reglab/statecodes huggingface dataset:
Rhode Island Code of Regulations › Title 216 - Department of health › Chapter 10 - Public Health Administration › Subchapter 10 - Registries › Part 5 - Rhode Island All-Payer Claims Database › Section 216-RICR-10-10-5.8 - Procedures for the Approval and Release of Data

Current through June 14, 2024
5.8.1
Release Policies and Procedures
A. General Provisions
1. The Department may release RIAPCD data to
				  a person or organization engaged in improving, evaluating, or otherwise
				  measuring health care provided to Members.
2. The Department may provide pre-determined
				  files at varying levels of detail to meet requests for RIAPCD data, per the
				  procedures established by the Department, pursuant to this Part.
3. All Users of RIAPCD data, including Rhode
				  Island State Agencies, shall adhere to the following privacy guidelines:
a. No User shall attempt to identify an
				  individual Member using RIAPCD data, or data outputs derived from RIAPCD
				  data.
b. RIAPCD data shall not be
				  linked with any other data source that could potentially re-identify a member
				  or patient.
c. All Users shall
				  adhere to RIAPCD data display and reporting requirements when disclosing RIAPCD
				  data or data outputs to the public or any person who has not been authorized as
				  a User by the Department, as follows, and as specified in the Data Use
				  Agreement entered into by the User and the Department:
(1) "Outputs" refers to any reports,
				  analyses, displays, products, tables, manuscripts, presentations, and other
				  data uses derived from APCD Data.
(2) All RIAPCD Data Outputs must adhere to
				  CMS cell size suppression requirements for CMS Research Identifiable
				  Files.
(3) Outputs must use
				  complementary cell suppression techniques to ensure that observations in
				  suppressed cells cannot be identified by manipulating data in the
				  Output.
(4) Member-level records
				  may not be disseminated or published in any form.
Rhode Island Code of Regulations › Title 216 - Department of health › Chapter 10 - Public Health Administration › Subchapter 10 - Registries › Part 5 - Rhode Island All-Payer Claims Database › Section 216-RICR-10-10-5.9 - Compliance and Enforcement

Current through June 14, 2024
5.9.1
Enforcement Options
A. The
				  Director may pursue any combination of the following administrative and
				  judicial enforcement actions, depending upon the circumstances and gravity of
				  each case:
1. Compliance orders pursuant to
				  R.I. Gen. Laws §
												23-1-20;
2. Immediate compliance orders pursuant to
				  R.I. Gen. Laws §
												23-1-21;
3. Enforcement of compliance orders pursuant
				  to R.I. Gen. Laws §
												23-1-23;
				  and
4. Criminal penalties pursuant
				  to R.I. Gen. Laws §
												23-1-25.
Rhode Island Code of Regulations › Title 216 - Department of health › Chapter 10 - Public Health Administration › Subchapter 10 - Registries › Part 5 - Rhode Island All-Payer Claims Database › Section 216-RICR-10-10-5.10 - Variance Procedure

Current through June 14, 2024
The Department may grant a variance from the provisions of
					 a Rule or Regulation in a specific case if it finds that enforcement of such
					 provision will result in unnecessary hardship to the Applicant and that such a
					 variance will not be contrary to the public interest, public health and/or
					 health and safety of residents.
Rhode Island Code of Regulations › Title 216 - Department of health › Chapter 10 - Public Health Administration › Subchapter 10 - Registries › Part 5 - Rhode Island All-Payer Claims Database › Section 216-RICR-10-10-5.11 - Rules Governing Practices and Procedures

Current through June 14, 2024
All hearings and reviews required under the provisions of
					 R.I. Gen. Laws Chapter 23-17.17 shall be held in accordance with the provisions
					 of Subchapter 05 Part 4 of this Chapter, Practices and Procedures Before the
					 Rhode Island Department of Health, and Subchapter 05 Part 1 of this Chapter,
					 Access to Public Records.
Rhode Island Code of Regulations › Title 216 - Department of health › Chapter 10 - Public Health Administration › Subchapter 10 - Registries › Part 5 - Rhode Island All-Payer Claims Database › Section 216-RICR-10-10-5.12 - Severability

Current through June 14, 2024
A. If any provision of this Part or their
				  applicability to any person or circumstance shall be held invalid, such holding
				  shall not affect the provisions or application of this Part that can be given
				  effect, and to this end the provisions of this Part are declared to be
				  severable.
B. If the effect of such
				  a holding that a provision or application of this Part is invalid is to
				  compromise any of the Member privacy or data security measures contained
				  herein, such that Direct Personal Identifiers may be in any way put at risk of
				  Disclosure, the Director shall have the authority, upon his or her discretion,
				  to suspend the release of all Health Care Claims Data Set(s) and/or analytic
				  files for a period of time sufficient to address such concerns.
Rhode Island Code of Regulations › Title 216 - Department of health › Chapter 10 - Public Health Administration › Subchapter 10 - Registries › Part 6 - Regional Health Information Organization and Health Information Exchange › Section 216-RICR-10-10-6.1 - Authority

