Nursing Homes
Provider Representative: Marlene Lamoureux
Tel. (571) 895-4938
Email: Marlene.Lamoureux@gainwelltechnologies.com
Medicaid Finance Questions
Email: OHHS.MedicaidFinance@ohhs.ri.gov
Training
All documents are in pdf format
Reference Guide
CSM Forms Overview
CSM 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
Program Information
COVID At-Home Test Reimbursement for Duals
Rates
Rates Effective 10/1/2024
Historical Rates
- Rates Effective 10/1/2023
- 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
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
Requests for Fair Rental Value Review
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
Minimum Staffing Compliance Information
FFY 2024 Minimum Staffing Information
The Submission of the 10/1/2023 to 9/30/2024 minimum wage pass-through certification form is due 7/31/2025. All attestations must be submitted using the Certification Portal.
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.
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 2024 Nursing Facility Medicaid Cost Report Documentation
CY 2023 Nursing Facility Medicaid Cost Report Documentation
BM-64 Cost Report 2022 & Related Documentation: