Tag Archives for Rhode Island General Assembly

Complete Streets Legislation Stalled in House Committee

Published May 19. 2012, Pawtucket Times

            A properly designed road system helpsolder Rhode Islanders to successfully “age in place” and stay safely and comfortably in their homes for as long as they choose. But the benefits of so-called Complete Streets design benefits people regardless of age, abilities or mode of transportation.  AARP Rhode Island has joined a broad-based coalition of 17 aging, health and transportation groups and smart growth advocates to push state policy makers into making the Ocean State’s streets, highways and byways more accessible and safer for all users. Out of 2,111 legislative proposals submitted this year for consideration by the Rhode Island General Assembly, H 7352 and S 2131, its companion measure in the Senate, would accomplish this lofty goal.

          Coalition members fear that their efforts to make sure that the state’s transportation infrastructure becomes more user friendly for all ages and abilities is in jeopardy with the House Committee on Municipal Government which has held H 7352 for further study.  While the Senate passed the companion measure (for the second year in a row) last month, this House Committee might just kill the legislation unless it can be resuscitated. 

The Details of H 7352

            The legislationwould require that whenever the state is building or modifying a road, planners and designers must consider Complete Streets design concepts – that is, considering safe travel by all users, current and projected, particularly pedestrians and bicyclists of all ages and mobility capabilities.  Features of Complete Streetsdesign include sidewalks, paved shoulders suitable for use by bicyclists, lane striping, bicycle lanes, “share the road” signage, “road diets” (narrower lanes to discourage speeding and leave room  for pedestrians and bicyclists), roundabouts, crosswalks, pedestrian control signalization, bus pull-outs, curb cuts, raised crosswalks and ramps and traffic-calming measures.

            Meanwhile, this legislation allows common-sense exceptions, such as on interstate highways, where pedestrians and bicyclists are prohibited, and on projects where the space is too limited or costs would be disproportionate to the use such features would likely get.

            Furthermore, this legislation also requires the State’s Department of Transportation to issue a report within two years detailing what it has done to comply with the law, how it has changed its guidelines on such features as lane width, design speed and more, and what best practices the agency has employed.  It would also be required to include information on exceptions made, and why they were made.

            In a press release touting the passage of S 2131, bill sponsor, Senator Louis P. DiPalma, noted that the legislation’s goal is to plan streets that encourage people to use healthy, greener, transportation modes whenever possible, contributing in their own health as well as the wellbeing of the environment.

            “Cars shouldn’t be the only consideration when public roads are being built.  The health and environmental benefits of walking, bicycling and other active modes of transportation are well know, and we should be building our roads in ways that are safe for those activities and encourage people to choose them,” said Senator DiPalma.

Pushing for Safer Roads, Highways and Byways

            In her testimony before the House Committee on Municipal Government, AARP State Director Kathleen Connellsaid the goal of H 7352 is to direct the Department of Transportation  to plan with all users in mind.  “Making it easier for older people to get around is an obvious reason we’re involved, but Complete Streets design promotes public safety, helps revive our towns and cities and increases property value,” she said.

            Molly Clark, Manager, Health Promotion and Public Advocacy for the American Lung Association, also testifying to support H 7352, predicted that Complete Streets design that would promote walking and bicycling and this would ultimately improve the health of Rhode Islanders.

             Also attending the Committee Hearing, Co-Chair John Flaherty, of the Coalition for Transportation Choices, advocated for 21st century transportation system “that’s good for the economy, good for the environment and that provides clean, healthy and affordable transportation choices for all Rhode Islanders.”

            There is no fiscal note estimating the true costs of H 7352 due to the multitude of factors that must be considered.  However, bill supporters believe that this legislative proposal does not necessarily add costs to the road construction project.

            Addressing concerns about the legislative proposals “possible” fiscal impact on the State’s budget, Senator DiPalma notes that H 7352 has been crafted in such a way to reduce the fears of fellow lawmakers that there could be initial and future costs if the legislation is enacted.  Provisions would protect the state’s coffers by requiring common sense exceptions to take effect if a road construction design project incurs a cost that is disproportional to its benefits, he says.

