Home Health & Personal Care Assistant

Provider Representative: Marlene Lamoureux   Tel. (571) 895-4938
                                                email marlene.lamoureux@gainwelltechnologies.com 

Medicaid Finance Questions

Email: OHHS.MedicaidFinance@ohhs.ri.gov 

Reference Guide

Home and Community Based Services Reference Guide

Home Health Reference Guide

Useful Information

Provider Specific Rates

Historical Rate Information

HCBS Modifier and Enhancement Program 

Shift Differential Wage Pass Through

Other Helpful Links

Home Care Provider

For claims that are submitted by a home care agency, a member must have RI Medicaid eligibility, a prior authorization and an active enrollment for the dates of service into one of the below waiver/programs. 

· LTSS-HCBS Services

· OHA Community Services

· BHDDH Community Support

· Medicaid Preventive Services

· Habilitation Community Services

· OHA At Home Cost Share

To verify program enrollment and eligibility sign into the Health Care Portal. Verify that a member has RI Medicaid and program eligibility under the “Eligibility” tab.  For OHA copay clients, you will see OHA At Home Cost Share and they will not have Medicaid Eligibility. 

For claims to process and pay, there also needs to be a prior authorization on file for the correct number of units and dates of service that you will be submitting your claims for. 

The Prior Authorizations are viewable under “Interactive Web Services” on the right of the home page of the portal.  Please select “Check Prior Authorization”. 

If either their eligibility or a prior authorization is missing on the portal than please call or email the case worker.  Below is the contact information for DHS programs:

DHS Help Line 401-574-8474 or dhs.ltss@dhs.ri.gov

For DEA Waiver (OHA) or OHA At Home Cost Share clients please contact the regional case manager at Tri-County Community Action, West Bay CAP, East Bay Cap, or Child and Family Services.

If you can see eligibility and a prior authorization on the Health Care portal but you do not see it in the EVV system, then please contact Sandata directly. 

SAM Providers:
Questions or issues with the SAM EVV system, please contact Sandata’s Customer Care via email at                          RIcustomercare@sandata.com  or 1-855-781-2079.

Alternate EVV/Third-Party
Questions or issues with the Alt. EVV/Third Party system, please contact Sandata’s Customer Care via email                  at rialtevv@sandata.com .

You should always ask for your ticket number when you contact Sandata Customer Care for an issue.  If a Customer Care ticket has not been acknowledged after two (2) business days (a response from Sandata acknowledging the ticket issue), you may escalate with the ticket number to Meg Carpinelli via email at Margaret.Carpinelli@ohhs.ri.gov

Important:  Please note you should not email Meg directly with an issue.  You must open a ticket with Sandata first.  If the ticket is not acknowledged after 2 business days, you can then escalate.

If you have any billing issues after verifying that a member has eligibility and a prior authorization in place please reach out to Marlene.Lamoureux@gainwelltechnologies.com or (571) 895-4938. 

HCBS Workforce Recruitment and Retention – One-Time Supplemental Payment for Home Health Agencies

Background and Purpose of Funds

The State Fiscal Year (SFY) 2023 Enacted Budget provided the Executive Office of Health and Human Services (EOHHS) with one-time state funds to support long-term care rebalancing by promoting and strengthening community-based alternatives. EOHHS is awarding a portion of these funds to support Home Health Agencies serving Medicaid patients, to help alleviate the current wait time for home care services and improve timely access to these services. The purpose of this one-time supplemental payment is to support the Home Health Agencies with staff recruitment, development, and retention efforts, as described below.

The disbursement of this one-time supplemental payment is contingent upon the agency’s ongoing compliance with the terms below, including submission of Workforce and Expenditure Reports.  

Program Participation Requirements

One-time supplemental payment received through this Program must be used in a manner consistent with the Permissible Use of Funds outlined below. At the end of the program period March 31, 2024, any unexpended funds must be returned to the State. Participating Agencies are required to maintain detailed and complete financial and payroll records demonstrating that funds received through this Program are spent in accordance with Program guidance and cooperate fully with the State and any third parties in audits of such records. The State recommends that participating Agencies maintain these funds in a separate account. In the event of an audit, if a participating Agency is found to have used funds for ineligible expenses, the Provider will be required to repay such funds to the State. 

