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 1 - "Medicaid Long-Term Services and Supports: Home and Community-Based Services (HCBS)" (210-RICR-50-10-1) › Section 210-RICR-50-10-1.4 - Accessing Medicaid Home and Community Based Services

Current through June 14, 2024
A. Medicaid LTSS is available to applicants
				  and beneficiaries who meet the non-financial, financial and functional/clinical
				  eligibility criteria for eligibility set forth in this Chapter. Under the terms
				  of the State's Section 1115 demonstration waiver, a person seeking Medicaid
				  LTSS must have an established need as set forth in Subchapter 00 Part 1 of this
				  Title but is not required to be receiving long-term care at the time an
				  application is made. In addition, it is not necessary for an applicant to make
				  a choice of the type of LTSS -- HCBS or health institution -- when requesting
				  Medicaid coverage. As indicated in Part 5 of this Chapter, a person's level of
				  need in the functional/clinical eligibility determination process affects the
				  range of Medicaid LTSS options and settings that may be available.
B. Persons seeking Medicaid HCBS are subject
				  to a functional assessment that includes a standard set of evaluation criteria
				  that consider the full range of the person's physical, medical, behavioral
				  health and social needs. This assessment takes a variety of forms and may be
				  performed by an agency representative or a contractual entity. The assessment
				  is a component of the person-centered planning process, when feasible, and is
				  one of several factors reviewed when determining whether and to what extent a
				  person has the need for an institutional level of care and the scope of HCBS
				  authorized for payment.
C. The
				  Medicaid State Plan and Rhode Island's Section 1115 demonstration waiver
				  authorize the State to implement certain conditions affecting access to
				  Medicaid HCBS including:
1. No room and board
				  coverage -- Medicaid does not provide coverage for room and board costs when
				  LTSS is provided in a home or a community-based setting. The post-eligibility
				  treatment of income process, set forth in Subchapter 00 Part 8 of this of this
				  Title, provides various allowances that protect -- that is, treat as
				  unavailable -- a portion of beneficiary's income for room and board costs.
				  Other forms of public assistance are also available to help pay shelter and
				  food costs including the federal Supplemental Security Income (SSI) and
				  Supplemental Nutrition Assistance (SNAP) programs and the State's optional
				  Supplemental Payment (SSP) program, as well as a variety of publicly funded
				  housing and meal support programs. Agency representatives are available to
				  assist applicants and beneficiaries seeking these additional forms of
				  assistance.
2. Needs-based -- The
				  scope, amount and duration of authorized HCBS a beneficiary receives is
				  determined by needs level, as specified in Subchapter 00 Part 5 of this Title,
				  and within these parameters the goals and outcomes the beneficiary establishes
				  in the person-centered planning process. Only the HCBS that have been
				  authorized by the Medicaid State Plan and Section 1115 demonstration are
				  covered and, therein, only the service array associated with a beneficiary's
				  LTSS level of need -- high or highest -- may be accessed unless the exceptions
				  established in Subchapter 00 Part 5 of this Title apply.
3. Expedited eligibility [DOT] Expedited
				  eligibility for persons seeking Medicaid LTSS in a home and community-based
				  setting is available in certain circumstances. The provisions governing
				  expedited eligibility for Medicaid LTSS are located in Subchapter 00 Parts 1
				  and 5 of this Title.