Medicaid Payments and Providers


210-RICR-20-00-1 ACTIVE RULE

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1.1Legal Authority

1.2Incorporated Materials

1.3 Definitions

1.4Medicaid Payment Policy

1.5Long-term Care Facilities – Surveys

1.6Provider Eligibility – Screening Requirements

1.7Provider Eligibility – Eligibility Criteria

1.8 Provider Eligibility – Termination of Participation for Ineligibility

1.9Provider Eligibility – Suspension of Participation Pursuant to United States Department of Health and Human Services Order

1.10Medicaid Provider Administrative Sanctions

1.11Notice of Violations and Sanctions

1.12Severability


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
Type of Filing Amendment
Regulation Status Active
Effective 07/17/2023

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

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 the Centers for Medicare and Medicaid Services (CMS). High risk providers will now be required to submit to a national criminal background check supported by fingerprints as required by federal program integrity regulations. This amendment also requires caregivers to submit to a national criminal background check supported by fingerprints prior to providing care to elderly and disabled individuals without the presence of other employees, as required by R.I. Gen. Laws § 42-7.2-18.3. This applies to caregivers in the shared living and self-directed programs. 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.