Participating Agencies shall submit the following documents to the State as required components of Program participation, following the schedule outlined below.

Signed Attestation Form: Due February 17, 2023. The attestation affirms the Agency’s understanding of, and commitment to, the requirements associated with the one-time supplemental payment. 

Quarterly Workforce and Expenditure Report: Webform submissions due six weeks following the end of each calendar quarter (reporting calendar found in guidance document). These quarterly reports address the impact of the one-time supplemental payment on workforce recruitment, retention, and capacity, and serve as documentation of the distribution of funds consistent with the requirements in this Program Guidance.

  • Workforce Report:  
    • Agencies can use their current eFMAP workforce data as the workforce portion of the reports for these funds (no need to duplicate data; enter 0s in workforce portion of report). Once the Agency’s eFMAP reporting ends, the Agency will need to submit the workforce reports in association with this funding source.
    • Any Agency not already submitting reports under eFMAP will need to submit workforce reports for all four quarters.
  • Expenditure Report:  
    • Agencies must submit this report for each quarter through to reflect the expenditures associated with this funding source.
    • Additional expenditure reporting guidance can be found here.

Permissible uses of funds

One-Time Supplemental Payment for HHA-Guidance Document

Eligible employees
The one-time supplemental payment for Home Health Agencies must be used for the specific purpose of recruitment, development, and/or retention of employees who spend (or in the case of recruitment, are expected to spend) at least fifty percent (50%) of their hours on home health activities for Medicaid beneficiaries.

Eligible expenditures

Provider agencies must spend at least 85% of the one-time supplemental payment on staff recruitment, development, and retention efforts. Due to the temporary nature of the funds and federal requirements, this supplemental payment may not be used to increase base hourly wage rates.

  • Staff development includes the cost of training for staff to develop new skills and/or obtain new certifications/other qualifications (e.g., Behavioral Health Certification. More information available online). It may also include payments to staff for the time they spend participating in the trainings and/or for successfully completing the training.
  • Staff recruitment includes time/money spent on activities to find new staff (for example, staff time to attend job fairs) and to offer sign-on bonuses.
  • Staff retention includes retention bonuses if needed to complement sign-on bonuses offered to new staff, recognizing that inequity between current and new staff would likely hinder efforts to maintain staffing levels.

Any recruitment/retention bonuses and the cost of any training/payments for time spent in training must be over and above compensation that was paid to eligible workers prior to the one-time supplemental payment (as of March 1, 2023) and shall not be used to replace base wages or other regular compensation (e.g., standard overtime or health care benefits in line with current Agency policies). Each Agency should maintain documentation to show the compensation paid to its eligible workers prior to the supplemental payment, for compliance purposes. 

No more than 15% of the one-time supplemental payment may be spent on increased payroll costs (i.e., payroll taxes and insurance) that are directly related to the additional compensation for eligible employees.

Calculation of funding per agency

Each Home Health Agency with any paid claims in SFY 2022 or 2023 that completes the Attestation and Initial Workforce Report is eligible to receive a minimum payment of $5,000.

The funding will be distributed using the following methodology:

EOHHS reviewed SFY 2022 Home Health Agency Medicaid and Department of Human Services (DHS) CNOM (Costs Not Otherwise Matchable) fee-for-service and managed care claims for the S5125, S5125 U1, and S5130 procedure codes and associated modifiers. Each agency’s share of the available funding is based on the agency’s share of paid claims for SFY 2022 as shown in the Medicaid Management Information System (MMIS) on 1/31/2023. However, if an agency’s share of claims results in a payment of less than $5,000, or if an agency has no eligible claims in SFY22 but does have paid claims for SFY23 as shown on MMIS on 1/31/23, the agency will receive the minimum payment of $5,000.