MCO Contract Update RI EOHHS and Medicaid are in the process of establishing a new managed care contract. If you or a loved one currently have health coverage through RI Medicaid, it’s important to know that you don’t need to take any action at this time. When a new contract is in place, the State will send information about any next steps.
Nursing Homes Provider Representative: Marlene LamoureuxTel. (571) 895-4938Email: Marlene.Lamoureux@gainwelltechnologies.com Medicaid Finance QuestionsEmail: 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 OverviewCSM 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