reglab/statecodes huggingface dataset:
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 30 - Medicaid for Children, Families, and Affordable Care Act (ACA) Adults › Subchapter 10 - Premium Assistance › Part 1 - Rhode Island Affordable Health Care Coverage Assistance Program (210-RICR-30-10-1) › Section 210-RICR-30-10-1.12 - For Further Information or to Obtain Assistance

Current through June 14, 2024
A. See the following websites:
1. www.eohhs.ri.gov
2.
www.HealthSourceRI.com
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 30 - Medicaid for Children, Families, and Affordable Care Act (ACA) Adults › Subchapter 10 - Premium Assistance › Part 1 - Rhode Island Affordable Health Care Coverage Assistance Program (210-RICR-30-10-1) › Section 210-RICR-30-10-1.13 - 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 30 - Medicaid for Children, Families, and Affordable Care Act (ACA) Adults › Subchapter 15 - Early Intervention › Part 1 - Early Intervention Program (210-RICR-30-15-1) › Section 210-RICR-30-15-1.1 - Purpose

Current through June 14, 2024
A. The purpose of the Rhode Island Early
				  Intervention (EI) Program is to provide a comprehensive, and coordinated,
				  system of home and community based services and supports for families of
				  infants and toddlers with developmental disabilities or delays.
B. The purpose of Early Intervention is to:
1. Enhance the capacity of families to meet
				  the special needs of their infant or toddler.
2. Enhance the developmental functioning of
				  infants and toddlers with special needs.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 30 - Medicaid for Children, Families, and Affordable Care Act (ACA) Adults › Subchapter 15 - Early Intervention › Part 1 - Early Intervention Program (210-RICR-30-15-1) › Section 210-RICR-30-15-1.2 - Statewide Equity

Current through June 14, 2024
Children and families must have equal access to
					 comprehensive Early Intervention services, as defined in these regulations,
					 irrespective of geographic location. The provision of Early Intervention must
					 be fully compliant with all provisions of the regulations. Early Intervention
					 must be made available to all children referred irrespective of gender, race,
					 ethnicity, religious beliefs, cultural orientation, citizenship, economic
					 status, and educational or medical diagnosis.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 30 - Medicaid for Children, Families, and Affordable Care Act (ACA) Adults › Subchapter 15 - Early Intervention › Part 1 - Early Intervention Program (210-RICR-30-15-1) › Section 210-RICR-30-15-1.4 - Lead Agency

Current through June 14, 2024
The EOHHS is the lead agency responsible for Early
					 Intervention services for infants, toddlers, and their families consistent with
					 final Part C of IDEA regulations effective September 6, 2011 and R.I. Gen. Laws
					 §
										23-13-22,
					 as amended.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 30 - Medicaid for Children, Families, and Affordable Care Act (ACA) Adults › Subchapter 15 - Early Intervention › Part 1 - Early Intervention Program (210-RICR-30-15-1) › Section 210-RICR-30-15-1.7 - Monitoring

Current through June 14, 2024
A. The EOHHS is responsible for the general
				  administration, supervision and monitoring of certified Early Intervention
				  programs and activities to carry out Part C of the Act.
B. The EOHHS shall establish and implement a
				  system of general supervision that includes multiple methods to ensure
				  implementation of Part C of the ACT, and compliance with Rhode Island Early
				  Intervention Certification Standards, identify and correct noncompliance,
				  facilitate improvement, and support practices that improve results and
				  functional outcomes for children and their families.
C. Monitoring activities shall include annual
				  determination about the performance of each certified Early Intervention
				  provider.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 30 - Medicaid for Children, Families, and Affordable Care Act (ACA) Adults › Subchapter 15 - Early Intervention › Part 1 - Early Intervention Program (210-RICR-30-15-1) › Section 210-RICR-30-15-1.8 - Eligible Population

Current through June 14, 2024
1.8.1
DEFINITION OF THE ELIGIBLE POPULATION
A. Children eligible for early intervention
				  include:
1. Children with a single established
				  condition. Criteria: The child has a diagnosed physical or mental condition
				  that has a high probability of resulting in developmental delays including, but
				  not limited to, chromosomal abnormalities; genetic or congenital disorders;
				  neurological, metabolic disorders; hearing impairments and visual impairments
				  not corrected by medical intervention or prosthesis; congenital infections;
				  severe attachment disorders and disorders secondary to exposure to toxic
				  substances including fetal alcohol syndrome. Evidence of diagnosis must be in
				  the child's record.
a. Children with
				  established developmental delays. Criteria: The child exhibits a delay in one
				  or more areas of development as measured by a norm referenced standardized tool
				  that identifies a delay that is 2 standard deviations below the mean in one
				  area of development, or 1.5 standard deviations below mean in two or more areas
				  of development).
Or
b.
				  Through the use of informed clinical opinion, the multidisciplinary team
				  identifies a significant delay not captured by test scores, significant
				  atypical behaviors or significant circumstances. In order to be eligible under
				  informed clinical opinion, there must be an impact on child/family functioning
				  to the degree that, without intervention, developmental delay would
				  result.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 30 - Medicaid for Children, Families, and Affordable Care Act (ACA) Adults › Subchapter 15 - Early Intervention › Part 1 - Early Intervention Program (210-RICR-30-15-1) › Section 210-RICR-30-15-1.9 - State Interagency Coordination

