210 R.I. Code R. 210-RICR-50-10-2.12

Current through December 3, 2024

Section 210-RICR-50-10-2.12 - Participant Rights and Responsibilities

A. Every participant has the right to:

1. Be treated as an adult, with dignity and respect at all times;

2. Privacy in all interactions with EOHHS, the Case Manager, and the Fiscal Intermediary and freedom from unnecessary intrusion;

3. Make informed choices based upon appropriate information provided to the participant, and have questions answered and choices respected, while respecting the rights of others to disagree with their choices;

4. Freely choose between approved providers as appropriate or applicable;

5. Feel safe and secure in all aspects of life, including health and well-being, be free from exploitation and abuse, and not be overprotected;

6. Realize the full opportunity that life provides by not being limited by others, by making full use of the resources their self-directed program provides, and by being free from judgments and negativity;

7. Live as independently as they choose;

8. Have their individual ethnic background, language, culture and faith valued and respected;

9. Be treated equally and live in an environment that is free from bullying, harassment and discrimination;

10. Voice grievances about care or treatment without fear of discrimination or reprisal;

11. Voluntarily withdraw from the Personal Choice program at any time;

12. Manage PCAs by:

a. Deciding who to hire, whether self-selected or selected from the registry of available PCAs;

b. Deciding what special knowledge or skills the PCA must possess;

c. Training each PCA to meet individual needs; and

d. Replacing PCAs who do not meet individual needs.

13. Request a new assessment and/or person-centered service plan if needs change;

14. Know about all fees;

15. Appeal any decision made by the Conflict-Free Case Management Agency, Fiscal Intermediary, or EOHHS and expect a prompt response.

B. Every participant has the responsibility to:

1. Manage and maintain their health and access medical help as needed, or seek assistance in order to do so;

2. Demonstrate the required skills and abilities needed to self-direct PCAs without jeopardizing their health and safety, or designate a representative to assist them;

3. Be aware of the Personal Choice program rules and regulations;

4. Act as a supervising employer by:

a. Screening prospective PCAs to determine who is best able to meet the participant's needs at the desired times;

b. Interviewing prospective PCAs if they are not already known to the participant;

c. Requesting and checking references for prospective PCAs if they are not already known to the participant;

d. Completing hiring agreements with each PCA;

e. Ensuring that the PCA is oriented, trained, and understands the participant's goals, boundaries and house rules;

f. Deciding wages and schedules for each PCA, and ensuring that hours do not exceed forty (40) hours per week;

g. Developing a plan for communication process for the PCA to inform the participant if they will be late or unable to report to work;

h. Supervising PCAs and ensuring they are performing their duties as required;

i. Completing Electronic Visit Verification, unless the PCA lives in the same household;

j. Reviewing timesheets for accuracy, ensuring that time is not billed when services were not delivered by the PCA (such as when the participant was on vacation, in an emergency room, in an inpatient hospital stay, at an adult day care center, or receiving therapies or other services), and submitting timesheets to the Fiscal Intermediary in a timely manner;

k. Following all employment laws and Regulations, including providing a safe, harassment-free working environment and treating all employees with dignity and respect;

l. Following all requirements of the Fiscal Intermediary/IRS for hiring and paying PCAs, including completing all necessary forms and paying PCAs promptly; and

m. Deciding whether and when to dismiss a PCA and notifying the Fiscal Intermediary when termination occurs.

5. Develop an emergency back-up plan in the event a PCA is unavailable;

6. Manage personal care services by:

a. Meeting and cooperating with the Case Manager and Service Advisement Team as required for completing all needed assessments and monitoring; and

b. Developing and monitoring an ISSP to address personal care service needs;

7. Report instances or concerns about critical incidents to the Conflict-Free Case Management Agency and/or appropriate State agency;

8. Understand what Medicaid fraud is and how to report it;

9. Track expenses so that the budget is not exceeded and contact the Fiscal Intermediary in the event of a billing or payment complaint;

10. Notify the Conflict-Free Case Management Agency and Fiscal Intermediary of absences from home that are nonmedical (vacations or trips); and

11. Notify the Conflict-Free Case Management Agency of any changes in medical status, admissions to hospitals or other medical facilities, or if other services are being provided (for example, visiting nurses, hospice, home delivered meals, or adult day services).

C. The participant may request that the PCA perform additional tasks that help them continue to live in the community. The PCA may, but is not required to, perform such additional tasks. The participant cannot ask the PCA to support another person. The requested task cannot pose a health or safety risk to the participant or the PCA, the PCA should feel comfortable and confident in the ability to perform the task, the task must be legal and cannot be considered fraudulent.

210 R.I. Code R. 210-RICR-50-10-2.12

Adopted effective 2/12/2024