reglab/statecodes huggingface dataset:
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 05 - Consumer Rights, Responsibilities, and Protections › Part 1 - Confidentiality Rule (210-RICR-10-05-1) › Section 210-RICR-10-05-1.6 - Types of Information to be Maintained as Confidential

Current through June 14, 2024
A. It is the beneficiary's right and
				  expectation that all information requested about him/her and his/her situation
				  will be respected and safeguarded by EOHHS and all its personnel. The
				  beneficiary will be made aware of his/her right to confidentiality in the
				  application process.
B. The types
				  of information to be safeguarded are as follows:
1. Name and address of applicant or
				  beneficiary;
2. Information related
				  to the social and economic conditions or circumstances of an applicant or
				  beneficiary;
3. Agency evaluation
				  of information about an applicant or beneficiary;
4. Medical data, including diagnosis and
				  history of disease or disability concerning an applicant or
				  beneficiary;
5. Any other material
				  defined in law or regulation as a confidential matter;
6. Any information received for verifying
				  income eligibility and amount of Medicaid payments;
7. Information received from the Social
				  Security Administration or the Internal Revenue Service that must be
				  safeguarded according to the requirements of the agency furnishing the
				  data;
8. Any information received
				  in connection with the identification of legally liable third party resources
				  under the provisions of
				   42 C.F.R. §
												433.138;
9. Any information which, at the discretion
				  of the EOHHS Secretary, or his/her designee, is deemed necessary for the proper
				  administration of the Medicaid Program.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 05 - Consumer Rights, Responsibilities, and Protections › Part 1 - Confidentiality Rule (210-RICR-10-05-1) › Section 210-RICR-10-05-1.7 - Procedures to Maintain Confidentiality

Current through June 14, 2024
A. EOHHS has
				  established the following procedures to safeguard the conditions for use and
				  release of confidential applicant / beneficiary information:
1. Orientation for new staff members and
				  ongoing in-service staff trainings shall include the topic of confidentiality
				  and EOHHS policies and procedures related to its implementation.
2. All newly appointed staff, who will have
				  access to applicant /beneficiary records, must sign a statement attesting to
				  the fact that they have read the State's confidentiality agreement and that
				  they will maintain compliance with same.
3. The applicant's/ beneficiary's right to
				  privacy shall be protected during any necessary interviews. The information to
				  be safeguarded will only be shared with others as is necessary and appropriate
				  for purposes of administering the Medicaid Program.
4. Contractors, vendors, and any other
				  persons having in their possession information related to Medicaid applicants/
				  beneficiaries must execute data exchange agreements with EOHHS that safeguard
				  the confidential nature of this information.
5. Information must be adequately stored and
				  processed so that it is protected against unauthorized disclosure. All paper
				  records and electronic files shall be properly stored and shall only be
				  available to the staff responsible for the administration and supervision of
				  the Program.
6. Materials sent or
				  distributed to applicants, beneficiaries, or providers of services must be
				  limited to that which are directly related to the administration of the
				  Medicaid Program and have no political implications except to the extent
				  required to implement the National Voter Registration Act ( Public Law 103-931
				 ). Materials such as "holiday" greetings, public announcements, partisan voting
				  information, and non-citizen registration notices shall not be mailed or
				  distributed.
7. Materials in the
				  immediate interest of the health and welfare of applicants / beneficiaries,
				  such as announcements of free medical examinations, availability of surplus
				  food, and consumer protection information are not prohibited.
8. Only the names of persons directly
				  connected with the administration of the Program shall be contained in material
				  sent or distributed to applicants/ beneficiaries and vendors. Such persons
				  shall only be identified in their EOHHS official capacity.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 05 - Consumer Rights, Responsibilities, and Protections › Part 1 - Confidentiality Rule (210-RICR-10-05-1) › Section 210-RICR-10-05-1.8 - Release of Information

Current through June 14, 2024
A. The release or
				  use of information concerning an applicant or beneficiary applying for or
				  receiving assistance or services is restricted to other social agencies whose
				  representatives are subject to standards of confidentiality that are
				  substantially similar to those of EOHHS.
B. EOHHS must obtain permission from an
				  applicant/beneficiary or their family, whenever possible, before responding to
				  a request for information from an outside source, unless the information is to
				  be used to verify income, eligibility, or the amount of Medicaid payments.
C. In an emergency, when the
				  applicant/beneficiary cannot be reached to obtain consent, s/he will be
				  notified immediately by EOHHS after the information is supplied.
D. In the event of the issuance of a subpoena
				  for the case record or for any EOHHS representative to testify concerning an
				  applicant or beneficiary, the request must be transmitted to EOHHS Division of
				  Legal Services. The Court will be advised by EOHHS's lawyer of these rules and
				  regulations against disclosure of information. The same policy applies to
				  requests for information from a governmental authority, the courts, a law
				  enforcement official, or the media.
E. EOHHS exchanges information with other
				  entities to verify the income and eligibility of applicants and beneficiaries.
				  Information made available by EOHHS is only to the extent necessary to assist
				  in the valid administrative needs of the program receiving the information.
				  Information received under §6103(1) of the Internal Revenue Code will be
				  exchanged only with agencies authorized to receive that information under that
				  section of the IRS Code.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 05 - Consumer Rights, Responsibilities, and Protections › Part 1 - Confidentiality Rule (210-RICR-10-05-1) › Section 210-RICR-10-05-1.9 - Disclosure of Tax Data

