Attention RI Medicaid Members: Update on Prescription Access Due to a cybersecurity issue, a contractor serving pharmacies and Medicaid programs across the US is unable to provide important online services at this time. In Rhode Island, this situation impacted pharmacies’ ability to fill prescriptions for members of the AIDS Drug Assistance Program (ADAP) and the Medicaid Program. In response, RI EOHHS has quickly brought online a new way for pharmacies to process claims. Rhode Island Medicaid has also told pharmacies that they can provide a 30-day supply of any prescriptions you are trying to fill, to help you get through this time. The pharmacy should not charge you for any prescription that is covered by Medicaid. Learn more.
Nursing Homes Provider Representative: Marlene Lamoureux Tel. (571) 895-4938 Email: Marlene.Lamoureux@gainwelltechnologies.com Medicaid Finance Questions Email: OHHS.MedicaidFinance@ohhs.ri.gov Training Nursing Home Billing Helpful Hints (February 2024) Nursing Home Stay 30 Days or Less (January 2024) All documents are in pdf format Reference Guide CSM Forms Overview CSM User ID Request Form For Password Resets please contact: Telephone: 1-844-718-0775 Email: rixix-ticket-system@gainwelltechnologies.com Medicaid State Plan – Nursing Facility Principals of Reimbursement Medicaid State Plan (See Attach. 4.19-D Pg. 2 to Attach. 4.19-D Supp. 1) Program Information COVID At-Home Test Reimbursement for Duals Reimbursement Process Overview Reimbursement Template Bed Hold Policy Rates Rates Effective 10/1/2023 All Facilities – PDF All Facilities – Excel Rates Effective 7/1/2023 Rates Effective 10/1/2022 Rates Effective 10/1/2021 – Updated for Minimum Staffing Law Rates Effective 10/1/2021 Resource Utilization Grouper (RUG) Frequently Asked Questions RUG IV Weights Effective from 10/1/2021 RUG IV Weights Effective 6/1/2013 - 9/30/2021 Requests for Changes in Licensed Medicaid Beds Memo with Instructions Application Requests for Fair Rental Value Review Guidance Invoice Tracker Uniform Accountability Procedures for Residents' Personal Needs Funds Rules and Regulations on the Rhode Island Secretary of State website Personal Needs Fund Regulations - Effective November 27, 2017 Personal Needs Fund (Authorization Document & Related Forms: Exhibit B, Exhibit C) Long Term Care Interim Payment Process - Posted May 16, 2017 Interim Payment Letter RI Communication Tool May 2017 NH Turnaround Document Long Term Care Business Process - Click here to view letter to providers Nursing Facility Specialized Psychiatric Units Program Program Certification Standards Program Application Minimum Staffing Compliance Information FFY 2023 Minimum Staffing Information The submission of the 10/1/2022 to 9/30/2023 minimum wage pass-through certification form is due 12/31/2023. All attestations must be submitted using the Certification Portal. FFY 2023 Policy and Procedures FFY 2023 Certification Portal Civil Monetary Penalties Information Civil Monetary Penalties (CMPs) are fines imposed against nursing facilities that do not meet federal health and safety requirements. CMPs are collected by the federal Centers for Medicare & Medicaid Services (CMS). A portion of the penalty funds collected by CMS are released to the State of Rhode Island to reinvest in projects that improve quality of care and/or quality of life for nursing home residents. For more information on CMPs and the facility application process to receive reinvestment funds, please visit the EOHHS CMP webpage. BM-64 Cost Report Information CY 2023 Nursing Facility Medicaid Cost Report Documentation Letter to Administrators Nursing Facility Medicaid Cost Report Administrator’s Scale BM-64 Cost Report 2022 & Related Documentation: Letter to Administrators BM-64 Cost Report Document Submission Checklist Residents’ Personal Needs Funds Administrator’s Scale Updates RI Nursing Facility Payment Methodology Status Update Statement of Policy Intent (November 16, 2020) Nursing Facility Change in Licensed Beds Capacity Request