Current through June 14, 2024
It is the responsibility of the EOHHS to identify and
					 coordinate all available resources for Early Intervention in the state
					 including developing formal interagency agreements, assigning financial
					 responsibility to the appropriate agencies and developing procedures for
					 securing timely reimbursement of funds. Additional responsibilities include
					 resolving intra- and interagency disputes and developing procedures to ensure
					 that services are provided in a timely manner pending resolution of any
					 disputes.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 30 - Medicaid for Children, Families, and Affordable Care Act (ACA) Adults › Subchapter 15 - Early Intervention › Part 1 - Early Intervention Program (210-RICR-30-15-1) › Section 210-RICR-30-15-1.10 - Central Directory of Services

Current through June 14, 2024
A. The EOHHS shall
				  oversee a central directory that is accessible to the general public (i.e.,
				  through the EOHHS's web site and other appropriate means) that is accurate and
				  up to date and includes:
1. Information on
				  research and demonstration projects in the state;
2. Professionals and other groups providing
				  assistance to infants and toddlers with disabilities eligible for early
				  intervention and their families;
3.
				  Public and private early intervention services.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 30 - Medicaid for Children, Families, and Affordable Care Act (ACA) Adults › Subchapter 15 - Early Intervention › Part 1 - Early Intervention Program (210-RICR-30-15-1) › Section 210-RICR-30-15-1.12 - Comprehensive System of Personnel Development

Current through June 14, 2024
A. The
				  EOHHS shall establish and implement a comprehensive system of personnel
				  development including training paraprofessionals, and primary referral sources
				  with respect to the basic components of early intervention and training
				  personnel to coordinate transition services for infants and toddlers with
				  disabilities. Functions of the Rhode Island Comprehensive System of Personnel
				  Development shall include:
1. Recruitment and
				  retention of qualified personnel;
2. Increased workforce capacity;
3. Professional development and technical
				  assistance for the current workforce;
4. Implementation of evidence based
				  practices;
5. Leadership
				  development across the Rhode Island Early Intervention systems.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 30 - Medicaid for Children, Families, and Affordable Care Act (ACA) Adults › Subchapter 15 - Early Intervention › Part 1 - Early Intervention Program (210-RICR-30-15-1) › Section 210-RICR-30-15-1.13 - System of Payments

Current through June 14, 2024
A. The Rhode Island
				  Early Intervention system of payments includes a combination of state and
				  federal funds and the use of public and private insurance. Early Intervention
				  is a state-required benefit for all insurance plans issued in Rhode Island. RI
				  General Laws §§27-18-64,
				  27-20-50,
				  and
				  27-41-68
				  require private and public insurers based in Rhode Island and providing
				  coverage for dependent children to cover the cost of Early Intervention
				  services. Plans may not include deductibles, co-pays, or co-insurance. Rhode
				  Island residents may have employer-sponsored health benefit plans or "self-
				  insured" plans that are exempt from Rhode Island State law but these plans must
				  follow federal law. These plans and other out-of-state plans may provide
				  "essential benefits", including "rehabilitative and habilitative services and
				  devices" depending on the plan design, which may cover early intervention
				  services. Any Early Intervention service not covered by health insurance or
				  health benefit plans exempt from Rhode Island State law including deductibles,
				  co-pays or co-insurance is funded through the use of public and Part C
				  funds.
B. The Rhode Island Early
				  Intervention system of payments does not include any family fees, co-payments
				  or deductibles. Therefore, there is no family payment system; no sliding or
				  cost participation fees; no basis for determining fees; and no definitions
				  regarding ability and inability to pay.
C. The Rhode Island Early Intervention system
				  will ensure that parents are not charged any out-of-pocket costs for any Part C
				  services. Fees will not be charged for the services that a child is otherwise
				  entitled to receive at no cost to the parents including:
1. Implementation of the child find
				  requirements;
2. Evaluation and
				  assessment;
3. Service
				  coordination;
4. Administrative and
				  coordinative activities related to:
a. The
				  development, review, and evaluation of IFSPs;
b. The implementation of procedural
				  safeguards;
c. All Early
				  Intervention services authorized on the IFSP, including any co-payments or
				  deductibles related to these services.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 30 - Medicaid for Children, Families, and Affordable Care Act (ACA) Adults › Subchapter 15 - Early Intervention › Part 1 - Early Intervention Program (210-RICR-30-15-1) › Section 210-RICR-30-15-1.14 - Resolving Complaints

