department of Health, will review, certify and re-certify that the facility has
				  adopted the written policies and procedures included herein pertaining to the
				  resident accounts, and verify that such policies and procedures are being
				  followed.
B. The EOHHS will
				  interview residents and review resident records to determine whether they:
1. Have access to their personal funds held
				  by the facility.
2. Know the
				  current status of their accounts.
3. Receive in writing, and have explained if
				  necessary, at least quarterly accountings of transactions made on their
				  behalf.
4. Can ensure that their
				  resources, including personal needs funds, are within the limits for continued
				  eligibility.
5. Review resident's
				  records to verify a quarterly accounting of deposits, withdrawals and balances
				  has been completed.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 50 - Medicaid Long-Term Services and Supports › Subchapter 05 - Institutionally Based LTSS › Part 2 - Uniform Accountability Procedures for Title XIX Resident Personal Needs Funds in Community Nursing Facilities, ICF/DD Facilities, and Assisted Living Residences › Section 210-RICR-50-05-2.5 - Assisted Living Residences

Current through June 14, 2024
Assisted living residences that maintain personal needs
					 funds for their residences shall sustain compliance with the provisions of R.I.
					 Gen. Laws §§2317.4-16(a)(2)(xiii)(A), (B), (C), and
					 (D) and the applicable rules promulgated
					 under R.I. Gen. Laws Chapter
					 23-17.4 by the Rhode Island
					 Department of Health.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 50 - Medicaid Long-Term Services and Supports › Subchapter 10 - Home and Community Based LTSS › Part 1 - "Medicaid Long-Term Services and Supports: Home and Community-Based Services (HCBS)" (210-RICR-50-10-1) › Section 210-RICR-50-10-1.1 - Overview and Purpose

Current through June 14, 2024
A. Medicaid LTSS
				  was only available to beneficiaries in institutional settings until 1983 when
				  Congress amended Title XIX of the Social Security Act to add Section 1915(c)
				  which established the authority for home and community-based service (HCBS)
				  waivers. Rhode Island was among the first states to pursue this authority and,
				  in that first year alone, received approval for four (4) Section 1915(c)
				  waivers. By the time Rhode Island sought approval for its program-wide Medicaid
				  Section 1115 waiver demonstration, the State was administering eleven, separate
				  Section 1915(c) waivers, many of which had distinct eligibility requirements.
				  The State consolidated these separate HCBS waivers in 2009 when the federal
				  government approved Rhode Island's innovative Section 1115 demonstration
				  waiver.
B. Under the broad
				  authority of the State's Section 1115 waiver, Rhode Island has established a
				  core set of home and community-based services which are available to LTSS
				  beneficiaries in multiple living arrangements. The scope of HCBS available to a
				  beneficiary varies somewhat depending on the type of institutional eligibility
				  a person is seeking (i.e., nursing facility (NF), intermediate care facility
				  for persons with intellectual or developmental disabilities (ICF/I-DD), or
				  long-term care hospital (LTH)), level of need as measured by the applicable
				  evaluation instrument (e.g., high or highest need for the NF services or
				  service intensity scale for ICF/I-DD), and the person-centered planning
				  process. The purpose of this Part is to identify the full range of Medicaid
				  HCBS options available to LTSS beneficiaries, depending on their level of need,
				  as determined in Part 50-00-1 of this Title.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 50 - Medicaid Long-Term Services and Supports › Subchapter 10 - Home and Community Based LTSS › Part 1 - "Medicaid Long-Term Services and Supports: Home and Community-Based Services (HCBS)" (210-RICR-50-10-1) › Section 210-RICR-50-10-1.2 - Legal Authority

Current through June 14, 2024
A. This Chapter is
				  promulgated pursuant to the following federal and state authorities:
1. Federal Law -- Title XIX of the U.S.
				  Social Security Act
				   42 U.S.C. §§
												1396a,  1115, 1902, 1903, 1905, 1915, 1919,
				  1929, and 1934(a).
2. Federal
				  Regulations --  42 C.F.R. Part 441  including §§441.180, 441.300 to
				  310, 441.350 to 365 and
				   42 C.F.R. §§
												430.25, 435.217, 440.180, 441.700, and 460.92(b).
3. The RI Medicaid State Plan and the Title
				  XIX, Section 1115(a) Demonstration Waiver (11-W-00242/1), effective through
				  December 31, 2018.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 50 - Medicaid Long-Term Services and Supports › Subchapter 10 - Home and Community Based LTSS › Part 1 - "Medicaid Long-Term Services and Supports: Home and Community-Based Services (HCBS)" (210-RICR-50-10-1) › Section 210-RICR-50-10-1.3 - Definitions

