Section 210-RICR-50-10-2.6 - Enrollment and DisenrollmentA. Enrollment Enrollment in the Personal Choice program is by choice. Individuals who wish to participate and who meet all the eligibility requirements may contact a person-centered options counselor, Conflict-Free Case Management Agency, or visit the My Options RI website http://www.myoptions.ri.gov/.
B. Involuntary Disenrollment 1. The participant shall be involuntarily disenrolled from the Personal Choice Program if they lose either Medicaid financial eligibility or level of care eligibility.2. Involuntary disenrollment may also occur when:a. The participant or representative is unable to self-direct care and provide oversight of the PCA and spending plan.b. A representative proves incapable of acting in the best interest of the participant, can no longer assist the participant, and no replacement is available.c. The participant or representative fails to comply with legal/financial obligations as an employer of domestic workers and/or is unwilling to participate in advisement training or training to remedy non-compliance.d. The participant or representative fails to maintain a safe working environment for PCAs.e. The participant or representative is unable to manage the monthly budget as evidenced by: repeatedly submitting time sheets for unauthorized budgeted amount of care; underutilizing the monthly budget, which results in inadequate services; and/or continuing attempts to spend budget funds on non-allowable goods and services.f. The participant's health and well-being is not maintained through the actions and/or inactions of the participant or representative.g. EOHHS receives a substantiated critical incident report involving the participant that cannot otherwise be remediated.h. The participant or representative refuses to cooperate with minimum program oversight activities, even when staff has made efforts to accommodate the participant.i. The participant or representative fails to pay the amount determined in the post eligibility treatment of income, as described Subchapter 00 Part 8 of this Chapter, Post-Eligibility Treatment of Income, to the fiscal agency.j. There is evidence that Medicaid funds were used improperly or illegally according to local, State or Federal Regulations.k. No Conflict-Free Case Management Agency is able to provide proper service, such as the inability to meet repeated requests for services, satisfy participant needs, and/or provide the individual with a quality working relationship.l. The participant or representative fails to notify both the Conflict-Free Case Management Agency and the Fiscal Intermediary of any change of address and/or telephone number within ten (10) days of the change.3. When a Medicaid-eligible participant is involuntarily disenrolled from the Personal Choice Program, the participant is referred to EOHHS or BHDDH to explore other available options.4. EOHHS shall notify the participant in writing that they intend to remove the participant from the Personal Choice Program, the reason for disenrollment, and shall inform the participant that services may be provided through Medicaid long-term care via a home health agency.5. Disenrollment is determined by the Conflict-Free Case Management Agency, and confirmed by EOHHS, based on an assessment in conjunction with the policies and procedures of that Agency, and/or the receipt of information from the Fiscal Intermediary or EOHHS.C. Voluntary Disenrollment1. The participant or representative may request discharge from the Personal Choice Program with a thirty (30) day written notice to the Conflict-Free Case Management Agency and Fiscal Intermediary.2. A participant's representative must provide both the Conflict-Free Case Management Agency and Fiscal Intermediary with a thirty (30) day written notice stating they are no longer able to provide representative services.D. Disenrollment Appeal 1. The Conflict-Free Case Management Agency and the Fiscal Intermediary Agency shall inform the participant in writing of an involuntary disenrollment with the reason and provide the participant with a Medicaid appeal procedure and request forms.2. The participant has the right to appeal utilizing the standard appeals process as described in Part 10-05-2 of this Title, Appeals Process and Procedures for EOHHS Agencies and Programs.210 R.I. Code R. 210-RICR-50-10-2.6
Amended effective 10/28/2019
Amended effective 12/15/2020
Amended effective 3/8/2023
Amended effective 2/12/2024