Current through June 14, 2024
These Regulations are promulgated pursuant to the authority
					 conferred under R.I. Gen. Laws §
										5-37.7-5 for the purpose of
					 establishing safeguards and confidentiality protections for the Health
					 Information Exchange (HIE) in order to improve the quality, safety and value of
					 health care, keep confidential health information secure and confidential and
					 use the HIE to prevent disease and protect and promote the health and safety of
					 the people of Rhode Island.
Rhode Island Code of Regulations › Title 216 - Department of health › Chapter 10 - Public Health Administration › Subchapter 10 - Registries › Part 6 - Regional Health Information Organization and Health Information Exchange › Section 216-RICR-10-10-6.4 - HIE Advisory Commission

Current through June 14, 2024
A. Pursuant to R.I.
				  Gen. Laws §
										5-37.7-5(c), the
				  Director shall establish an HIE Advisory Commission of no more than nine (9)
				  members that shall be responsible for recommendations relating to the type of
				  and use of, and appropriate confidentiality protection for, the confidential
				  health information of the HIE, subject to regulatory oversight by the
				  Department. The responsibilities of the HIE Advisory Commission shall be
				  pursuant to R.I. Gen. Laws §
										5-37.7-5.
B. Pursuant to R.I. Gen. Laws §
										5-37.7-5(c), the
				  Director shall recommend prospective HIE Advisory Commission members to the
				  Governor, subject to the advice and consent of the Senate. The membership of
				  the HIE Advisory Commission shall include one (1) person with experience in
				  HIPAA and privacy and security of health care information requirements, one (1)
				  person with experience in operations, maintenance and security of complex
				  electronic databases, one (1) person who is a health care consumer or consumer
				  advocate, one (1) person who represents a minority or underserved population,
				  one (1) person who has experience in epidemiology and the use of data for
				  public health purposes, and no more than three (3) persons employed by a health
				  care delivery organization, at least two (2) of whom shall be a physician
				  licensed pursuant to R.I. Gen. Laws Chapter
				  5-37. The remaining member(s) shall
				  be selected from business professionals and health care consumers whose
				  experience and expertise will facilitate the work of the Commission.
C. The Director shall appoint a chairperson
				  for the HIE Advisory Commission.
D.
				  HIE Advisory Commission members shall be appointed for a term of two (2) years.
				  A Commission member may be reappointed for an additional term, but shall not be
				  eligible to serve more than three (3) consecutive terms. RHIO staff and board
				  members shall not be eligible for appointment to the Commission.
E. The HIE Advisory Commission shall meet at
				  least annually and shall not vote on any recommendations regarding the use of
				  confidential health information unless a quorum is present.
F. The RHIO shall report at least annually to
				  the HIE Advisory Commission and the Department on topics such as, but not
				  limited to:
1. Usage of the HIE;
2. Security assessment results;
3. Opt-out frequency and
				  characteristics;
4. Patient
				  matching;
5. Education and outreach
				  campaigns regarding public awareness of the HIE;
6. Data requests; and
7. Disclosure report requests.
8. Additionally, the HIE Advisory Commission
				  may request at any time to review the policies and procedures required of the
				  RHIO in §§6.3.2 and 6.6 of this Part.
Rhode Island Code of Regulations › Title 216 - Department of health › Chapter 10 - Public Health Administration › Subchapter 10 - Registries › Part 6 - Regional Health Information Organization and Health Information Exchange › Section 216-RICR-10-10-6.5 - Confidentiality Protections

Current through June 14, 2024
6.5.1
Patients' Rights
A. In addition
				  to the requirements of R.I. Gen. Laws Chapter
				  5-37.7 and this Part, a patient
				  participant who has his or her confidential health information in the HIE shall
				  have the following rights:
1. To obtain a copy
				  of his or her confidential health information from the HIE by:
a. Submitting a valid and authenticated
				  request to access the HIE record via the methods made available by the
				  RHIO.
b. The form and methods shall
				  be publicly available through posting on the HIE website including enrolling in
				  any available patient portal.
c.
				  Requestors may also call the CurrentCare information line to complete and
				  submit the information on the form over the phone. To do so, the requestor must
				  successfully complete the requirements of the identity verification process by
				  supplying identifying information through a series of questions initiated by a
				  RHIO representative over the phone and for the sole purpose of a single
				  occurrence of a telephone request to submit the form.
d. If the requestor prefers, he or she may
				  fill out a form in person at the RHIO offices after identity verification has
				  occurred. The requestor may either obtain an enrollee request to access record
				  form via the website or request a form be mailed to them.
e. If neither is possible, then the requestor
				  may send a letter containing the same information as is required by the form
				  and have it authenticated in the same manner as the written form.
Rhode Island Code of Regulations › Title 216 - Department of health › Chapter 10 - Public Health Administration › Subchapter 10 - Registries › Part 6 - Regional Health Information Organization and Health Information Exchange › Section 216-RICR-10-10-6.6 - Security Requirements