Current through June 14, 2024
A. For the purposes of this Part, the terms
				  below are defined as follows:
1. "HCBS living
				  arrangement" means a private home in which a beneficiary lives, or a
				  community-based supportive care residence as defined in R.I. Gen. Laws §
											40-8.13-12 and §
											1.6(A)(4)   of
				  this Part that has been certified by Medicaid and authorized by the State, by
				  licensure or certification standards, to provide long-term care services and
				  supports to one or more persons. This category includes assisted living
				  residences, State and provider operated groups homes, shared living
				  arrangements, the home of the beneficiary and other private
				  residences.
2. "Programs of
				  All-Inclusive Care for the Elderly" or "PACE" means the Medicaid State Plan
				  service delivery option for beneficiaries who are dually eligible for Medicare
				  and Medicaid. PACE is available for beneficiaries opting for HCBS who meet the
				  NF level of care at the "high" or "highest" level.
3. "RIte@Home" means the shared living,
				  supportive care living arrangement administered by the Executive Office of
				  Health and Human Services (EOHHS) for persons who have LTSS needs that meet the
				  NF level of care.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 50 - Medicaid Long-Term Services and Supports › Subchapter 10 - Home and Community Based LTSS › Part 1 - "Medicaid Long-Term Services and Supports: Home and Community-Based Services (HCBS)" (210-RICR-50-10-1) › Section 210-RICR-50-10-1.7 - Limitations on the Availability of Medicaid HCBS

Current through June 14, 2024
A. The
				  State may establish waiting lists for an HCBS service option, including a
				  specific setting, when demand exceeds the availability of services and/or
				  appropriated funds.
1. Prioritized access --
				  During a period in which a waiting list is in effect, access to HCBS is based
				  on level of need. Persons determined to have the highest needs levels,
				  including those with imminent health and safety risks, are therefore given
				  priority access over those with lower needs levels.
2. Limits -- The State may not extend waiting
				  lists for HCBS determined to be medically necessary by a treating health care
				  practitioner to prevent an imminent risk to a beneficiary's health or
				  safety.
3. Notice [DOT] Prior to
				  the establishment of HCBS waiting lists, the State provides a full
				  implementation plan indicating the date the waiting list takes effect, the
				  process for notifying beneficiaries of their status and the procedures in place
				  to ensure compliance with applicable federal and state laws and address the
				  needs of beneficiaries at risk.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 50 - Medicaid Long-Term Services and Supports › Subchapter 10 - Home and Community Based LTSS › Part 2 - Self-Directed Care › Section 210-RICR-50-10-2.1 - Purpose

Current through June 14, 2024
This Rule applies to the Personal Choice self-directed
					 program and the home and community-based services provided by Personal Care
					 Aides (PCAs) under this program. This Rule sets out the eligibility criteria
					 and program operations for self-direction, a service delivery model which
					 allows individuals to have responsibility for managing their long-term services
					 and supports in a person-centered manner. Individuals choose who provides their
					 services and when and how the services are provided. Self-directed services are
					 intended to support community tenure and individual control, choice, and
					 independence.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 50 - Medicaid Long-Term Services and Supports › Subchapter 10 - Home and Community Based LTSS › Part 2 - Self-Directed Care › Section 210-RICR-50-10-2.2 - Applicability

Current through June 14, 2024
A. The Personal Choice Program provides
				  self-directed home and community-based services to Medicaid long-term services
				  and supports (LTSS) eligible individuals. Personal Choice is a long-term care
				  program for individuals with disabilities who are over the age of eighteen (18)
				  or all individuals age sixty-five (65) or over who meet either a high or
				  highest level of care. Services are geared toward reducing unnecessary
				  institutionalization by providing specialized home and community-based services
				  to qualified Medicaid participants at an aggregate cost which is less than or
				  equal to the cost of institutional or nursing facility care.
B. This Regulation does not apply to
				  self-directed programs for individuals with intellectual and developmental
				  disabilities (I/DD) overseen by the Rhode Island Department of Behavioral
				  Healthcare, Developmental Disabilities and Hospitals (BHDDH) pursuant to R.I.
				  Gen. Laws §
										40.1-1-13. To reference the
				  Regulations for BHDDH Self-Directed services, please refer to the Rules and
				  Regulations for Developmental Disability Organizations 212-RICR-10-05-1.10.3,
				  Fiscal Intermediary Services, and 212-RICR-10-05-1.2(A)(42),
				  Definitions.
C. Pursuant to R.I.
				  Gen. Laws §
										40-8.15-2(b),
				  nothing in this Part shall interfere with the regulatory authority of the Rhode
				  Island Department of Health (RIDOH) over individual providers'
				  licensing.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 50 - Medicaid Long-Term Services and Supports › Subchapter 10 - Home and Community Based LTSS › Part 2 - Self-Directed Care › Section 210-RICR-50-10-2.3 - Authority

Current through June 14, 2024
Title XIX of the Social Security Act,
					 42 U.S.C. §§
											1396-1396w-7, provides the legal
					 authority for the Rhode Island Medicaid Program. The Medicaid Program also
					 operates under a waiver granted by the Secretary of the U.S. Department of
					 Health and Human Services pursuant to § 1115 of the Social Security Act,
					 42 U.S.C. §
											1315. Additionally, R.I. Gen. Laws Chapters
					 40-6, 40-8, 40-18, 40-8.14, and 40-8.15 serve as the enabling statutes for the
					 Personal Choice Program.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 50 - Medicaid Long-Term Services and Supports › Subchapter 10 - Home and Community Based LTSS › Part 2 - Self-Directed Care › Section 210-RICR-50-10-2.5 - Eligibility

