212 R.I. Code R. 212-RICR-10-05-1.10

Current through December 3, 2024

Section 212-RICR-10-05-1.10 - Service Provision

A. The DDO ensures that the provision of all certified services is in accordance with the goals of the ISP.

B. The DDO must have adequate staffing as identified for each participant and as documented in the ISP.

C. The DDO ensures all communication is in a format and language accessible to participants and families in a clear, accurate and consistent manner wherein special communication needs are identified and addressed.

1.10.1Health Education

A. Organizations shall develop human sexuality policies and health education policies that reflect the philosophy that people with developmental disabilities are people with sexual identities, feelings and needs.

B. Organizations shall offer training in human sexuality and/or health education to educate persons with disabilities to protect themselves from sexual abuse, sexual exploitation, pregnancy, sexually transmitted diseases and other areas pertaining to sexuality.

1.10.2Shared Living Arrangement (SLA)

A. In contracting with a Shared Living Arrangement (SLA) contractor, a DDO shall:

1. Have the ability to respond twenty-four (24) hours a day, every day, to support the provider and participant as problems arise;

2. Have a respite procedure for safely accommodating a participant who requires emergency removal from the SLA home;

3. Have a policy to define its SLA oversight plan that includes face-to-face visitation, commensurate with the needs of the provider and the needs and preferences of the participant.

4. Notifies the Department of any change in the household composition.

5. Establishes policies and procedures for the termination of an SLA contract if the participant chooses to leave or if the shared living contractor of any member of the household has:

a. Been charged with or convicted of a crime as defined under § 00-1.21(D) of this Chapter;

b. Abused, neglected, mistreated or exploited a child or adult;

c. Suffered serious illness, injury or stressful situation that impacts deliver of service to the participant;

d. Failure to comply with any of the requirements of the SLA contractor contained herein; or § 00-1.21 of this Chapter.

e. A current or untreated substance use disorder. The DDO shall notify the Department immediately upon discovery. The DDO may continue with the SLA upon written approval of the Department.

6. Require that the SLA contractor is not named as the beneficiary of any insurance policy held by the participant or testamentary instrument and/or document or gift executed by the participant or named on any bank account or as Representative Payee.

B. The DDO and its agents are not to be the participant's legal guardian or Power of Attorney.

C. The DDO ensures that there is a legally enforceable written agreement that includes, at minimum, the same responsibilities and protections from eviction that tenants have under the landlord/tenant laws of the state, county, city or other designated entity.

1.10.3Fiscal Intermediary Services

A. The Fiscal Intermediary shall ensure that no person shall be hired by an individual prior to the completion of a Bureau of Criminal Identification (BCI) check; prior to the verification of all needed licenses, including a driver's license, proof of insurance, and proof of vehicle inspection certificate.

B. The Fiscal intermediary shall document that employment and reference checks were completed by the individual for potential employees.

1. Said documentation shall include, but not be limited to: the name of the person called for a reference, the telephone number, the date called, the company name, and the reference provided.

C. The Fiscal Intermediary shall obtain assurances from the individual that any non-related person or agency providing supports is not named as a beneficiary on the life insurance policy(ies) of the individual with developmental disabilities.

D. The Fiscal Intermediary shall maintain a record of any formal connections an employee or potential employee has with any entity(ies) providing services to the individual with developmental disabilities.

1. If there is a formal relationship (i.e., board member or an employee of an agency providing support to the individual with developmental disabilities), then this relationship should be stated in writing by the potential employee at the time of the interview, or when such relationship begins (subsequent to employment).

2. In addition, the Fiscal Intermediary shall obtain, from the individual, notice of any family relationship with any potential employee to be hired by the individual prior to the actual hiring.

E. Develop and implement a timesheet for direct support professionals.

F. Distribute, collect, and process direct support professionals' timesheets based upon an agreed-upon period (i.e., weekly, bi-weekly, semi-monthly, monthly).

G. Ensure that the individual's direct support professionals are paid hourly rates and overtime pay, when applicable, in accordance with Federal and State Department of Labor FLSA rules and regulations.

H. Compute, withhold, file and deposit federal and state income tax, if requested by the individual's direct support professional and agreed to by individual employers in compliance with IRS rules.

I. Compute, withhold, and deposit FICA and FUTA taxes using the IRS Form 940; Employer's Annual Federal Unemployment (FUTA) Tax Return and IRS Form 941; Employer's Quarterly Federal Tax Return (filing in the aggregate under the Fiscal Intermediaries separate FEIN) in accordance with IRS Notice 95-18. Compute, withhold, and deposit any state taxes and unemployment insurance taxes in accordance with State policies and procedures,

J. Ensure that FICA and FUTA withholdings are done appropriately in accordance with IRS rules and regulations when family members are direct support professionals.

K. Prepare and distribute payroll checks for direct support professionals in accordance with the agreed upon time frame with the individual employer. The payroll checks shall include a pay stub that reports the hours worked, gross wages, with holdings by type, and net salary for the current period and year-to-date. The payroll check will be sent to the individual employer or the direct support professional, as agreed to by the individual and the Fiscal Intermediary. The Fiscal Intermediary shall offer direct support professionals the option of having their paychecks directly deposited in their bank.

L. Inform direct support professionals of the availability of receiving advanced Federal Earned Income Credit (EIC) payments and process advanced payments when applicable (i.e., include IRS Notice 797 in the Employee Start-up Packet).

