Rhode Island 2025 Regular Session

Rhode Island House Bill H5228 Compare Versions

Only one version of the bill is available at this time.

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5	5	2025 -- H 5228
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7	7	LC000762
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9	9	S T A T E O F R H O D E I S L A N D
10	10	IN GENERAL ASSEMBLY
11	11	JANUARY SESSION, A.D. 2025
12	12	____________
13	13
14	14	A N A C T
15	15	RELATING TO BEHAVIORAL HEALTHCARE, DEVELOPMENTAL DISABI LITIES AND
16	16	HOSPITALS – QUALITY SELF-DIRECTED SUPPORTS ACT OF 2025
17	17	Introduced By: Representatives Shanley, Edwards, Craven, McNamara, Solomon,
18	18	Kazarian, Slater, Diaz, Potter, and Casey
19	19	Date Introduced: January 29, 2025
20	20	Referred To: House Labor
21	21
22	22
23	23	It is enacted by the General Assembly as follows:
24	24	SECTION 1. Legislative findings. 1
25	25	(1) The State of Rhode Island is committed to closing the gap between the demand for 2
26	26	personal care services for developmentally disabled adults and the supply of trained workers willing 3
27	27	to provide this personal care. 4
28	28	(2) The purpose of this chapter is to further the state’s goal of meeting the demand for 5
29	29	personal care services by investing in self-directed personal care jobs. By raising wages and 6
30	30	benefits for self-directed direct support professionals, the State of Rhode Island will ensure that 7
31	31	more developmentally disabled adults can self-direct the care they need and want. In addition, by 8
32	32	incorporating collective bargaining rights into the self-directed supports program, this chapter will 9
33	33	enhance service access, increase the availability of education and training options, and improve the 10
34	34	recruitment and retention of the people selected by participants as direct support professionals. 11
35	35	(3) This chapter does not alter or limit the director’s authority to administer the self-12
36	36	directed supports program, enforce existing rules, regulations and procedures or adopt amended 13
37	37	rules, regulations and procedures for operating the program, determine a participant’s Medicaid 14
38	38	eligibility and appropriateness for self-directed personal care services, or assess the scope, amount 15
39	39	and duration of services authorized to meet a participant’s needs, except as specifically set forth in 16
40	40	this chapter. 17
41	41	(4) This chapter does not alter or limit the rights of participants and their representatives to 18
42	42
43	43
44	44	LC000762 - Page 2 of 11
45	45	select, direct, and terminate the services of self-directed direct support professionals or to determine 1
46	46	the wages of self-directed direct support professionals within a range set by the director. 2
47	47	SECTION 2. Title 40.1 of the General Laws entitled "BEHAVIORAL HEALTHCARE, 3
48	48	DEVELOPMENTAL DISABILITIES AND HOSPITALS" is hereby amended by adding thereto 4
49	49	the following chapter: 5
50	50	CHAPTER 22.2 6
51	51	QUALITY SELF-DIRECTED SUPPORTS ACT OF 2025 7
52	52	40.1-22.2-1. Short title. 8
53	53	This chapter shall be known and may be cited as the “Quality Self-Directed Supports Act 9
54	54	of 2025”. 10
55	55	40.1-22.2-2. Definitions. 11
56	56	For the purposes of this chapter: 12
57	57	(1) “Department” means the department of behavioral healthcare, developmental 13
58	58	disabilities and hospitals. 14
59	59	(2) “Developmental disability organizations” or “DDOs” means an organization licensed 15
60	60	by the department to provide services to adults with disabilities. 16
61	61	(3) “Director” means the director of the department of behavioral healthcare, 17
62	62	developmental disabilities and hospitals or the director’s designees. 18
63	63	(4) “Fiscal intermediary” means a third-party organization operating in accordance with 19
64	64	applicable federal and state requirements under contract with the state that is responsible for 20
65	65	performing payroll and other employment-related functions on behalf of a participant as set forth 21
66	66	in the implementing regulations for the self-directed supports program. 22
67	67	(5) “Participant” means an adult who has a developmental disability as defined by § 40.1-23
68	68	21-4.3(1) and has been determined by the state to be eligible for Medicaid-funded long-term 24
69	69	services and supports under the Medicaid state plan and/or the RI section 1115 waiver 25
70	70	demonstration and/or Medicaid authorities created in the future. 26
71	71	(6) “Participant’s representative” means a participant’s legal guardian or a person who has 27
72	72	been designated by the participant or otherwise has the authority and responsibility to act on behalf 28
73	73	of a participant with respect to the provision of self-directed services, including the developmental 29
74	74	services subject to this chapter. 30