Current through June 14, 2024
6.6.1
Minimum
				  Security Requirements
The RHIO and HIE shall implement security procedures
					 pursuant to R.I. Gen. Laws §
											5-37.7-8.
6.6.2
Safeguards and Security
				  Measures
The RHIO shall have in place appropriate physical,
					 technical and procedural safeguards and security measures to ensure the
					 technical integrity, physical safety, and confidentiality of any confidential
					 health information in the HIE. These safeguards and security measures shall be
					 in place at all times and at any location at which the RHIO, its workforce
					 members, or its contractors hold or access confidential health information.
					 Such safeguards and security measures shall comply with State and Federal
					 confidentiality laws and Regulations including, without limitation, the Health
					 Insurance Portability and Accountability Act of 1996 and its implementing
					 Regulations (45 C.F.R. Parts
					 160 through
					 164), HITECH and the HIPAA Final
					 Omnibus Rule.
6.6.3
Security Framework
The RHIO shall develop appropriate and scalable security
					 standards, policies, and procedures in compliance with the Rhode Island
					 Division of Information Technology Enterprise Strategy and Services policies
					 which are developed and align with the National Institute of Standards and
					 Technology (NIST) security policies and controls.
6.6.4
Security Management
A. The RHIO shall:
1. Maintain and effectively implement written
				  policies and procedures that conform to the requirements of this Section to
				  protect the confidentiality, integrity, and availability of the confidential
				  health information that is processed, stored, and transmitted; to protect
				  against any reasonably anticipated threats or hazards to the security or
				  integrity of the confidential health information and to monitor, modify and
				  improve the effectiveness of such policies and procedures, and
2. Train the RHIO workforce who access or
				  hold confidential health information regarding the requirements of the Act,
				  this Part and the RHIO's policies and procedures regarding the confidentiality
				  and security of confidential health information. The RHIO will secure written
				  acknowledgement of training of its employees.
Rhode Island Code of Regulations › Title 216 - Department of health › Chapter 10 - Public Health Administration › Subchapter 10 - Registries › Part 6 - Regional Health Information Organization and Health Information Exchange › Section 216-RICR-10-10-6.7 - Immunity and Waivers

Current through June 14, 2024
Immunity and waiver Rules shall be pursuant to those stated
					 in R.I. Gen. Laws §§
										5-37.7-11 and
					  5-37.7-14.
Rhode Island Code of Regulations › Title 216 - Department of health › Chapter 10 - Public Health Administration › Subchapter 10 - Registries › Part 6 - Regional Health Information Organization and Health Information Exchange › Section 216-RICR-10-10-6.8 - Penalties - Attorneys' Fees for Violations

Current through June 14, 2024
Penalties shall be pursuant to those stated in R.I. Gen.
					 Laws §
										5-37.7-13.
Rhode Island Code of Regulations › Title 216 - Department of health › Chapter 10 - Public Health Administration › Subchapter 10 - Registries › Part 7 - Health Care Quality Program (216-RICR-10-10-7) › Section 216-RICR-10-10-7.1 - Authority

Current through June 14, 2024
These rules and regulations are promulgated pursuant to the
					 authority conferred under R.I. Gen. Laws 23-17.17, as amended, and are
					 established for the purpose of the development and reporting of quality
					 performance measures to guide quality improvement initiatives and promote
					 quality in the state's healthcare system.
Rhode Island Code of Regulations › Title 216 - Department of health › Chapter 10 - Public Health Administration › Subchapter 10 - Registries › Part 7 - Health Care Quality Program (216-RICR-10-10-7) › Section 216-RICR-10-10-7.3 - General Program Requirements

Current through June 14, 2024
7.3.1
Health
				  Care Quality Performance Measurement and Reporting Program
A. The Health Care Quality Performance
				  Measurement and Reporting Program shall include quality performance measures
				  and reporting for health care facilities licensed in Rhode Island.
B. The Health Care Quality Performance
				  Measurement and Reporting Program established under the Act shall, at a
				  minimum, incorporate the following:
(1) a
				  standardized data set of clinical performance measures, risk-adjusted for
				  patient variables, that shall be collected and reported periodically to the
				  Department, and
(2) comparable,
				  statistically valid patient satisfaction measures that shall be conducted
				  periodically by facilities and reported to the Department.
C. The Department may deny, suspend, or
				  revoke the license or curtail the activities of any health care facility that
				  has failed to comply with the rules and regulations stated herein.
Rhode Island Code of Regulations › Title 216 - Department of health › Chapter 10 - Public Health Administration › Subchapter 10 - Registries › Part 7 - Health Care Quality Program (216-RICR-10-10-7) › Section 216-RICR-10-10-7.4 - Administrative Requirements

Current through June 14, 2024
7.4.1
Health
				  Care Quality Program Steering Committee
A. The Director shall establish and serve as
				  chairperson of a Health Care Quality Steering Committee of no more than
				  nineteen (19) members to advise in the following matters:
1. Determination of the comparable
				  performance measures to be reported on;
2. Assessment of factors contributing to the
				  provision of quality health care;
3. Selection of the patient satisfaction
				  survey measures and instrument;
4.
				  Methods and format for data collection;
5. Program expansion and quality improvement
				  initiatives;
6. Format for the
				  public quality performance measurement report;
7. Consideration of nursing sensitive
				  performance measures to be reported on;
8. Consideration of the relationship between
				  human resources and quality, beginning with measurement and reporting for
				  nursing staff; and
9. Other related
				  issues as requested by the Director.
Rhode Island Code of Regulations › Title 216 - Department of health › Chapter 10 - Public Health Administration › Subchapter 10 - Registries › Part 7 - Health Care Quality Program (216-RICR-10-10-7) › Section 216-RICR-10-10-7.5 - Practices and Procedures and Severability