Current through June 14, 2024
A. All general eligibility Rules for Medicaid
				  LTSS contained in the Rhode Island Code of Regulations, Subchapter 00 Part 1 of
				  this Chapter, Medicaid LTSS Overview and Eligibility Pathways, and Subchapter
				  00 Part 4 of this Chapter, Medicaid Long-Term Services and Supports Application
				  and Renewal Process, apply to the Personal Choice Program. Additional
				  eligibility requirements for Personal Choice are as follows:
1. Individuals who are either aged (age
				  sixty-five (65) and older) or who have a disability and are at least eighteen
				  (18) years old and are determined to have high or highest need for level of
				  care;
2. Individuals who have
				  demonstrated the ability and competence to direct their own care or have a
				  qualified designated representative to direct care, and want to either remain
				  in their home or return to their home; and
3. Individuals who have been determined to
				  have a developmental disability and are receiving services via the Department
				  of Behavioral Healthcare, Developmental Disabilities, and Hospitals (BHDDH) and
				  are interested in the Personal Choice Program must be approved by BHDDH and
				  EOHHS Medicaid.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 50 - Medicaid Long-Term Services and Supports › Subchapter 10 - Home and Community Based LTSS › Part 2 - Self-Directed Care › Section 210-RICR-50-10-2.7 - Appeals

Current through June 14, 2024
An opportunity for a hearing is granted to an
					 applicant/participant, or their designated representative, when a person is
					 aggrieved by an agency action resulting in a disenrollment, suspension,
					 reduction, discontinuance, or termination of a participant's services or
					 budget, or a requested adjustment to the budget or service is denied in
					 accordance with the provisions of Part 10-05-2 of this Title, Appeals Process
					 and Procedures for EOHHS Agencies and Programs.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 50 - Medicaid Long-Term Services and Supports › Subchapter 10 - Home and Community Based LTSS › Part 2 - Self-Directed Care › Section 210-RICR-50-10-2.8 - Screening Requirements and Qualifications for PCAs

Current through June 14, 2024
A. Age: PCAs must be at least eighteen (18)
				  years of age.
B. Work Status: PCAs
				  must be authorized to work in the United States.
C. Relationship: Individuals cannot work as a
				  PCA if they are the participant's representative, spouse, financial power of
				  attorney, or Social Security Representative Payee.
D. Driver's License: If the PCA is approved
				  to provide transportation for the participant, the PCA must have a valid
				  driver's license, liability coverage and provide their own vehicle.
E. Training: Training requirements vary based
				  on how the prospective PCA is introduced to the program. PCAs will not be paid
				  until the participant has verified that training has occurred.
1. If the PCA is known to the participant,
				  the participant may choose to provide in-home training, request that the PCA
				  undergo mandatory orientation and training, or a combination of in-home
				  training and selected courses from the mandatory orientation and
				  training.
2. If the PCA is
				  introduced to the Personal Choice program through the registry, the PCA is
				  required to undergo mandatory orientation and training before the PCA is listed
				  on the registry.
3. Participants
				  may request that their PCA complete continuing education courses offered by
				  EOHHS or its designee. PCAs may also voluntarily complete continuing education
				  courses.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 50 - Medicaid Long-Term Services and Supports › Subchapter 10 - Home and Community Based LTSS › Part 2 - Self-Directed Care › Section 210-RICR-50-10-2.9 - Assessments

Current through June 14, 2024
A. Nursing Assessment - The Nursing
				  Assessment is one (1) of the multiple assessments done for the participant.
				  This assessment measures Activities of Daily Living (ADLs) and Instrumental
				  Activities of Daily Living (IADLs) which are conducted to determine participant
				  needs and goals. A nursing assessment must be performed by a nurse licensed by
				  RIDOH in accordance with 216-RICR-40-05-3, Licensing of Nurses and Standards
				  for the Approval of Basic Nursing Education Programs.
B. Functional Assessment - The functional
				  assessment rates the participant's level of assistance required to complete
				  each task, and the number of times the task is performed. If there is a
				  condition or characteristic in addition to the disability, the participant may
				  require more time to complete a particular task. These conditions and/or
				  characteristics do not apply to all ADL/IADL tasks; they only apply if the
				  condition has a direct impact on the performance of the task. In addition to
				  medical information and self-reporting, the assessor may observe or request
				  that the participant demonstrate their ability to complete a task.
1. Initial assessments occur upon entry to
				  the Personal Choice program and reassessments occur annually thereafter. A
				  participant or representative may request a reassessment sooner if their
				  situation has changed and there is either an increased or decreased need for
				  assistance. The Case Manager may also perform a reassessment sooner if there
				  are life changes resulting in a possible increase or decrease in need for
				  assistance.
2. When a participant
				  is identified through the Nursing Home Transition Program/Money Follows the
				  Person Program, a temporary assessment shall be conducted. This shall be a
				  temporary assessment because it is conducted while the participant is in an
				  institutional Nursing Home setting and may not fully reflect the participant's
				  functional abilities within a non-institutional home setting. The Conflict-Free
				  Case Management Agency selected by the participant shall complete an updated
				  assessment within ninety (90) days of the participant returning home. After the
				  temporary assessment is completed, the Office of Community Programs staff shall
				  review the assessment with the participant to:
a. Verify that the participant wants to
				  participate in the Personal Choice program; and
b. Identify the participant's choice of
				  Conflict-Free Case Management Agency responsible for the additional assessments
				  and oversight of the participant's services.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 50 - Medicaid Long-Term Services and Supports › Subchapter 10 - Home and Community Based LTSS › Part 2 - Self-Directed Care › Section 210-RICR-50-10-2.10 - Budget Development

