Medicaid Managed Care Delivery Options (210-RICR-30-05-2)


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2.1RIte Care Overview

2.2Scope and Purpose

2.3Program Management


2.5Coverage Groups in RIte Care

2.6Excluded Medicaid Coverage Groups

2.7Retroactive Coverage

2.8Overview of RIte Care Services

2.9RIte Care In-Plan Capitated Benefits

2.10Out-of-Plan Benefits


All Rhody Health Partners, RIte Care and Expansion members

Dental services

Court-ordered mental health and substance use services ordered to a non- network facility or provider

Non-Emergency Transportation Services (Non-Emergency transportation is coordinated by the contracted Health Plans).

Nursing home services in excess of thirty (30) consecutive days (RHP members only)

Residential services for MR/DD clients that are paid by the State’s BHDDH

Respite (Adult)

Neonatal intensive care Unit (NICU) Services at Women’s and Infants Hospital. Except as specified in § 2.9(C) of this Part

Special Education services as defined in the child’s Individual Education Plan (IEP) for children with special health needs or developmental delays

Lead Program home assessment and non-medical case management provided by Department of Health or Lead Centers for lead poisoned children

Cedar Family Center Services

Centers of Excellence Programs

2.11Limits on Services

2.12Scope of Provider Networks

2.13Mainstreaming/Selective Contracting

2.14Primary Care Providers (PCPs)

2.15Service Accessibility Standards

2.16Mandatory Participation in Managed Care

2.17Enrollment Procedures, Rights and Responsibilities

2.18Rhody Health Partners – Program Overview

2.19Scope and Purpose


2.21MACC Group in Rhody Health Partners

2.22Overview of RHP

2.23Access to Benefits

2.24RHP In-Plan Capitated Benefits

2.25SPMI Modifications

2.26Out-of-Plan Benefits

2.27Services that are Not Covered by Medicaid

2.28Scope of Provider Networks

2.29Mainstreaming/Selective Contracting

2.30Primary Care Providers (PCPs)

2.31Service Accessibility Standards

2.32Mandatory Participation in Managed Care

2.33Enrollment Procedures, Rights, and Responsibilities

2.34Enrollment Processes for RIte Care and Rhody Health Partners Managed Care Plans Overview

2.35Scope and Purpose

2.36Initiating Enrollment: No Wrong Door

2.37Enrollment of Newborns and Adopted Children

2.38Medicaid Members Exempt from Enrollment Managed Care

2.39MCO Lock-In

2.40Open Enrollment

2.41Membership Handbook

2.42Identification Cards

2.43Interim Fee-for-Service Coverage

2.44Verification of Eligibility/Enrollment

2.45Responsibility of Medicaid Members to Report Change in Status

2.46Transitioning Members between MCOs and Delivery Systems

2.47Grievances, Appeals, and Hearings

2.48MCO Initiated Disenrollment

2.49EOHHS Authority

2.50Reasons for Disenrollment

2.51Disenrollment Effective Dates

2.52Right to Appeal

2.53Medicaid Member Rights and Protections

2.54Pharmacy Home Program

2.55Rite Smiles Dental Plan Overview

2.56Legal Authority

2.57Coverage Groups

2.58Excluded Coverage Groups

2.59Retroactive Eligibility

2.60Enrollment Process

2.61Voluntary Selection of a Dental Plan

2.62Auto Re-Enrollment Following Resumption of Eligibility

2.63Rite Smiles Lock-In

2.64Open Enrollment

2.65Voluntary Disenrollment

2.66Member Disenrollment

2.67Information and Referral


Title 210 Executive Office of Health and Human Services
Chapter 30 Medicaid for Children, Families, and Affordable Care Act (ACA) Adults
Subchapter 05 Service Delivery Options
Part 2 Medicaid Managed Care Delivery Options (210-RICR-30-05-2)
Type of Filing Amendment
Regulation Status Inactive
Effective 12/12/2023

Regulation Authority:

R.I. Gen. Laws Chapters 40-6 and 40-8
as amended; Title XIX of the Social Security Act
H.R.6 - 115th Congress (2017-2018): SUPPORT for Patients and Communities Act
115th Cong. (2018)

Purpose and Reason:

Former Foster Care Youth:

Effective 1/1/23, the SUPPORT Act directed states to provide Medicaid eligibility for individuals turning 18 after January 1, 2023 who qualify under the former foster care children (FFCC) eligibility group if they were enrolled in Medicaid at the time they aged out of the foster care system in any state. Previously, this only applied to individuals who aged out of the Rhode Island foster care system.

This regulation is being amended to reflect this change in policy


Extended Family Planning

As part of the FY23 Budget signed by Governor McKee:

EOHHS is required to provide 12 months of full benefit medical assistance to postpartum women.  As a result, postpartum individuals would not need be eligible for EFP benefits until after the 12 month postpartum period.


INACTIVE RULE Amendment - effective from 01/08/2018 to 07/29/2018
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