5.2.1Certificate 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.5.2.2Application for Certificate An application for a certificate shall be made to the Division of Elderly Affairs upon forms provided by the Division and shall contain such information as the Division reasonably requires. Included shall be affirmative evidence of the applicant's ability to comply with the attached rules, regulations and standards as are lawfully prescribed herein.
5.2.3Issuance and Transfer or Assignment of CertificateUpon receipt of a completed application for a certificate, the Division shall issue a certificate if the applicant meets the requirements of R.I. Gen. Laws § 42-66.6-2 and the rules, regulations and standards herein. A certificate issued hereunder shall be the property of the state and loaned to such certified entity. The certificate shall be kept posted in a conspicuous place on the premises. Each certificate shall be issued only for the premises and persons named in the application and shall not be transferable or assignable except with the written approval of the Division.
5.2.4Expiration and Renewal of Certificate A. A certificate, unless sooner suspended or revoked, shall expire by limitation one (1) year following its issuance, and may be renewed after inspection, report and approval by the Division. 1. Such inspection may be made any time prior to the date of expiration of said certificate.2. A certificate issued to a case management program or agency that has been certified for two consecutive one- year periods, unless sooner suspended or revoked, shall expire by limitation two (2) years following its issuance, and may be renewed for additional, successive two-year (2-year) periods after inspection, report and approval by the Division.3. Such inspection may be made any time prior to the date of expiration of said certificate.5.2.5InspectionsA. The Division shall make or cause to be made such inspections and investigations as it deems necessary by duly authorized agents of the Director at such time and frequencies as determined by the Division. 1. A duly authorized representative of the Director shall have the right to enter at any time without prior notice, to inspect the premises and services for which an application has been received, or for which a certificate has been issued. 2. Duly authorized representatives of the Director shall be permitted to interview staff, consumers, and any other interested parties.3. Refusal to permit inspection or investigation shall constitute a valid ground for suspension or revocation of certificate or curtailment of activities. 4. Each agency shall be given notice by the Division of its level of compliance with these rules, regulations and standards, including a list of all deficiencies reported as a result of an inspection or investigation.5.2.6Denial, Suspension or Revocation of Certificate or Curtailment of ActivitiesA. The Division is authorized to deny, suspend or revoke the certificate or curtail activities of any case management program or agency that receives state or federal funding and 1. has failed to comply with the rules, regulations and standards herein;2. has offered or provided services to participants outside of the scope of its certificate; or3. has failed to comply with the provisions of R.I. Gen. Laws § 42-66.6-2.B. Reports of deficiencies shall be maintained on file in the Division and shall be considered by the Division in rendering determinations to deny, suspend or revoke the certificate or to curtail activities of the case management program or agency.C. Notice of such suspension or revocation shall be made through formal correspondence. 1. Personal service of the notice is authorized in lieu of notice by mail. a. The notice shall set forth the particular reasons for the proposed action and the procedures for requesting a fair hearing.2. All requests for a fair hearing must be made in writing.a. The applicant or certificate holder has thirty (30) days from the date of the Division's notice to notify the Division that he/she is requesting a fair hearing to object to the Division's decision.b. If a request for hearing is not received within thirty (30) days from the date of the Division's mailing or personal notice, the decision of the Division is final.c. If the applicant or certificate holder requests a fair hearing, the applicant or certificate holder shall be given notice in accordance with R.I. Gen. Laws § 42-35-9.d. If a request for a hearing is received, the Director shall appoint an administrative hearing officer who shall conduct a fair hearing. The rules for conducting fair hearings are set forth in R.I. Gen. Laws § 42-35-9 et seq.5.2.7Review of Certificate ActionAny applicant, certificate holder, or the state acting through the Attorney General, 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'".
5.2.8Injunction to Restrain Operation without CertificateNotwithstanding the existence or pursuit of any other remedy, the Division may, in a manner prescribed by law and upon the advice of the Attorney General, who will represent the Division in the proceedings, maintain an action in the name of the state for injunction or other process against any person or persons to restrain or prevent the establishment, conduct, management or operation of a program as defined in this chapter without a certificate.