Current through June 14, 2024
7.5.1
Rules Governing Practices and Procedures
All hearings and reviews required under the provisions of
					 R.I. Gen. Laws 23-17.17, shall be held in accordance with the provisions of the
					 Rules and Regulations of the Rhode Island Department of Health Regarding
					 Practices and Procedures Before the Department of Health and Access to Public
					 Records of the Department of Health.
7.5.2
Severability
If any provision of these rules and regulations or the
					 circumstance shall be held invalid, such invalidity shall not affect the
					 provisions or application of the rules and regulations which can be given
					 effect, and to this end the provisions of the regulations are declared to be
					 severable.
Rhode Island Code of Regulations › Title 216 - Department of health › Chapter 20 - Community Health › Subchapter 05 - Maternal and Child Health › Part 1 - Newborn Genetic, Metabolic, Endocrine, and Hemoglobinopathy Screening Program and Newborn Hearing Loss Screening Program › Section 216-RICR-20-05-1.1 - Authority

Current through June 14, 2024
These rules and regulations are promulgated pursuant to the
					 authority conferred under R.I. Gen. Laws §§
										23-13-13 and
					  23-13-14,
					 and are established for the purpose of updating a comprehensive genetic,
					 metabolic, endocrine, and hemoglobinopathy screening program for newborns and a
					 newborn hearing loss screening program and for adopting a fee structure for
					 said programs.
Rhode Island Code of Regulations › Title 216 - Department of health › Chapter 20 - Community Health › Subchapter 05 - Maternal and Child Health › Part 1 - Newborn Genetic, Metabolic, Endocrine, and Hemoglobinopathy Screening Program and Newborn Hearing Loss Screening Program › Section 216-RICR-20-05-1.2 - Definitions

Current through June 14, 2024
A. Wherever used in this Part the following
				  terms shall be construed as follows:
1. "Act"
				  means R.I. Gen. Laws Chapter 23-13 entitled, "Maternal and Child Health
				  Services for Children with Special Health Care Needs."
2. "Department" means the Rhode Island
				  Department of Health.
3. "Director"
				  means the Director of the Rhode Island Department of Health.
4. "Health care facilities" means facilities
				  licensed under the provision of R.I. G en. Laws Chapter 23-17 and the
				  regulations promulgated thereunder. Health care facilities include, but are not
				  limited to, hospitals, birth centers, and other health care facilities subject
				  to licensure.
5. "Health care
				  provider" means any person licensed by the State of Rhode Island to provide
				  health care services, including, but not limited to, a physician, health care
				  facility, nurse, pharmacist, and any officer, employee or agent of that
				  provider acting in the course and scope of his or her employment or agency
				  related to or supportive of health services.
6. "Midwife" means a person who has
				  successfully completed an approved educational program in midwifery and is
				  licensed to practice midwifery in Rhode Island pursuant the Rules and
				  Regulations for Licensing of Midwives (Part 40-05-23 of this Title) and R.I.
				  Gen. Laws §
											§
											23-13-9 and
				   23-1-1.
7. "Newborn disease" means conditions that
				  have their origin in mutational events that alter the genetic constitution of
				  an individual and/or disrupts normal functions through some other disease
				  mechanism.
8. "Newborn testing for
				  hearing loss" means screening and evaluation through the Rhode Island Early
				  Hearing Detection and Intervention Program (RI-EHDI), using procedures
				  prescribed by the Director.
9.
				  "Physician" means a person with a license to practice medicine in Rhode Island
				  pursuant to the provisions of R.I. Gen. Laws Chapter 5-37 entitled, "Board of
				  Medical Licensure and Discipline."
10. "Newborn Screening Program" means the
				  Rhode Island Department of Health, Office of Newborn Screening and Follow-Up
				  program of screening all newborns for genetic, metabolic, endocrine,
				  hemoglobin, hearing, and developmental conditions.
Rhode Island Code of Regulations › Title 216 - Department of health › Chapter 20 - Community Health › Subchapter 05 - Maternal and Child Health › Part 1 - Newborn Genetic, Metabolic, Endocrine, and Hemoglobinopathy Screening Program and Newborn Hearing Loss Screening Program › Section 216-RICR-20-05-1.3 - Newborn Genetic, Metabolic, Endocrine, and Hemoglobinopathy Screening Program

Current through June 14, 2024
A. The physician
				  and/or midwife attending a newborn child shall cause said child to be subject
				  to screening tests for the conditions listed below. Notwithstanding the
				  foregoing, if parents of a newborn child object to the screening tests on the
				  grounds that such tests conflict with their religious tenets and practices,
				  such tests shall not be performed, in accordance with R.I. Gen. Laws §
										23-13-14.
1. Amino Acid Metabolism Disorders
a. Argininosuccinic Acidemia
b. Citrullinemia
c. Homocystinuria
d. Maple Syrup Urine Disease
e.  Phenylketonuria
f. Tyrosinemia Type I
Rhode Island Code of Regulations › Title 216 - Department of health › Chapter 20 - Community Health › Subchapter 05 - Maternal and Child Health › Part 1 - Newborn Genetic, Metabolic, Endocrine, and Hemoglobinopathy Screening Program and Newborn Hearing Loss Screening Program › Section 216-RICR-20-05-1.4 - Testing for Hearing Loss

Current through June 14, 2024
Pursuant to R.I. Gen. Laws §
										23-13-13,
					 the physician and/or midwife attending a newborn child shall cause said child
					 to be subject to newborn testing for hearing loss in accordance with procedures
					 approved by the Department. Notwithstanding the foregoing, if parents of a
					 newborn child object to the newborn testing for hearing loss on the grounds
					 that such testing conflicts with their religious tenets and practices, such
					 testing shall not be performed, in accordance with R.I. Gen. Laws §
										23-13-13.
Rhode Island Code of Regulations › Title 216 - Department of health › Chapter 20 - Community Health › Subchapter 05 - Maternal and Child Health › Part 1 - Newborn Genetic, Metabolic, Endocrine, and Hemoglobinopathy Screening Program and Newborn Hearing Loss Screening Program › Section 216-RICR-20-05-1.5 - Fees

