reglab/statecodes huggingface dataset:
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 00 - General Provisions › Part 3 - Medicaid and Children's Health Insurance Program (CHIP) Non-Financial General Eligibility Requirements › Section 210-RICR-10-00-3.8 - Sponsor Deeming

Current through June 14, 2024
A. Under the
				  deeming provisions for non-citizens, the income and resources of the sponsor(s)
				  are counted as available and received, even if not in fact received, by the
				  applicant. Income and resources of the sponsor(s) and of the sponsor's spouse
				  (when living together) are counted when determining the income and resources of
				  the noncitizen applicant.
1. Scope and
				  application - Deeming applies ONLY to lawful permanent residents (LPR) who:
a. Entered the U.S. or were granted LPR
				  status on or after December 19, 1997; and
b. Were sponsored by a person or entity with
				  U.S. citizenship status such a family member, employer, or representative of an
				  academic institution or business owner; and
c. Received legally binding affidavit(s) of
				  support from the sponsor (USCIS form
				  1-864).
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 00 - General Provisions › Part 3 - Medicaid and Children's Health Insurance Program (CHIP) Non-Financial General Eligibility Requirements › Section 210-RICR-10-00-3.9 - Evidence Accepted for Verification Purposes

Current through June 14, 2024
A.
				  Accepted forms of documented evidence for each non-financial eligibility factor
				  is set forth below:
1. Identity - The State
				  accepts the following as proof of identity, provided such document has a
				  photograph or other identifying information sufficient to establish identity,
				  including, but not limited to, name, age, sex, race, height, weight, eye color,
				  or address:
a. Driver's license issued by a
				  State or Territory;
b. School
				  identification card;
c. U.S.
				  military card or draft record;
d.
				  Identification card issued by the Federal, State, or local
				  government;
e. Military dependent's
				  identification card;
f. U.S. Coast
				  Guard Merchant Mariner card;
g. For
				  children under the age of nineteen (19), a clinic, doctor, hospital, or school
				  record, including preschool or day care records;
h. Two (2) other documents containing
				  consistent information that corroborates an applicant's identity. Such
				  documents include, but are not limited to, employer identification cards; high
				  school, high school equivalency and college diplomas; marriage certificates;
				  divorce decrees; and property deeds or titles.
i. Finding of identity from a Federal or
				  State governmental agency. The State may accept as proof of identity a finding
				  of identity from a another government agency, federal or state, including but
				  not limited to a public assistance, law enforcement, internal revenue or tax
				  bureau, or corrections agency, if the identity of the applicant has been
				  verified and certified.
j. If the
				  applicant does not have any of the documentation cited herein, the State
				  accepts an affidavit signed, under penalty of perjury, by a person other than
				  the applicant who can reasonably attest to the applicant's identity. Such
				  affidavit must contain the applicant's name and other identifying information
				  establishing identity. The affidavit does not have to be notarized.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 00 - General Provisions › Part 4 - "Collections and Payments: Liens and Recovery of Medicaid Payments" (formerly Medicaid Code of Administrative Rules, Section # 0312) (210-RICR-10-00-4) › Section 210-RICR-10-00-4.1 - LEGAL authority

Current through June 14, 2024
In accordance with federal mandates and R.I. Gen. Laws
					 §
										40-8-15,
					 this lien and recovery regulation applies to the estates of recipients, whether
					 categorically or medically needy, fifty-five (55) years of age or older at the
					 time of receipt of Medicaid.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 00 - General Provisions › Part 4 - "Collections and Payments: Liens and Recovery of Medicaid Payments" (formerly Medicaid Code of Administrative Rules, Section # 0312) (210-RICR-10-00-4) › Section 210-RICR-10-00-4.2 - OVERVIEW

Current through June 14, 2024
A. A lien shall attach against property,
				  which is included or includable in the decedent's probate estate, regardless of
				  whether or not a probate proceeding has been commenced in a probate court. Such
				  a lien shall only be effective upon proper prior notice and if the lien is
				  recorded in the land evidence records in accordance with R.I. Gen. Laws §
										40-8-15.
B. This Part, as it applies to all probate
				  proceeding of a decedent aged fifty-five years (55) or older, shall include
				  voluntary informal probate proceedings and any references to an executor or
				  administrator shall include, without limitation, a voluntary executor or
				  voluntary administrator.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 00 - General Provisions › Part 4 - "Collections and Payments: Liens and Recovery of Medicaid Payments" (formerly Medicaid Code of Administrative Rules, Section # 0312) (210-RICR-10-00-4) › Section 210-RICR-10-00-4.3 - Definitions

