MCO Contract Update RI EOHHS and Medicaid are in the process of establishing a new managed care contract. If you or a loved one currently have health coverage through RI Medicaid, it’s important to know that you don’t need to take any action at this time. When a new contract is in place, the State will send information about any next steps.
Resource Documents Program Year 7 Application for NEW Accountable Entities New AE Certification Application Instructions 2024.pdf PDF file, less than 1mbmegabytes Attachment A AE Application Checklist.pdf PDF file, less than 1mbmegabytes Attachment B AE Attestations Assurances.pdf PDF file, about 3mbmegabytes Attachment C Proposal Narrative Template.pdf PDF file, less than 1mbmegabytes Attachment D Application Template Tool 2024.pdf PDF file, less than 1mbmegabytes Program Year 7: Requirement Documents Attachment H - AE Certification Standards_PY7.pdf PDF file, less than 1mbmegabytes Attachment J - TCOC Requirements_PY7.pdf PDF file, less than 1mbmegabytes Attachment K - Incentive Program Requirements_PY7.pdf PDF file, less than 1mbmegabytes Attachment M - Attribution Guidance_PY7.pdf PDF file, less than 1mbmegabytes Total Cost of Care Technical Guidance_PY7.pdf PDF file, less than 1mbmegabytes Program Year 7: Accountable Entity Roadmap and Sustainability Plan Attachment L - Accountable Entity Roadmap_PY7.pdf PDF file, less than 1mbmegabytes Program Year 6 Application for NEW Accountable Entities New AE Certification Application Instructions 2023.pdf PDF file, less than 1mbmegabytes Attachment A AE Application Checklist.pdf PDF file, less than 1mbmegabytes Attachment B AE Attestations Assurances.pdf PDF file, less than 1mbmegabytes Attachment C Proposal Narrative Template.pdf PDF file, less than 1mbmegabytes Attachment D Application Template Tool 2023.pdf PDF file, less than 1mbmegabytes Program Year 6 Requirements Documents: Attachment H - AE Certification Standards PY6 Final Attachment J - TCOC Requirements PY6 Final Attachment K - Incentive Program Requirements PY6 Final Attachment M - Attribution Guidance PY6 Final TCOC Technical Guidance PY6 Final Updated TCOC Technical Guidance PY6 Final May 31, 2023 Attachment L_Accountable Entity Roadmap_PY6 Final Attachment L_Accountable Entity Roadmap_PY6 Final.pdf PDF file, about 20mbmegabytes PY5-PY7 Implementation Manuals PY5-PY7 Implementation Manual 2024 02-02 .pdf PDF file, less than 1mbmegabytes PY5-PY7 Implementation Manual 2023 12-13.pdf PDF file, less than 1mbmegabytes PY5-PY7 Quality Measure Specifications Manuals PY5-PY7 Quality Measure Specifications Manual 2024 02-02 .pdf PDF file, about 1mbmegabytes PY5-PY7 Quality Measure Specifications Manual 2023 09-29.pdf PDF file, less than 1mbmegabytes PY5-PY7 Quality Measure Specifications Manual 2023 8-10.pdf PDF file, less than 1mbmegabytes 2023 PY5-PY6 Quality Measure Specifications Manuals PY5-PY6 Quality Measure Specifications Manual 2023 5-31.pdf PDF file, less than 1mbmegabytes PY5-PY6 Quality Measure Specifications Manual 2023 3-1.pdf PDF file, about 2mbmegabytes PY4-PY6 Implementation Manual 2022 09 13 PY4-PY6 Implementation Manual 2022 09 13.pdf PDF file, less than 1mbmegabytes Program Year 5 Requirements Documents: Public Comment Closed 11/08/2021 Attachment M - PY5 Attribution Guidance_Final PDF file, less than 1mbmegabytes Attachment_H_AE_Certification_Standards_PY5_Final PDF file, less than 1mbmegabytes Attachment_K_Incentive_Program_Requirements_PY5_Final PDF file, less than 1mbmegabytes PY3-PY5 Implementation Manual 2022 4-20 PDF file, about 2mbmegabytes Attachment J - PY5 TCOC Requirements_Final PDF file, less than 