Current through June 14, 2024
A. The Rhode Island
				  EOHHS, as lead agency, is responsible to review, investigate and act on any
				  complaints or allegations of noncompliance with Part C of IDEA or with Rhode
				  Island Early Intervention Certification standards, policies, or procedures by a
				  certified Early Intervention Provider. The complaint procedure is publicly
				  available on the EOHHS website.
B.
				  Any public agency, public employee, parent, private individual or organization
				  may file a written complaint alleging that there has been an instance of
				  noncompliance with IDEA Part C or with Rhode Island Certification Standards,
				  policies, or procedures by any certified Early Intervention Provider.
C. The parent, organization, or individual
				  filing the complaint must submit a signed written complaint to the Part C
				  Coordinator and simultaneously forward a copy of the complaint to the EI
				  provider serving the child.
D. The
				  complaint must be completed, signed, dated and submitted to the Part C
				  Coordinator. The Early Intervention Complaint form is given to parents at
				  Intake and is available on line at: http://www.eohhs.ri.gov
E. The EI provider will assist the parent in
				  filing a written complaint if requested.
F. The Early Intervention Complaint Form (or
				  facsimile) shall be used and must include:
1.
				  A statement that the EI provider has violated a requirement of Part C of the
				  IDEA;
2. The facts on which the
				  statement is based;
3. The
				  signature and contact information for the individual filing the complaint;
				  and
4. The name and address of the
				  child;
5. The name of the EI
				  provider serving the child;
6. A
				  description of the nature of the problem of the child, including facts relating
				  to the problem; and
7. A proposed
				  resolution of the problem to the extent known and available to the party at the
				  time the complaint is filed.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 30 - Medicaid for Children, Families, and Affordable Care Act (ACA) Adults › Subchapter 15 - Early Intervention › Part 1 - Early Intervention Program (210-RICR-30-15-1) › Section 210-RICR-30-15-1.15 - Mediation

Current through June 14, 2024
A. When filing a written complaint or a
				  request for a due process hearing, families must be offered mediation as a
				  formal method for resolving any dispute. Parents will be notified of mediation
				  procedures in writing, initially and annually from the EI provider. Parents
				  also receive written notice of all rights available to them whenever prior
				  written notice is given.
B. The
				  EOHHS will offer mediation to the parent as a first step in resolving a
				  disagreement when the parent(s) file:
1. A
				  written complaint;
2. A request for
				  a due process hearing.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 30 - Medicaid for Children, Families, and Affordable Care Act (ACA) Adults › Subchapter 15 - Early Intervention › Part 1 - Early Intervention Program (210-RICR-30-15-1) › Section 210-RICR-30-15-1.16 - Due Process Hearing

Current through June 14, 2024
A. A due process
				  hearing is a formal review of a complaint identified by the parent, all data
				  related to the problem, and testimony from the parties concerned.
B. Parents may request a hearing with regard
				  to:
1. A proposal to initiate or change the
				  identification, evaluation or early intervention services of their
				  child;
2. Refusal to initiate or
				  change the child's identification, evaluation, or early intervention services
				  of their child.
3. A request that
				  information in their child's record be amended and the Early Intervention
				  provider refuses to amend the record in accordance with the request (see Access
				  to Records procedure).
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 30 - Medicaid for Children, Families, and Affordable Care Act (ACA) Adults › Subchapter 15 - Early Intervention › Part 1 - Early Intervention Program (210-RICR-30-15-1) › Section 210-RICR-30-15-1.17 - Severability

Current through June 14, 2024
If any provisions of these rules and regulations or the
					 application thereof to any person or circumstance shall be held invalid, such
					 invalidity shall not affect the provisions or application of the rules and
					 regulations which can be given effect, and to this end the provisions of the
					 rules and regulations are declared to be severable.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 40 - Medicaid for Elders and Adults with Disabilities › Subchapter 00 - Integrated Coverage Groups › Part 1 - Overview of Medicaid Integrated Care Coverage (210-RICR-40-00-1) › Section 210-RICR-40-00-1.1 - Overview of this Chapter

