Medicaid Managed Care Manual
Intro Text
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
2.6 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
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
Financial documentation will be provided upon readiness.
To be Developed
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)
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 (6/2024)
11.3 Attestation Statement for Health Plan Reporting Submission (11/2024)
11.4 Medicaid Managed Care Report Date Change Request Form (10/2018)
11.5 DRAFT - CY24_MCO_Core_Contract_Reporting_Calendar (11/2023)
EOHHS Medicaid Managed Care Reporting Templates
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
11.14 AE Base Contract Checklist
11.19 Claims Timely Filing Processing
11.25 Member Fraud Out of State
11.26 MCFU Case Presentation Report
11.30 COVID Vaccine Non-Risk Base Payment
11.32 Provider Termination and Network Change
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
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)