1mbmegabytes Total Cost of Care Technical Guidance _PY5_FINAL PDF file, less than 1mbmegabytes Attachment-L_Accountable-Etity-Roadmap_PY5_final.pdf PDF file, less than 1mbmegabytes Program Year 5 Application for NEW Accountable Entities Attachment A-AE Application Checklist PDF file, less than 1mbmegabytes New AE Certification Application Instructions 2022 PDF file, less than 1mbmegabytes Attachment_B_AE_Attestations_Assurances PDF file, less than 1mbmegabytes Attachment C - Proposal Narrative Template PDF file, less than 1mbmegabytes Attachment D Application Template Tool 2022 PDF file, less than 1mbmegabytes Accountable Entities Program Year 4 Requirements Documents Attribution Guidance - 12/14/2020 – public comment closed November 13, 2020 PDF file, less than 1mbmegabytes Incentive Program Requirements 12/14/2020 – public comment closed November 13, 2020 PDF file, less than 1mbmegabytes AE Certification Standards12/14/2020 – public comment closed November 13, 2020 PDF file, less than 1mbmegabytes Quality and Outcome Implementation Manual 9/23/2021 PDF file, about 1mbmegabytes Total Cost of Care Requirements12/14/2020 – public comment closed November 13, 2020 PDF file, less than 1mbmegabytes Total Cost of Care Technical Guidance12/14/2020 – public comment closed November 13, 2020 PDF file, less than 1mbmegabytes Attachment L-Accountable Entities Roadmap- Final - November 16, 2020 PDF file, less than 1mbmegabytes HSTP PY4 Accountable Entity Application for NEW Accountable Entities Medicaid AE Program Application 12/21/2020 PDF file, less than 1mbmegabytes Attachment B - AE Attestations and Assurances 12/21/2020 PDF file, less than 1mbmegabytes Attachment E - AE Material Modification Protocol 12/21/2020 PDF file, less than 1mbmegabytes Additional Guidance Documents 12/21/2020 PDF file, less than 1mbmegabytes Accountable Entities Program Year 3 Requirement Documents COVID 19 HSTP Update 5/28/2020 PDF file, less than 1mbmegabytes Attribution Guidance revised 12/14/2020 -public comment closed November 13, 2020 PDF file, less than 1mbmegabytes PY3 Incentive Program Requirements Final 20200528.pdf PDF file, less than 1mbmegabytes Preparedness Planning Template 6/18/2020 PDF file, less than 1mbmegabytes PY3 Quality and Outcome Implementation Manual 20200528.pdf PDF file, less than 1mbmegabytes AE Certification Standards 12/13/2019 PDF file, less than 1mbmegabytes Total Cost of Care Technical Guidance 5/28/2020 PDF file, less than 1mbmegabytes Overview of Changes to Total Cost of Care Methodology 11/06/2019 PDF file, less than 1mbmegabytes TCOC, Quality, and Outcome Measures, and Associated Incentive Methodologies for Comprehensive Accountable Entities Implementation Manual Draft 12/13/2019 PDF file, less than 1mbmegabytes PY3 TCOC Requirements COVID Updates 20200528.pdf PDF file, less than 1mbmegabytes PY3 AE Roadmap Final 10.30.19.pdf PDF file, less than 1mbmegabytes See the Public Comments page for feedback on Program Year 3 documents. Evaluations Accountable Entity Pilot: Early Lessons and Recommendations, prepared by Center for Health Care Strategies, Inc., 2018 PDF file, about 1mbmegabytes Managed Care Organizations Resource Documents Transitioning to Alternative Payment Methodologies: Requirements for Medicaid Managed Care Partners January 2020 updated December 2021 PDF file, less than 1mbmegabytes Accountable Entities Program Resource Documents Medicaid Infrastructure Incentive Program (MIIP) Presentation 4/13/2017 PDF file, less than 1mbmegabytes Accountable Entities Program Resource Documents - Quality Comprehensive AE Quality Incentive Outcome Metrics 4/2/2018 18 