Current through June 14, 2024
A. This chapter
				  establishes the Medicaid "Integrated Health Care Coverage (IHCC)" groups for
				  elders, adults with disabilities, and certain individuals who qualify as
				  medically needy (MN) due to high health care expenses. In addition, sections of
				  this chapter set forth the basic tenets of the SSI methodology for determining
				  Medicaid eligibility in general and, specifically, for those applicants and
				  beneficiaries seeking coverage through an IHCC Community Medicaid eligibility
				  pathway. The term Community Medicaid refers hereinafter to anyone applying for
				  or renewing eligibility for non-LTSS Medicaid health coverage as MN or through
				  a pathway for elders and adults with disabilities on the basis of Supplemental
				  Security Income (SSI), an SSI-related characteristic (that is, age, blindness
				  or disabling impairment), or special requirements related to a particular
				  characteristic, condition or circumstances. Community Medicaid also encompasses
				  Medicare beneficiaries seeking financial assistance through the State's
				  Medicare Premium Payment Program (MPPP). Although all the IHCC groups for MN
				  and elders and adults with disabilities are described in this chapter - both
				  Community Medicaid and LTSS, there are separate sections, as indicated below,
				  that provide more in-depth provisions related to IHCC groups, as follows:
1. The Sherlock Plan provides an eligibility
				  pathway for adults with disabilities who are working. Although referenced in
				  this section as one of the IHCC groups subject to the SSI methodology, the
				  Sherlock Plan is covered in detail in a separate section (Medicaid Code of
				  Administrative Rules, Sherlock Plan Regulations) along with other eligibility
				  opportunities for persons with disabilities who are working.
2. An overview of the LTSS coverage groups
				  subject to the SSI methodology is included in this chapter to show areas of
				  overlap in the application process and determination of financial eligibility.
3. Children and families in the
				  IHCC category who are eligible on the basis of their participation in other
				  programs - e.g., children in foster care or SSI-eligible -- are addressed in
				  the Medicaid Code of Administrative Rules, Medicaid Coverage for Children and
				  Families.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 40 - Medicaid for Elders and Adults with Disabilities › Subchapter 00 - Integrated Coverage Groups › Part 1 - Overview of Medicaid Integrated Care Coverage (210-RICR-40-00-1) › Section 210-RICR-40-00-1.2 - Authority

Current through June 14, 2024
This chapter of rules entitled, "Medicaid Code of
					 Administrative Rules: "Medicaid Integrated Health Care Coverage (IHCC)" is
					 promulgated pursuant to the authority set forth in R.I. Gen. Laws Chapters 40-8
					 (Medical Assistance); Title XIX of the Social Security Act; Patient Protection
					 and Affordable Care Act (ACA) of 2010 (U.S.
					 Public Law
					 111-148); and the Health Care and Education
					 Reconciliation Act of 2010 (U.S.
					 Public Law
					 111-15).
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 40 - Medicaid for Elders and Adults with Disabilities › Subchapter 00 - Integrated Coverage Groups › Part 1 - Overview of Medicaid Integrated Care Coverage (210-RICR-40-00-1) › Section 210-RICR-40-00-1.3 - Scope and Purpose

Current through June 14, 2024
A. This section
				  provides an overview of the IHCC groups included in this chapter. The rules
				  governing the IHCC groups have been amended and revised as set forth herein to
				  reflect programmatic changes resulting from the following State and federal
				  Medicaid initiatives:
1. Extension of Rhode
				  Island's Section 1115 demonstration waiver - In December 2013, the State's
				  Section 1115 demonstration waiver was reauthorized and extended until 2018. The
				  rules in this chapter implement Section 1115 waiver authorities that streamline
				  and refine SSI-based eligibility determinations, enhance the availability of
				  cost-effective primary care, and improve the integration of services and a
				  wider range of supports across the care continuum.
2. ACA Implementation - The federal
				  Affordable Care Act of 2010 mandated changes in the way states organize
				  Medicaid coverage groups, the standards they use for determining income-based
				  eligibility, and the application and renewal processes for all eligible
				  populations. This chapter establishes administrative rules that implement ACA
				  reforms related to eligibility and the application and renewal process for the
				  IHCC groups to ensure they match those already in effect for MACC groups
				  subject to the MAGI.
3. Integrated
				  Eligibility System --- "RI Bridges" is the State's new integrated health and
				  human services eligibility system (IES) launched in September 2016. The State's
				  IES provides the State with the system capacity to implement all programmatic
				  changes required by the ACA and authorized under the Section 1115 waiver. In
				  addition to automating most facets of the application, eligibility
				  determination and enrollment processes, the State's IES also conducts a
				  multi-tiered evaluation of eligibility that makes it possible to consider
				  applicants for most forms of publicly financed health coverage and various
				  other State-administered health and human services through a single application
				  process.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 40 - Medicaid for Elders and Adults with Disabilities › Subchapter 00 - Integrated Coverage Groups › Part 1 - Overview of Medicaid Integrated Care Coverage (210-RICR-40-00-1) › Section 210-RICR-40-00-1.6 - IHCC Special Coverage Groups

