reglab/statecodes huggingface dataset:
Rhode Island Code of Regulations › Title 218 - Department of Human Services › Chapter 40 - Division of Elderly Affairs › Subchapter 00 - N/A › Part 1 - Rules and Regulations Governing the Long Term Care Ombudsperson Program (218-RICR-40-00-1) › Section 218-RICR-40-00-1.5 - Confidentiality, Retaliation, Immunity, Inspections, and Penalties

Current through June 14, 2024
1.5.1
Access
A. In the course of an investigation, the
				  ombudsperson shall, personally or through designated employees of the Office:
1. Make the necessary inquiries and obtain
				  information as is deemed necessary;
2. Have access to facilities and residents;
				  and
3. Enter facilities and, after
				  notifying the individual in charge, inspect any books, files, medical records,
				  or other records that pertain to the resident, subject to the following
				  requirements.
a. access to review the medical
				  and social records of a resident shall be provided, if-
(1) the representative has the permission of
				  the resident, or the legal representative of the resident; or
(2) the resident is unable to consent to the
				  review and has no legal representative;
b. access to the records as is necessary to
				  investigate a complaint shall be provided if-
(1) a legal guardian of the resident refuses
				  to give the permission;
(2) a
				  representative of the Office has reasonable cause to believe that the guardian
				  is not acting in the best interests of the resident; and
(3) the representative obtains the approval
				  of the Ombudsperson;
c.
				  access shall be provided to the administrative records, policies, and
				  documents, to which the residents have, or the general public has access, of
				  long term care facilities; and
d.
				  access to and, on request, copies of all licensing and certification records
				  maintained by the State with respect to long term care facilities.
Rhode Island Code of Regulations › Title 218 - Department of Human Services › Chapter 40 - Division of Elderly Affairs › Subchapter 00 - N/A › Part 1 - Rules and Regulations Governing the Long Term Care Ombudsperson Program (218-RICR-40-00-1) › Section 218-RICR-40-00-1.6 - Termination, Appeal Procedures and Severability

Current through June 14, 2024
1.6.1
Procedures for Appeal
Any complainant who is aggrieved by the decision of the
					 Division after a hearing may appeal the decision to the Executive Office of
					 Health and Human Services, as outlined under "Medicaid Code of Administrative
					 Rules, Section #0110, 'Complaints and Appeals'".
1.6.2
Complaints Regarding the
				  Ombudsperson Program; Termination of Ombudsman Program
A. All complaints concerning the Office shall
				  be sent in writing to the Director of the Division. The director may request
				  additional information relating to the specifics of the complaint. The Director
				  shall exercise reasonable discretion in addressing each complaint.
B. Termination:
1. In the event that the ombudsperson or the
				  Office fails to comply with the provisions of these Regulations in whole or in
				  part, the Division may, after specifying any alleged breach, default, or
				  non-compliance in writing to the Ombudsperson and after allowing a reasonable
				  time, but not less than fifteen (15) calendar days for correction thereof,
				  withdraw the ombudsperson program from the agency where the Office is situated
				  by sending written notice of termination which specifies the reasons for
				  termination to the agency, at least fifteen (15) calendar days prior to the
				  effective date of termination.
2.
				  Notwithstanding the provisions governing appeals set forth in §1.6.1 of
				  this Part and elsewhere in §1.6.2 of this Part, if the Division determines
				  that any action or omission on the part of the Office endangers life, health,
				  and safety of residents or staff of any facility, it shall withdraw the
				  ombudsperson program from the agency where the Office is situated by orally
				  notifying the agency of termination followed by the mailing of written
				  notification, return receipt requested, within seven (7) calendar days
				  following the oral notification, setting forth the reasons for termination.
a. Termination pursuant to this subsection
				  shall take effect upon the oral notification.
b. The Division shall forward with such
				  written notification a notice that the terminated program shall have the right
				  to request an appeal of such action to the Division's hearing office pursuant
				  to §1.6.1 of this Part.
3. Upon withdrawal of the ombudsperson
				  program from an agency by the Division, the Division likewise shall terminate
				  the funding status of such ombudsperson program for the balance of the funding
				  period.
4. Except as otherwise set
				  forth herein, the ombudsperson program shall continue at the agency during the
				  pendency of the appeal, subject to an adverse decision pursuant to the
				  appeal.
Rhode Island Code of Regulations › Title 218 - Department of Human Services › Chapter 40 - Division of Elderly Affairs › Subchapter 00 - N/A › Part 2 - Rules, Regulations, and Standards Governing the Pharmaceutical Assistance to the Elderly Program (218-RICR-40-00-2) › Section 218-RICR-40-00-2.2 - Definitions