M. File and distribute IRS Forms W-2 and Forms W-3 on behalf of individuals for each of their direct support professionals who have earned the cash wage thresholds for employment taxes (FICA and possibly FUTA) and/or had federal and state income taxes withheld in the calendar year per the IRS rules/instructions for employer agents. Ensure that these forms are completed in accordance with IRS rules for agents.

N. Establish and implement a process for identifying, computing and issuing refunds to direct support professionals (for the employee contribution) and the individual's budget (for the employer contribution) of any over collection of federal employment taxes (FICA and/or FUTA) for direct support professionals who do not earn the federal cash wage threshold amounts from a single employer during the calendar year.

O. Process all judgments, garnishments, tax levies, or any related holds on an employee's funds, as may be required by state or federal laws. The Fiscal Intermediary shall comply with all federal and state income and employment taxes, statutory benefits, and labor laws related to the employment of their direct support professionals. All tasks and responsibilities shall be performed by the Fiscal Intermediary, in accordance with all applicable federal and state laws, rules and/or regulations.

P. Determine the requirements for workers compensation for household employees in the state and facilitate the purchase of worker's compensation insurance for individuals' direct service professionals and process invoices for premium payments. The Fiscal Intermediary shall verify and document that all individual employers have sufficient workers' compensation coverage for all the direct support professionals that they hire.

Q. Develop and implement a process of documenting any relevant training that the direct support professional has at the time of hire, and any additional training that the direct support professional completes after the date of hire.

R. The Fiscal Intermediary shall monitor the expenses reported by the individual to ensure that funds will be available for the full-time frame of the quarterly authorization. Should the Fiscal Intermediary find that funds are being expended at an accelerated pace, it will notify the individual/responsible person of this finding and work with the individual to stay within his/her budgeted resource allocation.

S. The Fiscal Intermediary shall keep an accounting of all services received by the individual, including the dates and types of service.

T. On a quarterly basis, the Fiscal Intermediary shall prepare a report for the individual as to the individual's financial status.

U. The Fiscal Intermediary shall submit to the Department annual audited financial statements, audit findings and any recommendations, including corrective action plans, and any supplemental schedules, as may be required by the Department. The Fiscal Intermediary shall disclose all Related Party Transactions in the notes to the annual audited Financial Statements.

V. The Fiscal Intermediary shall be required to report earned income to the Medicaid Authority (Executive Office of Health and Human Services) pursuant to federal and state Medicaid requirements on behalf of a participant who earns income from employment.

W. Should the individual subcontract with an Organization/business that should be licensed by the federal or state government, the Fiscal Intermediary shall verify that the Organization/business has the necessary license.

X. The Fiscal Intermediary shall account for any corrected or previously omitted services/encounters reported and process a recoupment to correct payment(s).

Y. The Department shall have the right to request any and all information pertaining to assets, liabilities, revenue, expenditures, records, contracts and any other financial, program, personnel, or administrative data. The Fiscal Intermediary shall submit the information requested to the Department within the time frame specified.

Z. The Department, EOHHS, DHS, CMS and its designated representatives shall have the authority to review all Fiscal Intermediary records, reports of financial data, at any time. The Department, EOHHS, DHS, CMS, or its designated representatives shall have the right at all times to inspect the work performed or being performed under the DDO's license.

AA. The Fiscal Intermediary shall not undertake any work that represents a legally cognizable conflict of interest or is otherwise contrary to State and Federal law or regulation. The Fiscal Intermediary shall fully and completely disclose any situation and/or relationship that may present a legally cognizable conflict of interest at the time of applying for licensure and/or as such situations occur.

1.10.4Respite

A. Respite care services may be provided to participants on a short-term basis in the participant's home, private place of residence, the private residence of a respite care provider, a licensed residence, or at a licensed day program.

B. Respite care services provides for a participant who requires support and/or supervision in his/her day-to-day life, in the absence of his/her primary care giver.

C. Respite care services maintain the participant's routine while receiving respite care services to attend school, work, or other community activities/outings. Community outings shall be included in the supports provided and shall include school attendance, other school activities, or other activities the participant would receive if they were not in a center-based respite center.

D. Respite care services includes transportation for community outings (included in reimbursement).

E. A respite care service provider who provides services in a participant's home, private place of residence, or the private residence of a respite care provider:

1. Shall be at least eighteen (18) years old, have a high school diploma or GED certification;

2. Shall complete training and certification as defined by the state to provide the service, that includes criminal, abuse/neglect registry and professional background checks, and completion of the following trainings:

a. Roles and responsibilities of the respite care provider;

b. Human Rights of Adults with Developmental Disabilities;

c. Mandatory reporting of abuse, neglect and mistreatment of adults with developmental disabilities to the Department and appropriate law enforcement agencies;

d. Code of Ethical Conduct;

e. Current valid certification in cardiopulmonary resuscitation (CPR), annual refresher training in CPR, and annual first aid training;

f. Access to medical and psychiatric supports; and

g. Confidentiality.

h. Should have one year of related experience (preferred);

i. May be members of the participant's family, provided the participant does not live in the family member's residence and the family member meets the same standards described above.

j. The DDO shall ensure that health care services are provided and documented for the participant in accordance with the requirements contained herein.

F. A respite care service provider who is also an employee of the DDO respite agency shall be compensated in accordance with state and federal tax and labor laws.

212 R.I. Code R. 212-RICR-10-05-1.10

Adopted effective 1/7/2019