Current through June 14, 2024
A. The IHCC
				  category also includes members of the special coverage groups below who are
				  subject to unique eligibility requirements waiving some or all facets of the
				  SSI methodology due to specific conditions, circumstances or characteristics.
1. Low-income, uninsured women with breast or
				  cervical cancer - Medicaid coverage group for uninsured women under age
				  sixty-five (65) who are screened under the Centers for Disease Control and
				  Prevention's (CDC) National Breast and Cervical Cancer Early Detection Program
				  and are found to need treatment for breast or cervical cancer or for
				  precancerous conditions of the breast or cervix.
2. Refugee Medicaid Assistance (RMA) -
				  Federally mandated coverage group for individuals and families operating under
				  the auspices of the U.S. Department of Health and Human Services, Office of
				  Refugee Resettlement. Refugees who qualify for this program receive eight (8)
				  months of Medicaid health coverage or commercial coverage with financial help
				  through HSRI, depending on income. Eligibility is evaluated first using the
				  MAGI methodology set forth in Medicaid Code of Administrative Rules, Overview
				  of the Affordable Care Coverage Groups, and the SSI standards for Community
				  Medicaid in §05-1.11.1 of this Chapter. Only persons in this group who are
				  ineligible for Medicaid or commercial plan with financial help and have income
				  at or below 200 percent of the FPL may qualify for MN coverage under this
				  chapter.
3. Emergency Medicaid -
				  Medicaid health coverage available to non-citizens who have emergency health
				  care needs who meet all the general and income requirements for coverage with
				  the exception of immigration status.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 40 - Medicaid for Elders and Adults with Disabilities › Subchapter 00 - Integrated Coverage Groups › Part 1 - Overview of Medicaid Integrated Care Coverage (210-RICR-40-00-1) › Section 210-RICR-40-00-1.7 - The State's Integrated Eligibility System (IES)

Current through June 14, 2024
A. With the implementation of the State's
				  IES, all IHCC group members have the option of applying on-line, using a
				  self-service portal, submitting a completed paper application, or in-person by
				  visiting one of the field offices of the RI Department of Human Services (DHS).
				  The IES also allows for the following important changes to the application and
				  eligibility determination process:
1.
				  Coverage Group Options - To maximize choice and ease of access, the State's IES
				  evaluates all applicants for Medicaid health coverage using multiple
				  eligibility pathways, within and across the major coverage group
				  categories.
2. Streamlined Document
				  Submission and Verification - The State's IES created the capacity for
				  applicants and beneficiaries to upload important documents and verification
				  materials on-line as well through more traditional means. The State is also
				  building into the system access to a broader array of electronic data sources
				  for verifying and updating critical eligibility information related to income
				  and assets.
3. Modified Passive
				  Eligibility Renewal - The eligibility renewal process for IHCC group members
				  has been reformed to ease the burden on beneficiaries. The State's new passive
				  renewal process requires beneficiaries to review the eligibility information in
				  their accounts, including updates through electronic data sources, and notify
				  the agency within a specified time period of any changes or discrepancies that
				  may affect the continuation of coverage. The renewal process and variations
				  across coverage groups are set forth in Part 2 of this Subchapter.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 40 - Medicaid for Elders and Adults with Disabilities › Subchapter 00 - Integrated Coverage Groups › Part 1 - Overview of Medicaid Integrated Care Coverage (210-RICR-40-00-1) › Section 210-RICR-40-00-1.9 - Service Delivery Options

Current through June 14, 2024
A. The service
				  delivery options for IHCC group members are dictated in large part by type of
				  Medicaid health coverage and eligibility pathway. Subchapter 10 Part 1 of this
				  Chapter.
B.
Overview IHCC Group Service
								Delivery
Eligibility Pathway
Service Delivery Option
SSI, EAD with no Medicare
Rhody Health Partners
SSI, EAD with Medicare
Rhody Health Options, PACE, Fee-for- Service (FFS)
								w/Community Health Team, or FFS-only
LTSS No Medicare
Same as above
LTSS with Medicare
Rhody Health Options, Medicare-Medicaid Plan II,
								PACE
Sherlock Plan - EAD and LTSS
FFS
Medically Needy - non-LTSS
FFS
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 40 - Medicaid for Elders and Adults with Disabilities › Subchapter 00 - Integrated Coverage Groups › Part 2 - Application and Renewal Process for IHCC Groups › Section 210-RICR-40-00-2.1 - Scope and Purpose

Current through June 14, 2024
In September 2016, the State implemented its new integrated
					 eligibility system (IES) which has the capacity to cross-walk with the State's
					 health insurance marketplace, HealthsourceRI.gov (HSRI) and, through a single
					 application process, evaluate eligibility for publicly financed health coverage
					 and needs-based programs administered by DHS and other EOHHS agencies. This
					 section focuses on the application and renewal processes that have been
					 established in conjunction with the implementation of the
					 IES.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 40 - Medicaid for Elders and Adults with Disabilities › Subchapter 00 - Integrated Coverage Groups › Part 2 - Application and Renewal Process for IHCC Groups › Section 210-RICR-40-00-2.2 - Access Points