It’s All About the Economy

            Doing it right the first time makes economic sense,” says AARP Associate Director for Advocacy Deanna Casey.

             Enacting H 7352 is just good economic policy, adds Scott Wolf, Executive Director of Grow Smart Rhode Island.  According to Wolf, “forRhode Islandto thrive economically it needs to attract and retain talented young people. These people, research shows, are looking for places that are vibrant, user friendly and possess an abundant natural and architectural beauty.” 

            Wolf stated “Rhode Island has many of these ingredients but we need to be much more user friendly with regard to transit, walk ability and bike ability to maximize our appeal to this new segment of workers. He added, “Adopting an aggressive complete street strategy that requires all roads built to accommodate bikes, pedestrians, and mass transit as well as autos could do a lot to increase our appeal to this critical cadre of mobile young talented workers.”   

             In these tough economic times usually a price tag on a legislative proposal is just enough for General Assembly leadership to doom a legislative proposal’s passage by not taking action on it.  Just refer it for further study.  Complete Street supporters are puzzled by the inaction in the House panel because of the protections built into the measure to rein in initial or future costs of a project.  At press time, the City of Pawtucket along with eight other cities and towns, have already passed resolutions supporting the Complete Street legislation being considered by the Rhode Island General Assembly and another eight communities are also considering supporting this legislation by enacting  resolutions.  Most important, the State’s Department of Transportation is not even blocking passage but endorsing it.

           According to the National Complete Streets Coalition, in 2011 alone “over 140 jurisdictions adopted a policy, up from 80 that committed to Complete Streets in 2010. In total, 352 regional and local jurisdictions, 26 states, the Commonwealth of Puerto Rico, and the District of Columbia have adopted policies or have made written commitment to do so.”

           Elections are looming and House and Senate leadership are looking to adjourn in early June.  The Rhode Island General Assembly must move quickly in the waning days of the 2012 legislative session to join 26 states that get it.  House leadership must do the right thing to make streets, highways and byways more accessible and safer for all Rhode Islanders, regardless of age, abilities or modes of transportation.   That is to pass H 7352.    

             Herb Weiss is a Pawtucket-based writer covering aging and health care issues.  His Commentaries are published in two Rhode Island Daily’s The Pawtucket Times and Woonsocket Call.

State Lawmakers Ok Many Senior Initiatives  

Published in Pawtucket Times on July 7, 2003

 As this year’s legislative session came to an end, even the widely publicized tight state budget did not keep aging advocates from seeing some of their legislative proposals get passed by the House and Senate.

With the passage of companion legislative proposals (H 5841/ S 876), the state’s long-term care ombudsman law will be revised to reflect federal law, expanding the scope and authority of the state’s ombudsman program.

The new statute changes will require the state ombudsman to represent the interests of nursing facility residents or clients of service providers before governmental agencies.

The state ombudsman will also be charged with seeking administrative, legal and other remedies to protect the health, safety, welfare and rights of Ocean State seniors.

Another legislative proposal also got the thumbs-up from lawmakers. With the passing of companion proposals  H 5418/ S 506, new state funds totaling $ 300,000 will pay for nursing facility care of legal immigrant Rhode Island seniors who ae not eligible for Medicaid.

Meanwhile, the Rhode Island General Assembly provided that it sees the value in preventative medicine and how it can ultimately save health care dollars.

The Ocean State Adult Immunization Coalition requested $ 103,000 in new state funding to expand the coalition’s efforts to get the world out about the importance of seniors getting influenza and pneumococcal vaccinations.  While not receiving the whole loaf, lawmakers gave a half loaf instead – about $ 50,000.

With state dollars now allocated up front, large savings will be realized down the road. The cost of a flu shot is $ 15 and a pneumonia shot is $ 30.

If a senior is hospitalized, the average length of stay for an older person with influenza is five days, costing $ 12,000.  That’s a huge savings.

Lawmakers also passed legislation to make pharmaceutical drugs more affordable to Rhode Island seniors.

With the passing of companion proposals H 5237/S 374, persons eligible to participate in the Rhode Island Pharmaceutical Assistance to the Elderly Program (RIPAE) who also have prescription drug coverage through a health plan, will now be allowed to use RIPAE to pay for an individual prescription drug once they reach the maximum level of coverage for that drug.

Also, companion measures H 5239/ S378 passed, expanding RIPAE to allow persons age 55 to 61 on Social Security Disability Insurance to receive a 15 percent RIPAE co-payment in addition to their RIPAE drug discount rate.

As previously reported in All About Seniors, an 18-month study of .B.D.O. Seidman, a consulting firm hired by the state Department of Human Services, found that Rhode Island was underpaying its nursing facilities in excess of $ 30 million annually.

It seems that the General Assembly agreed with that report’s assessment and made a partial allocation of new Medicaid dollars to overhaul the state’s ailing Medicaid system.

With the passage of the state’s budget, nursing facilities will receive a total of $ 18.8 million in state and federal dollars – a three-year phase in will bring the total federal and state dollars to $30 million.

On the other hand, some aging agenda items went down in flames.

Aging advocates called on Gov. Don Carcieri and state lawmakers to allocate taxpayer dollars in the FY 2004 budget to allow more low-and moderate-income persons to choose Medicaid waiver-funded assisted living.

Although the federal government has already approved an additional 180 units in the state’s Medicaid assisted living waiver program, state funding of this initiative is required.

No funding in this year’s budget ensures that low-and- moderate income seniors will continue to be denied an option of choosing a less restrictive level of care, an option that higher income seniors have.

Additionally, lawmakers chose not to pass companion proposals (H 5478/ S 299) which would have allowed Rhode Island residents to buy prescription drugs from Canadian pharmacies, where they are routine cheaper.

Finally, in the aftermath of the tragic Station nightclub fire, the General Assembly and governor moved quickly to tighten regulations and to hire additional staffing at the Fire Marshal’s office to protect the patrons of bars and restaurants from fire.  However, beefing up the state Department of Health’s regulatory oversight of the Ocean State’s assisted living facilities, where 3,700 plus seniors reside, did not receive one dime in funding in the FY 2004 budget.

An assisted-living provider group, aging advocates, the Long-Term Coordinating Council, the state ombudsman and officials at the state Department of Health, have all called for new state dollars to fill one full-time surveyor position ( a nurse) to ensure that assisted living residences across Rhode Island are inspected on a timelier basis.

Last year, state lawmakers passed legislation to protect frail Rhode Island seniors who receive assisted-living services.

As this legislative session ends, the governor and General Assembly have failed to allocate the necessary funding in the FY 2004 state budget to fully implement state law that would result in the inspection of the state’s 72 assisted-living facilities and 155 assisted-living beds in nursing facilities in a timely manner.

According to the state’s Department of Health, another seven assisted-living projects are expected to be up and running over the next 18 months.

The ball now moves to Carcieri’s court to either use contingency funds in his office budget or to take administrative action to hire more assisted-living inspectors.

While it has been reported that the governor is amenable to using funds flushed out by his “fiscal fitness program” to pay for a new surveyor position, the time to act is now, rather than later.

Acting now to fix this policy glitch is sound public policy.  I am sure that Rhode Island seniors and taxpayers will agree.

Fix the Nursing Facility Problem Once and For All

Published in Pawtucket Times on April 28, 2003

Forty-years ago, the Senate Aging Committee hearings put the spotlight on the poor care provided in the nation’s nursing facilities.

This month, the April 2003 special issue of “the Gerontologist” sends the troubling message that nationwide improvement in nursing facility care is not likely.

Despite substantial regulatory oversight, Joshua Wiener, of the Urban Institute said “quality of care in nursing homes remains problematic. Quality of care in nursing facilities remains a problem for which there are not simple solutions.”

Before this national crisis can e directly confronted, increased staffing and raising the wages of nursing facility workers appear to be necessary preconditions for improving care quality and should receive high priority, said Weiner. (Rhode Island nursing facility providers hold similar beliefs and have called on Gov. Don Carcieri and state lawmakers to provide the necessary funding to raise facility worker’s wages.