Current through June 14, 2024
A. As used in this section, the following
				  terms shall be construed as follows:
1.
				  "Estate", with respect to a deceased individual, means all real and personal
				  property and other assets included or includable within the individual's
				  probate estate.
2. "Executive
				  Office of Health and Human Services" or "EOHHS" means the state agency
				  established in 2006 under the provisions of R.I. Gen. Laws Chapter 42-7.2 et
				  seq. within the executive branch of state government and serves as the
				  principal agency for the purposes of managing the Departments of Children,
				  Youth, and Families (DCYF); Health (DOH); Human Services (DHS); and Behavioral
				  Healthcare, Developmental Disabilities, and Hospitals (BHDDH). The EOHHS is
				  designated as the "single state agency," authorized under Title XIX of the U.S.
				  Social Security Act (42 U.S.C. §
												1396a  et seq.) and, as such, is legally
				  responsible for the program / fiscal management and administration of the
				  Medicaid Program.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 00 - General Provisions › Part 4 - "Collections and Payments: Liens and Recovery of Medicaid Payments" (formerly Medicaid Code of Administrative Rules, Section # 0312) (210-RICR-10-00-4) › Section 210-RICR-10-00-4.4 - APPLICATION OF THE LIEN

Current through June 14, 2024
A. The lien shall
				  apply to the individual's estate which includes all real and personal property
				  and other assets that are included or includable within the individual's
				  probate estate. Consequently, an individual's probate estate may be comprised
				  of liquid assets as well as real property, including any resources remaining at
				  the time of death which were allowable in the individual's Medicaid eligibility
				  determination.
B. Other than as
				  provided in §
										4.15   of this Part, a lien
				  cannot attach to assets which are not the subject of a probate estate initiated
				  within the State of Rhode Island, or in any other state in which the individual
				  was a domiciliary. Real or personal property which passes by operation of law,
				  or passes to beneficiaries under a contract, deed, annuity, or other
				  instruments such as trust agreements or insurance policies, or any other
				  property which does not require the initiation of a probate process to convey
				  title or beneficial interests or ownership to others, is excluded from the lien
				  process.
C. The lien shall attach
				  against property of a beneficiary, which is included or includable in the
				  decedent's probate estate, regardless of whether or not a probate proceeding
				  has been commenced in the probate court by EOHHS or by any other party.
				  Provided, however that such lien shall only attach and shall only be effective
				  against the beneficiary's real property included or includable in the
				  beneficiary's probate estate upon proper prior notice and if such lien is
				  recorded in the land evidence records and is in accordance with R.I. Gen. Laws
				  §
										40-8-15.
				  Decedents who have received Medicaid are subject to the assignment and
				  subrogation provisions of R.I. Gen. Laws §§
										40-6-9 and
				   40-6-10.
D. The lien for the recovery of Medicaid
				  expenditures:
1. Does not attach during the
				  beneficiary's lifetime;
2. Does not
				  attach to any real or personal property that is not included or includable in
				  the deceased Medicaid beneficiary's probate estate.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 00 - General Provisions › Part 4 - "Collections and Payments: Liens and Recovery of Medicaid Payments" (formerly Medicaid Code of Administrative Rules, Section # 0312) (210-RICR-10-00-4) › Section 210-RICR-10-00-4.5 - REQUIREMENTS FOR TRANSFER/SALE OF PROPERTY

Current through June 14, 2024
A. Whenever an
				  individual who is receiving Medicaid, transfers an interest in real or personal
				  property on or after July 1, 2012, such individual shall notify the EOHHS
				  within ten (10) days of the transfer:
1.
				  EOHHS Legal Office, Virks Building, 3 West Road, Cranston, RI 02920
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 00 - General Provisions › Part 4 - "Collections and Payments: Liens and Recovery of Medicaid Payments" (formerly Medicaid Code of Administrative Rules, Section # 0312) (210-RICR-10-00-4) › Section 210-RICR-10-00-4.6 - EXCEPTIONS TO THE LIEN

Current through June 14, 2024
A. A lien shall not
				  apply:
1. For periods of receipt of Medicaid
				  before the beneficiary reached the age of fifty-five (55).
2. If the beneficiary is survived by:
a. A spouse; or
b. A child who is under the age of twenty-one
				  (21); or
c. A child who is blind or
				  permanently and totally disabled as defined in Title XVI (SSI) of the Social
				  Security Act.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 00 - General Provisions › Part 4 - "Collections and Payments: Liens and Recovery of Medicaid Payments" (formerly Medicaid Code of Administrative Rules, Section # 0312) (210-RICR-10-00-4) › Section 210-RICR-10-00-4.7 - REDUCTIONS OF THE LIEN UNDER QLTCIP PROGRAM

Current through June 14, 2024
A. RI
				  has established a Qualified Long-Term Care Insurance Partnership (QLTCIP)
				  program. This Qualified LTC Insurance Partnership provides:
1. For the disregard of a Medicaid
				  applicant's resources in an amount equal to the benefits paid by their QLTCIP
				  policy as of the time of their application for Medicaid; and
2. For the total amount paid by the
				  individual's QLTCIP policy at the time of death to be disregarded in the
				  determination of the amount to be recovered from a beneficiary's
				  estate.
3. The amount that will be
				  protected during estate recovery is the same amount that was disregarded in the
				  eligibility determination. (There may be continuing QLTCIP policy payments
				  after Medicaid eligibility is established, so if the person later gains assets,
				  he/she may have more protected than he/she had at the time of
				  eligibility).
4. Thus, the total
				  amount paid by the individual's QLTCIP at the time of death is to be
				  disregarded in the determination of the amount to be recovered from a
				  beneficiary's estate.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 00 - General Provisions › Part 4 - "Collections and Payments: Liens and Recovery of Medicaid Payments" (formerly Medicaid Code of Administrative Rules, Section # 0312) (210-RICR-10-00-4) › Section 210-RICR-10-00-4.8 - CLIENT NOTIFICATION

