210 R.I. Code R. 210-RICR-30-05-2.10

Current through December 3, 2024

Section 210-RICR-30-05-2.10 - Out-of-Plan Benefits

A. Out-of-plan benefits are not included in the capitated rate paid to the MCOs and are not the responsibility of the MCO to provide. These services are provided by existing Medicaid-approved providers who are reimbursed directly by EOHHS on a fee-for-service basis. Out-of-plan benefits are provided to all Rite Care enrollees with the following exceptions: Individuals eligible for Extended Family Planning only; Pregnant women who are otherwise ineligible for Medicaid and post-partum women with income above two hundred fifty-three percent (253%) of FPL; and anyone enrolled in the guaranteed enrollment period but otherwise ineligible for Medicaid. The covered benefits are as follows:

ELIGIBLE GROUP

BENEFIT(S) PROVIDED OUT-OF-PLAN

All Rhody Health Partners, RIte Care and Expansion members

Dental services Court-ordered mental health and substance use services ordered to a non-network facility or provider Non-Emergency Transportation Services (Non-Emergency transportation is coordinated by the contracted Health Plans). Nursing home services in excess of thirty (30) consecutive days (RHP members only) Residential services for MR/DD clients that are paid by the State's BHDDH Respite (Adult) Neonatal intensive care Unit (NICU) Services at Women's and Infants Hospital. Except as specified in § 2.9(C) of this Part Special Education services as defined in the child's Individual Education Plan (IEP) for children with special health needs or developmental delays Lead Program home assessment and non-medical case management provided by Department of Health or Lead Centers for lead poisoned children Cedar Family Center Services Centers of Excellence Programs

210 R.I. Code R. 210-RICR-30-05-2.10

Amended effective 10/5/2021
Amended effective 12/12/2023
Amended effective 3/17/2024