Medicaid Payments and Providers

Regulation Authority:

Chapters 40-6
40-8
and 42-7.2 of the Rhode Island General Laws as amended
Title XIX of the Social Security Act
R.I. Gen. Laws § 42-35-2.10
42 CFR 424.518

Purpose and Reason:

In response to emerging concerns related to potential fraud, waste, and abuse (FWA) and the health and safety of Medicaid beneficiaries, the Rhode Island Executive Office of Health and Human Services (EOHHS) is proposing updates to the Community Health Worker (CHW) program to strengthen oversight, safeguard beneficiary health and safety and Medicaid funds, and ensure the continued integrity of the program.

EOHHS has identified a need to enhance provider screening and improve documentation and billing standards to better align with federal and state program integrity requirements.  As part of this effort, CHW providers will be designated as high-risk providers for the purposes of enrollment, which will include additional screening measures to protect the health and safety of Medicaid members and promote the appropriate use of Medicaid resources.