Current through June 14, 2024
During application for Medicaid for the individual who is
					 fifty-five (55) or older at the time of application or who will turn fifty-five
					 (55) before renewal, the individual, or his/her representative, must be advised
					 that, under Rhode Island law, receipt of Medicaid may constitute a lien upon
					 his/her estate. Similarly, at renewal for Medicaid for an individual who is
					 fifty-five (55) years of age or older or who will become fifty-five (55) before
					 the next renewal, it must be explained to such individual that the lien is an
					 attachment against the individual's estate, taking effect at death, which
					 allows EOHHS to recover from the individual's estate any Medicaid paid on
					 behalf of the individual from the time s/he became fifty-five (55) years of age
					 (and after the effective date of the law). The exceptions in §
										4.6   of this Part relative to
					 certain survivors must be explained to the applicant.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 00 - General Provisions › Part 4 - "Collections and Payments: Liens and Recovery of Medicaid Payments" (formerly Medicaid Code of Administrative Rules, Section # 0312) (210-RICR-10-00-4) › Section 210-RICR-10-00-4.9 - RECOVERY

Current through June 14, 2024
A. Based on the information regarding the
				  deceased's resources and the assistance which would by law be recovered, a
				  decision regarding recovery is made by EOHHS.
B. EOHHS Recovery Practices:
1. Upon the filing of a petition for
				  admission to probate of a decedent's will or for administration of a decedent's
				  estate, when the decedent was fifty-five (55) years or older at the time of
				  death, a copy of said petition and a copy of the death certificate shall be
				  sent to the EOHHS:
a. EOHHS Legal Office,
				  Virks Building, 3 West Road, Cranston, RI 02920.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 00 - General Provisions › Part 4 - "Collections and Payments: Liens and Recovery of Medicaid Payments" (formerly Medicaid Code of Administrative Rules, Section # 0312) (210-RICR-10-00-4) › Section 210-RICR-10-00-4.10 - DISCHARGE OF LIEN

Current through June 14, 2024
A. EOHHS will issue
				  a discharge of its lien in each of the following situations:
1. Upon payment in full of its
				  claim;
2. Upon payment of its claim
				  in part by payment to EOHHS of all remaining estate assets after allowance for
				  the preferences outlined in R.I. Gen. Laws §
											33-12-11 and any court-approved expenses relating to any pre-existing guardianship or
				  conservatorship of the decedent.
a. EOHHS
				  does not "compromise" or reduce its claim except as provided above;
b. EOHHS will require the sale or liquidation
				  of non-liquid assets;
3.
				  Upon determination that §§
											4.10(A)(1) and
				  (2)   if this Part above are satisfied and the
				  lien is recorded in the land evidence records.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 00 - General Provisions › Part 4 - "Collections and Payments: Liens and Recovery of Medicaid Payments" (formerly Medicaid Code of Administrative Rules, Section # 0312) (210-RICR-10-00-4) › Section 210-RICR-10-00-4.11 - DISCHARGE OF INAPPLICABLE RECORDED LIEN

Current through June 14, 2024
A. EOHHS will
				  issue a discharge of a recorded lien upon a determination by EOHHS that the
				  lien is inapplicable. Inapplicability occurs in the following situations:
1. If there is a statutory exception as found
				  in §
											4.6   of this Part;
				  or
2. The decedent was never a
				  beneficiary of Medicaid, was not age fifty-five (55), or was receiving Medicaid
				  but was not "Medically Needy" or "Categorically Needy" during the relevant time
				  periods; or
3. The EOHHS received
				  reimbursement from another third-party source or insurer; or
4. No assets are included or includable in
				  the decedent's probate estate; or
5. There is no required form to request a
				  discharge of an inapplicable lien. A written request for discharge should be
				  sent to:
a. EOHHS, Virks Building, 3 West
				  Road Cranston, RI 02920 and should contain, at a minimum:
(1) A copy of the Death
				  Certificate;
(2) The decedent's
				  Social Security Number;
(3) A
				  detailed explanation of the basis for a finding of inapplicability, with
				  appropriate documentation for the finding. Acceptable documentation may include
				  affidavits;
(4) A description of
				  the real estate (tax assessor's plat/lot numbers and street address).
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 00 - General Provisions › Part 4 - "Collections and Payments: Liens and Recovery of Medicaid Payments" (formerly Medicaid Code of Administrative Rules, Section # 0312) (210-RICR-10-00-4) › Section 210-RICR-10-00-4.12 - UNDUE HARDSHIP CONSIDERATION