Current through June 14, 2024
The fee for the newborn screening (per newborn) and the
					 coordination fee for testing for hearing loss in newborns (per newborn) shall
					 be as set forth in the Fee Structure for Licensing, Laboratory and
					 Administrative Services Provided by the Department of Health (Part 10-05-2 of
					 this Title). These fees shall be adjusted annually to cover the cost of
					 inflation using the Medicare Economic Index (MEI).
Rhode Island Code of Regulations › Title 216 - Department of health › Chapter 20 - Community Health › Subchapter 05 - Maternal and Child Health › Part 1 - Newborn Genetic, Metabolic, Endocrine, and Hemoglobinopathy Screening Program and Newborn Hearing Loss Screening Program › Section 216-RICR-20-05-1.6 - Designation of the Newborn Screening Program as a Covered Benefit

Current through June 14, 2024
A. The newborn screenings and testing for
				  hearing loss shall be a covered benefit reimbursable by all health insurers, as
				  defined in R.I. Gen. Laws §
										27-38.2-2(4),
				  providing health insurance coverage in Rhode Island except for supplemental
				  policies which only provide coverage for specific diseases, hospital indemnity,
				  Medicare supplement or other supplemental policies.
B. When the patient is eligible for Medical
				  Assistance under the provisions of R.I. G en. Laws Chapter 40-8, Medical
				  Assistance, or R.I. Gen. Laws Chapter 42-12.3, Health Care for Children and
				  Pregnant Women, the cost of the newborn screenings and testing for hearing loss
				  shall be paid in accordance with R.I. Gen. Laws §
										23-13-14(b).
C. In the absence of a third-party payor, or
				  in the absence of insurance information sufficient for billing and collection,
				  the cost for the newborn screenings and testing for hearing loss shall be paid
				  by the hospital or other health care facility where the birth occurred, or, in
				  the event the birth occurred in a location other than a health care facility,
				  by the physician or midwife attending the newborn.
D. Any health care provider compensated for
				  the newborn screenings and testing for hearing loss shall reimburse the
				  Department for such newborn screenings and testing for hearing loss in
				  accordance with Part 10-05-2 of this Title.
Rhode Island Code of Regulations › Title 216 - Department of health › Chapter 20 - Community Health › Subchapter 05 - Maternal and Child Health › Part 2 - Comprehensive Family Planning Program (216-RICR-20-05-2) › Section 216-RICR-20-05-2.1 - Authority

Current through June 14, 2024
These rules are promulgated pursuant to R.I. Gen. Laws
					 §
										23-13-21,
					 Pub. L. 91-572, and
					  42 U.S.C. §
											300  and are established for the
					 purpose of adopting requirements for the implementation of the Family Planning
					 Program, which is designed to provide comprehensive services, including patient
					 education, medical services, and access to safe and effective methods of
					 contraception to Rhode Island citizens who have no health insurance and whose
					 family income is between 100 and 185 percent of the federal poverty
					 level.
Rhode Island Code of Regulations › Title 216 - Department of health › Chapter 20 - Community Health › Subchapter 05 - Maternal and Child Health › Part 2 - Comprehensive Family Planning Program (216-RICR-20-05-2) › Section 216-RICR-20-05-2.2 - Incorporated Materials

Current through June 14, 2024
These regulations hereby adopt and incorporate the HHS
					 Office of Population Affairs, Title X: Family Planning,  42 C.F.R. part 59, subpart A (2014) by reference, not including any further editions or amendments
					 thereof and only to the extent that the provisions therein are not inconsistent
					 with these regulations.
https://www.hhs.gov/opa/sites/default/files/ogc-cleared-final-april.pdf
Rhode Island Code of Regulations › Title 216 - Department of health › Chapter 20 - Community Health › Subchapter 05 - Maternal and Child Health › Part 2 - Comprehensive Family Planning Program (216-RICR-20-05-2) › Section 216-RICR-20-05-2.3 - Definitions

Current through June 14, 2024
A. Wherever used in these rules and
				  regulations, the following terms shall be construed as follows:
1. "Act" means the R.I. Gen. Laws Chapter
				  23-13, entitled "Maternal and Child Health/Services for Children with Special
				  Health Care Needs.
2. "Covered
				  Services" means the services provided through the Family Planning Program
				  pursuant to statutory provisions of the Act.
3. "Department" means the Rhode Island
				  Department of Health.
4. "Director"
				  means the Director of the Rhode Island Department of Health.
5. "Family Planning Program" means the
				  educational, counseling, and comprehensive medical and contraceptive services
				  provided pursuant to R.I. Gen. Laws §
											23-13-21.
6. "Income" means the gross annual income of
				  the applicant, and of the applicant's spouse provided they are married and
				  living in the same household.
7.
				  "Person" means an individual, trust or estate, partnership, corporation
				  (including associations, joint stock companies) state or political subdivision
				  or instrumentation of a state.
8.
				  "Provider" means those persons participating in the Family Planning Program for
				  the provision of covered services.
Rhode Island Code of Regulations › Title 216 - Department of health › Chapter 20 - Community Health › Subchapter 05 - Maternal and Child Health › Part 2 - Comprehensive Family Planning Program (216-RICR-20-05-2) › Section 216-RICR-20-05-2.4 - General Requirements and Administrative Procedures

