Section 210-RICR-30-05-2.46 - Transitioning Members between MCOs and Delivery SystemsA. It may be necessary to transition a Medicaid member between MCOs or from one (1) delivery system - RHP to RIte Care or vice versa - for a variety of reasons:1. Change in MCOs within a delivery system - The transition between Medicaid MCOs may occur as a result of change in MCO during open enrollment or a change that is ordered as part of a grievance resolution. The MCOs have written policies and procedures for transferring relevant patient information, including medical records and other pertinent materials, when transitioning a member to or from another MCO. The MCO must transfer this information at no cost to the member.2. Change in delivery systems - Medicaid members may be transitioned from one managed care delivery system into another as a result of changes in eligibility status. Adults enrolled in RIte Care who are between the ages of nineteen (19) and sixty-four (64) may be eligible under the MACC group for adults when their dependent children age out of MACC group for children and young adults. Once a RHP member has given birth, both newborn and/or parents may be transitioned to RIte Care if income is within the eligibility thresholds set forth in Medicaid Affordable Care Coverage Groups Overview and Eligibility Pathways (Subchapter 00 Part 1 of this Chapter). Enrollment in MCOs during such transitions will strive to preserve the continuity of care to the full extent feasible. Accordingly, Medicaid members enrolled in a particular MCO subject to a delivery system transition will be enrolled in the same health plan, if participating, in the new delivery system.210 R.I. Code R. 210-RICR-30-05-2.46
Amended effective 10/5/2021
Amended effective 12/12/2023
Amended effective 3/17/2024