Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 30 - Medicaid for Children, Families, and Affordable Care Act (ACA) Adults › Subchapter 00 - Affordable Coverage Groups › Part 4 - Presumptive Eligibility for Medicaid as Determined by Rhode Island Hospitals (210-RICR-30-00-4) › Section 210-RICR-30-00-4.6 - Requirements for Hospitals

Current through June 14, 2024
A. A hospital must
				  meet certain requirements to be deemed qualified to participate in the HPE.
1. Participation. A qualified hospital must
				  be licensed in RI and a participating Medicaid provider under the Rhode Island
				  Medicaid State Plan or Section 1115 waiver. The hospital must notify EOHHS of
				  its election to make presumptive eligibility determinations, and agree to HPE
				  determinations in compliance with State policies/procedures and these
				  rules.
2. Application Process: The
				  qualified hospital must:
a. Assist
				  individuals in completing and submitting the full application for health
				  insurance affordability programs in Rhode Island. This assistance includes
				  assuring that the individual understands any documentation
				  requirements.
b. NOT require
				  individuals assessed for HPE to verify information related to any HPE
				  eligibility criteria/characteristic, including pregnancy.
c. Accept self-attestation of income,
				  citizenship, and residency, as applicable, when determining
				  eligibility.
d. Provide individuals
				  with written notice after the HPE determination is made that includes, but is
				  not limited to:
(1) HPE determination (i.e.,
				  approved or denied);
(2) If
				  approved, the beginning and ending dates;
(3) If denied, the reason(s) for the denial,
				  options for submitting a regular Medicaid application and information on how to
				  make application.
e. The
				  qualified hospital must utilize EOHHS-approved materials and methods in
				  determining HPE and completing full Medicaid applications, including the EOHHS
				  and HSRI websites and the State's single streamlined
				  application.
3.
				  Confidentiality. The qualified hospital must comply with all applicable State
				  and federal laws and regulations regarding patient privacy and the
				  confidentiality of health care communications and information.
4. Records Retention. In accordance with the
				  provisions of the state agency's record retention policy, the qualified
				  hospital shall maintain organized records of all HPE applications for ten (10)
				  years from the date the last Medicaid billing was submitted to EOHHS.
5. Medicaid Agency Notification. The
				  qualified hospital shall notify the state agency of HPE approvals, and the
				  applicable date ranges, within five (5) business days.
6. Hospital Staff. The qualified hospital
				  must only use employees of the hospital to assist with HPE applications. The
				  hospital is prohibited from subcontracting HPE work to a non-hospital based
				  company or independent contractor. In addition:
a. Each qualified hospital shall have a
				  minimum of one (1) staff member trained and certified to perform HPE duties on
				  each shift.
b. The hospital must
				  affirm that all HPE personnel meet the minimum qualifications specified herein
				  and comply with EOHHS policies and procedures for participation in the Medicaid
				  hospital presumptive eligibility program and participate in all trainings,
				  knowledge-based tests, and keep up-to-date on notifications with regard to HPE.
				  The hospital must assign one accountable individual to be the liaison with the
				  State Medicaid Agency and its designees.
c. The qualified hospital HPE staff must
				  assist Medicaid applicants with the completion and submission of a Medicaid
				  application. Additionally, qualified hospital staff must provide the
				  information specified in this subsection pertaining to the HPE decision,
				  eligibility period, and requirement to complete a full application.
d. HPE staff must complete the requisite
				  EOHHS training and maintain knowledge of any program changes. HPE staff
				  training must include: in-person training; computer-based training; and
				  proficiency testing and certification. Training and testing shall be completed
				  at specific intervals as directed by EOHHS, but no less than annually.
(1) Assignment of Qualified Hospital Staff
				  Online Application Credentials. Prior to assignment of online HPE administrator
				  credentials, qualified hospital staff must complete EOHHS-approved training and
				  provide documentation of completion of training in the format required. Proof
				  of training also must be made available upon request by applicants.
(2) Proficiency standards. Hospital HPE staff
				  must achieve the minimum certification testing score set forth in contractual
				  standards established with EOHHS.