Medicaid Payments and Providers (formerly Medicaid Code of Administrative Rules, Section #0301) (210-RICR-20-00-1)


This rule will be effective on 03/17/2024.
My Page Title

1.1Legal Authority


1.3Medicaid Payment Policy

1.4Long-term Care Facilities – Surveys

1.5Provider Eligibility – Screening Requirements

1.6Provider Eligibility – Eligibility Criteria

1.7 Provider Eligibility – Termination of Participation for Ineligibility

1.8Provider Eligibility – Suspension of Participation Pursuant to United States Department of Health and Human Services Order

1.9Medicaid Provider Administrative Sanctions

1.10Notice of Violations and Sanctions


Title 210 Executive Office of Health and Human Services
Chapter 20 Medicaid Payments and Providers
Subchapter 00 N/A
Part 1 Medicaid Payments and Providers (formerly Medicaid Code of Administrative Rules, Section #0301) (210-RICR-20-00-1)
Type of Filing Amendment
Regulation Status Inactive
Effective 01/20/2023 to 07/17/2023

Regulation Authority:

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

Purpose and Reason:

This amendment defines the provider types that are considered high, moderate, and limited risk. The FY2023 Budget as Enacted directed EOHHS to define these risk categories, which is also required by CMS. High risk providers will now be required to submit to a national criminal background check supported by fingerprints. This is a federal program integrity requirement and Medicaid match is at risk if Rhode Island does not comply. The amendment also defines the criteria for qualified providers and the bases for rejection or termination to ensure that this information is clearly stated to existing and prospective Medicaid providers.

Brief statement of Reason for Finding Imminent Peril:

Federal funding is at risk and we have assured CMS that we will implement the fingerprint requirement as soon as possible. We are one of very few states that are out of compliance with this federal mandate. These regulations are a necessary step to ensure that this is implemented and the sooner the better, else we will lose substantial federal funding (R.I. Gen. Laws 42-35-2.10).