75	75	(7) “Provider representative” means a provider organization that is certified as the 31
76	76	exclusive negotiating representative of self-directed direct support professionals as provided in § 32
77	77	40.1-22.3-7. 33
78	78	(8) “Secretary” means the secretary of the executive office of health and human services 34
79	79
80	80
81	81	LC000762 - Page 3 of 11
82	82	(EOHHS). 1
83	83	(9) “Self-directed direct support professional” means an individual selected by and working 2
84	84	under the direction of a self-directed supports participant or the participant’s duly authorized 3
85	85	representative to provide self-directed personal care services to the participant in accordance with 4
86	86	a person-centered plan and the implementing regulations promulgated for the program by the 5
87	87	director. Self-directed direct support professional does not mean or include an employee of a DDO, 6
88	88	subject to the DDO’s direction and control commensurate with DDO employee status. 7
89	89	(10) “Self-directed personal care services” means home and community-based personal 8
90	90	care and in-home support services a participant is authorized to self-direct to meet their daily living 9
91	91	needs, function adequately at home, safely access the community, or other nonprofessional services 10
92	92	under the self-directed supports program or any similar program that may provide similar services 11
93	93	in the future under the Medicaid state plan, section 1115 demonstration waiver, or future Medicaid 12
94	94	authorities promulgated by the secretary or director. 13
95	95	40.1-22.2-3. Scope of coverage. 14
96	96	Self-directed direct support professionals may provide all self-directed personal care 15
97	97	services to the extent the applicable federal and state laws and rules and regulations allow. 16
98	98	40.1-22.2-4. Use of employee workforce. 17
99	99	(a) The state’s ability to afford participants and participants’ representatives who choose 18
100	100	not to employ a self-directed direct support professional, or are unable to do so, the option of 19
101	101	receiving personal care services through the employees of provider agencies, rather than through a 20
102	102	self-directed direct support professional, shall not be restricted. 21
103	103	(b) Nothing in this chapter shall restrict the state’s ability to afford self-directed supports 22
104	104	participants with the freedom of choice guaranteed under Title XIX of the Social Security Act, 42 23
105	105	U.S.C. § 1396 et seq., to enter into service delivery agreements with any authorized Medicaid 24
106	106	provider. 25
107	107	40.1-22.2-5. Duties of the department of behavioral healthcare, developmental 26
108	108	disabilities and hospitals. 27
109	109	(a) Notwithstanding the state’s obligations to meet and negotiate under chapter 7 of title 28 28
110	110	(“labor relations act”), nothing in this chapter shall be construed to make self-directed direct support 29
111	111	professionals employees of the state for any purpose, including for the purposes of eligibility for 30
112	112	the state employee pension program or state employee health benefits. 31
113	113	(b) The director has authority over the terms and conditions of self-directed direct support 32
114	114	professionals’ employment, including compensation as required under § 40.1-22.2-6, payment, 33
115	115	benefit terms, provider qualification standards, other appropriate terms and conditions for the 34
116	116
117	117
118	118	LC000762 - Page 4 of 11
119	119	workforce of self-directed direct support professionals without infringing on participants’ or 1
120	120	participant representatives’ rights and responsibilities to hire, direct, supervise, and/or terminate 2
121	121	the employment of their self-directed direct support professionals, and orientation, training, and the 3
122	122	operation of a registry as required under § 40.1-22.2-7. 4
123	123	(c) The director’s authority in subsection (b) of this section only applies to self-directed 5
124	124	personal care services and is subject to the state’s obligation to meet and negotiate with a provider 6
125	125	representative pursuant to § 40.1-22.3-3. 7
126	126	40.1-22.2-6. Wage ranges. 8
127	127	(a) The state shall set wage ranges for all self-directed direct support professionals. All 9
128	128	self-directed personal care services performed by self-directed direct support professionals shall be 10
129	129	compensated at a wage that is within the range set by the director for the services; provided, 11
130	130	however, the participant may choose what wage to pay within the applicable range. 12
131	131	(b) The wage range shall be the subject of collective bargaining as provided in this chapter. 13
132	132	However, such collective bargaining shall be related solely to self-directed personal care services. 14
133	133	All other self-directed services available to self-directed supports participants other than personal 15
