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 (October 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:
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)

Reports

Rhode Island Medicaid Nursing Facility Rate Development October 1, 2024 through Sepatember 2025

• Final Report
• Final Report Appendices
• Report Questions and Answers
  • Attachment-Facility Per Diem Costs

Program Information

COVID At-Home Test Reimbursement for Duals

• Reimbursement Process Overview
• Reimbursement Template 

Bed Hold Policy

Rates

Rates Effective 10/1/2024

• All Facilities – PDF
• All Facilities – Excel

Historical Rates

• Rates Effective 10/1/2023
  • All Facilities – PDF
  • All Facilities – Excel
• Rates Effective 10/1/2022
• Rates Effective 10/1/2021 – Updated for Minimum Staffing Law
• Rates Effective 10/1/2021

Resource Utilization Grouper (RUG) to Patient Driven Payment Model (PDPM) Transition Information

• OBRA Assessment with PDPM HIPPS Code Required Between 9/1/2024 and 11/1/2024
• RUG to PDPM Data Collection Effective 9/1/2024
  
  • Guidance Letter
    
    • MDS Item Matrix FFY 2024 
    • MDS Item Matrix FFY 2025 
    • MatrixCare Instructions

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

• Application Instructions
• Application

Requests for Fair Rental Value Review

• FRV Pause Effective 4/5/2024 through 9/30/2025
• 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)
• Personal Needs Allowance Audit Findings
• Clarification on Personal Needs Allowance (PNA) Authorization Form

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