§ 40-8.14-4. Duties of the executive office for health and human services.
(a) The secretary shall afford to all Medicaid LTSS beneficiaries who receive authorized
HCBS-covered services in accordance with a service plan the option of employing an
individual provider to provide direct-support services.
(b) The secretary shall modify program operations as necessary to ensure implementation
of the individual provider model and to ensure all relevant vendors assist and cooperate
as needed, including managed care organizations and providers of fiscal support, fiscal
intermediary, financial management, or similar services to provide support to participants
and participants' representatives with regard to employing individual providers, and
otherwise fulfill the requirements of this section, including the provisions of subsection
(f) of this section.
(c) The secretary shall have the authority to:
(1) Establish reimbursement rates for all individual providers, in accordance with chapter
8.15 of this title, provided that these rates may permit individual provider variations
based on traditional and relevant factors otherwise permitted by law; provided, however,
that reimbursement rates shall be required to be approved by the general assembly;
(2) Ensure delivery of required orientation programs for individual providers;
(3) Implement training and educational opportunities negotiated in accordance with chapter
8.15 of this title for individual providers, as well as for participants and participants'
representatives who receive services from individual providers, including opportunities
for individual providers to obtain certification documenting additional training and
experience in areas of specialization;
(4) In collaboration with the provider representative, provide for the maintenance of
a public registry of individuals who have consented to be included to:
(i) Allow for routine, emergency, and respite referrals of qualified individual providers
who have consented to be included in the registry to participants and participants'
representatives;
(ii) Enable participants and participants' representatives to gain improved access to,
and choice among, prospective individual providers, including by having access to
information about individual providers' training, educational background, work experience,
national criminal background check results, and availability for hire;
(5) Establish provider qualification standards for individual providers, including undergoing
a national criminal background check and behavior that would disqualify someone as
an individual provider;
(6) Establish other appropriate terms and conditions for the workforce of individual providers
without infringing on participants' or their responsible parties' rights and responsibilities
to hire, direct, supervise, or terminate the employment of their individual providers;
(7) Establish an advisory board for participants, their representatives, and advocates,
to communicate directly with the secretary about the provision of quality direct-support
services.
(i) The board shall consist of thirteen (13) members:
(A) One of whom shall be the secretary of the executive office of health and human services,
or a designee, who shall serve as chair;
(B) Six (6) of whom shall be consumers of the individual provider model, two (2) to be
appointed by the governor, two (2) to be appointed by the president of the senate,
and two (2) to be appointed by the speaker of the house;
(C) Three (3) of whom shall be representatives from statewide independent living centers,
one to be appointed by the governor, one to be appointed by the president of the senate,
and one to be appointed by the speaker of the house;
(D) Three of whom shall be from a 501(c)(3) statewide senior advocacy organization, one
to be appointed by the governor, one to be appointed by the president of the senate,
and one to be appointed by the speaker of the house.
(ii) The board members shall be appointed for three-year (3) terms.
(iii) The board shall advise the secretary, or a designee, regarding issues relating to
the quality, access, and consumer autonomy offered through the individual provider
model; and
(8) Contract with a fiscal intermediary service for the operations of the individual provider
model.
(d) The secretary's authority in this section shall be subject to the state's obligations
to meet and negotiate under § 40-8.15-3 and chapter 7 of title 28, as modified and made applicable to individual providers under § 40-8.15-3, and to agreements with any exclusive representative of individual providers, as
authorized by § 40-8.15-3. Except to the extent otherwise provided by law, the secretary shall not undertake
activities in subsections (c)(3) and (c)(4) of this section, prior to October 1, 2019,
unless included in a negotiated agreement and an appropriation has been provided by
the legislature to the secretary.
(e) The secretary shall cooperate in the implementation of chapter 8.15 of this title
with all other relevant state departments and agencies. Any entity providing relevant
services, including, but not limited to, providers of fiscal support, fiscal intermediary,
financial management, or similar services to provide support to participants and participants'
representatives with regard to employing individual providers shall assist and cooperate
with the secretary in the operations of this section, including with respect to the
secretary's obligations under subsections (b) and (f).
(f) The secretary, or a designee, shall, no later than October 1, 2019, and then quarterly
thereafter, in accordance with rules and regulations promulgated by EOHHS, compile
and maintain a list of the names and addresses of all individual providers who have
been paid for providing direct-support services to participants within the previous
six (6) months. The list shall not include the name of any participant, or indicate
that an individual provider is a relative of a participant or has the same address
as a participant. The secretary, or a designee agency, shall share the lists with
others as needed for the state to meet its obligations under this chapter and chapter
8.15 of this title. This sharing shall not include access to private data on participants
or participants' representatives. Nothing in this section or chapter 8.15 of this
title shall alter the access rights of other private parties to data on individual
providers.
(g) The secretary shall immediately commence all necessary steps to ensure that direct-support
services are offered in conformity with this section; to gather all information that
may be needed for promptly compiling lists required under this section, including
information from current vendors; and to complete any required modifications to currently
providing direct-support services by October 1, 2019.