Current through June 14, 2024
A. Section
				   26 U.S.C. §
											6103(l)  of the
				  Internal Revenue Code does not allow for disclosure of tax data by the State
				  except when such disclosure is for the purposes of determining eligibility or
				  the amount of benefits for a public assistance program.
B. The taxpayer does not have authority to
				  authorize the EOHHS to disclose tax data in his/her file.
C. Section
				   26 U.S.C. §
											7213(a)  of the Internal
				  Revenue Code prohibits disclosure of any return or return information.
				  Violations of this statute shall be a felony punishable by a fine in any amount
				  not exceeding $5,000, or imprisonment of not more than five (5) years, or both,
				  together with the costs of prosecution.
D. Section
				   26 U.S.C. §
											7431  of the Internal Revenue
				  Code provides that any person who knowingly, or by reason of negligence,
				  discloses any return or return information with respect to a taxpayer, is
				  subject to civil action for damages in a District Court of the United
				  States.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 05 - Consumer Rights, Responsibilities, and Protections › Part 1 - Confidentiality Rule (210-RICR-10-05-1) › Section 210-RICR-10-05-1.10 - Access to Public Information

Current through June 14, 2024
A. EOHHS recognizes
				  both the public's right to access public records and the individual's right to
				  dignity and privacy. It is EOHHS's policy to facilitate public access to all
				  public records that may be disclosed in accordance with R.I. Gen. Laws Chapter
				  38-2. It is also the policy of EOHHS to ensure all public records under its
				  jurisdiction are available for public inspection and reproduction consistent
				  with all applicable state and/or federal laws, unless otherwise prohibited by a
				  court of competent jurisdiction.
B.
				  EOHHS has established regulations to set forth the specific rules to access
				  public records maintained by EOHHS. (Please refer to "Access to Public Records"
				  regulations).
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 05 - Consumer Rights, Responsibilities, and Protections › Part 1 - Confidentiality Rule (210-RICR-10-05-1) › Section 210-RICR-10-05-1.11 - Penalties and Sanctions

Current through June 14, 2024
R.I. Gen. Laws §
										40-6-12 states that any person violating any of the provisions of these rules and
					 regulations shall be deemed guilty of a misdemeanor, and shall be fined not
					 more than two hundred dollars ($200) or shall be imprisoned for not more than
					 six (6) months, or both. Other provisions of law cited herein may contain
					 additional penalties and sanctions for violations of confidentiality and/or
					 privacy.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 05 - Consumer Rights, Responsibilities, and Protections › Part 1 - Confidentiality Rule (210-RICR-10-05-1) › Section 210-RICR-10-05-1.12 - Severability

Current through June 14, 2024
If any provision in any section of this rule or the
					 application thereof to any person or circumstances is held invalid, its
					 invalidity does not affect other provisions or applications of the rule which
					 can be given effect without the invalid provision or application, and to this
					 end the provisions of this rule are declared to be severable.?
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 05 - Consumer Rights, Responsibilities, and Protections › Part 2 - Appeals Process and Procedures for EOHHS Agencies and Programs › Section 210-RICR-10-05-2.1 - Purpose, Scope and Applicability

Current through June 14, 2024
2.1.1
LEGAL
				  AUTHORITY
A. The Rhode Island
				  Executive Office of Health and Human Services (EOHHS) was established in 2006
				  within the executive branch of state government and serves as the principal
				  agency of the executive branch for the purposes of managing the Departments of
				  Children, Youth, and Families (DCYF); Health (RIDOH); Human Services (DHS); and
				  Behavioral Healthcare, Developmental Disabilities, and Hospitals (BHDDH). The
				  EOHHS 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.
B. Although the
				  four (4) state agencies under EOHHS (DCYF, RIDOH, DHS, and BHDDH) maintain the
				  authority to execute their respective administrative powers and duties in
				  accordance with state law, R.I. Gen. Laws §
											42-7.2-6.1(2) 
				  transferred to the EOHHS the principal responsibility for "legal services
				  including applying and interpreting the law, oversight of the rule making
				  process, and administrative duties and any related functions and duties deemed
				  necessary by the secretary" for all publicly funded health and human services.
				  It is in this capacity that the EOHHS is authorized and designated by state law
				  to be the entity responsible for appeals and hearings related to the
				  publicly-funded health and human services programs identified in § 2.1.3
				  of this Part below. EOHHS has been authorized as the designated exchange
				  appeals entity pursuant to the Rules and Regulations Pertaining to Health
				  Source RI, 220-RICR- 90-00-1.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 05 - Consumer Rights, Responsibilities, and Protections › Part 2 - Appeals Process and Procedures for EOHHS Agencies and Programs › Section 210-RICR-10-05-2.2 - Appeals: General Provisions