Current through June 14, 2024
A. EOHHS may make
				  adjustments to and settle estate liens to obtain the fullest amount
				  practicable.
B. A lien may be
				  postponed in whole or in part when EOHHS determines execution of the lien would
				  work an undue hardship.
C. An undue
				  hardship may be found to exist and execution of the lien may be postponed if a
				  sale of real property, in the case of an individual's home, would be required
				  to satisfy a claim, if all of the following conditions are met.
D. An heir or beneficiary may request that
				  the EOHHS delay the execution of its lien if:
1. An individual was using the property as a
				  principal place of residence on the date of the recipient's death;
				  and
2. That individual resided in
				  the decedent's home on a continual basis for at least twenty-four (24) months
				  immediately prior to the date of the deceased recipient's death; and
3. That individual has, from the time EOHHS
				  first presented its claim for recovery against the deceased recipient's estate
				  and after, annual gross income in an amount not to exceed 250 percent (250%) of
				  the then applicable federal poverty level (FPL) income standard based on the
				  same family size, and assets not to exceed the then applicable Medically Needy
				  resource standards.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 00 - General Provisions › Part 4 - "Collections and Payments: Liens and Recovery of Medicaid Payments" (formerly Medicaid Code of Administrative Rules, Section # 0312) (210-RICR-10-00-4) › Section 210-RICR-10-00-4.13 - APPLICATION FOR UNDUE HARDSHIP CONSIDERATION

Current through June 14, 2024
A. A
				  requestor shall mail his or her application for an undue hardship consideration
				  in writing to EOHHS within forty-five (45) days after the date EOHHS has filed
				  its claim with probate court. The application shall include the following
				  information:
1. The relationship of the undue
				  hardship applicant to the decedent and copies of documents establishing that
				  relationship; and
2. The basis for
				  the application and documentation supporting the undue hardship applicant's
				  position; and
3. Supporting
				  documentation that the requestor has the legal standing and will be allowed to
				  continue to reside in the property indefinitely should the undue hardship
				  request be approved.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 00 - General Provisions › Part 4 - "Collections and Payments: Liens and Recovery of Medicaid Payments" (formerly Medicaid Code of Administrative Rules, Section # 0312) (210-RICR-10-00-4) › Section 210-RICR-10-00-4.14 - UNDUE HARDSHIP GRANTED

Current through June 14, 2024
A. If EOHHS finds
				  that an undue hardship exists, the execution of the lien is delayed for as long
				  as:
1. The undue hardship grantee is alive
				  and residing in the property; and has income and assets not to exceed the
				  amounts specified in this Part.
2.
				  The undue hardship circumstances upon which the decision is based continue to
				  exist; and
3. As long as the
				  property is adequately maintained and continues to exist in its then current
				  state.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 00 - General Provisions › Part 4 - "Collections and Payments: Liens and Recovery of Medicaid Payments" (formerly Medicaid Code of Administrative Rules, Section # 0312) (210-RICR-10-00-4) › Section 210-RICR-10-00-4.15 - TRANSFER/SALE OF PROPERTY UNDER HARDSHIP

Current through June 14, 2024
If the owner of the property sells or transfers ownership
					 of the home, EOHHS will execute the lien.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 00 - General Provisions › Part 5 - Interception of Insurance Payments (210-RICR-10-00-5) › Section 210-RICR-10-00-5.1 - Legal Authority

Current through June 14, 2024
A. Federal law
				  requires the Executive Office of Health and Human Services (EOHHS) to seek
				  recovery of Medicaid expenses from Medicaid beneficiaries' third-party
				  payments. The purpose of this regulation is to set forth the process for the
				  recovery of such payments by the State using the Medical Assistance Intercept
				  System (MAIS) as mandated by R.I. Gen. Laws Chapter 27-57.1.
B. In accordance with R.I. Gen. Laws §
										40-6-9 and applicable administrative rules, when applying for Medicaid, an applicant
				  automatically assigns, as a condition of eligibility, his/her rights of
				  subrogation to the EOHHS for any third-party payments from insurers. Nothing in
				  this Part shall limit EOHHS from recovery of any other monies allowed, to the
				  extent of the distribution, in accordance with all state and federal
				  laws.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 00 - General Provisions › Part 5 - Interception of Insurance Payments (210-RICR-10-00-5) › Section 210-RICR-10-00-5.2 - Definitions

Current through June 14, 2024
A. For the purposes of this regulation, the
				  following terms shall be construed as follows:
1. "Executive Office of Health and Human
				  Services" or "EOHHS" means the state agency that is designated under the
				  Medicaid State Plan as the single state agency responsible for the
				  administration of the Title XIX Medicaid Program.
2. "Worker's Compensation" means an insurance
				  program that provides wage replacement and medical benefits to employees
				  injured during the course of their employment in exchange for the mandatory
				  relinquishment of the employee's right to sue the employer.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 00 - General Provisions › Part 5 - Interception of Insurance Payments (210-RICR-10-00-5) › Section 210-RICR-10-00-5.4 - Notice