file, less than 1mbmegabytes AE Measures Guidance and TCOC Metrics 7/20/2018 PDF file, less than 1mbmegabytes Accountable Entities Program Resource Documents - Social Determinants of Health (SDOH) HSTP Social Determinants of Health Investment Strategy Final 11/20/2020 PDF file, less than 1mbmegabytes AE Social Determinants of Health Measure 2/15/2018 PDF file, less than 1mbmegabytes AE Self-Reported Health Status Measure 2/15/2018 PDF file, less than 1mbmegabytes Accountable Entities Program Year 2 Requirement Documents Responses to Public Comments on Technical Corrections 6/14/2019 PDF file, less than 1mbmegabytes Attribution Requirements 12/11/2018 PDF file, less than 1mbmegabytes Total Cost of Care Requirements 12/11/2018, Amended 4/30/2019 PDF file, less than 1mbmegabytes Incentive Program Requirements 12/11/2018, Amended 6/1/2019 PDF file, less than 1mbmegabytes Medicaid AE Certification Guidelines for Program Year 2 Memo to Stakeholders 12/21/2018 PDF file, less than 1mbmegabytes Program Year Two Public Stakeholder AE Requirement Documents Memo to MCOs, AEs and Public Stakeholders 9/18/2018 PDF file, less than 1mbmegabytes See the Public Comments page for feedback on Program Year 2 documents. Accountable Entities Program Year 1 Requirement Documents Certification Standards 5/31/2017 PDF file, less than 1mbmegabytes Attribution Requirements 9/29/2017 PDF file, less than 1mbmegabytes Total Cost of Care Requirements 9/29/2017, Amended 2/22/2018 18-Amended file, about 1mbmegabytes Incentive Program Funding Requirements 9/29/2017, Amended 2/23/2018 PDF file, less than 1mbmegabytes AE Roadmap 4/13/2017 PDF file, about 1mbmegabytes CMS letter of approval for the AE Roadmap 11/17/2017 PDF file, about 2mbmegabytes AE Roadmap Comments Summary 4/13/2017 PDF file, less than 1mbmegabytes Application for Certification for Comprehensive AEs
Attribution Guidance - 12/14/2020 – public comment closed November 13, 2020 PDF file, less than 1mbmegabytes
Incentive Program Requirements 12/14/2020 – public comment closed November 13, 2020 PDF file, less than 1mbmegabytes
AE Certification Standards12/14/2020 – public comment closed November 13, 2020 PDF file, less than 1mbmegabytes
Total Cost of Care Requirements12/14/2020 – public comment closed November 13, 2020 PDF file, less than 1mbmegabytes
Total Cost of Care Technical Guidance12/14/2020 – public comment closed November 13, 2020 PDF file, less than 1mbmegabytes
Attachment L-Accountable Entities Roadmap- Final - November 16, 2020 PDF file, less than 1mbmegabytes
Attribution Guidance revised 12/14/2020 -public comment closed November 13, 2020 PDF file, less than 1mbmegabytes
TCOC, Quality, and Outcome Measures, and Associated Incentive Methodologies for Comprehensive Accountable Entities Implementation Manual Draft 12/13/2019 PDF file, less than 1mbmegabytes
Accountable Entity Pilot: Early Lessons and Recommendations, prepared by Center for Health Care Strategies, Inc., 2018 PDF file, about 1mbmegabytes
Transitioning to Alternative Payment Methodologies: Requirements for Medicaid Managed Care Partners January 2020 updated December 2021 PDF file, less than 1mbmegabytes
Medicaid Infrastructure Incentive Program (MIIP) Presentation 4/13/2017 PDF file, less than 1mbmegabytes
HSTP Social Determinants of Health Investment Strategy Final 11/20/2020 PDF file, less than 1mbmegabytes
Medicaid AE Certification Guidelines for Program Year 2 Memo to Stakeholders 12/21/2018 PDF file, less than 1mbmegabytes
Program Year Two Public Stakeholder AE Requirement Documents Memo to MCOs, AEs and Public Stakeholders 9/18/2018 PDF file, less than 1mbmegabytes