Current through June 14, 2024
A. Personal Choice
				  monthly budgets are based on the functional assessment of participant need for
				  hands-on assistance or supervision with ADLs (such as bathing, toileting,
				  dressing, grooming, transfers, mobility, skincare, and/or eating) and IADLs
				  (such as communication, shopping, housework, meal preparation, and/or food
				  shopping), as described in §
										2.9 of this Part and listed
				  in the tables in § 2.15 of this Part.
B. The Conflict-Free Case Management Agency
				  and Service Advisement Team will perform assessments to determine the
				  individual's budget and Individual Service and Spending Plan (ISSP). In
				  accordance with the service provider agreements, a budget is developed based on
				  the amount and level of assistance required, frequency of the task, and
				  presence of any secondary conditions that would require a need for more time to
				  complete the task. There are six (6) levels of assistance for each activity.
1. Determine Monthly Budget Amount: Each
				  Activity of Daily Living (ADL) and Instrumental Activity of Daily Living (IADL)
				  has an amount of unit and/or functional time allowed to complete the task. The
				  monthly figures for each ADL/IADL are added together to form a monthly budget.
				  Taxes, worker's compensation insurance, and administrative costs are deducted
				  from the Personal Choice participant's monthly budget.
a. Unit Time - the amount of time allowed to
				  complete the task if the participant is unable to participate and requires
				  total assistance with the task.
b.
				  Functional Time - the amount of time allowed to complete the task if the
				  participant is unable to participate and requires total assistance with the
				  task and certain conditions or characteristics are present. These
				  characteristics are listed in the table in § 2.15 of this Part.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 50 - Medicaid Long-Term Services and Supports › Subchapter 10 - Home and Community Based LTSS › Part 2 - Self-Directed Care › Section 210-RICR-50-10-2.11 - Participant Directed Goods and Services

Current through June 14, 2024
A. Participants
				  may also set aside a specified amount of their budget each month to purchase
				  services, equipment and supplies not otherwise provided by Medicaid that
				  address an identified need, are documented in the approved ISSP, and meet the
				  following requirements:
1. Alternative funding
				  sources are not available; and
2.
				  The item or service would decrease the need for other Medicaid services;
				  and/or
3. The item or service would
				  promote inclusion in the community; and/or
4. The item or service would increase the
				  individual's ability to perform ADLs/IADLs; and/or
5. The item or service would increase the
				  person's safety in the home environment.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 50 - Medicaid Long-Term Services and Supports › Subchapter 10 - Home and Community Based LTSS › Part 2 - Self-Directed Care › Section 210-RICR-50-10-2.12 - Participant Rights and Responsibilities

Current through June 14, 2024
A. Every
				  participant has the right to:
1. Be treated as
				  an adult, with dignity and respect at all times;
2. Privacy in all interactions with EOHHS,
				  the Case Manager, and the Fiscal Intermediary and freedom from unnecessary
				  intrusion;
3. Make informed choices
				  based upon appropriate information provided to the participant, and have
				  questions answered and choices respected, while respecting the rights of others
				  to disagree with their choices;
4.
				  Freely choose between approved providers as appropriate or
				  applicable;
5. Feel safe and secure
				  in all aspects of life, including health and well-being, be free from
				  exploitation and abuse, and not be overprotected;
6. Realize the full opportunity that life
				  provides by not being limited by others, by making full use of the resources
				  their self-directed program provides, and by being free from judgments and
				  negativity;
7. Live as
				  independently as they choose;
8.
				  Have their individual ethnic background, language, culture and faith valued and
				  respected;
9. Be treated equally
				  and live in an environment that is free from bullying, harassment and
				  discrimination;
10. Voice
				  grievances about care or treatment without fear of discrimination or
				  reprisal;
11. Voluntarily withdraw
				  from the Personal Choice program at any time;
12. Manage PCAs by:
a. Deciding who to hire, whether
				  self-selected or selected from the registry of available PCAs;
b. Deciding what special knowledge or skills
				  the PCA must possess;
c. Training
				  each PCA to meet individual needs; and
d. Replacing PCAs who do not meet individual
				  needs.
13. Request a new
				  assessment and/or person-centered service plan if needs change;
14. Know about all fees;
15. Appeal any decision made by the
				  Conflict-Free Case Management Agency, Fiscal Intermediary, or EOHHS and expect
				  a prompt response.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 50 - Medicaid Long-Term Services and Supports › Subchapter 10 - Home and Community Based LTSS › Part 2 - Self-Directed Care › Section 210-RICR-50-10-2.13 - EOHHS Responsibilities