Current through June 14, 2024
2.2.1
APPEAL
				  PROCESS
A. The filing of an appeal
				  initiates the hearing process. There are multiple opportunities to resolve an
				  appeal while a hearing is pending.
1.
				  Notification of Appeal Rights. An agency must include on all application forms
				  - paper and electronic - a statement of the applicant's right to appeal and
				  request a hearing related to any agency action related to eligibility; the
				  process for determining eligibility; or a change in the scope, amount, or
				  duration of assistance. Such notices must also state the:
a. Nature of the agency action, the legal
				  basis for the action, the date the action takes effect, the right to
				  representation, the process for review of agency documents if appealing and
				  requesting a hearing, as well as the timelines and locations for doing so; and
b. Except for HSRI notices,
				  information about continuation or reinstatement of assistance while an appeal
				  is pending, as indicated in the aid pending provisions contained in §
				  2.2.2 of this Part.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 05 - Consumer Rights, Responsibilities, and Protections › Part 2 - Appeals Process and Procedures for EOHHS Agencies and Programs › Section 210-RICR-10-05-2.4 - Agency/Program Specific Appeal and Hearing Provisions

Current through June 14, 2024
The EOHHS Hearing Office is bound by federal and/or state
					 law and regulations to recognize the unique appeal provisions applicable to
					 persons participating in the following programs and/or delivery systems.
2.4.1
AID PENDING
A. See § 2.2.2 of this Part for
				  additional information related to the continuation or reinstatement of Aid
				  Pending the resolution of an appeal.
B. HSRI - Commercial Health Insurance through
				  HSRI Renewals.
1. HSRI. Aid Pending is
				  available to customers who appeal an eligibility redetermination. Eligibility
				  redetermination shall be defined in accordance with
				   45 C.F.R. §
													155.330(e)(1)(ii)  (December
				  22, 2016) and
				   45 C.F.R. §
													155.335(h)(1)(ii)  (March 8,
				  2016) not to include later amendments thereto. Aid Pending is available to
				  customers who appeal eligibility redetermination.
C. For appeals pertaining to General Public
				  Assistance (GPA), a written request for hearing made within the ten (10) day
				  advance notice period and must be accompanied by or include a written request
				  for continuation of GPA to stay the reduction, suspension, or discontinuance
				  until the administrative fair hearing decision is issued. Only at the
				  applicant/recipient's specific written request must the agency continue GPA
				  benefits.
D. If an appeal of
				  resident discharge or transfer is filed within ten (10) days from the date of
				  the notice of intended action, a resident may continue residing in the facility
				  until the EHO administrative hearing decision is issued.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 05 - Consumer Rights, Responsibilities, and Protections › Part 4 - Access to Public Records (210-RICR-10-05-4) › Section 210-RICR-10-05-4.1 - LEGAL Authority

Current through June 14, 2024
This Regulation is promulgated pursuant to R.I. Gen. Laws
					 §
										38-2-1 et seq.
					 (Access to Public Records) and R.I. Gen. Laws §
										42-35-2(a) 
					 (Administrative Procedures).
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 05 - Consumer Rights, Responsibilities, and Protections › Part 4 - Access to Public Records (210-RICR-10-05-4) › Section 210-RICR-10-05-4.2 - Definitions

Current through June 14, 2024
A. As used herein, the following terms shall
				  be construed as follows:
1. "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 et seq. within the
				  executive branch of state government and serves as the principal agency for the
				  purposes of managing the Departments of Children, Youth, and Families (DCYF);
				  Health (DOH); Human Services (DHS); and Behavioral Healthcare, Developmental
				  Disabilities, and Hospitals (BHDDH). The EOHHS 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.
2. "Public
				  record" or "Public records" means all documents, papers, letters, maps, books,
				  tapes, photographs, films, sound recordings, magnetic or other tapes,
				  electronic data processing records, computer stored data (including electronic
				  mail messages, except specifically for any electronic mail messages of or to
				  elected officials with or relating to those they represent and correspondence
				  of or to elected officials in their official capacities) or other material
				  regardless of physical form or characteristics made or received pursuant to law
				  or ordinance or in connection with the transaction of official business by any
				  agency.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 05 - Consumer Rights, Responsibilities, and Protections › Part 4 - Access to Public Records (210-RICR-10-05-4) › Section 210-RICR-10-05-4.3 - Purpose

