210 R.I. Code R. 210-RICR-50-10-2.11

Current through December 3, 2024

Section 210-RICR-50-10-2.11 - Participant Directed Goods and Services

A. Participants may also set aside a specified amount of their budget each month to purchase services, equipment and supplies not otherwise provided by Medicaid that address an identified need, are documented in the approved ISSP, and meet the following requirements:

1. Alternative funding sources are not available; and

2. The item or service would decrease the need for other Medicaid services; and/or

3. The item or service would promote inclusion in the community; and/or

4. The item or service would increase the individual's ability to perform ADLs/IADLs; and/or

5. The item or service would increase the person's safety in the home environment.

B. Limitations:

1. Participant goods and services generally do not include any good/service that is medical in nature and requires a physician's order which is covered by health insurance or another primary payor.

2. Items must be necessary to ensure the health, welfare, and safety of the participant, or must enable the participant to function with greater independence in the home or community, and to avoid institutionalization.

3. Items cannot be restrictive to the individual or strictly experimental in nature.

4. Items for gifts or loans to others, housing and/or utility expenses, clothing, groceries, entertainment, alcohol or tobacco, or payments to a representative are not covered.

5. Items cannot duplicate equipment provided under Medicaid-funded primary and acute care or through other sources of funding, such as Medicare, private insurance or free services from community organizations.

6. Items intended to lessen the need for assistance from a caregiver will result in a redetermination of need for caregiver assistance.

7. No more than ten percent (10%) of a participant's monthly budget may be set aside for goods and services, so that an individual continues to receive personal care services that provide for their health, welfare, and safety.

210 R.I. Code R. 210-RICR-50-10-2.11

Adopted effective 3/8/2023
Amended effective 2/12/2024