Current through June 14, 2024
2.2.1
Definitions
A. For the purpose of these rules and
				  regulations, the following terms shall be construed as follows:
1. "The Act" means R.I. Gen. Laws Chapter
				  42-66.2, as amended.
2. "Additional
				  drugs" means those drugs as defined in R.I. Gen. Laws §
												42-66.2-3,
				  as amended.
3. "Approved
				  documentation" means and includes a current explanation of benefits (EOB)
				  statement from a Medicare prescription drug plan (Part D) and a statement of
				  current year- to-date pharmacy medication expenses from a participating
				  pharmacy.
4. "Consumer" means any
				  full-time resident of the State of Rhode Island who fulfills the eligibility
				  requirements set forth in the R.I. Gen. Laws §44-66.2-3 and §2.3.3 of
				  this Part herein.
5. "Contractor"
				  means a third party or private vendor as defined in R.I. Gen. Laws §
												42-66.2-3,
				  as amended.
6. "Coverage gap" means
				  the out-of-pocket expenses for medications between the point where an eligible
				  person exceeds the Medicare Part D coverage limit under §1860D-2(b)(3) (42 U.S.C. §
													1395w-114a) of the Patient Protection and
				  Affordable Care Act and below the catastrophic amount specified in
				  §1860D2(b)(4)(B) of the Patient Protection and Affordable Care Act for the
				  year.
7. "Delegate agency" means
				  any local community-based agency with which the Division negotiates a contract
				  for assistance with the implementation of the RIPAE Program.
8. "Department" means the Department of Human
				  Services.
9. "Director" means the
				  Director of the Division of Elderly Affairs
10. "Division" means the Department of Human
				  Services, Division of Elderly Affairs.
11. "Eligible drugs" is defined in R.I. Gen.
				  Laws §
												42-66.2-3,
				  as amended.
12. "Full-time
				  resident" shall be determined consistent with the residency requirements set
				  forth in R.I. Gen. Laws §
												17-1-3.1,
				  as amended, entitled, "Residence for Voting Purposes".
13. "Income" means the sum of federal
				  adjusted gross income as defined in the R.I. Gen. Laws §
												42-66.2-3,
				  as amended.
14. "Participating
				  pharmacy" means any licensed pharmacy which has a written agreement with the
				  contractor agreeing to the conditions and requirements of participation in the
				  RIPAE Program.
15. "Pharmaceutical
				  manufacturer" means any entity as defined in R.I. Gen. Laws §
												42-66.2-3,
				  as amended.
Rhode Island Code of Regulations › Title 218 - Department of Human Services › Chapter 40 - Division of Elderly Affairs › Subchapter 00 - N/A › Part 2 - Rules, Regulations, and Standards Governing the Pharmaceutical Assistance to the Elderly Program (218-RICR-40-00-2) › Section 218-RICR-40-00-2.3 - Program Components

Current through June 14, 2024
2.3.1
Allowances and Restrictions of the Program
A. The RIPAE Program shall include the
				  following criteria:
1. Experimental drugs are
				  excluded from the program.
2. A
				  system of mail order delivery for prescriptions is allowed under the
				  program.
3. Eligible and additional
				  drugs must be dispensed within one (1) year of the original prescription
				  order.
4. Expenditures for multiple
				  sclerosis drugs shall not exceed thirty thousand dollars ($30,000 per fiscal
				  year).
5. Senior citizens
				  participating in the program are required to maintain records of each
				  transaction, as specified by the Director in accordance with R.I. Gen. Laws
				  §
												42-66.2-4(c) 
				  and this Part.
6. Prescription
				  benefits for any single prescription may be dispensed in the amounts authorized
				  by the physician, and agreed to by the consumer, up to a maximum of a 100-day
				  supply or 200 doses, whichever is less; and/or a 100-day supply or one quart of
				  liquid, whichever is less; provided, however, that disposable insulin syringes
				  are dispersed in a quantity of 100.
7. Generic drug substitution is mandatory
				  when there is an available generic drug equivalent.
Rhode Island Code of Regulations › Title 218 - Department of Human Services › Chapter 40 - Division of Elderly Affairs › Subchapter 00 - N/A › Part 2 - Rules, Regulations, and Standards Governing the Pharmaceutical Assistance to the Elderly Program (218-RICR-40-00-2) › Section 218-RICR-40-00-2.4 - Fraud and Abuse

Current through June 14, 2024
2.4.1
Fraud
				  and Abuse
A. The Division shall
				  declare ineligible any consumer who abuses or misuses RIPAE. The Division is
				  empowered to investigate cases of suspected provider or consumer
				  fraud.
B. Delegate agencies and
				  participating pharmacies shall report to the Division any suspected incident of
				  fraud or abuse. Such reports shall be made to the Director or
				  designee.
C. Fraud and abuse shall
				  include but not be limited to:
1.
				  Falsification of information on the application for assistance;
2. Use or attempted use of an eligibility
				  card by an unauthorized individual;
3. Falsification of information by a
				  participating pharmacy;
4. Consumer
				  or provider claims for duplicative benefits;
5. Any violation or attempt to violate the
				  provisions of R.I. Gen. Laws Chapter 42-66.2, as amended or this
				  Part.
D. Individuals
				  attempting fraud or abuse and individuals who aid or abet another in attempting
				  fraud or abuse shall be subject to R.I. Gen. Laws §
											42-66.2-8,
				  as amended.
E. Any provider or
				  consumer found guilty of intentionally violating the provisions of these rules
				  and regulations shall be subject to R.I. Gen. Laws §
											42-66.2-8,
				  as amended.
F. Any provider or
				  consumer who is found guilty under the Act and these regulations shall be
				  subject to R.I. Gen. Laws §
											42-66.2-8,
				  as amended.
Rhode Island Code of Regulations › Title 218 - Department of Human Services › Chapter 40 - Division of Elderly Affairs › Subchapter 00 - N/A › Part 2 - Rules, Regulations, and Standards Governing the Pharmaceutical Assistance to the Elderly Program (218-RICR-40-00-2) › Section 218-RICR-40-00-2.5 - Pharmaceutical Manufacturer Rebates