Current through June 14, 2024
2.4.1
General Requirements
A. Recipients of Services:
1. In order for a person to be eligible for
				  Family Planning Program services, he/she must meet the eligibility requirements
				  set forth in R.I. Gen. Laws §
												23-13-21.
Rhode Island Code of Regulations › Title 216 - Department of health › Chapter 20 - Community Health › Subchapter 05 - Maternal and Child Health › Part 2 - Comprehensive Family Planning Program (216-RICR-20-05-2) › Section 216-RICR-20-05-2.5 - Denial or Termination of Services

Current through June 14, 2024
A. The Director
				  is authorized to deny participation of a recipient and/or provider, to
				  terminate client and/or provider of services or deny payment for a service for
				  the following reasons:
1. Failure of the
				  applicant to meet the eligibility requirements of the Family Planning
				  Program;
2. Failure of the provider
				  to comply with the terms of the agreement;
3. Failure to comply with the statutory and
				  regulatory provisions of this Part; and
Rhode Island Code of Regulations › Title 216 - Department of health › Chapter 20 - Community Health › Subchapter 05 - Maternal and Child Health › Part 2 - Comprehensive Family Planning Program (216-RICR-20-05-2) › Section 216-RICR-20-05-2.6 - Rules Governing Hearings and Reviews

Current through June 14, 2024
All hearings and reviews required under the provisions of
					 R.I. Gen. Laws Chapter 23-13, shall be held in accordance with the provisions
					 of the rules and regulations regarding the Practices and Procedures Before the
					 Rhode Island Department of Health (216-RICR- 10-05-4).
Rhode Island Code of Regulations › Title 216 - Department of health › Chapter 20 - Community Health › Subchapter 05 - Maternal and Child Health › Part 3 - WIC Program (216-RICR-20-05-3) › Section 216-RICR-20-05-3.1 - Authority

Current through June 14, 2024
These Regulations pertaining to the WIC Program are
					 promulgated pursuant to R.I. Gen. Laws §
										23-13-17.
					 Pursuant to R.I. Gen. Laws §
										23-13-17,
					 these regulations shall be administered in a manner consistent with
					  42 U.S.C. §
											1786.
Rhode Island Code of Regulations › Title 216 - Department of health › Chapter 20 - Community Health › Subchapter 05 - Maternal and Child Health › Part 3 - WIC Program (216-RICR-20-05-3) › Section 216-RICR-20-05-3.2 - Incorporated Materials

Current through June 14, 2024
A. These
				  regulations hereby adopt and incorporate  7 C.F.R. §
											246  (2016) by
				  reference (https://www.fns.usda.gov/sites/default/files/wic/WICRegulations-
				   7CFR 246.pdf), not including any further editions or amendments thereof and
				  only to the extent that the provisions therein are not inconsistent with these
				  regulations.
B. These regulations
				  hereby adopt and incorporate Department of Agriculture; Special Supplemental
				  Nutrition Program for Women, Infants, and Children (WIC): 2016/2017 Income
				  Eligibility Guidelines, 81 Fed. Reg. 14826 (March 18, 2016) (
https://www.gpo.gov/fdsys/pkg/FR-2016-03-18/pdf/2016-06222.pdf
)
				  by reference, not including any further editions or amendments thereof and only
				  to the extent that the provisions therein are not inconsistent with these
				  regulations.
Rhode Island Code of Regulations › Title 216 - Department of health › Chapter 20 - Community Health › Subchapter 05 - Maternal and Child Health › Part 3 - WIC Program (216-RICR-20-05-3) › Section 216-RICR-20-05-3.4 - Application of Eligibility and Determination

Current through June 14, 2024
A. WIC
				  applicant income screening will be determined by USDA WIC Income Poverty
				  Guidelines, incorporated above at §
										3.2(A)   of
				  this Part. WIC participants must be either eligible under the USDA WIC Income
				  Poverty Guidelines or be adjunctively eligible.
B. All WIC applicants must sign an applicant
				  agreement form that gives the WIC Program permission for coordination of
				  services, describes rights and responsibilities of both the client and the
				  program and indicates agreement that the information provided is
				  accurate.
C. To be eligible to
				  receive available benefits of the WIC Program, a person must be:
1. A resident of the State of Rhode Island;
				  and
2. A pregnant, breastfeeding or
				  postpartum woman; an infant; or a child up to his/her fifth birthday;
				  and
3. A member of a household with
				  an income at or less than 185 percent of the poverty level guideline or be
				  adjunctively eligible (based on enrollment in SNAP, Medicaid, TANF, Katie
				  Beckett); and
4. Be at nutritional
				  risk.
Rhode Island Code of Regulations › Title 216 - Department of health › Chapter 20 - Community Health › Subchapter 05 - Maternal and Child Health › Part 3 - WIC Program (216-RICR-20-05-3) › Section 216-RICR-20-05-3.5 - Management Evaluations and Monitoring Reviews

Current through June 14, 2024
A.
				  Upon being contacted by the state agency, the local agency administrator and
				  local WIC staff will mutually establish the time with the state staff for the
				  team to conduct an on-site review.
B. Local agency staff members must be
				  available to participate in discussions with the review team, to provide
				  observation of local agency procedures and review of local agency records, and
				  to arrange participant interviews. Local agency staff members must be available
				  to assist the review as required. All local WIC records must be made available
				  as requested by the review team.
C.
				  Local agency staff must respond to the process in a constructive, objective,
				  and professional manner that will result in conclusions that are useful to the
				  local agency. State and local staff must identify local agency needs and
				  deficiencies, and feasible corrections and improvements.
D. Any deficiencies corrected prior to the
				  completion of the review must be brought to the attention of state review
				  staff.
E. At the completion of the
				  local agency review, a local agency administrator, above the level of the WIC
				  Program Coordinator, and other staff at the administrator's discretion must
				  meet with the review team in an exit conference, to discuss a verbal summary of
				  findings and recommendations.
F.
				  Upon receipt of the written formal statement of review findings and
				  recommendations by the WIC state agency, the local agency staff must review the
				  findings and formulate the plan of correction.
G. Within thirty days of the receipt of the
				  letter of the review findings, the local agency must submit to the state agency
				  a written response to the findings, including plans of corrections and
				  projected dates of implementation (and dates of corrections that have already
				  been made).
H. The plan of
				  correction must be signed by the Executive Director, or other management level
				  administrator acceptable to the RIDOH, to assure administrative review of WIC
				  Program operations and agency commitment to the plan.
I. The state agency will accept the plan of
				  correction or notify the local agency of needed revisions.
J. The local agency shall implement the plan
				  of corrections according to the stated timetable. If it is unable to do so, the
				  local agency must notify the state agency and submit a revised plan of
				  corrections acceptable to the state agency.
K. If the state agency determines that an
				  acceptable plan of correction is not submitted within thirty days, or if
				  corrective action is not completed according to the schedule established in the
				  corrective action plan, the state agency may withhold administrative and
				  program services funds through a reduction in the local agency funds
				  allocation.
Rhode Island Code of Regulations › Title 216 - Department of health › Chapter 20 - Community Health › Subchapter 05 - Maternal and Child Health › Part 3 - WIC Program (216-RICR-20-05-3) › Section 216-RICR-20-05-3.6 - Program Abuse and Participant Sanctions

Current through June 14, 2024
A.
				  Abuse
1. Dual/Multiple Participation
a. Whether discovered through participation
				  reports or other sources, once dual participation is verified, the State Agency
				  shall not issue checks.
b. The
				  local agency with which the participant has the next scheduled appointment or
				  check pickup shall:
(1) Discuss dual
				  participation with client; and
(2)
				  Inform client that dual participation is not allowed; and
(3) Have client determine which agency he/she
				  prefers; and
(4) Retrieve the WIC
				  ID folder of other agency and send it to the Rhode Island Department of Health
				  WIC Office; and
(5) Determine with
				  the state agency whether checks should be issued. The dual benefits received
				  should, in most cases, be applied towards the current or next month;
				  and
(6) Notify in writing the state
				  agency as to local agency preference, and steps that have been taken;
				  and
(7) Terminate the client from
				  one agency.
c. The
				  circumstances of the dual participation will be reviewed by a state supervisor
				  and local agency liaison and the local agency. This review must include a
				  determination as to whether the child participants have been receiving the
				  supplemental foods.
d. The state
				  and local agency shall then determine the severity of the violation, procedures
				  to be followed, and sanctions, if any, to be imposed.
e. If the client refuses reduction of service
				  to one local agency only or persistently denies dual participation, in the face
				  of conclusive evidence or there is evidence of deliberate dual participation, a
				  supervisor at the state agency and the WIC coordinator at the local agencies
				  involved must review the case for disqualification from the WIC Program.
Rhode Island Code of Regulations › Title 216 - Department of health › Chapter 20 - Community Health › Subchapter 05 - Maternal and Child Health › Part 3 - WIC Program (216-RICR-20-05-3) › Section 216-RICR-20-05-3.7 - Confidentiality

Current through June 14, 2024
A. Limitations on Disclosure
1. Each agency shall restrict the disclosure
				  of information obtained from WIC Program applicants or participants to:
a. Persons directly connected with the
				  administration or enforcement of the Program; or
b. Those public health or helping
				  organizations listed on the Client Agreement which the state agency has
				  designated for purposes of establishing eligibility; or
c. Other programs or services which may be of
				  help to the participants.
(1) Any person
				  seeking permission to inspect WIC records shall provide his/her identity and
				  shall state his/her reasons for making such a request.
(2) A client's confidential health care
				  information shall not be released or transferred without the written consent of
				  such client or his authorized representative, on a consent form meeting
				  designated requirements.
(3)
				  Consent forms for the release or transfer of confidential health care
				  information shall contain the following information:
(AA) A statement of the need for and proposed
				  uses of such information.
(BB) A
				  statement that all information is to be released or clearly indicating the
				  extent of the information to be released.
(CC) A statement that such information will
				  not be given, sold, transferred or in any way relayed to any other person not
				  specified in the consent form or notice without first obtaining the
				  individual's additional written consent on a form stating the need for the
				  proposed new use of such information or the need for its transfer.
(DD) A statement that the consent for release
				  or transfer of information may be withdrawn at any future time.
Rhode Island Code of Regulations › Title 216 - Department of health › Chapter 20 - Community Health › Subchapter 05 - Maternal and Child Health › Part 3 - WIC Program (216-RICR-20-05-3) › Section 216-RICR-20-05-3.8 - WIC Vendor Systems

