A. It is the purpose of these rules and regulations to implement R.I. Gen. Laws § 40.1-1-10 and § 40.1-1-10.1, the Parent Deinstitutionalization Subsidy Aid Program subject to available funds.

B. The program is founded for the express purpose of providing financial assistance or subsidy aid to the qualified parent applicant, as defined herein, who is found and certified to be qualified by the Director of the Department to receive and take into his or her care, custody, and control an eligible person, as defined herein.

A. Authority: These regulations are promulgated pursuant to R.I. Gen. Laws § 40.1-1-10 and § 40.1-1-10.1.

B. Scope: These regulations shall apply only to persons receiving or applying to receive the parent subsidy.

C. Enforcement: Applicants for, or recipients of, the subsidy who do not conform to the regulations shall not receive the subsidy.

A. Terms as used herein are defined below.

1. “Care, custody and control” means that the certified parent(s) will take into his/her/their place of residence an eligible person who requires supervised living and further:

a. Care means personal care or supervision of activities essential to the eligible individual’s daily functioning, includes the following:

(1) assistance with or supervision in dressing, eating, bathing and other personal hygiene;

(2) maintenance of a medication schedule as directed and supervised by a physician and assistance to obtain medical/nursing and rehabilitation services;

(3) management of the individual’s social and behavioral needs.

b. Custody and control means that the parent shall have full responsibility for the welfare of the eligible individual and shall be aware of his/her whereabouts at all times.

2. “Department” means the Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospitals.

3. “Designated local agency” means a mental health agency authorized by the Department to evaluate, certify and monitor placements under R.I. Gen. Laws § 40.1-1-10.

4. “Director” means the Director of the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals.

5. “Eligible person” or “Eligible individual” means:

a. A person who is and has been a resident (or patient) for ninety (90) days of the Dr. Joseph H. Ladd Center, the Dr. U. E. Zambarano Memorial Hospital, the Institute of Mental Health or the General Hospital; or

b. Resident in an out-of-state institution who would have been eligible for placement in the Dr. Joseph H. Ladd Center, Dr. U. E. Zambarano Memorial Hospital, the Institute of Mental Health, the General Hospital for a period of time not less than ninety (90) days; or

c. A person who would be a resident (or patient) for ninety (90) days or more in one of the aforementioned facilities in the absence of the subsidy. It shall be found that this criterion is met when one (1) or more of the following conditions exist:

(1) the person’s disability causes him/her to be dependent on others for basic functions of daily living.

(2) the person’s severe behavior problems require constant supervision.

d. Disability means any of the disabilities served by the facilities named in § 1.3(A)(1)(a) of this Part.

6. “General service plan” or “GSP” means the final written document which states the treatment and management needs of the eligible individual, specifies provision for appropriate services, and includes a description of the intended use of the subsidy.

7. “Home evaluator” means the person who visits the home of the parent applicant and evaluates the home and family to determine suitability.

8. “Parent” means natural parent(s), adoptive parent(s), foster parent(s), or caretaker friend or relative, any of which may include a court appointed guardian.

a. In the situation where the natural or adoptive parents are divorced or separated, the word “parent” shall mean the parent with whom the eligible person lives.

b. Foster parent refers to a person licensed by the Rhode Island Department of Children, Youth and Families (DCYF) who has an eligible child in their home.

c. Caretaker friend or relative refers to a person certified by the Department to receive the subsidy for an adult.

9. “Parent applicant” means the person who has made application to receive subsidy aid.

10. “Subsidy aid” means payment or continued payments to a certified parent(s) to receive and take into his/her/their care, custody and control an eligible individual.

11. “Training” means monitoring and implementing activities designed to assist the eligible individual in his or her development of functional skills and adaptive behavior.

a. Adaptive behavior means the effectiveness or degree with which an individual meets the standards of personal independence and social responsibility expected of his/her age and cultural group.

A. Application to be certified for the subsidy aid program shall be made on Department forms and shall be signed by the parent applicant(s). Each division of the Department shall make forms available for their applicants.

B. The minimum age is eighteen (18) years. Otherwise, age of the parent applicant(s) will be considered only if it affects his/her/their physical capability, flexibility, and ability to care for and provide training for an eligible child or adult.

C. All family members should be in sufficiently good health to meet the needs of the adult or child placed with the family. In instances where there is a question that health may affect the ability of the parent applicant to care for the person, a written statement from a physician will be obtained as part of the home study evaluation process. Statements concerning health must be annually updated.

D. Income Limit (See also § 1.12(A) of this Part). Gross income shall not exceed four hundred (400%) percent of federal poverty level guidelines in the case of natural parents.

E. Employment of the parents outside the home.

1. There must be arrangements for adequate care and supervision of the eligible individual during the parents’ absence. Parents must demonstrate that employment does not detract from implementation of the eligible individual’s program plan.

F. Home Study - characteristics of the family unit and home.

1. There shall be a home study conducted by a Home Evaluator who shall be a social worker from the appropriate division of the Department or designated local agency, (See § 1.3(A)(3) of this Part). The most important requirements pertain to the personal characteristics of the family as a unit and as individuals. These characteristics must be consistent with the needs of each eligible person placed with a family.