Current through June 14, 2024
2.5.1
Rebates
Matters regarding rebates from pharmaceutical manufacturers
					 must be in accordance with R.I. Gen. Laws §
											42-66.2-10.
Rhode Island Code of Regulations › Title 218 - Department of Human Services › Chapter 40 - Division of Elderly Affairs › Subchapter 00 - N/A › Part 2 - Rules, Regulations, and Standards Governing the Pharmaceutical Assistance to the Elderly Program (218-RICR-40-00-2) › Section 218-RICR-40-00-2.6 - Severability

Current through June 14, 2024
2.6.1
Severability
If any provision of the rules and regulations herein or the
					 application thereof to any program or circumstances shall be held invalid, such
					 invalidity shall not affect the provision or application of the rules and
					 regulations which can be given effect, and to this end the provisions of the
					 rules and regulations are declared to be severable.
Rhode Island Code of Regulations › Title 218 - Department of Human Services › Chapter 40 - Division of Elderly Affairs › Subchapter 00 - N/A › Part 2 - Rules, Regulations, and Standards Governing the Pharmaceutical Assistance to the Elderly Program (218-RICR-40-00-2) › Section 218-RICR-40-00-2.7 - Appeals Procedure

Current through June 14, 2024
2.7.1
Appeals
				  Procedure
Any person whose application for assistance under the RIPAE
					 Program is denied shall have the right to appeal such a decision. Such appeals
					 shall follow the procedures described under the Executive Office of Health and
					 Human Services, as outlined under "Medicaid Code of Administrative Rules,
					 Section #0110, 'Complaints and Appeals'".
Rhode Island Code of Regulations › Title 218 - Department of Human Services › Chapter 40 - Division of Elderly Affairs › Subchapter 00 - N/A › Part 3 - Rules, Regulations, and Standards Governing Security for Housing for the Elderly (218-RICR-40-00-3) › Section 218-RICR-40-00-3.1 - Introduction

Current through June 14, 2024
3.1.1
Preface
A. These rules and regulations supersede any
				  and all prior rules and regulations governing the security for housing for the
				  elderly promulgated pursuant to R.I. Gen. Laws Chapter 42-66.1. They have been
				  promulgated to provide basic information about the nature of required security
				  systems, personnel and equipment designed to ensure the health, safety and
				  welfare of elderly citizens who are residents of housing for the elderly in
				  Rhode Island.
1. Pursuant to the provisions of
				  the Administrative Procedures Act, R.I. Gen. Laws §
												42-35-3,
				  the following were given consideration in arriving at the regulations:
a. alternative approaches to the regulations;
				  and
b. duplication or overlap with
				  other state regulations. No alternative approach, duplication, or overlap was
				  identified.
Rhode Island Code of Regulations › Title 218 - Department of Human Services › Chapter 40 - Division of Elderly Affairs › Subchapter 00 - N/A › Part 3 - Rules, Regulations, and Standards Governing Security for Housing for the Elderly (218-RICR-40-00-3) › Section 218-RICR-40-00-3.2 - Definitions and General Requirements

Current through June 14, 2024
3.2.1
Definitions
A. Whenever used in
				  these rules and regulations, the following terms shall be construed as follows:
1. "Division" means the Rhode Island Division
				  of Elderly Affairs, within the Department of Human Services.
2. "Director" means the Director of the
				  Division of Elderly Affairs or her/his designee.
3. "Housing complex" means the residential
				  building or buildings, areas designated for use by residents, and grounds
				  leading to and from the building(s) and/or designated areas.
4. "Housing for the elderly" means private or
				  public housing complexes designated by the federal government as housing for
				  the elderly located in the State of Rhode Island.
5. "Management" means the representatives of
				  an agency or organization, local government, or a private or nonprofit company
				  who have full and exclusive legal authority for the owner or governing
				  body.
6. "Periodic and ongoing
				  resident security education program" means that at least once per quarter
				  information on security concerns will be supplied by management to all tenants
				  in one or more of the following methods: posters, pamphlets, brochures, and
				  face-to-face formal presentations.
7. "Private housing complex" means housing
				  for the elderly not owned and operated by the local public housing
				  authority.
8. "Public housing
				  complex" means housing for the elderly owned and operated by the local housing
				  authority.
9. "Safety and security
				  plan" means a building plan that addresses the safety and security needs of
				  residents.
10. "Security equipment"
				  means any mechanical/electrical security devices and/or physical improvements
				  to the building or grounds that would contribute to the overall security and
				  safety of the elderly housing complex.
11. "Security personnel" means any personnel
				  providing security services at the housing for the elderly complex.
Rhode Island Code of Regulations › Title 218 - Department of Human Services › Chapter 40 - Division of Elderly Affairs › Subchapter 00 - N/A › Part 3 - Rules, Regulations, and Standards Governing Security for Housing for the Elderly (218-RICR-40-00-3) › Section 218-RICR-40-00-3.4 - Safety and Security Plan