Current through June 14, 2024
A. The State is
				  committed to pursuing a "No Wrong Door" policy that offers consumers multiple
				  application and renewal access points which all lead to the State's IES.
1. Self-Service - Persons seeking initial or
				  continuing eligibility have the option of accessing the eligibility system
				  on-line using a self-service portal through links on the EOHHS (eohhs.ri.gov)
				  and DHS (dhs.ri.gov) websites or directly through HSRI (HealthSourceRI.com).
				  There are also kiosks located in DHS field offices that provide direct access
				  to the self-service portal. The information applicants provide on-line is
				  entered directly into the eligibility system and processed electronically in
				  real-time. For these reasons, the Medicaid agency encourages all new applicants
				  to select the self-service portal option and complete and submit the
				  application electronically whenever feasible.
2. Assisted Service - Applicants and
				  beneficiaries may also apply on paper and submit forms via mail, fax, or e-mail
				  or deliver in person to DHS field offices. Agency eligibility specialists are
				  available to provide help, as are HSRI representatives and various certified
				  assisters located at community agencies. Applications that are completed on
				  paper are scanned into the IES agency portal.
3. Applicants may submit paper applications
				  in-person or by U.S. mail, e-mail transmissions, and facsimile transmissions to
				  the address specified on the application. Paper applications are available
				  on-line, through the U.S. mail upon written request, by telephone, or in person
				  at any DHS field office. Information provided on the paper application is
				  directly scanned or entered into the eligibility system through an agency
				  portal by eligibility or LTSS specialists on the applicant's behalf.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 40 - Medicaid for Elders and Adults with Disabilities › Subchapter 00 - Integrated Coverage Groups › Part 2 - Application and Renewal Process for IHCC Groups › Section 210-RICR-40-00-2.3 - Application and Renewal Assistance

Current through June 14, 2024
A. The State
				  provides application and renewal assistance through eligibility specialists in
				  the DHS field offices and HSRI Contact Center and trained assisters, certified
				  in accordance with
				   42 CFR 435.908. This assistance must be provided in
				  a manner that is accessible to persons with disabilities and those who have
				  limited English proficiency. Information on obtaining application/renewal
				  assistance is available by calling 855-MYRIDHS ( 1-855-697-4347) as well as
				  on-line through the DHS, HSRI and EOHHS websites using the links specified in
				  this section. In addition, eligibility specialists and certified assisters are
				  responsible for upholding the following rights of current and perspective
				  Medicaid beneficiaries:
1. Eligibility and
				  Renewal Help - Including help provided by DHS, EOHHS, and HSRI eligibility
				  specialists and certified assisters in completing all necessary forms,
				  obtaining and submitting required documentation, and responding to inquiries or
				  requests for information. Assisters may provide help or act on behalf of the
				  applicant or beneficiary in dealing with agency representatives, but are not
				  permitted to make determinations of eligibility.
2. Translation Services - An interpreter or
				  translator is available to assist in the application process upon
				  request.
3. Protection of Privacy
				  -- All information applicants provide is kept confidential unless the agency is
				  otherwise authorized to share with other state and federal agencies for the
				  purposes of verification and enrollment.
4. Timely Determinations - Eligibility
				  determinations, including providing a notice of the agency's decision, must be
				  made in accordance with the timelines indicated in §
											2.4(A)(8)   of
				  this Part.
5. Appeals - The agency
				  accepts appeals and holds hearings on actions related to eligibility decisions
				  in accordance with Medicaid Code of Administrative Rules, Complaints and
				  Appeals, or any successor regulation.
6. Non-discrimination - Applicants are
				  treated in a manner that is free from discrimination on the basis of race,
				  color, national origin, sex, gender identity or sexual orientation, age or
				  disability.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 40 - Medicaid for Elders and Adults with Disabilities › Subchapter 00 - Integrated Coverage Groups › Part 2 - Application and Renewal Process for IHCC Groups › Section 210-RICR-40-00-2.4 - Completing and Submitting the Application

Current through June 14, 2024
A. In
				  general, the process of completing and submitting an application proceeds in
				  accordance with the following:
1. Account
				  Creation - To initiate the application process, a person must create a login
				  and establish an account in the eligibility system. This can be done through
				  the self-service portal by the person alone or with the help of an eligibility
				  specialist or certified assister.
a. Identity
				  proofing. The applicant must provide personally identifiable information for
				  the purpose of creating an on-line account as a form of identify proofing
				  during the process of applying for Medicaid. Verification of this information
				  is automated. Documentation proving identity may be required if the automated
				  verification process is unsuccessful. Acceptable forms of identity proof
				  include a driver's license, school registration, voter registration card, etc.
				  Documents may be submitted via mail, fax, on-line upload, or to a DHS
				  Office.
b. Account matches. Once
				  identity is verified, account matches are conducted to determine whether the
				  applicant or members of the applicant's household have other accounts or are
				  currently receiving benefits.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 40 - Medicaid for Elders and Adults with Disabilities › Subchapter 00 - Integrated Coverage Groups › Part 2 - Application and Renewal Process for IHCC Groups › Section 210-RICR-40-00-2.6 - Application Review Process