2. Placements shall not be made in households which include more than one (1) non-relative, such as roomers, boarders or foster family members.

3. The Home Evaluator shall meet all members of the family to determine their views, feelings and opinions about providing care and assistance.

4. The home study shall include the Home Evaluator’s observations about the family members’ characteristics such as: patience, understanding, open-mindedness, adaptability, and stability. Other factors to be included in the study are: the physical aspects of the house and the environment of the community, (e.g. availability of recreation, education or work facilities, home health services, stores, churches, transportation and the general physical environment), and, in the case of natural and adoptive parents, the financial dependence of the parents on the subsidy in order to avoid placement. The Home Evaluator shall provide a written report summarizing significant factors.

5. The home study shall be kept on file with the parent(s) application.

G. Visits by the Department or designated local agency.

1. The applicant(s) shall indicate in writing acceptance that unannounced visits may be made to his/her/their home by a representative from the Department or a designated local agency for the purpose of monitoring the program and services being provided.

H. Training Sessions.

1. Parent(s) or parent applicant(s) shall indicate in writing willingness to participate actively in such training sessions as specified by the Department or designated local agency in order to receive the subsidy aid.

2. Such training shall be to train parent(s) and parent applicant(s) to become knowledgeable about developmental and/or functional disabilities and about care and treatment techniques needed to assist in the individualized service program.

I. Licensing prior to certification for Subsidy Aid by the Department or the designated local agency.

1. Natural or Adoptive parent(s) are not subject to licensure regardless of age of eligible person.

2. Foster parent(s) for children shall be licensed by DCYF. The Home Evaluator assists the parent applicant(s) by directing him/her/them to the licensing authority.

3. Caretakers for adults are not subject to licensure under existing State laws unless there are two (2) or more adults receiving care.

J. Marital Status - No restrictions.

A. The Department shall provide the form for certification which will be signed in conformance with the law and shall be signed by the Home Evaluator.

B. Waiting lists shall be maintained by each division of the Department for their own clients. Priority shall be given to families with members who have severe and multiple disabilities and who are experiencing a high degree of family stress.

C. When an application is rejected, there shall be a written response to the applicant, which includes a clear statement of the reasons for rejection and an offer of an opportunity to discuss the findings informally or by appeal.

D. Applicants shall not be certified for more than one (1) client in the home, with the exception of siblings. Authorized placements in excess of that number will be excepted from this Part.

A. Where subsidy aid is to be provided, a written agreement between the Department or designated local agency and the parent applicant(s), with clearly delineated terms, shall precede the subsidy payments.

B. The provisions shall be explained verbally to the parent applicant(s) who, after a period of study and consultation, shall sign the agreement jointly with the Department or the designated local agency. Included in the agreement shall be relevant sections contained in this Part and other content herein requiring written agreement.

C. A new written agreement shall be provided for the certified parent for each year.

D. Each agreement shall require progress reports. The certified parent(s) shall prepare and submit reports as to implementation of the plan and will discuss them with a representative from the Department or designated local agency. Monthly reports are mandatory for the first twelve (12) months; reporting may then be scheduled as the social worker deems necessary, but at least semi-annually.

A. The appropriate division of the Department or designated local agency shall have written procedures to determine eligibility of an individual as defined in § 1.3 of this Part.

1. Division of Behavioral Healthcare: This determination shall be made by the designated local agency in whose catchment area the individual resides using the admission criteria of the Institute of Mental Health.

2. Division of Developmental Disabilities: This determination shall be made by Department of Revenue Social Services Unit.

3. Division of Hospitals and Community Rehabilitative Services: This determination shall be made by the Division’s hospital admission teams.

B. The client record shall contain documentation of the decision that the subsidy was essential to avoid institutionalization or to achieve discharge.

C. For residents/patients being placed from a Department placement, the placement’s interdisciplinary team shall review the client’s status and confer with staff from the appropriate local agency services in order to design an effective placement plan.

D. For individuals not residents/patients of a Department placement, the responsibility for review shall be as follows:

1. Division of Behavioral Healthcare: The designated local agency.

2. Division of Developmental Disabilities: The Department of Revenue Social Service Unit.

3. Division of Hospitals and Community Rehabilitative Service: Admission teams of the hospitals.

E. A General Service Plan (GSP) shall be constructed to reflect and prioritize each individual’s needs. The plan shall provide a framework in which each individual's progress can be monitored, measured, and assessed periodically. The plan shall include a description of the intended use of the subsidy.

1. The GSP shall be based upon data from professionally accepted assessments of the client performed within the previous twelve (12) months.

2. The GSP shall address physical health needs, mental health needs, social needs, educational needs, vocational needs, and leisure needs.

3. The GSP shall include the names of the providers who will be responsible for meeting the needs. The portion of the plan which constitutes the subsidy aid plan shall be developed with the parent(s) and incorporated into the GSP upon completion.

A. Applicant or certified parents and eligible persons shall be reviewed by the responsible Department division or designated local agency to determine appropriateness of placement.

