Medicaid Managed Care Manual Intro Text Chapter 1 - Introduction 1.0 Introduction 2023 Chapter 2 - Medicaid Services 2.1 340B Policies and Procedures 2.2 Childhood Lead Poisoning Prevention Program Referral Intervention Process 2.3 EPSDT Periodicity Schedule 2.4 Pharmacy Benefit Plan Protocols 2.5 RI Nutrition Standards 2.6 Schedule of In Plan Oral Health Benefits 2.7 Extended Family Planning Services 2.8 Treatment of Hepatitis C Prior Authorization Guidelines 2.9 Mental Health, Substance Use and Developmental Disability Services for Children 2.10 Behavioral Health and Substance Use Services for Adults CHAPTER 3 - Marketing Policies and Procedures 3.1 RI EOHHS Guidelines for Marketing and Member Communications for Medicaid Managed Care Program 3.2 Attachment A - Non-Discrimination Notice 3.3 Attachment B - Marketing & Member Communications Request for Approval 3.4 Attachment C - Notice of RI EOHHS Approval, Conditional Approval, or Rejection of Marketing & Member Communications Request for Approval CHAPTER 4 - Claims MMIS 4.1 Rhode Island Medicaid Managed Care Encounter Data Quality Measurement (08/2021) 4.2 EOHHS 837 Companion Guide 1 of 2 4.3 EOHHS 837 Companion Guide 2 of 2 4.4 OTP HH Medicaid Billing Manual (02/2017) 4.5 IHH and ACT Program Billing Manual for RI (DRAFT) CHAPTER 5 - Financial Financial documentation will be provided upon readiness. 5.1 Managed Care Health Plan Financial Reporting Program 5.2 APM Requirements for Managed Care Manual CHAPTER 6 - Critical Elements 6.1 Providers RI Model Member Handbook Model FINAL 6.2 VendorAddressChange_REPORTDATARANGE_HEALTHPLAN_V1.2 CHAPTER 7 - Program Integrity To be Developed CHAPTER 8 - Care Program and Accountable Entities 8.1 Accountable Entity Program Requirements Manual Section 8.2 Attribution Guidance (12/14/2020) 8.3 Incentive Program Requirements (12/14/2020) 8.4 AE Certification Standards (12/14/2020) 8.5 Quality and Outcome Implementation Manual (5/21/2021) 8.6 Total Cost of Care Requirements (12/14/2020) 8.7 Total Cost of Care Technical Guidance (12/14/20200 8.8 Attachment L-Accountable Entities Roadmap- Final (11/16/2020) CHAPTER 9 - Quality Programs 9.1 Quality Assessment and Performance Improvement 9.2 RI Medicaid Managed Care Quality Strategy (08-2022) 9.3 Rhode Island Medicaid Managed Care Encounter Data Quality Measurement CHAPTER 10 - Grievances and Appeals 10.1 Providers Appeal Grievance Rights Template (09/2021) CHAPTER 11 - Reporting Calendar and Templates EOHHS Medicaid Managed Care Reporting Templates 11.1 Reports of Legal and Other Proceedings 11.2 EOHHS Core Contract Requirements for Reporting and Intermediate Sanctions 2020 Policy (10/2022) 11.3 Attestation Statement for Health Plan Reporting Submission (10/2021) 11.4 Medicaid Managed Care Report Date Change Request Form (10/2018) 11.5 DRAFT - CY22 MCO Core Contract Reporting Calendar (10/2021) EOHHS Medicaid Managed Care Reporting Templates 11.6 AE Quality Measure QPY4 11.7 Clinical Data Exchange Implementation Status 11.8 MCO AE Milestone Performance Report (PY3) 11.9 MCO AE Milestone Performance Report (PY4) 11.10 AEIP Quarterly Outcome Metrics OPY4 11.11 AEIP Annual Outcome Metrics 11.12 TCOC Performance Report 11.13 Final TCOC Performance 11.14 AE Base Contract Checklist 11.15 Final ROI Project 11.16 APM Report 11.17 Access Report 11.18 Care Management 11.19 Claims Timely Filing Processing 11.20 QIP 11.21 Appeals 11.22 MCO Call Center Metrics 11.23 Grievance Complaints 11.24 MCO Program Integrity 11.25 Member Fraud Out of State 11.26 MCFU Case Presentation Report 11.27 837 Processing 11.28 Newborn File 11.29 Vendor Address Change 11.30 COVID Vaccine Non-Risk Base Payment 11.31 Immunization Tracker 11.32 Provider Termination and Network Change 11.33 Member Transition Plan AE Attribution Technical Requirements 11.34 AE Attribution Technical Requirement V2.0 11.35 AE Attribution Technical Appendix NHPRI V2.0 11.36 AE Attribution Technical Appendix UHC V2.0 AE Provider Roster Technical Requirements 11.37 AE Provider Roster Specifications Technical Requirements 2.0 11.38 AE Provider Roster Technical Appendix UHC V2.0 11.39 AE Provider Roster Technical Appendix NHP V2.0 CHAPTER 12 - Certification and Forms CHAPTER 13 - Other Medicaid Managed Care Policies and Guidelines 13.1 EOHHS MCO Core Contract Requirements for Reporting Demographic Changes 2020 Policy V1 13.2 EOHHS Provider Termination and Network Changes 2020 Policy V1.2 13.3 Immunization Tracker Guidelines for Health Plans Medicaid Health Plan Change Request Form 13.4a Medicaid Health Plan Change Request Form - English (04/2021) 13.4b Medicaid Health Plan Change Request Form - Portuguese (04/2021) 13.4c Medicaid Health Plan Change Request Form - Spanish (04/2021)