Section 210-RICR-30-05-2.22 - Overview of RHPA. Individuals enrolled in RHP receive the full scope of services covered under the Medicaid State Plan and the State's Section 1115 waiver, unless otherwise indicated. Covered services may be provided through the MCO or through the fee-for-service delivery system if the service is "out-of-plan" - that is, not included in the MCO but covered under Medicaid. Fee-for-service benefits may be furnished either by the managed care provider or by any participating provider. Rules of prior authorization apply to any service required by EOHHS. In response to the novel Coronavirus Disease (COVID-19), EOHHS will temporarily suspend most prior authorization requirements. Effective October 1, 2021, prior authorization requirements will be reinstated for all services except for behavioral healthcare services. Effective January 1, 2022, prior authorizations will be reinstated for behavioral healthcare services. Each RHP member selects a primary care provider (PCP) who performs the necessary medical care and coordinates referrals to specialty care. The primary care provider orders treatment determined to be medically necessary in accordance with MCO policies.210 R.I. Code R. 210-RICR-30-05-2.22
Amended effective 10/5/2021
Amended effective 12/12/2023
Amended effective 3/17/2024