For purposes of this section:
(1) "Activities of daily living" (ADL) means the routine activities that people tend to do every day without needing assistance. There are six (6) basic ADLs: eating, bathing, dressing, toileting, transferring (walking), and continence.
(2) "Covered home- and community-based services (HCBS)" means any core, preventive, or specialized long-term-care services and supports available in a person's home or a community-based living arrangement that the state is authorized to provide under the Medicaid state plan, the Medicaid section 1115 waiver, or any similar program.
(3) "Direct-support services" means the range of home- and community-based services (HCBS) covered services that are identified in the Medicaid state plan, Rhode Island's section 1115 waiver, or any similar program that may provide similar services in the future, and the rules and regulations promulgated by the executive office of health and human services (EOHHS) or a designated agency authorize individual home-care providers to provide. The direct-support services must be provided in accordance with applicable federal and state law, rules, and regulations and include, but are not limited to, personal care assistance, homemaker, and companion services that the state is authorized to provide under the Medicaid state plan, the Medicaid section 1115 waiver, or any similar program in the future, including:
(i) Participant assistance with activities of daily living and instrumental activities of daily living as defined in this chapter;
(ii) Assistance with monitoring health status and physical condition;
(iii) Assistance with preparation and eating of meals (not the cost of the meal itself);
(iv) Assistance with housekeeping activities (bed making, dusting, vacuuming, laundry, grocery shopping, cleaning);
(v) Assistance with transferring, ambulation, and use of special mobility devices assisting the participant by directly providing or arranging transportation; and
(vi) Other similar, in-home, non-medical long-term services and supports provided to an elderly person or individual with a disability by an individual provider to meet the person's daily living needs and ensure that the person may adequately function in the person's home and have safe access to the community.
(4) "Director" means the director of the Rhode Island department of administration.
(5) "Fiscal intermediary" means a third-party organization under contract with the EOHHS responsible for performing payroll and other employment-related functions on behalf of the participant.
(i) The fiscal intermediary shall:
(A) Be authorized by the secretary or a designated agency to receive and distribute support funds on behalf of a participant in accordance with the participant's service plan; and
(B) Act as a fiscal intermediary on behalf of a participant in compliance with all rules, regulations, and terms and conditions established by the secretary.
(ii) The fiscal intermediary shall not make any decisions regarding hiring, supervising, or firing individual providers.
(6) "Individual provider" means an individual selected by and working under the direction of a Medicaid LTSS beneficiary or the beneficiary's duly authorized representative to provide direct-support services to the participant in accordance with the beneficiary's service plan, but does not include an employee of a provider agency, subject to the agency's direction and control commensurate with agency employee status or an individual providing services to a participant electing the personal choice option in any program.
(7) "Instrumental activities of daily living" means the skills a person needs to live safely and successfully in a residential setting of choice without outside supports. These skills include, but are not limited to, using the telephone, traveling, shopping, preparing meals, doing housework, taking medications properly, and managing money.
(8) "Medicaid LTSS beneficiary" means a person who has been determined by the state to obtain Medicaid-funded long-term services and supports.
(9) "Participant" means a Medicaid LTSS beneficiary who receives direct-support services from an individual provider.
(10) "Participant's representative" means a participant's legal guardian or an individual having the authority and responsibility to act on behalf of a participant with respect to the provision of direct-support services.
(11) "Provider representative" means a provider organization that is certified as the exclusive negotiating representative of individual providers as provided in § 40-8.15-7.
(12) "Secretary" means the secretary of the Rhode Island executive office of health and human services (EOHHS).
History of Section.
P.L. 2018, ch. 106, § 1; P.L. 2018, ch. 110, § 1.