Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 50 - Medicaid Long-Term Services and Supports › Subchapter 10 - Home and Community Based LTSS › Part 2 - Self-Directed Care › Section 210-RICR-50-10-2.6 - Enrollment and Disenrollment

Current through June 14, 2024
A. Enrollment
Enrollment in the Personal Choice program is by choice.
					 Individuals who wish to participate and who meet all the eligibility
					 requirements may contact a person-centered options counselor, Conflict-Free
					 Case Management Agency, or visit the My Options RI website
http://www.myoptions.ri.gov/
.
B. Involuntary Disenrollment
1. The participant shall be involuntarily
				  disenrolled from the Personal Choice Program if they lose either Medicaid
				  financial eligibility or level of care eligibility.
2. Involuntary disenrollment may also occur
				  when:
a. The participant or representative is
				  unable to self-direct care and provide oversight of the PCA and spending
				  plan.
b. A representative proves
				  incapable of acting in the best interest of the participant, can no longer
				  assist the participant, and no replacement is available.
c. The participant or representative fails to
				  comply with legal/financial obligations as an employer of domestic workers
				  and/or is unwilling to participate in advisement training or training to remedy
				  non-compliance.
d. The participant
				  or representative fails to maintain a safe working environment for
				  PCAs.
e. The participant or
				  representative is unable to manage the monthly budget as evidenced by:
				  repeatedly submitting time sheets for unauthorized budgeted amount of care;
				  underutilizing the monthly budget, which results in inadequate services; and/or
				  continuing attempts to spend budget funds on non-allowable goods and
				  services.
f. The participant's
				  health and well-being is not maintained through the actions and/or inactions of
				  the participant or representative.
g. EOHHS receives a substantiated critical
				  incident report involving the participant that cannot otherwise be
				  remediated.
h. The participant or
				  representative refuses to cooperate with minimum program oversight activities,
				  even when staff has made efforts to accommodate the participant.
i. The participant or representative fails to
				  pay the amount determined in the post eligibility treatment of income, as
				  described Subchapter 00 Part 8 of this Chapter, Post-Eligibility Treatment of
				  Income, to the fiscal agency.
j.
				  There is evidence that Medicaid funds were used improperly or illegally
				  according to local, State or Federal Regulations.
k. No Conflict-Free Case Management Agency is
				  able to provide proper service, such as the inability to meet repeated requests
				  for services, satisfy participant needs, and/or provide the individual with a
				  quality working relationship.
l.
				  The participant or representative fails to notify both the Conflict-Free Case
				  Management Agency and the Fiscal Intermediary of any change of address and/or
				  telephone number within ten (10) days of the change.
3. When a Medicaid-eligible participant is
				  involuntarily disenrolled from the Personal Choice Program, the participant is
				  referred to EOHHS or BHDDH to explore other available options.
4. EOHHS shall notify the participant in
				  writing that they intend to remove the participant from the Personal Choice
				  Program, the reason for disenrollment, and shall inform the participant that
				  services may be provided through Medicaid long-term care via a home health
				  agency.
5. Disenrollment is
				  determined by the Conflict-Free Case Management Agency, and confirmed by EOHHS,
				  based on an assessment in conjunction with the policies and procedures of that
				  Agency, and/or the receipt of information from the Fiscal Intermediary or
				  EOHHS.