134	134	care and in-home support services are excluded from collective bargaining. 16
135	135	(c) The provisions of this section shall take effect upon the certification of a provider 17
136	136	representative as provided in § 40.1-22.3-13. 18
137	137	40.1-22.2-7. Other duties of the director of behavioral healthcare, developmental 19
138	138	disabilities and hospitals. 20
139	139	(a) The director shall determine by rule or regulation that self-directed direct support 21
140	140	professionals selected by self-directed supports participants are required to complete an orientation, 22
141	141	pursuant to the director’s authority under § 40.1-21-12. The director shall determine by rule or 23
142	142	regulation the specific types of education, experience, or training that shall be required for a self-24
143	143	directed direct support professional to be included on a registry of persons qualified to be self-25
144	144	directed direct support professionals. The provisions of this section shall be collectively bargained 26
145	145	with the provider representative. 27
146	146	(1) Representatives of the provider representative shall be permitted to attend and present 28
147	147	information about the provider representative at educational and training programs presented by 29
148	148	the John E. Fogarty Institute of Rhode Island pursuant to § 40.1-21-6. The John E. Fogarty Institute 30
149	149	of Rhode Island shall provide the provider representative with a schedule of educational and 31
150	150	training programs at least two (2) weeks in advance. The provider representative shall be authorized 32
151	151	to provide self-directed direct support professionals with access to more training or education than 33
152	152	is minimally required by the director. Nothing in this chapter prohibits a self-directed supports 34
153	153
154	154
155	155	LC000762 - Page 5 of 11
156	156	participant from requiring a self-directed direct support professional to complete more training or 1
157	157	education than is minimally required by the director. 2
158	158	(b) The director shall maintain, either directly or through a contracted vendor, a registry 3
159	159	for self-directed direct support professionals pursuant to the authority provided under § 40.1-21-12 4
160	160	and shall collaborate with the provider representative to maintain this registry. This registry shall 5
161	161	be consolidated with the registry established for the personal choice program pursuant to § 40-8.15-6
162	162	15. 7
163	163	(c) The provisions of this section shall take effect upon the certification of a provider 8
164	164	representative as provided in § 40.1-22.3-13. 9
165	165	40.1-22.2-8. Authority of the department of administration. 10
166	166	In accordance with chapter 22.3 of this title, the director of the department of 11
167	167	administration shall have the authority to: 12
168	168	(1) In coordination with the director, meet and negotiate with any provider representative 13
169	169	chosen pursuant to § 40.1-22.3-2(a); 14
170	170	(2) In coordination with the director, negotiate over any of the topics in § 40.1-22.3-2(a) 15
171	171	and any other appropriate matters governing the workforce of self-directed direct support 16
172	172	professionals without infringing on participants’ or their responsible parties’ rights and 17
173	173	responsibilities to hire, direct, supervise, or terminate the employment of their self-directed direct 18
174	174	support professionals; and 19
175	175	(3) In coordination with the director, execute a collective bargaining agreement, subject to 20
176	176	any approval required under § 40.1-22.3-5. 21
177	177	40.1-22.2-9. Severability. 22
178	178	Should any part of this chapter be declared invalid or unenforceable, or the enforcement or 23
179	179	compliance with it is suspended, restrained, or barred, either by the state or by the final judgment 24
180	180	of a court of competent jurisdiction, the remainder of this chapter shall remain in full force and 25
181	181	effect. 26
182	182	SECTION 3. Title 40.1 of the General Laws entitled "BEHAVIORAL HEALTHCARE, 27
183	183	DEVELOPMENTAL DISABILITIES AND HOSPITALS" is hereby amended by adding thereto 28
184	184	the following chapter: 29
185	185	CHAPTER 22.3 30
186	186	SELF-DIRECTED DIRECT SUPPORT PROFESSIONALS 31
187	187	40.1-22.3-1. Definitions. 32
188	188	For the purposes of this chapter: 33
189	189	(1) “Department” means the department of behavioral healthcare, developmental 34
190	190
191	191
192	192	LC000762 - Page 6 of 11
193	193	disabilities and hospitals. 1
194	194	(2) “Developmental disability organizations” or “DDOs” means an organization licensed 2
195	195	by the department to provide services to adults with disabilities. 3
196	196	(3) “Director” means the director of the department of behavioral healthcare, 4
197	197	developmental disabilities and hospitals or the director’s designees. 5
198	198	(4) “Fiscal intermediary” means a third-party organization operating in accordance with 6