Current through June 14, 2024
A. The purpose of this Regulation is:
1. To establish consistency with
				  implementation of R.I. Gen. Laws §
											38-2-1 et seq.
				  and R.I. Gen. Laws §
											42-35-2(a) 
				  relating to access to public records maintained by the Department of Human
				  Services; Department of Children, Youth and Families; Department of Behavioral
				  Healthcare, Developmental Disabilities and Hospitals; Division of Elderly
				  Affairs; Division of Veteran's Affairs; and the Department of Health as
				  detailed in the current Rules and Regulations Pertaining to Access to Public
				  Records of the Department of Health;
2. To facilitate open and transparent
				  government at the Department to the greatest extent possible, while balancing
				  privacy rights of the public, employees and vendors of the State; and
3. To recognize the public's right to access
				  public records while balancing an individual's right to be protected from an
				  unwarranted invasion of personal privacy.
4. To provide the public with rules and
				  procedures for accessing public records maintained by each of the State
				  agencies set forth in §
											4.2(A)(1)   of
				  this Part.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 05 - Consumer Rights, Responsibilities, and Protections › Part 4 - Access to Public Records (210-RICR-10-05-4) › Section 210-RICR-10-05-4.4 - Policy

Current through June 14, 2024
The Executive Office of Health and Human Services (EOHHS)
					 recognizes both the public's right to access public records and the
					 individual's right to dignity and privacy. It is the EOHHS policy to facilitate
					 public access to all public records that may be disclosed in accordance with
					 R.I. Gen. Laws §
										38-2-1 et seq.
					 It is also the policy of the EOHHS to ensure all public records under its
					 jurisdiction be available for public inspection and reproduction consistent
					 with all applicable state and/or federal law, unless otherwise prohibited by a
					 court of competent jurisdiction.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 05 - Consumer Rights, Responsibilities, and Protections › Part 4 - Access to Public Records (210-RICR-10-05-4) › Section 210-RICR-10-05-4.6 - Severability

Current through June 14, 2024
If any provision of these rules and regulations or the
					 application thereof to any person or circumstances 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 these
					 rules and regulations are declared to be severable.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 05 - Consumer Rights, Responsibilities, and Protections › Part 5 - Declaratory Order Petitions (210-RICR-10-05-05) › Section 210-RICR-10-05-5.1 - Purpose

Current through June 14, 2024
This regulation states the requirements for submitting a
					 request for Declaratory Order under R.I. Gen. Laws §
										42-35-8(b),
					 and the procedure for its consideration and prompt
					 disposition.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 05 - Consumer Rights, Responsibilities, and Protections › Part 5 - Declaratory Order Petitions (210-RICR-10-05-05) › Section 210-RICR-10-05-5.2 - Authority

Current through June 14, 2024
This regulation is promulgated pursuant to the authority
					 granted in R.I. Gen. Laws §
										42-35-8.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 05 - Consumer Rights, Responsibilities, and Protections › Part 5 - Declaratory Order Petitions (210-RICR-10-05-05) › Section 210-RICR-10-05-5.3 - Definitions

Current through June 14, 2024
A. The following definitions shall apply to
				  this regulation:
1. "Declaratory order" means
				  an order issued by the State Agency that:
a.
				  Interprets or applies a statute administered by the State Agency;
b. Clarifies whether a rule, guidance
				  document, or order issued by the State Agency applies to a Petitioner;
				  or
c. Clarifies how a rule,
				  guidance document, or order issued by the State Agency applies to a
				  Petitioner.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 05 - Consumer Rights, Responsibilities, and Protections › Part 5 - Declaratory Order Petitions (210-RICR-10-05-05) › Section 210-RICR-10-05-5.4 - Request for Declaratory Order: Form and Submission

Current through June 14, 2024
A. A request for Declaratory Order must be in
				  writing and include the following information:
1. The name and address of the
				  Petitioner;
2. A plain statement
				  identifying the statute, rule, guidance document, or order at issue;
3. A detailed statement of all facts relied
				  upon by the Petitioner;
4. A copy
				  of any and all documents relied upon by Petitioner that are not otherwise
				  accessible to the State Agency; and
5. A plain statement requesting a Declaratory
				  Order, and further indicating whether Petitioner seeks:
a. An interpretation or application of a
				  statute administered by the State Agency;
b. Clarification as to whether a rule,
				  guidance document, or order issued by the State Agency applies to Petitioner;
				  and/or
c. Clarification as to how a
				  rule, guidance document, or order issued by the State Agency applies to
				  Petitioner.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 05 - Consumer Rights, Responsibilities, and Protections › Part 5 - Declaratory Order Petitions (210-RICR-10-05-05) › Section 210-RICR-10-05-5.5 - Consideration and Disposition of Request for Declaratory Order