5.2.9Change of Ownership, Operation and or LocationA. When a change of ownership or operation or location of a case management program or agency is planned or when discontinuation of services is contemplated, the Division shall be given written notice of pending changes.1. A certificate shall immediately become void and shall be returned to the Division when operation of a case management program or agency is discontinued or when any changes in ownership occur.2. When there is a change in ownership or in the operation or control of the program or agency, the Division reserves the right to extend the expiration date of such certificate, allowing the program or agency to operate under the same certificate which applied to the prior certificate holder for such time as shall be required for the processing of a new application or reassignment of consumers, not to exceed six (6) weeks.5.2.10Nondiscrimination and Civil Rights Policy Each program or agency shall be responsible for maintaining a policy of non-discrimination in the provision of services to participants and in the employment of staff without regard to race, color, creed, national origin, sex, sexual orientation, age, handicapping condition or degree of handicap, in accordance with 42 U.S.C. § 2000d et seq.; Americans with Disabilities Act of 1990, 42 U.S.C. § 12101; Public Law 88-352, July 2, 1964, 78 Stat. 253, 42 U.S.C. Sec. 2000e et. seq; United States Department of Labor Regulations, 20 C.F.R. § 1 - 1099; Title V of the Rehabilitation Act of 1973, as amended, 29 U.S.C. § 792; the 1990 Americans With Disabilities Act, 42 U.S.C. § 12101; R.I. Gen. Laws Chapter 42-87, which states that "Discrimination" includes those acts prohibited on the basis of race by 42 U.S.C. § 1981, 42 U.S.C. § 1983 and those on the basis of handicap by 29 U.S.C. § 794 and those on the basis of disability by U.S.C. §12100 et seq. and U.S.C. §12101 et seq., and those on the basis of handicap by R.I. Gen. Laws Chapter 28-5; and the Rhode Island Fair Employment Practices Act, R.I. Gen. Laws § 28-5-7.3.
5.2.11Compliance with All Laws, Codes, Rules and RegulationsEach program or agency shall be responsible for complying with all local, state, and federal laws, codes, rules and regulations that apply to the program or agency.
5.2.12DefinitionsA. Whenever used in these rules, regulations and standards, the following terms shall be construed as follows: 1. "Agency" means the case management agency.2. "Building Code" means the current Rhode Island State Building Code, R.I. Gen. Laws §23 - 27.3-1 et. seq.3. "Case Management" means a service that coordinates and links care across community-based health and social services organizations. Case management identifies and secures the necessary resources, equipment, and supplies from formal and informal sources including professionals, paraprofessionals, volunteers, family and friends.4. "Confidentiality of Health Care Information" means the current Rhode Island Confidentiality Law, R.I. Gen. Laws § 5-37.3-1 et. seq.5. "Division" means the Rhode Island Department of Human Services, Division of Elderly Affairs.6. "Director" means the Director of the Rhode Island Division of Elderly Affairs.7. "Emergency Procedures" means written protocols to specify exactly the conditions under which agency activities will be cancelled and/or agency will be closed; and agency personnel and consumers will be evacuated; and to specify means by which consumers and families will be notified of cancellations, evacuations and early closings.8. "Life Safety Code" means the current applicable Rhode Island State Fire Safety Code, R.I. Gen. Laws § 23-28.1-1 et. seq.9. "Major Components of the Case Management Process" means Intake/ Screening; Assessment; Care Planning; Care Coordination and Service Implementation; Monitoring; Advocacy; Reassessment; and Termination and Discharge.10. "Role of the Case Manager" means to facilitate access by the consumer to the various services available to meet, maintain, and improve the functional level and independence of the consumer.11. "Support Services" means anything needed to achieve the care plan.218 R.I. Code R. 218-RICR-40-00-5.2