Attention RI Medicaid Members: Update on Prescription Access Due to a cybersecurity issue, a contractor serving pharmacies and Medicaid programs across the US is unable to provide important online services at this time. In Rhode Island, this situation impacted pharmacies’ ability to fill prescriptions for members of the AIDS Drug Assistance Program (ADAP) and the Medicaid Program. In response, RI EOHHS has quickly brought online a new way for pharmacies to process claims. Rhode Island Medicaid has also told pharmacies that they can provide a 30-day supply of any prescriptions you are trying to fill, to help you get through this time. The pharmacy should not charge you for any prescription that is covered by Medicaid. Learn more.
RI Medicaid - Health Plan Accreditation Rhode Island Medicaid has required its Medicaid participating health plans to be accredited by the National Committee for Quality Assurance (NCQA) since the inception of our State’s managed care program in 1994. What is NQCA? The National Committee for Quality Assurance (NCQA) is an organization dedicated to improving health care quality. NCQA issues an accreditation status based on the health plan’s performance against the rigorous standards and audited HEDIS® and CAHPS® quality measure results. The standards evaluate the health plan’s quality management and improvement, network management, utilization management, credentialing and re-credentialing, member’s rights and responsibilities, member connections, and Medicaid benefits and services. Accreditation is issued at varying levels based on evaluation of the standards. How are Rhode Island's health plans rated? Rhode Island Medicaid’s health plans have consistently been highly rated by NCQA. EOHHS has contracts with three (3) Managed Care Organizations (MCOs) and one (1) Prepaid Ambulatory Health Plan (PAHP) For more information on RI health plans,’ see the 2022 NCQA Report Card results below or links to further information: Neighborhood Health Plan of Rhode Island Tufts Health Plan UnitedHealthcare Community Plan What is URAC? The Utilization Review Accreditation Commission (URAC) is an independent, nonprofit accreditation entity dedicated to improve the quality of health care. URAC helps facilitate this by providing health care organizations with renowned accreditation and certification programs that set the highest standards in quality and safety. Our standards use evidence-based measures and are developed in collaboration with a wide array of stakeholders, including health plans, providers and associations. United Healthcare Dental/RIte Smiles