Current through June 14, 2024
3.4.1
Crime
Management is responsible for being familiar with the level
					 of criminal activity in the vicinity of the complex and for acting accordingly
					 with respect to security, in light of such criminal activity. The Division
					 strongly recommends the use of security guards. Any complex that chooses to
					 hire security guards must be in compliance with §3.4.2 of this
					 Part.
3.4.2
Requirements for Security Guards
A. Security guards in elderly housing must
				  meet the requirements of this Subchapter. The security guard schedule shall be
				  determined by housing management, subject to reasonable review and approval by
				  the Division.
1. Minimum Standards for
				  Employment of Security Guards in Elderly Housing. Security guards must meet
				  certain minimum standards for employment to be suitable for work in elderly
				  residences:
a. Housing directors or managers
				  of housing for the elderly sites which have been determined to require security
				  guards shall be responsible for ensuring that the security guards who work at
				  their sites have completed training before they begin work at the
				  site;
b. Personal interview,
				  and;
c. Background screening to
				  include:
(1) Bureau of Criminal
				  Identification (mandatory);
(2)
				  Personal references, if possible;
(3) Former employer's references, if
				  possible.
d. Failure to
				  perform satisfactorily on any of the required examinations may result in
				  disqualification from employment.
Rhode Island Code of Regulations › Title 218 - Department of Human Services › Chapter 40 - Division of Elderly Affairs › Subchapter 00 - N/A › Part 3 - Rules, Regulations, and Standards Governing Security for Housing for the Elderly (218-RICR-40-00-3) › Section 218-RICR-40-00-3.5 - Appeals Procedures and Assessment of Penalties

Current through June 14, 2024
3.5.1
Appeals Procedures
A. If the Division determines a housing
				  complex is in violation of these regulations, the Division will give written
				  notice of same to the management of the housing complex.
B. Management will be allowed twenty (20)
				  working days to remedy the problem which has been identified. A shorter time
				  period or an immediate response may be required if there is a failure to meet a
				  requirement which places the residents in the building(s) at risk. A longer
				  time period to resolve the problem also may be permitted, at the Division's
				  discretion.
Rhode Island Code of Regulations › Title 218 - Department of Human Services › Chapter 40 - Division of Elderly Affairs › Subchapter 00 - N/A › Part 4 - Rules, Regulations and Standards Governing the Home and Community Care Services to the Elderly Program (218-RICR-40-00-4) › Section 218-RICR-40-00-4.1 - Introduction

Current through June 14, 2024
4.1.1
Preface
A. These Rules, Regulations and standards
				  supersede any and all prior Rules, Regulations, and standards relating to the
				  creation and provision of home and community care services to the elderly
				  promulgated pursuant to R.I. Gen Laws §
											42-66.3-1
et. seq
. They have been promulgated to ensure that basic
				  information about the nature of available services, eligibility to receive
				  these services, and the role and composition of the Home and Community Care
				  Advisory Committee is readily available to qualified service recipients and
				  their families.
B. Pursuant to the
				  provisions of the Administrative Procedures Act, R.I. Gen. Laws §
											42-35-3,
				  the following were given consideration in arriving at the Regulations:
1. Alternative approaches to the Regulations;
				  and
2. Duplication or overlap with
				  other State Regulations.
3. No
				  alternative approach was identified; nor any duplication or overlap.
Rhode Island Code of Regulations › Title 218 - Department of Human Services › Chapter 40 - Division of Elderly Affairs › Subchapter 00 - N/A › Part 4 - Rules, Regulations and Standards Governing the Home and Community Care Services to the Elderly Program (218-RICR-40-00-4) › Section 218-RICR-40-00-4.2 - Purpose and Services Available

Current through June 14, 2024
4.2.1
Purpose
The purpose of the Program is to provide eligible
					 individuals innovative options to help them remain in the community and avoid
					 premature institutionalization.
4.2.2
Services Available
A. The Program shall consist of:
1. Medicaid home and community based services
				  for Medicaid eligible clients; or
2. At Home Cost-Share program consists of
				  case management, a combination of homemaker/personal care services, adult day
				  care services and other support services deemed necessary by the
				  Director.
Rhode Island Code of Regulations › Title 218 - Department of Human Services › Chapter 40 - Division of Elderly Affairs › Subchapter 00 - N/A › Part 4 - Rules, Regulations and Standards Governing the Home and Community Care Services to the Elderly Program (218-RICR-40-00-4) › Section 218-RICR-40-00-4.3 - Client Eligibility and Financial Participation by Clients

Current through June 14, 2024
4.3.1
Medicaid Home and Community Based
				  Services
A. To be eligible for the
				  Program, the client must be determined, through a functional assessment, to
				  need assistance with activities of daily living and/or to meet an institutional
				  level of care and must meet the following criteria:
1. Medicaid eligible residents of the State
				  who are age sixty-five (65) or older; and
2. Eligible for the Rhode Island Medicaid
				  Program as determined by the Department of Human Services. Applicants must also
				  be assessed and determined to be in need of the assistance provided by the
				  Program.
Rhode Island Code of Regulations › Title 218 - Department of Human Services › Chapter 40 - Division of Elderly Affairs › Subchapter 00 - N/A › Part 4 - Rules, Regulations and Standards Governing the Home and Community Care Services to the Elderly Program (218-RICR-40-00-4) › Section 218-RICR-40-00-4.4 - Program Eligibility and Duration of Eligibility