Current through June 14, 2024
A. The EOHHS shall provide written notice to
				  the insurer, claimant and his/her attorney, if any, which shall include the
				  date, name, social security number, case number, total amount of the payment
				  proposed to be withheld to reimburse the state for Medicaid funded services and
				  a list of the items and services, including dates of service for which
				  reimbursement is sought. The notice shall explain the right to request a
				  hearing pursuant to §
										5.5   of this Part.
B. Claimant's counsel shall have access to
				  the centralized database to update all liens prior to settlement as provided
				  for herein; and to ensure compliance with R.I. Gen. Laws Chapter 27-57.1 and
				  R.I. Gen. Laws §§
										40-6-9 and
				   40-6-10.
				  Claimants should be aware that the liens under the intercept rules currently
				  apply to "fee-for-service" Medicaid. If a claimant is also covered by a
				  Medicaid Managed Care Organization (MCO), that entity may also have a Medicaid
				  lien.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 00 - General Provisions › Part 5 - Interception of Insurance Payments (210-RICR-10-00-5) › Section 210-RICR-10-00-5.5 - Request for Hearing

Current through June 14, 2024
Any payments made by an insurer pursuant to these rules,
					 shall be made to the EOHHS, unless there is a request for an administrative
					 hearing by the claimant. Any claimant aggrieved by any action taken under these
					 procedures may, within thirty (30) days of the date of the notice to the
					 claimant, request an administrative hearing from the EOHHS. If there is an
					 administrative hearing, the insurer must remit payment within ten (10) business
					 days of and in accordance with the hearing decision.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 00 - General Provisions › Part 5 - Interception of Insurance Payments (210-RICR-10-00-5) › Section 210-RICR-10-00-5.6 - Timeline for Payment by Insurer

Current through June 14, 2024
The insurer shall make any payments required, pursuant to
					 these rules, to the EOHHS, thirty (30) days after the date of notification to
					 the claimant or his/her attorney. Provided, however, that if the claimant has
					 requested a hearing, payment shall not be made until ten (10) days after the
					 hearing decision and in accordance with the hearing decision.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 00 - General Provisions › Part 5 - Interception of Insurance Payments (210-RICR-10-00-5) › Section 210-RICR-10-00-5.7 - Severability

Current through June 14, 2024
If any provisions of these regulations or the application
					 thereof to any person or circumstance shall be held invalid, such invalidity
					 shall not affect the provisions or application of these regulations which can
					 be given effect, and to this end the provisions of these regulations are
					 declared to be severable.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 00 - General Provisions › Part 6 - Collection of Overpayments via State Tax Refund Offset (formerly Medicaid Code of Administrative Rules, Section #0313) (210-RICR-10-00-6) › Section 210-RICR-10-00-6.1 - Legal authority

Current through June 14, 2024
In accordance with R.I. Gen. Laws §§
										44-30.1-1,
					  44-30.1-3,
					  44-30.1-4 and
					  44-30.1-8 entitled, "Setoff of Refund of Personal Income Tax", the Executive Office of
					 Health and Human Services (EOHHS) is authorized to recover Medicaid benefit
					 overpayments and cost share arrearages through the offset of the individual's
					 state income tax refund.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 00 - General Provisions › Part 6 - Collection of Overpayments via State Tax Refund Offset (formerly Medicaid Code of Administrative Rules, Section #0313) (210-RICR-10-00-6) › Section 210-RICR-10-00-6.2 - Definitions

Current through June 14, 2024
A. For the purposes of this section, the
				  following definitions apply:
1. "Medicaid
				  benefit overpayment" means any amount paid to or on behalf of a Medicaid
				  beneficiary for a Medicaid benefit to which the beneficiary was not entitled,
				  including but not limited to, an overpayment of a RIte Share premium.
2. "Medicaid cost share arrearage"
				  means any amount due and owed to EOHHS as a result of a Medicaid beneficiary's
				  failure to pay their cost share obligation, including any amount due for a cost
				  sharing obligation or Medicaid premium obligation, imposed in accordance with
				  R.I. Gen. Laws Chapter 40-8.4.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 00 - General Provisions › Part 6 - Collection of Overpayments via State Tax Refund Offset (formerly Medicaid Code of Administrative Rules, Section #0313) (210-RICR-10-00-6) › Section 210-RICR-10-00-6.3 - Criteria for Claims Referred for Setoff