Current through June 14, 2024
A. EOHHS shall be
				  responsible for the following activities:
1.
				  Approve budgets and individual service and spending plans;
2. Authorize participant-directed goods and
				  services;
3. Authorize
				  out-of-budget services when medically necessary;
4. Provide Personal Choice participants with
				  notice of budget amount through a standardized letter which provides
				  information on budget amount and any changes that occur in the assessment
				  process. The letter also includes information on the appeals process;
5. Certify, monitor, and conduct audits of
				  Conflict-Free Case Management and Fiscal Intermediary agencies.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 50 - Medicaid Long-Term Services and Supports › Subchapter 10 - Home and Community Based LTSS › Part 2 - Self-Directed Care › Section 210-RICR-50-10-2.14 - PCA Registry

Current through June 14, 2024
A. A registry of
				  qualified caregivers shall be posted by EOHHS from information validated by the
				  Fiscal Intermediary. Listed on the registry are the PCAs who have completed
				  training and screening requirements and are available to provide services. The
				  registry does not contain personally identifiable information, but rather
				  details regarding gender, experience, additional certifications, languages
				  spoken, town of origin, distance willing to travel, days and hours available to
				  work, smoking habits, allergies, willingness to be called for emergency visits,
				  and a free form self-description.
1.
				  Individuals working as PCAs are not required to join the registry, for example
				  when the PCA is only interested in working for one (1) dedicated participant.
				  PCAs will only be listed if they have expressed interest to EOHHS to be
				  listed.
2. PCAs who are trained by
				  the participant are not listed in the registry and cannot work for other
				  participants through the registry unless they complete mandatory orientation
				  and training and certifications. No accommodations are made to list provisional
				  providers on State registries/website.
3. PCAs may self-initiate entry into the
				  registry. Information posted on the registry is validated by the Fiscal
				  Intermediary.
4. Participants may
				  use the registry to find and hire PCAs.
5. The frequency of updates to the registry
				  is dependent on the availability of qualifying PCAs.
6. No participant information is listed on
				  the registry.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 50 - Medicaid Long-Term Services and Supports › Subchapter 10 - Home and Community Based LTSS › Part 3 - Katie Beckett Program › Section 210-RICR-50-10-3.1 - Overview

Current through June 14, 2024
A. In 1982, Congress created a new Medicaid
				  State Plan option under §134 of the Tax Equity and Fiscal Responsibility
				  Act (TEFRA), also referred to as the Katie Beckett (KB) provision, which
				  enables otherwise ineligible children who have severe disabling impairments
				  and/or complex health needs to obtain the services they need at home rather
				  than in an institutional setting in certain circumstances.
B. The scope of services KB-eligible children
				  receive are also generally available under the Medicaid State Plan for Medicaid
				  Affordable Care Coverage (MACC) group children with special needs eligible on
				  the basis of the MAGI standard. Accordingly, all children are evaluated for
				  MAGI-based eligibility first using the two hundred sixty-one percent (261%) of
				  the Federal Poverty Level (FPL) standard. The KB provision applies to children
				  who are not eligible for Medicaid through this pathway and, in doing so,
				  assures some of Rhode Island's most vulnerable children will have access to
				  critical home-based services which are not covered by most commercial and other
				  third-party insurers.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 50 - Medicaid Long-Term Services and Supports › Subchapter 10 - Home and Community Based LTSS › Part 3 - Katie Beckett Program › Section 210-RICR-50-10-3.2 - Scope and Authority

Current through June 14, 2024
Under the terms of the KB Medicaid State Plan option, a
					 child must meet general and financial requirements as well as clinical criteria
					 related to disability and the need for an institutional level of care. Prior to
					 authorization of services, the State must also apply a federally-required
					 cost-effectiveness test to determine whether home-based services are as
					 effective at meeting a child's needs at an equal or lower cost than care
					 provided in an institutional setting.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 50 - Medicaid Long-Term Services and Supports › Subchapter 10 - Home and Community Based LTSS › Part 3 - Katie Beckett Program › Section 210-RICR-50-10-3.3 - Special Conditions