Current through June 14, 2024
4.4.1
Program Eligibility
A. The Office and its contracted case
				  management agencies shall utilize the Office approved assessment form described
				  in Rules, Regulations, and Standards for Certification of Case Management
				  Agencies, Part 5 of this Subchapter. This form shall include, but shall not be
				  limited to:
1. Pertinent demographic
				  information;
2.
				  Residence;
3. Date of
				  birth;
4. Marital status;
5. Annual income for the previous calendar
				  year, including amount and source of income (such income must be supplied for
				  applicant and spouse when applicant is married);
6. Information on participation in other home
				  and community-based programs;
7.
				  Social security number;
8. All
				  other data essential for the determination of eligibility and the maintenance
				  of client statistics;
9.
				  Certification through signature of the applicant that permission is granted to
				  the Office to verify any and all information supplied on the application form
				  as well as certification through signature that the applicant will supply to
				  the Office, upon request, written documentation of all information included on
				  the application form.
Rhode Island Code of Regulations › Title 218 - Department of Human Services › Chapter 40 - Division of Elderly Affairs › Subchapter 00 - N/A › Part 4 - Rules, Regulations and Standards Governing the Home and Community Care Services to the Elderly Program (218-RICR-40-00-4) › Section 218-RICR-40-00-4.5 - Appeal Procedures

Current through June 14, 2024
4.5.1
Appeal
				  Procedures
Any person whose application for assistance is denied or
					 whose request for an increase in assistance is denied shall have the right to
					 appeal such a decision. Such appeals shall follow the procedures described in
					 210-RICR- 10-05-2, Appeals Process and Procedures for EOHHS Agencies and
					 Programs.
Rhode Island Code of Regulations › Title 218 - Department of Human Services › Chapter 40 - Division of Elderly Affairs › Subchapter 00 - N/A › Part 4 - Rules, Regulations and Standards Governing the Home and Community Care Services to the Elderly Program (218-RICR-40-00-4) › Section 218-RICR-40-00-4.6 - Advisory Committee

Current through June 14, 2024
4.6.1
Advisory Committee
A. A permanent
				  State committee to be known as the Home and Community Care Services Advisory
				  Committee is established according to R.I. Gen. Laws §
											42-66.3-8.
1. The Committee shall meet quarterly, or
				  more frequently if deemed necessary by the Director of the Office.
Rhode Island Code of Regulations › Title 218 - Department of Human Services › Chapter 40 - Division of Elderly Affairs › Subchapter 00 - N/A › Part 5 - Rules, Regulations, and Standards for Certification of Case Management Agencies (218-RICR-40-00-5) › Section 218-RICR-40-00-5.1 - General Provisions

Current through June 14, 2024
5.1.1
Preface
A. These standards
				  supersede any and all prior rules, regulations and standards relating to the
				  certification of agencies providing case management services promulgated
				  pursuant to R.I. Gen. Laws §
											42-66.6-4.
				  They have been promulgated to ensure that basic statutory requirements for
				  serving frail elderly and adult disabled clients are met. In order to comply
				  with these rules, regulations and standards, the agency must present sufficient
				  evidence that the overall philosophy, objectives and services are responsive to
				  the needs of those served; that the staff is adequate in number and properly
				  trained to carry out the goals of the program; and that the physical plant
				  meets safety and accessibility standards.
B. The issuance of a certificate requires
				  compliance with these rules, regulations and standards. Under no circumstances
				  does such a certificate commit the Division of Elderly Affairs or the State of
				  Rhode Island to any funding of any program or agency.
C. Pursuant to the provisions of the
				  Administrative Procedures Act, R.I. Gen. Laws §
											42-35-3,
				  the following were given consideration in arriving at the standards:
1. alternative approaches to the
				  standards;
2. duplication or
				  overlap with other state regulations; and
3. significant economic impact.
4. No alternative approach was identified;
				  nor any duplication or overlap. Furthermore, the protection of the health,
				  safety, and welfare of the public necessitates the adoption of the standards
				  despite any economic impact which may be incurred as a result of these
				  standards.
D. All
				  questions arising out of these rules, regulations and standards shall be
				  governed by the laws of the State of Rhode Island.
Rhode Island Code of Regulations › Title 218 - Department of Human Services › Chapter 40 - Division of Elderly Affairs › Subchapter 00 - N/A › Part 5 - Rules, Regulations, and Standards for Certification of Case Management Agencies (218-RICR-40-00-5) › Section 218-RICR-40-00-5.2 - Case Management Mandates

Current through June 14, 2024
5.2.1
Certificate Required
A. Any
				  person, acting alone or jointly with any other person, shall establish, conduct
				  or maintain a case management agency serving the elderly and receiving any
				  state or federal funding to provide case management services in this state must
				  have a certificate in accordance with the requirements of R.I. Gen. Laws
				  §§
											42-66.6-1 through 4 and in conformance with the rules, regulations and standards herein.
B. No agency and/or program shall
				  represent itself as a case management agency serving the elderly and receiving
				  any state or federal funding to provide case management or use the term case
				  management or any other similar term in its title, advertising, publication or
				  other form of communication, unless certified to offer case management services
				  in accordance with the provisions herein.
Rhode Island Code of Regulations › Title 218 - Department of Human Services › Chapter 40 - Division of Elderly Affairs › Subchapter 00 - N/A › Part 5 - Rules, Regulations, and Standards for Certification of Case Management Agencies (218-RICR-40-00-5) › Section 218-RICR-40-00-5.3 - Organization and Administration of Case Management Agencies