Current through June 14, 2024
A. The State Agency shall promptly consider
				  and respond to the request for Declaratory Order as provided in R.I. Gen. Laws
				  §
										42-35-8(c).
1. Should the State Agency schedule the
				  matter for further consideration, the State Agency shall notify Petitioner in
				  writing of the anticipated date on which the State Agency will grant or deny
				  the request for Declaratory Order.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 05 - Consumer Rights, Responsibilities, and Protections › Part 6 - Petition for Promulgation of Rules (210-RICR-10-05-06) › Section 210-RICR-10-05-6.1 - Purpose

Current through June 14, 2024
The purpose of this regulation is to prescribe the form of
					 a petition for promulgation of rules pursuant to R.I. Gen. Laws §
										42-35-6 and the procedure for its submission, consideration, and disposition.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 05 - Consumer Rights, Responsibilities, and Protections › Part 6 - Petition for Promulgation of Rules (210-RICR-10-05-06) › Section 210-RICR-10-05-6.2 - Authority

Current through June 14, 2024
This regulation is promulgated pursuant to the authority
					 granted in R.I. Gen. Laws §
										42-35-6.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 05 - Consumer Rights, Responsibilities, and Protections › Part 6 - Petition for Promulgation of Rules (210-RICR-10-05-06) › Section 210-RICR-10-05-6.3 - Definitions

Current through June 14, 2024
A. The following definitions shall apply to
				  this regulation:
1. "Petition" means a request
				  for the promulgation of a rule.
2.
				  "Petitioner" means a person requesting a Declaratory Order.
3. "Promulgate" means the process of writing
				  a new rule, or amending or repealing an existing rule.
4. "State agency" means the Executive Office
				  of Health and Human Services (EOHHS).
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 05 - Consumer Rights, Responsibilities, and Protections › Part 6 - Petition for Promulgation of Rules (210-RICR-10-05-06) › Section 210-RICR-10-05-6.4 - Request for the Promulgation of a Rule

Current through June 14, 2024
A. A
				  request for the promulgation of a rule must be in writing and include the
				  following information:
1. The name and
				  address of the Petitioner;
2. A
				  plain statement identifying the rule or proposed new rule at issue;
3. A detailed statement of all facts relied
				  upon by the Petitioner;
4. A copy
				  of any and all documents relied upon by Petitioner that are not otherwise
				  accessible to the State Agency; and
5. A plain statement requesting the
				  promulgation of a rule, and further indicating whether Petitioner seeks a new
				  rule or the amendment or repeal of an existing rule.
a. In the case of a request for promulgation
				  of a new rule or the repeal of an existing rule, the Petitioner shall identify
				  the rule by title and/or Rhode Island Code of Regulations (RICR)
				  citation.
b. In the case of a
				  request for an amendment to an existing rule, the Petitioner must identify with
				  specificity the proposed language to be added or removed by redlining or
				  similar means.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 05 - Consumer Rights, Responsibilities, and Protections › Part 6 - Petition for Promulgation of Rules (210-RICR-10-05-06) › Section 210-RICR-10-05-6.5 - Consideration and Disposition of Request for the Promulgation of a Rule

Current through June 14, 2024
A. The State Agency shall promptly consider
				  and respond to the request for the Promulgation of a Rule as provided in R.I.
				  Gen. Laws §
										42-35-6.
B. The agency may, at its discretion:
1. Hold a hearing for further consideration
				  and discussion on the Petition; or
2. Request further information or documents
				  from the Petitioner necessary for the full evaluation of his or her
				  petition.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 05 - Consumer Rights, Responsibilities, and Protections › Part 7 - Conduct of Public Hearings (210-RICR-10-05-7) › Section 210-RICR-10-05-7.1 - Purpose

Current through June 14, 2024
The purpose of this rule is to establish a defined set of
					 procedures for the conduct of public hearings regarding proposed rulemaking by
					 the Rhode Island Executive Office of Health and Human
					 Services.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 05 - Consumer Rights, Responsibilities, and Protections › Part 7 - Conduct of Public Hearings (210-RICR-10-05-7) › Section 210-RICR-10-05-7.2 - Authority

Current through June 14, 2024
This regulation is promulgated pursuant to the authority
					 granted in R.I. Gen. Laws §42 - 35-2(a)(4).
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 05 - Consumer Rights, Responsibilities, and Protections › Part 7 - Conduct of Public Hearings (210-RICR-10-05-7) › Section 210-RICR-10-05-7.3 - Definitions

