Habilitation Group Homes - Initial Attestation and Workforce Report Form

Direct Care Workers

For the purposes of this program, Direct Care Workers means frontline paraprofessional employees who provide care and services directly to Medicaid beneficiaries and are not licensed by the RI Department of Health. For the purposes of these Qualifying Activities, direct care workers shall also include Nursing Assistants. These staff shall be directly employed by the LTSS Provider Agency receiving the rate increase and shall not include exempt employees under the FLSA or employees who are contracted or subcontracted through a third-party vendor or staffing agency. Administrative/management staff who spend at least 50% of their time on frontline direct care may be considered a Direct Care Worker for the purposes of the Qualifying Activities outlined in this document.

Total # of Employed should equal the total of the each of the following sections:
• PT/FT employees
• Years of Service
• Ethnicity
• Race of employees

Ethnicity of employees

Race of employees

Licensed Health Professionals

Licensed Health Professionals means frontline employees, who provide care and services directly to Medicaid beneficiaries and are licensed by the RI Department of Health. These staff shall be directly employed by the Behavioral Health Provider Agency receiving the rate increase and shall not include employees who are contracted or subcontracted through a third-party vendor or staffing agency.   Administrative/management staff who spend at least 50% of their time on frontline direct care may be considered a Licensed Health Professional for the purposes of the Qualifying Activities outlined in this document.
Total # of Employed should equal the total of the each of the following sections:
• PT/FT employees
• Years of Service
• Ethnicity
• Race of employees

Ethnicity of Employees

Race of employees

Quarterly Workforce Report Attestation


I hereby attest that, to the best of my knowledge and belief, that the above information is accurate and complete. 

I recognize that the purpose of the HCBS FMAP temporary rate increase received by the Agency is to improve recruitment, retention, and capacity of the frontline home and community-based services (HCBS) workforce.  I hereby attest that at least 85% of the enhanced HCBS FMAP temporary rate increase will be spent to provide additional compensation for frontline workers via Qualifying Activities as described in Program Guidance, and that at least 50% of those funds (the 85%) will be dedicated to staff retention.   I further attest that no more than 15% of the enhanced HCBS rate increase will be spent on payroll costs directly related to the additional compensation for frontline workers.  My agency will maintain payroll records to support this attestation, and such payroll records may be subject to audit by EOHHS.  In the event that EOHHS determines that Program funds have been used for ineligible expenses, my agency may be required to repay such funds to EOHHS.   My agency also commits to returning to EOHHS any Program funds not expended after the Program end date of March 31, 2023.   My agency will maintain and submit quarterly Expenditure Reports and Workforce Reports as required by EOHHS.

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