Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 50 - Medicaid Long-Term Services and Supports › Subchapter 00 - Long-Term Services › Part 4 - Long-Term Services and Supports Application and Renewal Process › Section 210-RICR-50-00-4.3 - Definitions

Current through June 14, 2024
A. For the purposes of this rule, the
				  following definitions apply:
1. "ACA adults"
				  means persons between the ages of 19 and 64 who are eligible for Medicaid
				  authorized by the federal Affordable Care Act (ACA) of 2010.
2. "Additional documentation request" or
				  "ADR" means the notice sent to applicants subsequent to an initial review of
				  the application's completeness that identifies any additional information/forms
				  that must be submitted, and any related deadlines, for a determination of
				  eligibility to proceed.
3.
				  "Application completeness" means the point in time when all information
				  requested by the State, including the application and any ancillary required
				  forms and authorizations necessary to determine eligibility, are date-stamped
				  as received by the State.
4.
				  "Application timeliness" means the specific time frame for making
				  determinations of Medicaid eligibility as set forth in federal and State law,
				  regulations and rules. The timelines vary in length depending on whether a
				  functional/clinical eligibility determination is required.
5. "Clinical or functional eligibility" means
				  the application of needs-based criteria to determine whether a person requires
				  the level of care typically provided in an LTSS health institution as defined
				  herein.
6. "Department of Human
				  Services" or "DHS" means the State agency established under the provisions of
				  R.I. Gen. Laws Chapter 40-1 that has been delegated the responsibility through
				  an interagency service agreement with the Executive Office of Health and Human
				  Services (EOHHS), the Medicaid Single State Agency, to determine Medicaid
				  eligibility in accordance with applicable State and federal laws, rules and
				  regulations.
7. "DHS-2 application
				  form" means the principal paper application form for Medicaid LTSS.
8. "Eligibility pathway" means one of the
				  various ways authorized under the State's Medicaid State Plan and/or Section
				  1115 demonstration waiver that a person may be found eligible for LTSS.
9. "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 which 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.
10. "Financial
				  eligibility" means the process for determining whether an applicant meets the
				  income and resources requirements for Medicaid eligibility.
11. "Home and community-based services" or
				  "HCBS" means the services and supports provided to Medicaid LTSS beneficiaries
				  at home or in a community-based setting who would require the level of care
				  associated with one of the three institutions (health care facilities
				  identified below) recognized in federal Medicaid law if they were not receiving
				  these services and supports.
12.
				  "Institution" means one of the long-term care institutions recognized in
				  federal Medicaid law and is a State-licensed health care facility where health
				  and/or social services are delivered on an inpatient basis. For the purposes of
				  this document, the term means long-term care hospitals and treatment facilities
				  (LTHR), intermediate care facilities for persons with intellectual disabilities
				  (ICF/ID), and nursing facilities (NF).
13. "Integrated eligibility system" or "IES"
				  means the State's health and human services computer eligibility system - known
				  as RI Bridges - which processes applications for Medicaid as well as for the
				  programs and services administered by the DHS.
14. "Long-term services and supports" or
				  "LTSS" means a spectrum of services covered by the Medicaid program for people
				  with functional impairments and/or chronic illness that provide assistance with
				  activities of daily living (such as eating, bathing, and dressing) and
				  instrumental activities of daily living (such as preparing meals, managing
				  medication, and housekeeping).
15.
				  "LTSS specialist" means a State agency representative responsible for
				  determining eligibility for long-term services and supports, authorizing
				  services, and/or providing assistance to people in navigating the Medicaid
				  health care system.
16.
				  "Needs-based criteria" means the basis for determinations of functional/
				  clinical eligibility for Medicaid LTSS including medical, social, functional
				  and behavioral factors, and the availability of family support and financial
				  resources.
17. "Supplemental forms"
				  means the additional forms all LTSS applicants are required to
				  complete.
18. "Types of LTSS" means
				  the two forms of LTSS authorized under federal law and the State's Medicaid
				  State Plan and Section 1115 waiver: Medicaid LTSS in health care institutions
				  (NFs, ICF/IDs, and LTHR) and Medicaid home and community-based LTSS.