Current through June 14, 2024
A. For the purpose of this regulation:
1. "Executive Office of Health and Human
				  Services" or "EOHHS" means the state agency that is designated under the
				  Medicaid State Plan as the single state agency responsible for the
				  administration of the Title XIX Medicaid Program.
2. "Member of the public" means any
				  individual, firm, business, corporation, association, partnership or other
				  group.
3. "Presiding EOHHS
				  official" means the employee conducting the public hearing.
4. "Public hearing" means the convening of
				  members of the public and agency personnel for the purpose of obtaining public
				  comment on proposed rulemaking.
5.
				  "Proposed rulemaking" means a proposed new rule, proposed amendment to a rule,
				  or proposed repeal of a rule as noticed pursuant to R.I. Gen. Laws §
											42-35-2.7.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 05 - Consumer Rights, Responsibilities, and Protections › Part 7 - Conduct of Public Hearings (210-RICR-10-05-7) › Section 210-RICR-10-05-7.4 - Procedure for Conduct of Public Hearings

Current through June 14, 2024
A.
				  Convening of a Public Hearing
1. Public
				  hearings may be held at the election of the agency or as required pursuant to
				  R.I. Gen. Laws §
											42-35-2.8(c).
2. Notice of public hearings shall be issued
				  in accordance with the provisions of R.I. Gen. Laws §§
											42-35-2.8 and
				   42-46-6, when
				  applicable.
3. The public hearing
				  shall be held at a time and place designated by the EOHHS.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 20 - Medicaid Payments and Providers › Subchapter 00 - N/A › Part 1 - Medicaid Payments and Providers › Section 210-RICR-20-00-1.1 - Legal Authority

Current through June 14, 2024
A. The Rhode Island
				  Medicaid Program provides health care coverage authorized by Title XIX of the
				  Social Security Act,  42 U.S.C. §§
											1396-1396w-7  (Federal Medicaid Law)
				  and Title XXI of the Social Security Act,  42 U.S.C. §§
											1397aa-1397mm (Federal Children's Health Insurance Program ("CHIP") law) as well as the
				  State's Medicaid State Plan and Section  1115   demonstration waiver granted under
				  the authority of §
										1115   of the Social Security Act,  42 U.S.C. §
											1315.
				  To participate in the Medicaid program, health care providers must be certified
				  and agree to abide by the requirements established in federal law, Rhode Island
				  General Laws, and State and Federal Rules and Regulations.
B. To qualify for Federal matching funds,
				  payments to certified providers for authorized services must be made in
				  accordance with methodologies established by the State and approved for such
				  purposes by the Secretary of the U.S. Department of Health and Human Services
				  (DHHS) and/or the Federal Centers for Medicare and Medicaid Services (CMS). The
				  Secretary of the EOHHS is authorized to set forth in Rule, contractual
				  agreements, provider certification standards, and/or payment methodologies the
				  requirements for obtaining Federal financial participation established in
				  Federal laws, Regulations, or other such authorities. This Rule governs
				  participation of and payments to health care providers participating in the
				  Medicaid program.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 20 - Medicaid Payments and Providers › Subchapter 00 - N/A › Part 1 - Medicaid Payments and Providers › Section 210-RICR-20-00-1.2 - Incorporated Materials

Current through June 14, 2024
A. These
				  Regulations hereby adopt and incorporate  42 C.F.R. §
											424.518  (2021) 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  42 C.F.R. §
											455.470  (2021) 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.
C. These Regulations
				  hereby adopt and incorporate  42 C.F.R. §
											1002.214  (2021) 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.
D. These Regulations
				  hereby adopt and incorporate  42 C.F.R. §
											1002.215  (2021) 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 20 - Medicaid Payments and Providers › Subchapter 00 - N/A › Part 1 - Medicaid Payments and Providers › Section 210-RICR-20-00-1.3 - Definitions

