Section 210-RICR-50-10-2.13 - EOHHS ResponsibilitiesA. EOHHS shall be responsible for the following activities:1. Approve budgets and individual service and spending plans;2. Authorize participant-directed goods and services;3. Authorize out-of-budget services when medically necessary;4. Provide Personal Choice participants with notice of budget amount through a standardized letter which provides information on budget amount and any changes that occur in the assessment process. The letter also includes information on the appeals process;5. Certify, monitor, and conduct audits of Conflict-Free Case Management and Fiscal Intermediary agencies.B. The EOHHS reviews and approves the assessment and individual service and spending plan (ISSP) for each Personal Choice participant before services begin.C. Any changes made to a Personal Choice participant's ISSP must be forwarded to EOHHS for review and approval.D. Once the ISSP is approved, EOHHS will notify the appropriate Conflict-Free Case Management Agency who will inform the Fiscal Intermediary and participant that the ISSP will be implemented.E. EOHHS is responsible for educating participants, representatives and PCAs about reporting critical incidents and for reviewing reported critical incidents with the Conflict-Free Case Management Agency to determine feasibility of the individual continuing participation in the Personal Choice Program.F. If Medicaid fraud is either known or suspected, EOHHS, through the Office of Community Programs and the Office of Program Integrity, shall refer the case to the Medicaid Fraud Control Unit at the Rhode Island Department of Attorney General.210 R.I. Code R. 210-RICR-50-10-2.13
Adopted effective 2/12/2024