Current through June 14, 2024
A. The
				  Medicaid claim referred for setoff must comply with the State Personal Income
				  Tax Refund Offset procedure (as below).
B. The Medicaid claim must be:
1. Established by court order, by
				  administrative hearing conducted by EOHHS, or by written agreement between the
				  EOHHS and the individual:
a. Greater than or
				  equal to the minimum amount required for submission for setoff by the R.I.
				  Division of Taxation. The Division of Taxation shall, from time to time,
				  determine the minimum amount of claim to which the setoff procedure may be
				  applied.
b. Submitted in the name
				  of one individual or must be reduced by any amount submitted as a separate
				  claim for other individuals who are jointly or severally liable for the claim;
				  and
c. Not involved in a bankruptcy
				  stay or discharged in bankruptcy.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 00 - General Provisions › Part 6 - Collection of Overpayments via State Tax Refund Offset (formerly Medicaid Code of Administrative Rules, Section #0313) (210-RICR-10-00-6) › Section 210-RICR-10-00-6.4 - Setoff Procedures and Notification of Debtor

Current through June 14, 2024
A.
				  EOHHS will notify the individual of its intent to refer a claim to the R.I.
				  Division of Taxation for offset and provide the individual with thirty (30)
				  days to appeal the intended referral by presenting evidence that all or part of
				  the claim is not legally enforceable. The thirty (30) day notice ("pre-offset
				  notice") shall contain the following information:
1. The amount of the claim(s);
2. That the claim is legally
				  enforceable;
3. The individual's
				  Medicaid Case Identifier;
4. That
				  the claim(s) is to be referred to the R.I. Division of Taxation for offset
				  unless the claim is paid in full within thirty (30) days of the date of the
				  letter;
5. Instructions about how
				  to pay the claim(s), and the address and telephone number to call to discuss
				  the claim and the intended intercept.
6. That the individual has the right to
				  appeal the offset. The notice will advise:
a.
				  That the individual is entitled to an administrative hearing to contest the
				  setoff. The appeal request must be in writing and must be received by EOHHS not
				  later than thirty (30) days after the date of the notice.
b. The general nature of the potential
				  defenses available to the debtor;
c. The rights of non-obligated spouses with
				  respect to income tax refunds in the event a joint return is filed;
d. The individual's right to judicial review
				  of the administrative hearing decision.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 00 - General Provisions › Part 6 - Collection of Overpayments via State Tax Refund Offset (formerly Medicaid Code of Administrative Rules, Section #0313) (210-RICR-10-00-6) › Section 210-RICR-10-00-6.5 - Transfer of Funds by the R.I. Division of Taxation

Current through June 14, 2024
A. At the time of the transfer of funds to
				  EOHHS, the R.I. Division of Taxation shall notify the debtor that the transfer
				  has been made.
B. The notice shall
				  state the name of the debtor, the amount of Medicaid benefit overpayment or
				  cost share arrearage being claimed, the amount of the refund in excess of the
				  amount claimed, if any, and that the transfer of funds to EOHHS was
				  made.
C. In the case of a joint
				  refund, the R.I. Division of Taxation notice shall also state the name of a
				  taxpayer-spouse named in the return, if any, against whom no Medicaid benefit
				  overpayment or cost share arrearage is claimed, the opportunity to request that
				  the refund be divided between the spouses by filing an amended income tax
				  return showing each spouse's share of the tax and the contribution to the
				  overpayment of tax resulting in the refund.
D. Upon receipt of funds transferred from the
				  R.I. Division of Taxation, EOHHS deposits and holds the funds in an escrow
				  account until final determination of setoff. Upon final determination of the
				  amount of the claim to be set-off by:
1.
				  default for failure to apply for an administrative hearing, or by
2. decision of the administrative hearing
				  officer, EOHHS shall remove from the account of the claim payment from the
				  escrow account and credit the amount to the debtor's obligation. The pendency
				  of judicial proceedings to review the administrative decision shall not stay
				  nor delay the setoff, transfer, and disbursement of the tax refund in
				  question.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 00 - General Provisions › Part 6 - Collection of Overpayments via State Tax Refund Offset (formerly Medicaid Code of Administrative Rules, Section #0313) (210-RICR-10-00-6) › Section 210-RICR-10-00-6.6 - ADMINISTRATIVE HEARINGS

Current through June 14, 2024
A. As appropriate,
				  an administrative hearing may be held pursuant to the "Medicaid Code of
				  Administrative Rules, Section #0110, 'Complaints and Appeals'".
B. The hearing officer must issue her or his
				  decision in writing in accordance with the "Medicaid Code of Administrative
				  Rules, Section #0110, 'Complaints and Appeals'". If the decision is made that
				  the claim does not meet the requirements for offset, EOHHS must take
				  appropriate corrective action.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 00 - General Provisions › Part 6 - Collection of Overpayments via State Tax Refund Offset (formerly Medicaid Code of Administrative Rules, Section #0313) (210-RICR-10-00-6) › Section 210-RICR-10-00-6.7 - Severability

Current through June 14, 2024
If any provisions of these regulations or the application
					 thereof to any person or circumstance shall be held invalid, such invalidity
					 shall not affect the provisions or application of these regulations which can
					 be given effect, and to this end the provisions of these regulations are
					 declared to be severable.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 00 - General Provisions › Part 7 - Medicaid Program Institutions For Mental Dieases › Section 210-RICR-10-00-7.1 - Legal Authority

