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 5 - "Medicaid Long-Term Services and Supports: Functional/Clinical Eligibility" (210-RICR-50-00-5) › Section 210-RICR-50-00-5.5 - Development of Plan of Care, Service Planning and Authorization, and Case Management

Current through June 14, 2024
A. The development
				  of a plan of care is a multifaceted and multilayered process that may start
				  prior to making a request for Medicaid LTSS if a prospective applicant and his
				  or her family are seeking LTSS information and referral or counseling on the
				  available LTSS options. In instances in which an applicant by-passes these
				  options, care planning typically starts at the point of application and
				  continues after a determination of level of care has been completed and
				  services have been authorized. The core elements of the care planning process
				  include, but are not limited to:
1.
				  Person-centered -- Irrespective of the type of Medicaid LTSS a person is
				  seeking (health institution v. HCBS), the care planning process is driven by an
				  applicant's health care goals, expectations and choices.
2. Health institutions and service planning
				  -- Federal regulations require that health institutions providing Medicaid
				  funded LTSS conduct in-depth evaluations that consider a prospective resident's
				  needs, values, and preferences when establishing a plan of care. Agency
				  representatives consider the results of these evaluations when determining
				  level of care, assisting in the development of the plan of care, and
				  authorizing services. In addition:
a. NF and
				  PASRR. In accordance with federal law, the State Preadmission Screening and
				  Resident Review (PASRR) evaluation for all prospective NF residents focuses on
				  cognitive, developmental and intellectual disabilities and behavioral health
				  conditions that may require specialized services in a health institution. The
				  results of this evaluation are used to incorporate specific services into the
				  plan of care for applicants determined to have special needs as set forth in
				  subsection §
												5.7   of this Part below. The
				  State must authorize payment for any such services included in the plan of care
				  for Medicaid beneficiaries.
b. HCBS
				  transitions. Health institutions must inform prospective residents and
				  patients, as well anyone about to be discharged, who needs continuous LTSS
				  about HCBS options. This information must be considered and recorded in any
				  continuity of care service plans. NF and ICF/I-DD health institutions must also
				  report to EOHHS any Medicaid applicant or beneficiary expressing a preference
				  for HCBS options, as indicated subsection §
												5.5   of this
				  Part.
2. HCBS care
				  planning -- HCBS person-centered planning supports an individual's right and
				  ability to share his or her desires and goals, to consider different options
				  for support, and to learn about the benefits and risks of each option. The
				  essential elements of this process are set forth in in Subchapter 10 Part 1 of
				  this Chapter.