Current through June 14, 2024
2.6.1
Scope
				  and Purpose
This section provides an overview of the application review
					 process for all IHCC groups identified in this chapter and the specific
					 provisions that apply to Community Medicaid populations subject to eligibility
					 determinations made by the State. As a result of programmatic changes in the
					 State's IES required by the ACA, people are no longer required to apply for one
					 particular category of Medicaid eligibility. Instead, to maximize access and
					 choice, applicants are evaluated across a variety of MACC and IHCC pathways
					 which apply different eligibility standards, requirements, and criteria. In
					 short, the denial or termination of eligibility in one category does not
					 preclude eligibility through another pathway. The State must consider all bases
					 of eligibility.
2.6.2
Conversion Process
A. The
				  conversion to the State's new application review process requires new
				  applicants and existing beneficiaries to be treated differently during the
				  initial stages of implementation. A "new applicant", for these purposes, is a
				  person who is not currently receiving Medicaid health coverage in any
				  eligibility category. The conversion process is as follows:
1. New Applicants - New applicants are
				  evaluated first using the MAGI methodology for the MACC groups.
2. Existing Beneficiaries - At the time of
				  renewal, current IHCC beneficiaries are evaluated using the SSI income and
				  resource standards to ensure continuity of coverage. In the process of this
				  evaluation, an ancillary review of the information in the beneficiary's account
				  along with updates from all available data sources is conducted to determine
				  whether MAGI-based eligibility in one of the MACC groups is available. This
				  review is only conducted if the beneficiary is under age 65 or 65 and older and
				  the parent/caretaker of a Medicaid-eligible child. Upon completing this review,
				  a notice is sent to the beneficiary indicating if an alternative form of
				  coverage is available.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 40 - Medicaid for Elders and Adults with Disabilities › Subchapter 00 - Integrated Coverage Groups › Part 2 - Application and Renewal Process for IHCC Groups › Section 210-RICR-40-00-2.7 - Renewal of Eligibility for IHCC Groups

Current through June 14, 2024
2.7.1
Scope and Purpose
A. One of the
				  principal requirements of Medicaid is that continuing eligibility must be
				  re-evaluated at least once a year. For the IHCC groups, this annual review was
				  called a "redetermination" and, accordingly, often required beneficiaries to
				  reapply for coverage. Current federal regulations [
				42 CFR 435.916(b)]  governing the
				  IHCC groups now require that these annual reviews consider only those
				  eligibility factors that are subject to change. Accordingly, the continuing
				  eligibility of the IHCC group beneficiaries receiving Community and LTSS
				  Medicaid is now conducted by requiring them to review their account information
				  on key eligibility factors, as updated by internal and external data sources,
				  and report any inaccuracies or changes in the manner described in this section.
B. The factors subject to change
				  include income, resources, household composition (e.g., as a result of births,
				  deaths, divorce, etc.), disability or clinical factors, access to third-party
				  coverage, and changes in family size (e.g., due to death, marital status, birth
				  or adoption of child), and/or immigration status. LTSS beneficiaries may be
				  required to provide additional information related to change in care settings.
				  Note: The provisions in this section do not apply to beneficiaries who are
				  deemed eligible due to participation in other programs (e.g., SSI recipients),
				  or that are determined eligible by the SSA. Special MPPP renewal provisions
				  also apply.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 40 - Medicaid for Elders and Adults with Disabilities › Subchapter 00 - Integrated Coverage Groups › Part 3 - Medicaid Integrated Health Care Coverage, SSI Financial Eligibility Determinations › Section 210-RICR-40-00-3.1 - Incorporated Materials

Current through June 14, 2024
A. These
				  regulations hereby adopt and incorporate  20 C.F.R. Part 416  (2023) 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.
B. These regulations
				  hereby adopt and incorporate  20 C.F.R. Part 618  (2023) 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.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 40 - Medicaid for Elders and Adults with Disabilities › Subchapter 00 - Integrated Coverage Groups › Part 3 - Medicaid Integrated Health Care Coverage, SSI Financial Eligibility Determinations › Section 210-RICR-40-00-3.2 - Overview of the SSI Methodology

