Section 210-RICR-40-10-1.6 - Rhody Health Options (RHO)A. In accordance with § 7 of Pub. Laws 18-047 enacted on June 22, 2018, Medicaid beneficiaries enrolled in RHO on and before October 1, 2018 will be placed in fee-for-service arrangements effective that date for all Medicaid covered long-term services and supports. The RHO program termination date is September 30, 2018.B. Medicaid beneficiaries who were enrolled in RHO on and before October 1, 2018 will continue to receive all medically necessary services as contained in § 1.4(A) (4) of this Part. The standard of "medical necessity" is used as the basis for determining whether access to a Medicaid covered service is required and appropriate. Prior to the termination date of RHO for existing beneficiaries and after for all new beneficiaries, any member who is dually eligible for Medicaid and Medicare may be enrolled in a MMP while retaining the choice to opt out and receive LTSS on a fee-for service basis. For Medicaid beneficiaries who do not have Medicare, the transition is as follows: 1. Medicaid-only LTSS in a home and community-based setting - Beneficiaries who are seeking or receiving LTSS in a home and community-based setting as defined in Part 50-10-1 of this Title will receive all essential primary care benefits through a Rhody Health Partners managed care plan. Medicaid LTSS will be provided out-of-plan and paid for on a fee-for-service basis after the first 30 days.2. Medicaid-only LTSS in a health institution --Persons seeking or receiving Medicaid in an institutional setting such as a nursing facility or hospital in accordance with Part 50-05-1 of this Title will be receive all Medicaid-covered services (primary care, subacute care, long-term services and supports) on a fee-for-service basis.1.6.1RHO AppealsThe class of Medicaid beneficiaries who were enrolled in RHO on and before October 1, 2018 do not have the right to appeal the termination of their RHO coverage in accordance with 42 C.F.R. § 431.220(b) and §10 -05-2.2 .1(A)(7)(a) of this Title. The right to appeal agency actions unrelated to this change in law and policy that affect eligibility, or the scope, amount, and or duration of Medicaid benefits is preserved.
210 R.I. Code R. 210-RICR-40-10-1.6
Amended effective 10/5/2021