Current through June 14, 2024
The State of Rhode Island Executive Office of Health and
					 Human Services (EOHHS), as the single state agency responsible for the State of
					 Rhode Island Medicaid Program, reviews compliance with federal requirements to
					 determine whether a Medicaid provider remains eligible for Medicaid
					 reimbursement. R.I. Gen. Laws §
										42-7.2-2(a)(6);
					 Title XIX of the U.S. Social Security Act,
					  42 U.S.C. §
											1396a  et seq . This includes ensuring
					 compliance with federal regulations regarding whether a facility is excluded
					 from the Medicaid program as an Institution for Mental Disease (IMD).
					  42 C.F.R. §
											435.1010; CMS State Medicaid Manual, §
					 4390. T his IMD compliance review is critical to the proper administration of
					 the Medicaid Program in compliance with all applicable federal laws and
					 regulations.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 00 - General Provisions › Part 7 - Medicaid Program Institutions For Mental Dieases › Section 210-RICR-10-00-7.2 - Purpose and Scope

Current through June 14, 2024
This regulation applies to any hospital, nursing facility,
					 or other institution of more than sixteen (16) beds, that is primarily engaged
					 in providing diagnosis, treatment, or care of persons with mental diseases,
					 including medical attention, nursing care, and related services shall be
					 considered an IMD and be excluded from Medicaid reimbursement. Whether a
					 facility is an IMD is determined by its overall character as that of a facility
					 established and maintained primarily for the care and treatment of mental
					 disease whether or not the facility is licensed as such.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 00 - General Provisions › Part 7 - Medicaid Program Institutions For Mental Dieases › Section 210-RICR-10-00-7.3 - Definitions

Current through June 14, 2024
A. For purposes of this section, the
				  following definitions apply:
1. "At-risk
				  facility" means a facility that is considered at risk of becoming an IMD if one
				  (1) of the following applies:
a. The facility
				  was identified as an At-Risk Facility during a prior IMD review by
				  EOHHS;
b. Forty-five percent (45%)
				  or more of the facility's residents or patients carry a primary diagnosis of a
				  mental disorder or disease and/or have been determined to need specialized
				  services for serious mental illness.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 00 - General Provisions › Part 7 - Medicaid Program Institutions For Mental Dieases › Section 210-RICR-10-00-7.4 - IMD Determination Review Process

Current through June 14, 2024
A. EOHHS shall
				  make the final determination as to whether any hospital, nursing facility, or
				  other institution of more than sixteen (16) beds is an IMD and excluded from
				  the Medicaid program. EOHHS shall identify:
1. Facilities that are at risk of becoming
				  IMDs;
2. The course of action to be
				  taken when such facilities have been identified as at risk of becoming an IMD;
				  and
3. The course of action to be
				  taken if a facility is identified as an IMD.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 00 - General Provisions › Part 7 - Medicaid Program Institutions For Mental Dieases › Section 210-RICR-10-00-7.5 - Administrative Hearings

Current through June 14, 2024
A. As appropriate,
				  an administrative hearing may be held pursuant to Subchapter 05 Part 2 of this
				  Chapter.
B. The hearing officer
				  must issue her or his decision in writing in accordance with Subchapter 05 Part
				  2 of this Chapter. If the decision is made that the claim does not meet the
				  requirements for offset, EOHHS must take appropriate corrective
				  action.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 05 - Consumer Rights, Responsibilities, and Protections › Part 1 - Confidentiality Rule (210-RICR-10-05-1) › Section 210-RICR-10-05-1.1 - Purpose

Current through June 14, 2024
A. The Executive Office of Health and Human
				  Services (EOHHS) has an ethical and legal obligation to safeguard and maintain
				  as confidential the information it receives from or about Medicaid applicants
				  and beneficiaries. In accordance with R.I. Gen. Laws Chapter 40-6, all records
				  pertaining to the administration of the Medicaid Program are confidential in
				  nature. It is unlawful for any person to make use of, or cause to be used, any
				  information contained in these records for purposes not directly connected with
				  the administration of the Medicaid Program, except with the consent of the
				  person affected.
B. Further,
				   42 C.F.R. §
											431.300  et seq. requires EOHHS to have
				  safeguards in place that restrict the use or disclosure of information about
				  Medicaid applicants and beneficiaries. The purpose of this document is to meet
				  this requirement and to safeguard and maintain applicant /beneficiary
				  information as confidential.
C.
				  Nothing in this section shall be deemed to prohibit the EOHHS Secretary, or
				  his/her duly authorized agents, from issuing any statistical material or data,
				  or publishing or causing the same to be published whenever he/she shall deem it
				  to be in the public interest.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 05 - Consumer Rights, Responsibilities, and Protections › Part 1 - Confidentiality Rule (210-RICR-10-05-1) › Section 210-RICR-10-05-1.2 - Legal Authority