Current through June 14, 2024
A. Threshold
				  requirements:
1. An application will only be
				  issued to a grocery or pharmacy owner, partner or corporate officer which
				  satisfies the requirements of these regulations.
2. Mobile stores and home Vendor companies
				  are not eligible to be WIC Vendors.
Rhode Island Code of Regulations › Title 216 - Department of health › Chapter 20 - Community Health › Subchapter 05 - Maternal and Child Health › Part 3 - WIC Program (216-RICR-20-05-3) › Section 216-RICR-20-05-3.9 - Program Expenditures

Current through June 14, 2024
A. The following
				  are acceptable program expenditures for local agencies:
1. In addition to the cost of nutrition
				  education requirements, breastfeeding education and support must be calculated:
a. During each fiscal year, the local agency
				  shall use a minimum amount of 20% of the local agency's NSA expenditures for
				  nutrition education and Breastfeeding Promotion. The local agency shall
				  document the full amount of total NSA expenditures attributable to nutrition
				  education and breastfeeding, including grant funds and other funds or values in
				  its final closeout report for each fiscal year. If the local agency's reported
				  nutrition education expenditures are less than the amount required to be spent,
				  RIDOH may issue a claim for the difference. The local agency may request prior
				  written permission from RIDOH to spend less than the required amounts for
				  nutrition education and breastfeeding promotion and support if the local agency
				  can document that a total of funds from other sources and WIC Program funds
				  will be expended at amounts equal to the required amount. Nutrition education
				  costs are limited to activities which are distinct and separate efforts to help
				  clients understand the importance of nutrition and breastfeeding promotion and
				  support to health.
Rhode Island Code of Regulations › Title 216 - Department of health › Chapter 20 - Community Health › Subchapter 05 - Maternal and Child Health › Part 3 - WIC Program (216-RICR-20-05-3) › Section 216-RICR-20-05-3.10 - Claims and Penalties

Current through June 14, 2024
A. If the state
				  agency determines through a review of the local agency's reports, program or
				  financial analysis, monitoring, audit, or otherwise that any WIC Program funds
				  provided to a local agency for supplemental foods or administrative and program
				  services purposes were, through local agency negligence or fraud, misused or
				  otherwise diverted from the WIC Program purposes, a formal claim will be
				  assessed by state agency against the Local agency. The local agency shall
				  promptly pay the State agency a sum equal to the amount of the administrative
				  and program services funds or the value of supplemental foods or food
				  instruments so misused or diverted.
B. If the state agency determines that any
				  part of the WIC Program funds received by a local agency; or supplemental
				  foods, either purchased or donated commodities; or food instruments were lost
				  as a result of thefts, embezzlements or unexplained causes, the local agency
				  shall, on demand, pay a sum equal to the amount of the money or the value of
				  the supplemental foods or food instruments so lost.
C. The local agency shall have full
				  opportunity to submit evidence, explanation or information concerning alleged
				  instances of noncompliance or diversion before a final determination is made in
				  such cases.
D. Penalties. In
				  accordance with section 12(g) of the National School Lunch Act, whoever
				  embezzles willfully misapplies, steals or obtains by fraud any funds, assets or
				  property provided under Section 17 of the Child Nutrition Act of 1966, as
				  amended, whether received directly or indirectly from USDA, or whoever
				  receives, conceals or retains such funds, assets or property for his or her own
				  interest, knowing such funds, assets or property have been embezzled, willfully
				  misapplies, stolen, or obtained by fraud shall, if such funds, assets or
				  property are of the value of $100 or more, be fined not more than $10,000 or
				  imprisoned not more than five years, or both, or if such funds, assets or
				  property are of a value of less than $100, shall be fined not more than $1,000
				  or imprisoned for not more than one year, or both, incorporated above at
				  §246.23 of this part.
Rhode Island Code of Regulations › Title 216 - Department of health › Chapter 20 - Community Health › Subchapter 05 - Maternal and Child Health › Part 3 - WIC Program (216-RICR-20-05-3) › Section 216-RICR-20-05-3.11 - Fair Hearing Procedures

Current through June 14, 2024
A. Grounds for a
				  Fair Hearing: An individual may request a Fair Hearing to appeal a state or
				  local agency action which results in the individual's denial of participation,
				  disqualification or termination from the Program, or the attempted recovery of
				  the cash value of benefits issued to such individual.
B. Local Agency Responsibilities:
1. Inform each WIC applicant of his/her right
				  to a Fair Hearing during the initial contact with the local agency.
2. Assure an applicant (or client), against
				  whom sanctions have been imposed, of unrestricted freedom to request a Fair
				  Hearing.
3. Offer assistance to
				  help the applicant prepare and submit the Fair Hearing Request.
4. Inform the applicant that he/she may
				  request copies of any documents in his/her WIC record, in advance of the Fair
				  Hearing.
5. Inform each applicant
				  (or client), against whom sanctions have been imposed, in writing, at the time
				  the sanction is imposed, of the reason for the sanction, the right to a Fair
				  Hearing, and how to request a Fair Hearing. This written information is
				  contained in a separate form, "Fair Hearing Information," given to participants
				  at the time of initial certification and at the time of denial, termination
				  from the Program or other sanction.