199	199	applicable federal and state requirements under contract with the state that is responsible for 7
200	200	performing payroll and other employment-related functions on behalf of a participant as set forth 8
201	201	in the implementing regulations for the self-directed supports program. 9
202	202	(5) “Participant” means an adult who has a developmental disability as defined by § 40.1-10
203	203	21-4.3(1) and has been determined by the state to be eligible for Medicaid-funded long-term 11
204	204	services and supports under the Medicaid state plan and/or the RI section 1115 waiver 12
205	205	demonstration and/or Medicaid authorities created in the future. 13
206	206	(6) “Participant’s representative” means a participant’s legal guardian or a person who has 14
207	207	been designated by the participant or otherwise has the authority and responsibility to act on behalf 15
208	208	of a participant with respect to the provision of self-directed services, including the developmental 16
209	209	services subject to this chapter. 17
210	210	(7) “Provider representative” means a provider organization that is certified as the 18
211	211	exclusive negotiating representative of self-directed direct support professionals as provided in § 19
212	212	40.1-22.3-7. 20
213	213	(8) “Secretary” means the secretary of the executive office of health and human services 21
214	214	(EOHHS). 22
215	215	(9) “Self-directed direct support professional” means an individual selected by and working 23
216	216	under the direction of a self-directed supports participant or the participant’s duly authorized 24
217	217	representative to provide self-directed personal care services to the participant in accordance with 25
218	218	a person-centered plan and the implementing regulations promulgated for the program by the 26
219	219	director of behavioral healthcare, developmental disabilities and hospitals. Self-directed direct 27
220	220	support professional does not mean or include an employee of a DDO, subject to the DDO’s 28
221	221	direction and control commensurate with DDO employee status. 29
222	222	(10) “Self-directed personal care services” means home and community-based personal 30
223	223	care and in-home support services a participant is authorized to self-direct to meet their daily living 31
224	224	needs, function adequately at home, safely access the community, or other nonprofessional services 32
225	225	under the self-directed supports program or any similar program that may provide similar services 33
226	226	in the future under the Medicaid state plan, section 1115 demonstration waiver, or future Medicaid 34
227	227
228	228
229	229	LC000762 - Page 7 of 11
230	230	authorities promulgated by the secretary or director. 1
231	231	40.1-22.3-2. Right of self-directed support professionals to choose provider 2
232	232	representative -- Subject of negotiation. 3
233	233	(a) Self-directed direct support professionals may, in accordance with the procedures set 4
234	234	forth in § 40.1-22.3-7, choose a provider organization to be their provider representative and to 5
235	235	negotiate with the state, over the terms and conditions of self-directed direct support professionals’ 6
236	236	participation in providing direct-support services including, but not limited to: 7
237	237	(1) Training and professional development opportunities; 8
238	238	(2) Improving the recruitment and retention of qualified self-directed direct support 9
239	239	professionals; 10
240	240	(3) Reimbursement rates, wages, and other economic matters; 11
241	241	(4) Benefits; 12
242	242	(5) Payment procedures; 13
243	243	(6) Provider qualification standards; and 14
244	244	(7) A grievance resolution process. 15
245	245	(b) Nothing in this chapter or in chapter 22.2 of this title shall interfere with the regulatory 16
246	246	authority of the department of health (DOH) over self-directed direct support professionals 17
247	247	licensing. Self-directed direct support professional licensing shall be excluded from and not subject 18
248	248	to the negotiation process recognized and described in this section. 19
249	249	(c) Notwithstanding the provisions of this section, self-directed direct support professionals 20
250	250	shall operate in conformance with the relevant sections of the general laws applicable thereto and 21
251	251	regulations promulgated by the state. 22
252	252	40.1-22.3-3. Good faith negotiations. 23
253	253	It shall be the obligation of the director of the department of administration, or designee, 24
254	254	to meet and negotiate in good faith with the provider representative within thirty (30) days after 25
255	255	receipt of written notice from the provider representative of the request for a meeting for bargaining 26
256	256	purposes. This obligation shall include the duty to cause any agreement resulting from the 27