Current through June 14, 2024
A. To qualify for
				  Medicaid LTSS through the KB provision, a child must be under nineteen (19)
				  years of age and meet the general Medicaid requirements pertaining to
				  residency. The Regulations at Parts
				  30-00-1 and
				  10-00-3 of this Title governing
				  citizenship and immigration status for children up to age nineteen (19) also
				  apply to the KB State Plan option. In addition, the following conditions must
				  be met:
1. Financial Eligibility - Children
				  seeking coverage for an institutional level of care at home who do not meet the
				  eligibility criteria for MACC using the MAGI standard are subject to a
				  financial eligibility review of income and resources using the SSI method for
				  Community Medicaid, as set forth in Part
				  40-00-3 of this Title with the
				  following exception -
a. Parental assets
				  unavailable. When seeking Medicaid LTSS under the KB provision, the assets -
				  income and resources - of the parent(s) or legal guardian(s) are deemed to be
				  unavailable to the child applying for coverage. Accordingly, the financial
				  eligibility determination is based on the child's income and resources. The
				  standards that apply are the Federal benefit rate relative to income and up to
				  the medically needy limit of four thousand dollars ($4,000.00) in resources.
				  This is the SSI method of treatment of income and resources that applies when a
				  child with special needs is seeking coverage in an institutional
				  setting.
b. Excluded expenses. In
				  the calculation of countable income, any payments for in-home supportive
				  services provided to the child which are covered by Medicaid or other Federal,
				  State or local government programs are excluded.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 50 - Medicaid Long-Term Services and Supports › Subchapter 10 - Home and Community Based LTSS › Part 3 - Katie Beckett Program › Section 210-RICR-50-10-3.4 - Continuing Eligibility

Current through June 14, 2024
The financial eligibility of KB eligible children is
					 renewed on an annual basis and when there are changes in State residence, the
					 income and/or resources available to the child, living arrangements - that is,
					 from home into an alternative health care setting - or access to or coverage by
					 a third-party payer. Clinical eligibility is also reviewed annually or when
					 there is a change in health or functional status, unless it is determined that
					 the frequency of reviews must be altered due to the unique needs/circumstances
					 of the child.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 50 - Medicaid Long-Term Services and Supports › Subchapter 10 - Home and Community Based LTSS › Part 3 - Katie Beckett Program › Section 210-RICR-50-10-3.5 - Authorization and Delivery of Services

Current through June 14, 2024
Upon determining a child is eligible for Medicaid under the
					 KB provision, the necessary home-based services are authorized. Children
					 without third-party coverage are enrolled in a RIte Care Plan in accordance
					 with Part 30-05-2 of this Title. Children
					 with alternative forms of coverage are provided services on a fee-for-service
					 basis.
Rhode Island Code of Regulations › Title 212 - Department of Behavioral Healthcare, Developmental Disabilities and Hospitals › Chapter 10 - Licensing and General Administration › Subchapter 00 - N/A › Part 1 - Rules and Regulations for the Licensing of Organizations and Facilities Licensed by the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals › Section 212-RICR-10-00-1.1 - Applicability

Current through June 14, 2024
A. These regulations are promulgated pursuant
				 to the authority conferred under R.I. Gen. Laws §§
										23-17.8-9,
				  40.1-1-13,
				  40.1-2-2,
				  40.1-5-3,
				  40.1-5.4-11,
				  40.1-8.5-7,
				  40.1-21-12,
				  40.1-22-4,
				  40.1-24-9,
				  40.1-24.5-2,
				  40.1-26-11, and
				  40.1-27-3;
				 as well as R.I. Gen. Laws Chapter 42-35, and are established for the purpose of
				 adopting prevailing standards for the licensure and operation of facilities and
				 programs providing rehabilitation, support, and guidance for individuals with
				 developmental disabilities or cognitive disabilities.
B. It the expectation of the Department that
				 each individual's array of supports and services be customized to meet the
				 individual needs and desires in the least restrictive environment.
C. These Rules and Regulations apply to any
				 licensed organization under Subchapter 05 Part 1 of this Chapter (Rules and
				 Regulations for Developmental Disability Organizations), and Subchapter 10 Part
				 1 of this Chapter (Rules and Regulations for Behavioral Healthcare
				 Organizations).
D. These Rules and
				 Regulations do not apply to the following:
1.
				 Health care facilities licensed by the Rhode Island Department of Health
				 pursuant to R.I. Gen. Laws Chapter 23-17;
2. Assisted living residences licensed by the
				 Rhode Island Department of Health pursuant to R.I. Gen. Laws Chapter
				 23-17.4;
3. Facilities and programs
				 licensed by the Rhode Island Department of Children, Youth and Families
				 pursuant to R.I. Gen. Laws Chapter 42-72.1;
4. Facilities, programs, or organizations
				 already licensed or certified by any other appropriate state agency, pursuant
				 to R.I. Gen. Laws.
Rhode Island Code of Regulations › Title 212 - Department of Behavioral Healthcare, Developmental Disabilities and Hospitals › Chapter 10 - Licensing and General Administration › Subchapter 00 - N/A › Part 1 - Rules and Regulations for the Licensing of Organizations and Facilities Licensed by the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals › Section 212-RICR-10-00-1.2 - Authority

