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.
Medicaid Managed Care Contracts & Policy/Guidance Documents Tufts Health Public Plan- RI Together Contract THPP 2017-13 Amendment 13 (Full Contract) THPP 2017-01 Amendment 1 (11/08/2018) Base Contract, Addendums, Attachments THPP 2017-02 Amendment 2 (01/08/2019) Base Contract, Addendums, Attachments THPP 2017-03 Amendment 3 (09/23/2019) Base Contract, Addendums, Attachments THPP 2017-04 Amendment 4 (04/08/2021) THPP 2017-05 Amendment 5 (10/20/2021) THPP 2017-06 Amendment 6 (03/20/2022) THPP 2017-07 Amendment 7 (07/13/2022) THPP 2017-08 Amendment 8 (07/26/2022) THPP 2017-09 Amendment 9 (09/28/2022) THPP 2017-09B Amendment 9B (10/24/2023) THPP 2017-10 Amendment 10 (06/15/2023) THPP 2017-11 Amendment 11 (08/15/2023) THPP 2017-12 Amendment 12 (10/24/2023) THPP-2017-13 Amendment 13 (10/24/2023) United Healthcare Community Plan of Rhode Island Contract UHC 2017-13 Amendment 13 (Full Contract) UHC 2017-01 Amendment 1 Base Contract, Addendums, Attachments UHC 2017-02 Amendment 2 (02/15/2019) Base Contract, Addendums, Attachments UHC 2017-03 Amendment 3 (10/10/2019) Base Contract, Addendums, Attachments UHC 2017-04 Amendment 4 (04/08/2021) UHC 2017-05 Amendment 5 (10/06/2021) UHC 2017-06 Amendment 6 (03/29/2022) UHC 2017-07 Amendment 7 (08/10/2022) UHC 2017-08 Amendment 8 (08/10/2022) UHC 2017-09 Amendment 9 (09/28/2022) UHC 2017-09B Amendment 9B (10/24/2023) UHC 2017-10 Amendment 10 (06/15/2023) UHC 2017-11 Amendment 11 (08/09/2023) UHC 2017-12 Amendment 12 (10/24/2023) UHC 2017-13 Amendment 13 (10/24/2023) Neighborhood Health Plan of Rhode Island- Medicaid Managed Care Plan Contract NHPRI 2017-13 Amendment 13 (Full Contract) NHPRI 2017-01 Amendment 1 (10/03/2018) Base Contract, Addendums, Attachments NHPRI 2017-02 Amendment 2 (02/15/2019) Base Contract, Addendums, Attachments NHPRI 2017-03 Amendment 3 (09/23/2019) Base Contract, Addendums, Attachments NHPRI 2017-04 Amendment 4 (04/20/2021) NHPRI 2017-05 Amendment 5 (10/20/2021) NHPRI 2017-06 Amendment 6 (03/30/2022) NHPRI 2017-07 Amendment 7 (08/10/2022) NHPRI 2017-08 Amendment 8 (08/10/2022) NHPRI 2017-09 Amendment 9 (10/03/2022) NHPRI 2017-09B Amendment 9B (10/24/2023) NHPRI 2017-10 Amendment 10 (06/13/2023) NHPRI 2017-11 Amendment 11 (08/09/2023) NHPRI 2017-12 Amendment 12 (10/24/2023) NHPRI 2017-13 Amendment 13 (11/14/2023) United Healthcare-RIte Smiles Contract UHC RIte Smiles Amendment 5 (Full Contract) UHC-RIte Smiles Amendment 1 (10/15/2020) UHC-RIte Smiles Amendment 2 (10/06/2021) UHC-RIte Smiles Amendment 3 (08/10/2022) UHC-RIte Smiles Amendment 4 (06/14/2023) UHC-RIte Smiles Amendment 5 (07/18/2023) RIte Smiles Liquidated Damages Memo (06/2021) Neighborhood Health Plan of Rhode Island Medicare/Medicaid Contract Three Way Contract (07/01/2022) Amendment (07/01/2023) Medical Transportation Management Contract MTM 2023-01 Amendment 1 (Full Contract) MTM 2023-01 Amendment 1 (10/10/2023) MTM CAP - Timely Notification of Critical Incidents (12/04/2023) Medicaid Managed Care Policy and Guidance Documents Addendum A - Telemedicine Mandatory Minimum Codes V4 (02/01/2024) Katie Beckett Care Management FAQs (10/05/2023) Provider Screening Project FAQs (10/04/2023) MAPCO 2023 Information (06/23/2023) Continued Coverage of COVID-19 Testing Services & Treatments (05/11/2023) Terminated Member Outreach Policy (05/02/2023) 21st Century Cures Act-Provider Screening and Enrollment Compliance Deadline for Medicaid Managed Care Organizations (MCOs) (02/27/2023) Claim Paid Date Reporting on Financial Data Reporting (11/21/2022) Coverage of Over-the-Counter COVID-19 Tests (OTC COVID-19 Tests) – Pharmacy Benefit (01/25/2022) Prior Authorization Suspension-Medicaid (02/04/2022) Prior Authorization Suspension-Medicaid (01/13/2022) Prior Authorization Suspension-Medicaid (01/06/2022) COVID-19 Pediatric Codes (12/13/2021) EOHHS MCO Core Contract Requirements for Reporting and Intermediate Sanctions 2020 Policy (10/2022) EOHHS MCO Core Contract Requirements for Value Add Services (09/2021) Value-Added Services (VAS) Request Form (09/2021) RI EOHHS Guidelines for Marketing and Member Communications for Medicaid Managed Care Program (09/2021) EOHHS MCO Core Contract Requirements for Requesting In Lieu of Services (08/2021) RI Medicaid Managed Care In Lieu of Services Request Form (08/2021) Notify Medicaid Members of Impending Prior Authorization Lift (08/06/2021) RI Medicaid Managed Care COVID-19 Model Language for the Reinstatement of PA for Members (08/2021) Prior Authorization Requirements to be Reinstated for COVID-19 (06/2021) RI Managed Medicaid Model Member Handbook Appeal and Grievance Rights Template EOHHS MCO Core Contract Requirements for Reporting Demographic Changes 2020 Policy RIte Smiles Reference Materials RIte Smiles Reference Materials RI Medicaid Managed Care Quality Strategy RI Medicaid Managed Care Quality Strategy (08-2022) Accountable Entities Implementation Manual PY5-PY6 Implementation Manual (03/01/2023) Dual Special Needs (D-SNP) State Medicaid Agency Contracts 2024 State Medicaid Agency D-SNP Agreements Blue Cross Blue Shield of Rhode Island 2024 State Medicaid Agency D-SNP Agreement RI – Blue Cross Blue Shield of Rhode Island (H4152-021) Commonwealth Care Alliance 2024 State Medicaid Agency D-SNP Agreement RI – Commonwealth Care Alliance (H0876-001) WellCare Health Plans of Rhode Island, Inc 2024 State Medicaid Agency D-SNP Agreement RI – WellCare (H4699-003, H4699-005) United Healthcare (Oxford Health Plans, Inc) 2024 State Medicaid Agency D-SNP Agreement RI – Oxford Health Plans (H3113-010) United Healthcare (United Healthcare of New England, Inc.) 2024 State Medicaid Agency D-SNP Agreement RI – United Healthcare of New England (H0764-001) 2024 State Medicaid Agency D-SNP Agreement RI – United Healthcare of New England (H2272-001)