Current through June 14, 2024
A. These rules are
				  promulgated pursuant to the authority set forth in R.I. Gen. Laws Chapter 40-8
				  ("Medical Assistance") and various sections in the State's General Laws
				  including: §§5-37.3-4-1 et seq. ("Confidentiality of Health Care
				  Communications and Information Act");
				  23-5-9
				  ("Upon Death, Reports of Infectious Disease"); Chapter 40-6 ("Public Assistance
				  Act"); §§40-6-12
				  ("Records as to Assistance"); and
				  42-72-8
				  ("Confidentiality of Records, Department of Children, Youth, and
				  Families").
B. Additional authority
				  is derived from Title XIX of the Social Security Act; the State's Medicaid
				  State Plan; and the Rhode Island Comprehensive Section 1115 D emonstration, as
				  approved in final form on February 25, 2014, and as subsequently
				  amended.
C. Additional
				  confidentiality provisions exist for Medicaid beneficiaries who are receiving
				  treatment for HIV/AIDS and mental health/substance use. These provisions are
				  contained in State law, in substantive part, as follows: R.I. Gen. Laws
				  §§
										23-1.10-13 ("Confidentiality of records -Availability for Research, Health and Safety");
				  23-6.3-7
				  ("Confidentiality, Prevention and Suppression of Contagious Diseases -
				  HIV/AIDS");
				  23-6.3-8
				  ("Protection of Records, Prevention and Suppression of Contagious Diseases -
				  HIV/AIDS");
				  23-28.36-3
				  ("Notification of Fire Fighters, Police Officers and Emergency Medical
				  Technicians After Exposure to Infectious Diseases");
				  40.1-5-5
				  ("Admission of Patients Generally, Rights of Patients, Patients' Records,
				  Competence of Patients - Mental Health Law"); and
				  40.1-5-26
				  ("Disclosure of Confidential Information and Records, Mental Health
				  Law").
D. Additional federal
				  regulatory requirements related to confidentiality and protection of records
				  are adopted by reference below.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 05 - Consumer Rights, Responsibilities, and Protections › Part 1 - Confidentiality Rule (210-RICR-10-05-1) › Section 210-RICR-10-05-1.3 - Incorporated Materials

Current through June 14, 2024
A. These
				  regulations hereby adopt and incorporate the following by reference, not
				  including any further editions or amendments thereof, and only to the extent
				  that the provisions therein are not inconsistent with these regulations:
1.
											42 U.S.C. §
												1396a(a)(7)  ("State Plans
				  for Medical Assistance");
2.
											42 C.F.R. §
												431.300  ("Safeguarding Information on
				  Patients and Beneficiaries");
3. 42
				  C.F.R. Part 2 ("Confidentiality of Substance Use Disorder Patient
				  Records");
4.
											42 C.F.R. §
												460.200  (PACE Programs, Maintenance of
				  Records and Reporting of Data");
5.
											42 C.F.R. §§
												435.940 through  435.965  ("Verifying Financial Information");
6.
											42 C.F.R. §
												483.10(h)  (Nursing
				  Facilities "Resident Rights, Privacy and Confidentiality");
7.
											45 C.F.R. §§
												164.102 through  164.534  ("Security and Privacy").
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 05 - Consumer Rights, Responsibilities, and Protections › Part 1 - Confidentiality Rule (210-RICR-10-05-1) › Section 210-RICR-10-05-1.4 - Definitions

Current through June 14, 2024
A. As used herein, the following terms shall
				  be construed as follows:
1. "Confidential"
				  means that information is safeguarded, protected, and shared only on a
				  "need-to-know" basis.
2. "Executive
				  Office of Health and Human Services" or "EOHHS" means the state agency
				  established in 2006 under the provisions of R.I. Gen. Laws Chapter 42-7.2 et
				  seq. within the executive branch of state government and serves as the
				  principal agency for the purposes of managing the Departments of Children,
				  Youth, and Families (DCYF); Health (DOH); Human Services (DHS); and Behavioral
				  Healthcare, Developmental Disabilities, and Hospitals (BHDDH). The EOHHS is
				  designated as the "single state agency," authorized under Title XIX of the U.S.
				  Social Security Act (42 U.S.C. §
												1396a  et seq.) and, as such, is legally
				  responsible for the program / fiscal management and administration of the
				  Medicaid Program.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 05 - Consumer Rights, Responsibilities, and Protections › Part 1 - Confidentiality Rule (210-RICR-10-05-1) › Section 210-RICR-10-05-1.5 - Confidentiality Criteria

Current through June 14, 2024
A. The use and
				  disclosure of information concerning Medicaid applicants and beneficiaries
				  shall be limited to purposes directly related to:
1. The administration of the Medicaid
				  Program. This includes, but is not limited to, establishing eligibility,
				  determining the amount of Medicaid benefits provided, and providing services
				  for applicants and beneficiaries.
2. Any investigation, prosecution, or
				  criminal or civil proceeding conducted in connection with the administration of
				  the Medicaid Program.
3. The
				  administration of any other federal or state assistance program that provides
				  assistance, in cash or in kind, or services, directly to individuals on the
				  basis of need.
4. Any other release
				  shall be with the beneficiary's written permission, as obtained by
				  EOHHS.