Current through June 14, 2024
The statutes cited in §
										1.1     of this Part delineate
					 the general scope of authority for this Chapter, as do the Part's specific
					 provisions.
Rhode Island Code of Regulations › Title 212 - Department of Behavioral Healthcare, Developmental Disabilities and Hospitals › Chapter 10 - Licensing and General Administration › Subchapter 00 - N/A › Part 1 - Rules and Regulations for the Licensing of Organizations and Facilities Licensed by the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals › Section 212-RICR-10-00-1.3 - Definitions

Current through June 14, 2024
A. Wherever used in this Part, the following
				 terms shall be construed to mean:
1. "Abuse"
				 means the treatment or act toward any person with developmental disabilities,
				 as defined in R.I. Gen. Laws §
											40.1-27-1 on the part
				 of anyone, including an employee, intern, volunteer, consultant, contractor,
				 visitor, family member, caregiver, neighbor, citizen or other person with a
				 disability, whether or not the person is or appears to be injured or harmed.
				 The failure to exercise one's responsibility to intercede on behalf of a person
				 receiving services also constitutes abuse. Abuse includes:
a. "Physical abuse" may include, but is not
				 limited to: physical assault, battery and/or actions such as: hitting, kicking,
				 biting, pinching, burning, strangling, shoving, shaking, dragging, yanking,
				 punching, slapping, pulling hair, grabbing or pushing, or using more force than
				 is necessary for the safety of the person.
(1)
				 For incidents involving a caregiver, abuse is defined as the willful subjection
				 of an adult with developmental disabilities to willful infliction of physical
				 pain, willful deprivation of services necessary to maintain physical or mental
				 health, or to unreasonable confinement.
(2) For incidents of physical abuse involving
				 two people with disabilities, only an attack resulting in injury in which one
				 person needs medical care beyond routine first aid or a series of deliberate
				 acts (i.e. hitting, kicking, slapping, pulling hair, etc.) displayed by one
				 person with a disability towards another person with a disability should be
				 reported to the Office of Quality Assurance. Other incidents should be
				 documented and handled by the agency's internal Incident Management
				 Committee.
Rhode Island Code of Regulations › Title 212 - Department of Behavioral Healthcare, Developmental Disabilities and Hospitals › Chapter 10 - Licensing and General Administration › Subchapter 00 - N/A › Part 1 - Rules and Regulations for the Licensing of Organizations and Facilities Licensed by the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals › Section 212-RICR-10-00-1.4 - Application for Licensure, Renewal, or Change in Licensure Status

Current through June 14, 2024
1.4.1
Application for Licensure,
				 Renewal, or Change in Licensure Status
A. To apply for a license, renew an existing
				 license, or remove or replace the provisional or conditional status of a
				 license, an applicant or licensee shall contact the Department's Office of
				 Licensure and Standards. The Office of Licensure and Standards shall provide an
				 applicant or licensee with the appropriate Departmental license
				 forms.
B. Application for a license
				 to conduct, maintain or operate a BHO, DDO, or Cognitive Disability
				 Organization shall be made to the Department upon forms provided by the
				 Department and shall contain such information as the Department requires,
				 including but not limited to evidence of ability to comply with any and all
				 applicable Department rules and regulations.
C. The Department shall either deny an
				 application or renewal, or shall issue or renew a provisional license,
				 conditional license or license.
D.
				 Such license shall be issued to the applicant or licensee for the operation of
				 specific agencies and facilities and shall not be transferable or assignable
				 except with the written approval of the Director.
Rhode Island Code of Regulations › Title 212 - Department of Behavioral Healthcare, Developmental Disabilities and Hospitals › Chapter 10 - Licensing and General Administration › Subchapter 00 - N/A › Part 1 - Rules and Regulations for the Licensing of Organizations and Facilities Licensed by the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals › Section 212-RICR-10-00-1.5 - License Issuance and Renewal and Initial Licensure Review

Current through June 14, 2024
1.5.1
General Requirements
An
				 application for licensure is required for an initial license; for license
				 renewal; for changes in owner, operator, or lessee; and when there is a new
				 legal affiliation of two (2) or more Organizations.
1.5.2
Licensure
A. All licensed DDOs, BHOs and CDOs that
				 provide services to adults in Rhode Island must meet all the requirements
				 contained in these regulations.
B.
				 An entity seeking to become a licensed DDO, BHO or CDO shall complete initial
				 applications for licensure using the forms and in the format specified by the
				 Department. Upon approval by the Department, an applicant shall be granted a
				 license for a period of two (2) years.
C. Upon approval by the Department, including
				 an on-site review, an applicant for certification shall be granted provider
				 service certifications that shall remain in effect for up to two (2) years. To
				 remain a licensed provider, the provider must maintain active approved
				 certifications.
Rhode Island Code of Regulations › Title 212 - Department of Behavioral Healthcare, Developmental Disabilities and Hospitals › Chapter 10 - Licensing and General Administration › Subchapter 00 - N/A › Part 1 - Rules and Regulations for the Licensing of Organizations and Facilities Licensed by the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals › Section 212-RICR-10-00-1.6 - Mergers, Affiliations, Change of Ownership or Operator