Current through June 14, 2024
5.3.1
Organizational Philosophy
A. The agency must demonstrate how key
				  components of consumer centered care/service are incorporated into the agency's
				  organizational philosophy, service program and operations in terms of:
1. The degree and character of
				  consumer/family involvement in program development, implementation and
				  evaluation;
2. The degree and
				  character of consumer/family involvement in care/service planning;
3. The emphasis on consumer centered program
				  outcomes;
4. The extent to which
				  programs are flexible enough to meet special and individual needs;
5. Approaches to assuring consumers/families
				  are encouraged to voice concerns, provide input;
6. Combination of formal programs and
				  informal networks;
Rhode Island Code of Regulations › Title 218 - Department of Human Services › Chapter 40 - Division of Elderly Affairs › Subchapter 00 - N/A › Part 5 - Rules, Regulations, and Standards for Certification of Case Management Agencies (218-RICR-40-00-5) › Section 218-RICR-40-00-5.4 - Service Delivery of Home and Community Care

Current through June 14, 2024
5.4.1
Intake and Assessment
A. The
				  agency must respond by telephone to a request for assessment by the end of the
				  first business day after day of the request.
B. The agency must conduct and document:
1. An initial screening of each potential
				  consumer; and
2. An assessment of
				  each potential consumer to: identify consumer's care/service needs and concerns
				  in physical, cognitive, social, emotional, financial, nutritional,
				  environmental domains; and lead to the development of an individualized plan of
				  care and/or service by the case management agency and to a determination of the
				  required level of care by the Rhode Island Department of Human
				  Services.
C. The agency
				  must utilize the current Division assessment tool(s) and Confidential Release
				  of Information Form(s).
D. The
				  agency must schedule the assessment within the following time lines:
1. Schedule an assessment within five (5)
				  business days;
2. Conduct an
				  assessment within 10 business days.
E. In the event that the agency is unable to
				  meet one of the above time lines in a specific instance, the reasons shall be
				  documented.
Rhode Island Code of Regulations › Title 218 - Department of Human Services › Chapter 40 - Division of Elderly Affairs › Subchapter 00 - N/A › Part 5 - Rules, Regulations, and Standards for Certification of Case Management Agencies (218-RICR-40-00-5) › Section 218-RICR-40-00-5.5 - Service Delivery of Adult Protective Services

Current through June 14, 2024
5.5.1
Intake and Assessment
A. The
				  agency must utilize the current Division assessment tool(s) and Confidential
				  Release of Information Form(s).
B.
				  The agency must schedule the assessment of protective services clients referred
				  by the Division in an unannounced face to face visit within the following time
				  lines:
1. Priority 1 Cases. These cases may
				  be characterized by physical abuse or active neglect, a victim in poor health,
				  an unsafe environment, a perpetrator who is a substance abuser and/or
				  co-resides with the victim, and/or a lack of necessary supports. (Priority 1
				  Cases, at times, may require a same day or within 24 hour response. Priority 1
				  Cases are to be assessed within one to two ( 1-2) business days).
2. Priority 2 Cases. These cases may be
				  characterized by psychological abuse or financial exploitation, a victim of
				  self-neglect in fair health living in a stable environment, a perpetrator who
				  may be a substance abuser and/or may have access to the victim, and/or some
				  necessary supports. (Priority 2 Cases are to be assessed within three to five (
				  3-5) business days).
C.
				  In the event that the agency is unable to meet one of the above time lines in a
				  specific instance, the reasons shall be documented.
D. The agency must demonstrate how it will
				  respond to urgent/crisis requests, including what constitutes a crisis and
				  within what timeframes the agency will respond, schedule an assessment, and
				  perform an assessment.
Rhode Island Code of Regulations › Title 218 - Department of Human Services › Chapter 40 - Division of Elderly Affairs › Subchapter 00 - N/A › Part 5 - Rules, Regulations, and Standards for Certification of Case Management Agencies (218-RICR-40-00-5) › Section 218-RICR-40-00-5.7 - Data Management and Continuous Quality Improvement

Current through June 14, 2024
5.7.1
Collecting and Managing
				  Data
A. The agency must have an
				  information system to collect, analyze, report consumer data, indicators,
				  reports and improvement plans. This information system must be compatible with
				  the Division's client database so that the Division can generate reports
				  directly or via written requests to the agency.
B. The agency must collect measurable
				  indicators identified by the Division:
1.
				  Indicators will be in the following categories: service use, consumer
				  characteristics, unmet needs, gaps, service duplications; and
2. Specific data elements will be specified
				  in the service contract.
C. The agency must gather information in
				  standardized format supplied by the Division and report at intervals specified
				  by the Division.
D. The agency must
				  maintain consumer records that include at least the following:
1. Assessments, care plans, reevaluations,
				  consultations, discharge plans;
2.
				  Release of confidential information documents;
3. Copies of legal documents, such as power
				  of attorney and advance directives;
4. Fees and arrangements for reimbursement
				  and payment; and
5. Identification
				  of and authorization for third party payers.
E. The agency must comply with all current
				  Divisional policies and procedures and with all current state and federal laws
				  and regulations related to confidential consumer information and
				  records.
F. The agency must provide
				  the Division with all evaluation/quality assurance data specified in the
				  contract in the specified format, including but not limited to:
1. Consumer demographics;
2. Units of services provided;
3. Cost data;
4. A sample of care plans for expert
				  review;
5. Information needed to
				  conduct a Division consumer satisfaction survey.
Rhode Island Code of Regulations › Title 218 - Department of Human Services › Chapter 40 - Division of Elderly Affairs › Subchapter 00 - N/A › Part 5 - Rules, Regulations, and Standards for Certification of Case Management Agencies (218-RICR-40-00-5) › Section 218-RICR-40-00-5.8 - Organizational Ethics