Current through June 14, 2024
A. As used in this Rule, the following terms
				  and phrases have the following meanings:
1.
				  "Conviction" means as assigned in R.I. Gen. Laws §§
											42-7.2-18.2 and
				   42-7.2-18.4.
2. "Disqualifying
				  conviction" means a conviction, federal or state, for any of the crimes listed
				  in R.I. Gen. Laws §§
											42-7.2-18.2 and  42-7.2-18.4.
3. "High-risk provider" means a provider that
				  poses a high risk of fraud, waste or abuse. These providers are:
a. Designated by the Centers for Medicare and
				  Medicaid Services as high categorical risk according to  42 C.F.R. §
													424.518  (2021);
b. Individual
				  personal care attendants and homemakers providing direct care to individuals
				  under Chapter 50-10-2 of this Title; and
c. Shared living caregivers providing direct
				  care to individuals under Chapter 50-10-1 of this Title.
4. "Limited-risk provider" means a provider
				  that is neither a moderate-risk provider nor a high-risk provider.
5. "Moderate-risk provider" means a provider
				  that poses a moderate risk of fraud, waste or abuse. These providers are:
a. Providers designated by the Centers for
				  Medicare and Medicaid Services as moderate categorical risk according to  42 C.F.R. §
													424.518  (2021);
b.
				  Severely disabled nursing home care providers;
c. Providers employing personal care
				  attendants and homemakers; and
d.
				  RIte Share co-pay providers.
6. "Provider" means an individual or entity
				  including physicians, nurse practitioners, physician assistants, and others who
				  are engaged in the delivery of medical/behavioral health care services, or
				  ordering or referring for those services, and is legally authorized to do so by
				  the State in which the provider delivers the services. This includes
				  fee-for-service and managed care providers.
7. "Rhode Island Medicaid program" means a
				  combined State and Federally funded program established on July 1,1966, under
				  the provisions of  42 U.S.C. §§
												1396-1396w-7. The enabling State
				  legislation is to be found at R.I. Gen. Laws Chapter 40-8, as
				  amended.
8. "Secretary" means the
				  Rhode Island Secretary of the Executive Office of Health and Human Services
				  (EOHHS) who is responsible for the oversight, coordination, and cohesive
				  direction of State-administered health and human services, including the
				  Medicaid agency, and for ensuring all applicable laws are executed.
9. "State agency" means the Rhode Island
				  Executive Office of Health and Human Services (EOHHS) which is designated under
				  the Medicaid State Plan as the Single State Agency responsible for the
				  administration of the Medicaid Program.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 20 - Medicaid Payments and Providers › Subchapter 00 - N/A › Part 1 - Medicaid Payments and Providers › Section 210-RICR-20-00-1.4 - Medicaid Payment Policy

Current through June 14, 2024
A. Medicaid is the
				  payor of last resort. Community, public, and private resources such as Federal
				  Medicare, Veteran's Administration benefits, accident settlements, or other
				  health insurance plans must be utilized fully before payment from the Medicaid
				  program can be authorized, including for prenatal services, labor, delivery,
				  and postpartum care services. However, the State makes payments without regard
				  to third (3rd) party liability for pediatric preventive services, unless the
				  State has made a determination related to cost-effectiveness and access to care
				  that warrants cost avoidance for ninety (90) days. The State may also make
				  payments without regard to potential third (3rd) party liability for up to one
				  hundred (100) days for claims related to child support enforcement
				  beneficiaries.
B. Payments to
				  physicians and other providers of medical services and supplies are made in
				  accordance with contractual arrangements with health plans or on a
				  fee-for-service basis in accordance with applicable Federal and State Rules and
				  Regulations, the Medicaid State Plan, and the State's Section  1115    demonstration waiver.
C. Payments
				  to Medicaid providers represent full and total payment. No supplementary
				  payments are allowed, except as specifically provided in the contract. Direct
				  reimbursement to recipients is prohibited except in specific circumstances to
				  correct a denial that is reversed on appeal.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 20 - Medicaid Payments and Providers › Subchapter 00 - N/A › Part 1 - Medicaid Payments and Providers › Section 210-RICR-20-00-1.5 - Long-term Care Facilities - Surveys

Current through June 14, 2024
A. The Rhode Island
				  Department of Health surveys all Nursing Facilities (NF) and Intermediate Care
				  Facilities for persons with Intellectual Disabilities (ICF/ID) for compliance
				  with the Federal participation requirements of the Medicare and Medicaid
				  programs. As a result of these surveys, reports are issued for certification
				  purposes which cite provider deficiencies, if any exist, together with
				  appropriate plans of correction. Subsequent corrections of deficiencies are
				  also reported.
B. Statements of
				  provider deficiencies must be made available to the public as follows:
1. Nursing Facilities (NF) - To the extent
				  permitted by law, reports are sent to the Social Security Administration (SSA)
				  district office that covers the area in which the facility is located and the
				  Medicaid agency.
2. Intermediate
				  Care Facilities/Intellectual Disabilities (ICF/ID) - Reports are sent to the
				  Medicaid agency. The agency is required to send the reports for both Nursing
				  and Intermediate Care Facilities to the appropriate Long-term Services and
				  Supports (LTSS) Unit covering the district in which the facility is located.
				  The agency must also send the ICF/ID reports to the SSA office covering the
				  catchment area in which the facility is located.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 20 - Medicaid Payments and Providers › Subchapter 00 - N/A › Part 1 - Medicaid Payments and Providers › Section 210-RICR-20-00-1.6 - Provider Eligibility - Screening Requirements