B. All staff assigned by the appropriate division of the Department or designated local agency shall confer to discuss the needs of the placement candidate and the characteristics of the applicant or certified person. Such conferring is in addition to the established discharge planning procedures of the placement for those candidates leaving a placement.

C. When a match is made, the plan will be explained to the parent and training will be provided as needed by the division or designated local agency arranging the placement.

D. When the parent has agreed to the placement, the contract or agreement shall be processed by the appropriate division of the Department.

A. The approved written plan for the use of the subsidy and the contract or agreement shall constitute such authorization.

B. The plan shall be signed by parent(s) and the division or designated local agency representative and shall be filed in the record.

A. The appropriate division of the Department or designated local agency shall name the social worker or other staff member, who is responsible for the on-going monitoring of the placement and activity related to approving the subsidy payments.

B. A copy of the plan shall be retained by the social worker from the division of the Department or designated local agency.

A. Quarterly reports to evaluate the placement shall be prepared by a social worker from the appropriate division of the Department or designated local agency. The reports shall be filed in the client’s record in the appropriate division or designated local agency.

B. Program plans shall be updated and revised at least every twelve (12) months and more often if indicated by the needs of the client. The social worker (as in § 1.10(A) of this Part) is responsible for related activity as designated herein.

C. The twelve (12) month revision of the plan shall be based on professional assessments performed by the professional staff of the program or agency providing services to the eligible person.

D. The parent(s) shall participate in the interdisciplinary case conference relating to the client held by said program or agency, if possible. Otherwise, the written report of the conference shall be discussed with the parents by assigned staff.

E. The social worker shall revise the program plan for the parent subsidy program to incorporate the results of the conference.

F. In the event that the eligible person has no involvement with a program or agency, it shall be the responsibility of the appropriate Department division, upon request of the social worker, to assign professionals for the purpose of assessment and recommendations.

G. At least monthly for the first three (3) months, there shall be a personal visit made by the social worker to the home to see the parent and the eligible individual to assure that the placement is satisfactory. Thereafter frequency of visits may be reduced to quarterly at the discretion of the division of the Department or the designated local agency.

H. The case record shall include the dates of the visits and the observation of the social worker.

I. The social worker shall submit all monthly and quarterly reports to his/her supervisor and shall forward the monthly payment authorization to the Central Office of the division of the Department involved.

A. Subsidy Aid payments will be given to parent(s) after they are certified and have received a contract from the State and have accepted the person into their home. Payments are stated in, R.I. Gen. Laws § 40.1-1-10.1.

1. Subsidy payments to parents/foster parents shall be for needs which SSI or other benefits and/or DCYF supplementary payments do not meet. It must be documented that without the subsidy, the eligible person could not be maintained in the home.

2. Payments shall not be made when the eligible individual or his/her parent(s) is(are) the recipient of a court awarded or out-of-court settlement related to the eligible person’s condition.

3. Payments shall not be made to natural parents whose gross income exceeds four hundred (400%) percent of the federal poverty level guidelines, for a family of their size, including the eligible person.

A. Each contract expires at the end of the State fiscal year, June 30th.

1. In keeping with the intent of the Subsidy Aid program, which is to avoid institutionalization of people with significant health care and/or psychiatric needs by providing a subsidy, there must be documentation that the level of care needed by the individual would qualify them for admission to the placement and that without continuation of the subsidy the certified parents could not maintain the eligible person in the home.

2. Provided the GSP recommends the placement/subsidy continue, a recertification form shall be processed.

3. A contract shall be prepared and processed for the new fiscal year when there is a current certification in place.

A. The parent may terminate participation in the program upon written notice to the social worker of the appropriate division of the Department or designated local agencies and, in foster child placements, to the DCYF worker as well.

B. The Department or the designated local agency shall terminate the subsidy aid as needed to conform to § 1.12(A)(1) through (3) of this Part or for any of the following reasons:

1. Substantiated charges of physical or emotional abuse of the individual by the parent(s) or foster parent(s) or other individuals residing in the home.

2. Inability and/or unwillingness of the parent(s) or foster parent(s) to cooperate with the Department concerning the eligible person’s basic care and training program.

3. Determination that the parent(s) or foster parent(s) is/are unable to meet physical, nutritional, emotional or behavior needs of the eligible person.

4. Determination by the appropriate Department division or designated local agency that the eligible participant’s level of functioning has changed from dependent to independent.

C. The Department shall inform the parent(s) or foster parent(s) when and if the subsidy aid is to be terminated by a thirty (30) day notice in writing, except in cases of emergency or when determination has been made that the eligible person’s physical or mental well-being is endangered. Said notice shall include a statement advising the parent(s) or foster parent(s) of their right to appeal the decision. Other appropriate legal action will be taken as the situation warrants.

All hearings and reviews required pursuant to these rules and regulations shall be held in accordance with the provisions of R.I. Gen. Laws § 42-35-1 et seq. and the Executive Office of Health and Human Services (EOHHS) rules and regulations for Appeal Process and Procedures for EOHHS Agencies and Programs, 210-RICR-10-05-2.