Current through June 14, 2024
5.8.1
General
A. The agency must
				  operate free of conflicts of interest.
B. If the agency has a system for
				  reimbursement, bonuses or incentives to staff based on consumer service
				  utilization, the agency must establish and implement policies to ensure that
				  consumer care/service is not compromised.
C. The agency must comply with state
				  procedures for reporting suspected elder abuse and/or neglect to the Division
				  and to other legally mandated agencies and individuals.
Rhode Island Code of Regulations › Title 218 - Department of Human Services › Chapter 40 - Division of Elderly Affairs › Subchapter 00 - N/A › Part 5 - Rules, Regulations, and Standards for Certification of Case Management Agencies (218-RICR-40-00-5) › Section 218-RICR-40-00-5.9 - Variance Procedures, Violations, Sanctions and Severability

Current through June 14, 2024
5.9.1
Variance Procedure
A. The certification rules, regulations and
				  standards for case management programs and agencies are designed so that full
				  compliance is required in order for a certificate to be granted.
1. It is recognized that there will be need
				  from time to time for a program or agency to bypass a specific rule or rules in
				  order to best accomplish its stated philosophy, goals and purpose.
Rhode Island Code of Regulations › Title 218 - Department of Human Services › Chapter 40 - Division of Elderly Affairs › Subchapter 00 - N/A › Part 6 - Rules and Regulations Governing the Prescription Drug Discount Program for the Uninsured (218-RICR-40-00-06) › Section 218-RICR-40-00-6.1 - The Best RX Prescription Drug Program for the Uninsured

Current through June 14, 2024
6.1.1
Legal Provisions
A. Legal Authority
1. The Best RX Prescription Drug Program for
				  the Uninsured is authorized by, and these regulations are promulgated under,
				  the authority of R.I. Gen. Laws §42-66.2.1 -1 et. seq., as amended "Rhode
				  Island Best RX Prescription Drug Discount Program for the Uninsured".
Rhode Island Code of Regulations › Title 218 - Department of Human Services › Chapter 50 - Rehabilitation Services › Subchapter 00 - N/A › Part 1 - Vocational Rehabilitation Program › Section 218-RICR-50-00-1.1 - PURPOSE

Current through June 14, 2024
A. These rules establish the requirements for
				  implementation, based on the Rehabilitation Act of 1973,
				  Pub. L. No.
				  93-112 as amended by the Workforce Innovation and
				  Opportunity Act (WIOA) of 2014,
				  Pub. L. No.
				  113-128 of the Vocational Rehabilitation (VR)
				  Program and the Supported Employment (SE) Program. Under the Department of
				  Human Services (DHS), the Office of Rehabilitation Services (ORS) is
				  responsible for administering this program. These regulations will:
1. define required information for
				  application
2. define eligibility
				  requirements
3. specify scope of
				  services
4. specify standards for
				  continued eligibility
5. specify
				  mediation and appeals process for denial of services/ineligibility
6. specify criteria for case
				  closure
Rhode Island Code of Regulations › Title 218 - Department of Human Services › Chapter 50 - Rehabilitation Services › Subchapter 00 - N/A › Part 1 - Vocational Rehabilitation Program › Section 218-RICR-50-00-1.2 - AUTHORITY

Current through June 14, 2024
These rules and regulations are promulgated pursuant to
					 the Rehabilitation Act of 1973,
					 Pub. L. No.
					 93-112 as amended by the Workforce Innovation and
					 Opportunity Act (WIOA) of 2014,
					 Pub. L. No.
					 113-128 of the Vocational Rehabilitation (VR)
					 Program and the Supported Employment (SE) Program R.I. Gen. Laws §§
										42-12-8 through 17 and 22; and  29
					 U.S.C. §§721 - 722. Federal Laws supersede
					 RI General Law.
Rhode Island Code of Regulations › Title 218 - Department of Human Services › Chapter 50 - Rehabilitation Services › Subchapter 00 - N/A › Part 1 - Vocational Rehabilitation Program › Section 218-RICR-50-00-1.3 - INCORPORATED MATERIALS

Current through June 14, 2024
A. These
				  regulations hereby adopt and incorporate the following, not including any
				  further editions or amendments thereof and only to the extent that the
				  provisions therein are not inconsistent with these regulations.
1. The State Vocational Rehabilitation
				  Services Program,  34 C.F.R. §
												361  (VR Program); The State Supported
				  Employment Services Program,  34 C.F.R. §
												363  (SE program); and Limitations
				  on Use of Subminimum Wage,  34 C.F.R. §
												397  (2016).
2. The Uniform Administrative Requirements,
				  Cost Principles, and Audit Requirements for Federal Awards,  2 C.F.R. §
												200 (2014).
3. OMB Guidelines to
				  Agencies on Governmentwide Debarment and Suspension (Nonprocurement),  2 C.F.R.
				  Part 3485  (2012).
4. The Education
				  Department General Administrative Regulations (EDGAR) as follows:
a. Administration of Grants and Agreements
				  with Institutions of Higher Education, Hospitals, and other Non-profit
				  Organizations, with respect to subgrants to entities that are not State or
				  local governments or Indian tribal organizations,  34 C.F.R. Part 74
				   (2014);
b. State Administered
				  Programs,  34 C.F.R. Part 76  (2014);
c. Definitions that Apply to Department
				  Regulations,  34 C.F.R. Part 77  (2014);
d. Intergovernmental Review of Department of
				  Education Programs and Activities,  34 C.F.R. Part 79  (2014);
e. Uniform Administrative Requirements for
				  Grants and Cooperative Agreements to State and Local Governments,  34 C.F.R.
				  Part 80  (2014);
f. General
				  Education Provisions Act - Enforcement,  34 C.F.R. Part 81  (2014);
g. New Restrictions on Lobbying,  34 C.F.R.
				  Part 82  (1990);
h. Drug and Alcohol
				  Abuse Prevention,  34 C.F.R. Part 86  (1996).
5. Description of One-Stop Service Delivery
				  System under Title I of the Workforce Innovation and Opportunity Act of 2014,
				  20 C.F.R. Part
				  678.
6. Implementation of the Nondiscrimination
				  and Equal Opportunity Provisions of the Workforce Innovation and Opportunity
				  Act of 2014,  29 C.F.R. Part 38  (2015).
Rhode Island Code of Regulations › Title 218 - Department of Human Services › Chapter 50 - Rehabilitation Services › Subchapter 00 - N/A › Part 1 - Vocational Rehabilitation Program › Section 218-RICR-50-00-1.5 - REFERRALS AND APPLICATIONS