The article’s written by 14 prominent policy experts in this special issue – “The Challenges in Nursing Home Care” – address central concerns in nursing facility care and help provide answers to questions, such as how these facilities can be financed and how care can be delivered.

The articles in this issue are the result of a conference held at Florida State University that was sponsored in part by the National Institute on Aging.

Dr. Quadagno and Dr. Stahl, guest editors of this special issue, believe a major challenge at both the national and state levels concerns the effective recruitment, training and retention of certified nursing aides.  Nursing aides, they pointed out provide about 60 percent of total nursing hours to residents (Again, this observation has been delivered to lawmakers at numerous legislative hearings on Smith Hill).

Many experts who wrote articles in this special issue contend the overall quality of nursing facility care in America still remains poor.  There are serious ongoing quality problems.

And like the rest of the nation, Rhode Island’s facilities are having problems recruiting and retaining certified nursing aids and providing higher wages to them as they receive inadequate Medicaid reimbursement.

What can be done about it?

Simply put, improving the quality of care in Rhode Island nursing facilities is directly linked to getting adequate Medicaid funding. The state must pay a fair rate when facilities are required  to provide quality care to 10,000-plus vulnerable Ocean State seniors who require intensive 24-hour-a-day care.

“The Principes of Reimbursement for nursing facilities are grossly underfunded,” charged Hugh Hall, president of the Rhode Island Health Care Association (RIHCA), a state-wide trade group representing nursing facility providers.

Hall, who is the administrator of the Cherry Hill Manor Nursing & rehabilitation Center in Johnston, estimated only two percent of the state’s nursing facilities are receiving adequate Medicaid reimbursement to cover their true costs of care.

Hall said that unless reimbursement is addressed swiftly, the quality of care delivered by facilities will begin to suffer the effects of the continued lack of attention of state policy makers.

“There is always another need for state tax dollars to be spent elsewhere,” Hall said, recognizing the growing number of special interest groups, who approach the General Assembly each year.

“Hopefully, it will be spent on where it is needed most, on the state’s frailest citizens,” he said, noting that “if the state does not spend it on them, who will?”

According to Alfred Santos, RIHCA’s executive director, the General Assembly is considering legislation (H 5803/S 0901) that would revise the state’s Principles of Reimbursement. Passage would begin to address the inadequate funding of the state’s nursing facilities, he said.

The legislative proposals, referred to the House and Senate Finance Committees, reflect the findings of an 18-month study of B.D.O Seidman, a consulting firm hired by the Department of Human Services to review and recommend fixest to the state’s flawed reimbursement system. Santos said one of the findings of this study was the state was underpaying facilities in excess of $ 30 million annually.

It’s time to fix the state’s flawed Medicaid reimbursement system once and for all. A Band-aid solution is not the appropriate approach considering the growing number of Ocean State seniors who will require higher levels of intensive care.

At an AARP  debate in gubernatorial candidates last September, this writer asked Carcieri if he would budget $ 15 million to overhaul the existing Medicaid payment system. The additional funding would greatly improve the quality of care and services provided to 10,000-plus nursing facility residents.

With this additional $ 15 million in state funding, the federal government would pick up another $ 15 million for a total of $ 30 million. This funding would allow Rhode Island facilities to provide quality care.

Candidate Carcieri acknowledged it would be difficult to find $ 15 million to fix the system because of the state’s looming budget deficit.

But there may be a light at the end of the tunnel. When the dust settles on the governor’s “Big Audit,” state funds may be identified and targeted toward ratcheting up the state’s inadequate reimbursement rate.

Combine these newly discovered funds with new tx revenues generated from the Lincoln greyhound track and you might just have the $15 million in state funds required to bring in millions of federal dollars.

For those Rhode Island seniors who are currently in nursing facilities, and for their children and grandchildren who may unfortunately require that intensive level of care, lawmakers must fix the payment problem once and for all.

Hopefully, Carcieri, along with the General Assembly, will not allow the B.D.O. Seidman report’s recommendations on fixing the state’s Medicaid payment system to sit on the dusty shelf in the Department of Human Services.

If that happens, what a waste of taxpayer money.