257	257	negotiations to be reduced to a written contract. 28
258	258	40.1-22.3-4. Unresolved issues - Impasses procedures. 29
259	259	In the event that the provider representative and the director, or designee, are unable to 30
260	260	reach an agreement on a contract, or reach an impasse in negotiations, the procedures of §§ 36-11-31
261	261	7.1 through 36-11-11 shall be followed. 32
262	262	40.1-22.3-5. Economic aspects of contract subject to legislative appropriation. 33
263	263	Any aspects of a contract requiring appropriation by the federal government, the general 34
264	264
265	265
266	266	LC000762 - Page 8 of 11
267	267	assembly, or revisions to statutes and regulations shall be subject to passage of those appropriations 1
268	268	and any necessary statutory and regulatory revisions. 2
269	269	40.1-22.3-6. Duty to represent all self-directed direct support professionals fairly – 3
270	270	Deduction of membership dues and other voluntary deductions. 4
271	271	(a) A provider organization certified as the provider representative shall represent all self-5
272	272	directed direct support professionals in the state fairly and without discrimination, without regard 6
273	273	to whether or not the self-directed direct support professional is a member of the provider 7
274	274	organization. 8
275	275	(b) Each self-directed direct support professional may choose whether to be a member of 9
276	276	the provider organization. The state, or its designee, shall deduct from payments to self-directed 10
277	277	direct support professionals membership dues for self-directed direct support professionals who 11
278	278	elect to become members and authorize the deduction of membership dues, and any other voluntary 12
279	279	deductions authorized by self-directed direct support professionals. 13
280	280	40.1-22.3-7. Certification and decertification of provider organization. 14
281	281	(a) Petitions to certify a provider organization to serve as the provider representative of 15
282	282	self-directed direct support professionals; petitions to intervene in such an election; and any other 16
283	283	petitions for investigation of controversies as to representation may be filed with and acted upon 17
284	284	by the labor relations board in accordance with the provisions of chapter 7 of title 28 (“labor 18
285	285	relations act”) and the board’s rules and regulations; provided that, any valid petition as to whether 19
286	286	self-directed direct support professionals wish to certify or decertify a provider representative shall 20
287	287	be resolved by a secret ballot election among self-directed direct support professionals. 21
288	288	(b) The only appropriate unit shall consist of all self-directed direct support professionals 22
289	289	in the state. 23
290	290	(c) For purposes of this section, no self-directed direct support professional shall be deemed 24
291	291	excluded from the bargaining unit under § 28–7–3(3)(ii) because they provide care to a family 25
292	292	member or because they are in domestic service in a person’s home. 26
293	293	(d) The cost of any certification election held under this section shall be split equally among 27
294	294	all the provider organizations that appear on the ballot. 28
295	295	40.1-22.3-8. Unfair practices. 29
296	296	It shall be unlawful for the state to perform any of the acts made unlawful under § 28–7–30
297	297	13. It shall be unlawful for the provider representative to perform any of the acts made unlawful 31
298	298	under § 28–7–13.1. Any alleged violation of this provision may be filed with the labor relations 32
299	299	board as an unfair labor practice and considered and ruled upon in accordance with chapter 7 of 33
300	300	title 28 (“labor relations act”) and the board's rules and regulations. 34
301	301
302	302
303	303	LC000762 - Page 9 of 11
304	304	40.1-22.3-9. Right of families to select, direct and terminate self-directed direct 1
305	305	support professionals. 2
306	306	Nothing in this chapter shall be construed to alter the rights of families to select, direct, and 3
307	307	terminate the services of self-directed direct support professionals. 4
308	308	40.1-22.3-10. Strikes not authorized. 5
309	309	Self-directed direct support professionals shall not engage in any strike or other collective 6
310	310	cessation of the delivery of direct-support services. 7
311	311	40.1-22.3-11. State action exemption. 8
312	312	The state action exemption to the application of state and federal antitrust laws is applicable 9
313	313	to the activities of self-directed direct support professionals and their provider representative 10
314	314	authorized under this chapter. 11
315	315	40.1-22.3-12. Implementation. 12
316	316	(a) Within ninety (90) days of the effective date of this chapter, any provider organization 13
317	317	that has previously been certified to serve as the provider representative of individual providers 14
