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-50-00-4.9 - Information Tracking and Pre-Eligibility Screening and Review

Current through June 14, 2024
A. Application Information Tracking. Once the
				  application filing date is established, all information submitted to the agency
				  is entered or scanned into the applicant's account in the IES and tracked going
				  forward. LTSS eligibility specialists may provide information, upon request, of
				  the status of any application materials the agency receives after the filing
				  date.
B. Review of application
				  completeness. Within thirty-five days (35) after the application filing date, a
				  review is conducted of any pending application. The purpose of this process is
				  to identify any outstanding information and/or additional supporting
				  documentation or proof that is necessary to determine eligibility. Based on
				  this screening and review:
1. Additional
				  Documentation Request (ADR) - The IES generates a written notice informing the
				  applicant of any outstanding/additional information necessary to complete the
				  application.
2. ADR Response
				  -Applicants must respond to the ADR within fifteen (15) days (ten days (10)
				  from date of the notice plus five (5) days to cover mailing time). Information
				  may be emailed, faxed, mailed, uploaded into the applicant's account or
				  delivered in-person. At any time before the ADR response is due, an applicant
				  may make contact the DHS office, at number indicated on the form, and request
				  for a good cause extension. Such extensions are granted for an additional
				  fifteen (15) days when the applicant provides proof that the inability to
				  respond was due to returned mail, a debilitating health care condition or
				  emergency situation, or the negligence or failure of a third-party.
3. Application Complete - If all requested
				  information is received and the application is considered complete, the process
				  for determining eligibility proceeds. While conducting the eligibility
				  determination, an LTSS eligibility specialist may find that further information
				  is required from the applicant and/or a current or prospective provider to
				  establish a plan of care and/or authorize services. A supplemental ADR may be
				  sent out at this juncture with an appropriate response time
4. Application Denial - If the information
				  requested in an ADR is not received when due, the process for denying the
				  application for non-cooperation is initiated. The applicant has the right to
				  appeal the denial in accordance with the provisions of Part 10-05-2 of this
				  Title.
5. Application reinstatement
				  - An application denied on the basis of non-cooperation under this subpart may
				  be reinstated if the information requested by the applicant is provided to the
				  State within no more than thirty (30) days from the date the denial takes
				  effect if there is time remaining in the ninety (90) day application review
				  period. In such circumstances, a new application review period begins on the
				  application reinstatement date and eligibility dates back to the original
				  application filing date, providing all information subject to change has been
				  updated. If the initial ninety (90) day application review period has expired,
				  the reinstatement date is treated as a new application filing date and the
				  start date of eligibility is determined accordingly.