Current through June 14, 2024
A. Referral and
				  information requests submitted by individuals with disabilities to the Office
				  of Rehabilitation Services will be processed upon receipt. Individuals who are
				  not U.S. Citizens must be able to prove they are legally able to work in the
				  United States as determined by the U.S. Citizenship and Immigration
				  Services.
B. An individual and/or
				  their representative submits a signed Application (ORS-4) and a completed
				  Current Health and Functional Capacities Self-Assessment Form (ORS-3), a
				  completed common intake application in an America's Job (One-Stop) Center or
				  another type of request for vocational rehabilitation services, to initiate an
				  assessment to determine eligibility and priority for services.
C. When an incomplete application is
				  received, the assigned vocational rehabilitation counselor will make all
				  attempts to contact applicant for information.
D. Applications can be found at the Office of
				  Rehabilitation Services, America's Job (One Stop) Centers, or on the ORS
				  website (
www.ors.ri.gov
), etc.
E. Eligibility will be determined within
				  sixty (60) days, unless exceptional and unforeseen circumstances occur in
				  accordance with 34 C.F.R. § 361.471(b)(i), incorporated above.
Rhode Island Code of Regulations › Title 218 - Department of Human Services › Chapter 50 - Rehabilitation Services › Subchapter 00 - N/A › Part 1 - Vocational Rehabilitation Program › Section 218-RICR-50-00-1.6 - GENERAL ELIGIBILITY REQUIREMENTS

Current through June 14, 2024
A. For an applicant
				  to be found eligible for the VR Program, the following requirements must be met
				  in accordance with  34 C.F.R. §
											361.42, incorporated above:
1. Applicant has a
				  physical/emotional/intellectual impairment which constitutes or results in a
				  substantial impediment to employment; and
2. The individual has functional limitations
				  that are a barrier to competitive, integrated employment, and/or the individual
				  is on SSI and/or SSDI (verified by counselor), and is presumed to be eligible
				  for vocational rehabilitation services as long as the individual intends to
				  achieve an employment outcome; and
3. Applicant requires and can benefit from
				  vocational rehabilitation services to prepare for, secure, retain, regain, or
				  advance in competitive integrated employment that is consistent with their
				  unique strengths, resources, capabilities, interest and informed choice;
				  and
4. The individual is presumed
				  to be able to benefit in terms of an employment outcome in an integrated,
				  competitive setting, from vocational rehabilitation services;
5. The applicant's completion of the
				  application process for vocational rehabilitation services, is sufficient
				  evidence of the individual's intent to achieve an employment outcome, and no
				  additional demonstration on the part of the applicant is required; or
6. Applicant who has been determined eligible
				  for Social Security disability benefits under Title II or XVI of the Social
				  Security Act (42 U.S.C. §
												423
et seq
.) is presumed
				  eligible for vocational rehabilitation services, providing that the individual
				  intends to achieve an employment outcome, and can benefit from vocational
				  rehabilitation services in terms of a competitive integrated employment
				  outcome, and submits verified SSI and/or SSDI benefits
				  documentation.
Rhode Island Code of Regulations › Title 218 - Department of Human Services › Chapter 50 - Rehabilitation Services › Subchapter 00 - N/A › Part 1 - Vocational Rehabilitation Program › Section 218-RICR-50-00-1.7 - ELIGIBILITY/INELIGIBILITY DETERMINATION

Current through June 14, 2024
A. If an applicant
				  is found ineligible, ORS will, upon consulting with the individual/individual's
				  representative:
1. Inform the individual in
				  writing, as well as by other appropriate modes of communication, of their
				  determination and the reasoning for that determination, and their right to
				  appeal the decision;
2. Provide the
				  individual with a description of services available under the Client Assistance
				  Program (CAP);
3. Refer the
				  individual to other programs that are part of the one-stop service delivery
				  system, other Federal, State or Local programs, or service providers.
4. ORS will review within twelve (12) months,
				  and annually thereafter if requested by individual/individual's representative,
				  any ineligibility determination based on a finding that the individual is
				  incapable of achieving an employment outcome; unless the individual has refused
				  it, no longer lives in the state, whereabouts are unknown, or if their medical
				  condition is rapidly progressive and terminal.