318	318	pursuant to § 40-8.15-7 shall be furnished by the director with contact information for every person 15
319	319	providing self-directed personal care services under the self-directed supports program. The 16
320	320	director shall provide any such provider organization with updated contact information every sixty 17
321	321	(60) days thereafter. 18
322	322	(b) The labor relations board shall hold an election to determine whether a provider 19
323	323	organization shall be certified as the provider representative for the bargaining unit of self-directed 20
324	324	direct support professionals upon a ten percent (10%) showing of interest. All persons who are 21
325	325	providing self-directed services under the self-directed supports program shall be considered part 22
326	326	of the bargaining unit for purposes of the showing of interest and shall be eligible to vote in the 23
327	327	certification election. If a majority of those casting ballots vote to be represented by that provider 24
328	328	organization, then the provider organization shall be certified as the provider representative to 25
329	329	negotiate with the state over the terms and conditions of self-directed direct support professionals’ 26
330	330	participation in providing self-directed personal care services for all self-directed direct support 27
331	331	professionals in the state. The provisions of this chapter shall otherwise apply. 28
332	332	(c) Nothing in this chapter shall be construed to alter or limit the rights of participants and 29
333	333	their representative to select, direct, and terminate the services of self-directed direct support 30
334	334	professionals or to determine self-directed direct support professionals’ wages within a range set 31
335	335	by the director, or to alter or limit the director’s authority to administer the self-directed supports 32
336	336	program including to adopt rules and regulations and operate the program, to determine participant 33
337	337	budgets, to determine eligibility, or to authorize services, except as specifically set forth in this 34
338	338
339	339
340	340	LC000762 - Page 10 of 11
341	341	chapter. 1
342	342	(d) No provision of any agreement or award resulting from collective bargaining and 2
343	343	negotiations under this chapter shall provide for a reduction in Medicaid federal financial 3
344	344	participation under Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq., nor shall any 4
345	345	provision of any agreement or award provide for a reduction in the self-directed personal care 5
346	346	services for eligible self-directed supports participants. Any provision in any agreement or award 6
347	347	that would require an additional appropriation in order to maintain the levels of services provided 7
348	348	by existing appropriations shall be subject to the annual budget process. 8
349	349	40.1-22.3-13. Severability. 9
350	350	Should any part of this chapter be declared invalid or unenforceable, or the enforcement or 10
351	351	compliance with it is suspended, restrained, or barred, either by the state or by the final judgment 11
352	352	of a court of competent jurisdiction, the remainder of this chapter shall remain in full force and 12
353	353	effect. 13
354	354	SECTION 4. This act shall take effect upon passage. 14
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358	358
359	359
360	360	LC000762 - Page 11 of 11
361	361	EXPLANATION
362	362	BY THE LEGISLATIVE COUNCIL
363	363	OF
364	364	A N A C T
365	365	RELATING TO BEHAVIORAL HEALTHCARE, DEVEL OPMENTAL DISABILITIES AND
366	366	HOSPITALS – QUALITY SELF-DIRECTED SUPPORTS ACT OF 2025
367	367	***
368	368	This act would ensure that more developmentally disabled adults can self-direct the care 1
369	369	they need and want, by incorporating collective bargaining rights into the self-directed supports 2
370	370	program to enhance service access, increase the availability of education and training options and 3
371	371	improve the recruitment and retention of the individuals selected by participants as direct support 4
372	372	professionals. This act does not alter or limit the authority of the director of behavioral healthcare, 5
373	373	developmental disabilities and hospitals to administrator the self-directed supports program, 6
374	374	enforce existing rules, regulations and procedures, or adopt amended rules, regulations and 7
375	375	procedures for operating the program. This act further does not alter or limit the rights of 8
376	376	participants and their representatives to select, direct and terminate the services of self-directed 9
377	377	direct support professionals or to determine the wages of self-directed direct support professionals 10
378	378	within the range set by the director. 11
379	379	This act would take effect upon passage. 12
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381	381	LC000762
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