Current through June 14, 2024
A. The Department, and if required, any
				 federal, state or accrediting authority, shall be notified of any proposed
				 mergers, affiliations or change of ownership, program sponsor, or operator at
				 least ninety (90) days prior to that proposed merger, affiliation or change.
				 Any such change or action will require the application for and issuance of a
				 new license.
B. In cases where the
				 application involves a merger, consolidation or otherwise legal affiliation of
				 two (2) or more Organizations, the application shall include the proposed
				 immediate and long-term plans of such Organizations with respect to the
				 programs to be offered and services to be provided by such Organizations
				 because of the merger, consolidation or otherwise legal affiliation.
Rhode Island Code of Regulations › Title 212 - Department of Behavioral Healthcare, Developmental Disabilities and Hospitals › Chapter 10 - Licensing and General Administration › Subchapter 00 - N/A › Part 1 - Rules and Regulations for the Licensing of Organizations and Facilities Licensed by the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals › Section 212-RICR-10-00-1.7 - Types of Licenses

Current through June 14, 2024
1.7.1
Provisional License
A. A
				 Provisional License may be issued to a new Organization that demonstrates
				 compliance with:
1. administrative and
				 policy-related regulations;
2. all
				 health and safety requirements; and
3. has demonstrated the ability to perform
				 services to individuals in accordance to this Part;
Rhode Island Code of Regulations › Title 212 - Department of Behavioral Healthcare, Developmental Disabilities and Hospitals › Chapter 10 - Licensing and General Administration › Subchapter 00 - N/A › Part 1 - Rules and Regulations for the Licensing of Organizations and Facilities Licensed by the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals › Section 212-RICR-10-00-1.8 - Reports of Deficiencies

Current through June 14, 2024
Reports of deficiencies noted in inspections conducted in
					 accordance with these and other applicable Regulations, and results of any
					 Departmental investigation, and plans of correction or compliance orders as
					 described herein, shall be maintained on file in the Department, and shall be
					 considered by the Department in rendering determinations to deny, condition,
					 limit, suspend or revoke the license or to curtail certain specific activities
					 and programs of an Organization.
Rhode Island Code of Regulations › Title 212 - Department of Behavioral Healthcare, Developmental Disabilities and Hospitals › Chapter 10 - Licensing and General Administration › Subchapter 00 - N/A › Part 1 - Rules and Regulations for the Licensing of Organizations and Facilities Licensed by the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals › Section 212-RICR-10-00-1.9 - Suspension in Emergencies

Current through June 14, 2024
If the Director finds that public health, safety, or
					 welfare requires emergency action and the Department incorporates such findings
					 in an order, the Director may order summary suspension of the license or
					 curtailment of activities as enumerated above, pending proceedings for
					 revocation; or other action in accordance with R.I. Gen. Laws §
										42-35-14(c).
Rhode Island Code of Regulations › Title 212 - Department of Behavioral Healthcare, Developmental Disabilities and Hospitals › Chapter 10 - Licensing and General Administration › Subchapter 00 - N/A › Part 1 - Rules and Regulations for the Licensing of Organizations and Facilities Licensed by the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals › Section 212-RICR-10-00-1.10 - Suspension, Revocation, Curtailment, and Denial

Current through June 14, 2024
The Department may deny, suspend, annul, withdraw, amend,
					 refuse to issue or renew, or revoke the license of, or the operation of a
					 specific program authorized under the license of, or curtail some or all the
					 activities of, any Organization if the Department has sufficient evidence to
					 establish that the licensee has violated federal or state statute or regulation
					 subject to §
										1.9     or §
										1.12     of this
					 Part.
Rhode Island Code of Regulations › Title 212 - Department of Behavioral Healthcare, Developmental Disabilities and Hospitals › Chapter 10 - Licensing and General Administration › Subchapter 00 - N/A › Part 1 - Rules and Regulations for the Licensing of Organizations and Facilities Licensed by the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals › Section 212-RICR-10-00-1.11 - Licensing Actions

Current through June 14, 2024
A. The Department
				 may take licensing action against the license in whole and/or in part:
1. The Department may curtail, revoke,
				 suspend or place on conditional status certain services, programs and/or
				 facilities or premises without revoking or otherwise taking sanctions against
				 the Organization's license.
2. The
				 Department shall determine, in part or in whole, which of those applied for
				 services, programs, and/or facilities or premises included by the Organization
				 on the application for licensure or certification issuance or renewal shall be
				 granted.
Rhode Island Code of Regulations › Title 212 - Department of Behavioral Healthcare, Developmental Disabilities and Hospitals › Chapter 10 - Licensing and General Administration › Subchapter 00 - N/A › Part 1 - Rules and Regulations for the Licensing of Organizations and Facilities Licensed by the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals › Section 212-RICR-10-00-1.12 - Right of Appeal

Current through June 14, 2024
A licensee has the right to appeal any decision made by the
					 Department. All appeals will be addressed in accordance with the Appeals
					 Process and Procedures for EOHHS Agencies and Programs, 210-RICR-
					 10-05-2.