Current through June 14, 2024
A. EOHHS
				  performs a screening of all providers to ensure that providers meet all State
				  and federal requirements for enrollment and/or continued participation as a
				  provider in the Medicaid program. The screening process corresponds to the
				  provider's classification as a limited-risk provider, moderate-risk provider,
				  or high-risk provider, as determined by EOHHS. If a provider could fit within
				  more than one (1) risk level, the highest level of screening shall be
				  applicable. The information gathered during this screening shall impact
				  eligibility for participation as a Medicaid provider, as described
				  herein.
B. EOHHS performs the
				  minimum screenings required by State and federal law and regulations for each
				  risk level. For moderate-risk and high-risk providers, federal law requires an
				  unannounced site visit.
C. For the
				  following providers, and if a provider entity all persons with a five percent
				  (5%) or greater direct or indirect ownership interest in such providers, state
				  and federal law require a national criminal records check supported by
				  fingerprints, conducted through the Office of Attorney General:
1. Providers designated by the Centers for
				  Medicare and Medicaid Services (CMS) as high categorical risk;
2. Individual personal care attendants and
				  homemakers providing direct care to individuals under Chapter 50-10-2 of this
				  Title; and
3. Shared living
				  caregivers providing direct care to individuals under Chapter 50-10-1 of this
				  Title.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 20 - Medicaid Payments and Providers › Subchapter 00 - N/A › Part 1 - Medicaid Payments and Providers › Section 210-RICR-20-00-1.7 - Provider Eligibility - Eligibility Criteria

Current through June 14, 2024
A. To be
				  eligible to participate in the Rhode Island Medicaid program as any provider
				  type, a provider must:
1. Be fully licensed,
				  certified, registered, and/or credentialed, where required by the State, as an
				  active practitioner by the agency or board overseeing the specific provider
				  type;
2. Be registered with
				  appropriate state and federal agencies to prescribe controlled substances, for
				  any provider type that is legally authorized to write prescriptions for
				  medications;
3. Never have been the
				  subject of and/or never have had common parties in interest with any provider
				  subject to any disciplinary action, sanction, or other limitation or
				  restriction of any nature imposed with or without the consent of the provider,
				  by any state or federal agency, or board, including the Rhode Island Medicaid
				  program or another state's Medicaid program;
4. Never have purchased or otherwise obtained
				  its practice or business entity from any provider suspended or terminated from
				  participation in the Rhode Island Medicaid program due to violations of
				  applicable laws, rules, or regulations; or from a provider that is currently
				  subject to a withholding of Medicaid payments for a credible allegation of
				  fraud or who terminates or has its Medicaid participation terminated while
				  subject to such a withholding of Medicaid payments;
5. Cooperate with the Rhode Island Medicaid
				  program during any application, revalidation of enrollment, or other review
				  process, such as permitting, facilitating site visits, and submitting
				  fingerprints, as determined by EOHHS;
6. Not be subject to a moratorium on
				  enrollment imposed in accordance with  42 C.F.R. §
												455.470  (2021);
				  and
7. Not have any evidence of a
				  disqualifying conviction that is revealed during a national criminal records
				  check or otherwise revealed during EOHHS' provider risk screening
				  process.
Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 20 - Medicaid Payments and Providers › Subchapter 00 - N/A › Part 1 - Medicaid Payments and Providers › Section 210-RICR-20-00-1.8 - Provider Eligibility - Termination of Participation for Ineligibility

Current through June 14, 2024
A. When a provider fails or ceases to meet
				  any one (1) or more of the State or federal eligibility criteria applicable to
				  such provider, the provider's participation in the Rhode Island Medicaid
				  program may be terminated. If such termination is based upon a finding, ruling,
				  conviction, decision, order, notification, or statement of any nature
				  (including an agreement with the provider) by any federal, state, or
				  quasi-public board, department (other than EOHHS), or other agency or another
				  state's Medicaid program that revokes, voids, suspends, or denies the issuance,
				  renewal, or extension of a license, certificate, or other statement of
				  qualification that constitutes a statutory prerequisite or other eligibility
				  criterion, the correctness or validity of the action taken by the issuing
				  agency will be presumed, the termination will be effective as of the earliest
				  date on which the provider failed or ceased to meet any of such criteria, and
				  EOHHS shall not afford a hearing as to the correctness or validity of such
				  action. If such termination is based solely upon a determination of
				  ineligibility by EOHHS, the provider shall be afforded notice and an
				  opportunity for hearing in substantially the manner set forth in §
										1.10   of
				  this Part, and any termination will be effective as of the date of receipt of
				  notice thereof.