Current through June 14, 2024
3.2.1
Scope
				  and Purpose
A. All Supplemental
				  Security Income (SSI) recipients are automatically eligible for Medicaid. The
				  State has agreed to determine the eligibility of persons who have an SSI
				  characteristic - age sixty-five (65) and older, blind or disabled - but do not
				  qualify for cash benefits using the SSI methodology and in a manner that is no
				  more restrictive than the way it is applied for SSI. For the purposes of this
				  Chapter, the methodology applies to adults with an SSI characteristic - often
				  called SSI lookalikes - who have income at or below the SSI eligibility
				  standard of about seventy-five percent (75%) of the Federal Poverty Level (FPL)
				  as well as those in the State's optional coverage group for low-income elders
				  and adults with disabilities and all populations that qualify for Medically
				  Needy (MN) eligibility under the Medicaid State Plan. The SSI methodology also
				  applies to persons seeking Medicaid Long Term Services and Supports (LTSS) as
				  indicated in this Section.
B. The
				  basic tenets of the SSI methodology are established in the Social Security
				  Administration's rules for determining eligibility for SSI which are set forth
				  in federal regulations at  20 C.F.R. §
												416.101
et
				  seq
.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 40 - Medicaid for Elders and Adults with Disabilities › Subchapter 00 - Integrated Coverage Groups › Part 3 - Medicaid Integrated Health Care Coverage, SSI Financial Eligibility Determinations › Section 210-RICR-40-00-3.3 - SSI Methodology: Treatment of Income

Current through June 14, 2024
3.3.1
Scope and Purpose
A. This Section
				  focuses on the treatment of income and, specifically, the way earned and
				  unearned income are defined and evaluated when calculating countable income.
				  For the purposes of this Section, countable income is the total income
				  available to a person seeking Medicaid benefits subsequent to the application
				  of any required exclusions, disregards, and/or deductions and, as appropriate,
				  deeming.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 40 - Medicaid for Elders and Adults with Disabilities › Subchapter 00 - Integrated Coverage Groups › Part 3 - Medicaid Integrated Health Care Coverage, SSI Financial Eligibility Determinations › Section 210-RICR-40-00-3.4 - Factors Considered in the Treatment of Income

Current through June 14, 2024
3.4.1
Scope and Purpose
A. When
				  calculating countable income using the SSI methodology, certain disregards and
				  exclusions apply: some only to earned income, others only to unearned income,
				  and a few apply to both earned and unearned income. The availability of income
				  also affects whether it is counted. This Section focuses on these and any other
				  factors considered in the treatment of income for Medicaid eligibility purposes
				  across populations. The specific Rules for how they apply when determining
				  income eligibility for Community Medicaid are located in Subchapter 05 Part 1
				  of this Chapter; for Medicaid LTSS, all special provisions that apply are
				  located in Part 50-00-6 of this Title.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 40 - Medicaid for Elders and Adults with Disabilities › Subchapter 00 - Integrated Coverage Groups › Part 3 - Medicaid Integrated Health Care Coverage, SSI Financial Eligibility Determinations › Section 210-RICR-40-00-3.7 - Factors Considered in the Treatment of Resources

Current through June 14, 2024
3.7.1
Scope and Purpose
A. There are several common features in
				  process for evaluating resources when using the SSI methodology that apply
				  across IHCC groups, whether using a full or simplified review. The purpose of
				  this Section is to set forth these features and identify any exceptions where
				  appropriate.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 40 - Medicaid for Elders and Adults with Disabilities › Subchapter 05 - Community Medicaid › Part 1 - Medicaid for Elders and Adults with Disabilities: Community Medicaid › Section 210-RICR-40-05-1.1 - Overview

Current through June 14, 2024
The IHCC groups established in this section provide the
					 principal Medicaid non-Long Term Services and Supports (LTSS) eligibility
					 pathways for elders and adults with disabilities who have Supplemental Security
					 Income (SSI), an SSI characteristic, and/or meet special program specific
					 requirements. The medically needy (MN) eligibility pathway for all populations
					 seeking non-LTSS Medicaid coverage is also included in this section. The State
					 uses the term "Community Medicaid" to distinguish Integrated Health Care
					 Coverage (IHCC) group members from Medicaid LTSS beneficiaries eligible using
					 SSI financial eligibility requirements.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 40 - Medicaid for Elders and Adults with Disabilities › Subchapter 05 - Community Medicaid › Part 1 - Medicaid for Elders and Adults with Disabilities: Community Medicaid › Section 210-RICR-40-05-1.2 - Authority

Current through June 14, 2024
Legal authority for the IHCC groups is established in R.I.
					 Gen. Laws, the Medicaid State Plan, the State's §1115 demonstration waiver
					 and various provisions of Title XIX of the Social Security Act,
					  42 U.S.C. §§
											1396 - 1396w - 7  and Code of Federal
					 Regulations (C.F.R.). State law establishing the IHCC group that expands
					 eligibility to low-income elders and adults with disabilities (referred
					 hereinafter as "EAD") with income up to and including one hundred percent
					 (100%) of the Federal Poverty Level (FPL) is located in R.I. Gen. Laws Chapter
					 40-8.5. Many of the core
					 eligibility requirements associated with this group, including those pertaining
					 to MN eligibility, pre-date both this law's enactment and federal approval of
					 the State's §1115 waiver as extended in
					 2014 and, are dispersed in various other provisions of R.I. Gen. Laws Chapter
					 40-8 rather than in a single
					 statute.