Current through December 3, 2024
Section 210-RICR-30-00-4.5 - Scope of CoverageA. Eligibility Period. The hospital presumptive eligibility period begins, and includes, the date the hospital makes the HPE determination. The hospital presumptive eligibility period ends on the date that the Medicaid agency renders a determination for full Medicaid eligibility; or the last day of the month following the month in which the hospital made the HPE determination, whichever comes first.B. Covered Services. Individuals determined eligible for HPE, receive the same scope of State Plan and Section 1115 waiver services as members of a MACC group, except as follows: 1. All HPE beneficiaries -- No transportation services.2. Pregnant women -- Maternity services are limited to prenatal ambulatory care only. (Birthing expenses are not covered.)C. Service Delivery. Individuals determined to be presumptively eligible for Medicaid are enrolled in a fee-for-service plan. When full Medicaid eligibility is determined, participants will be enrolled at EOHHS' discretion in a managed care organization (MCO), as indicated in Subchapter 05 Part 2 of this Chapter.210 R.I. Code R. 210-RICR-30-00-4.5