Rhode Island Code of Regulations
Title 210 - Executive Office of Health and Human Services
Chapter 30 - Medicaid for Children, Families, and Affordable Care Act (ACA) Adults
Subchapter 05 - Service Delivery Options
Part 2 - Medicaid Managed Care Delivery Options
Section 210-RICR-30-05-2.26 - Out-of-Plan Benefits
Current through March 25, 2025
A. Out-of-plan benefits are not included in the managed care contracts and are not the responsibility of the MCO to provide. These services are provided by existing Medicaid-approved providers who are reimbursed directly by EOHHS on a fee-for-service basis. Out-of-plan benefits are provided to all RHP enrollees with the following exceptions: anyone enrolled in the guaranteed enrollment period but otherwise ineligible for Medicaid. The covered benefits are as follows:
|
ELIGIBLE GROUP |
BENEFIT(S) PROVIDED OUT-OF-PLAN |
|
All Rhody Health Partners and Expansion members |
Dental services Court-ordered mental health and substance use services ordered to a non-network facility or provider Non-Emergency Transportation Services (Non-Emergency transportation is coordinated by the contracted Health Plans) Nursing home services in excess of thirty (30) consecutive days Residential services for MR/DD clients that are paid by the State's BHDDH Respite (Adult) Neonatal intensive care Unit (NICU) Services at Women's and Infants Hospital. Except as specified in § 2.9(C) of this Part Special Education services as defined in the child's Individual Education Plan (IEP) for children with special health needs or developmental delays Lead Program home assessment and non-medical case management provided by Department of Health or Lead Centers for lead poisoned children Cedar Family Center Services (RIte Care) Centers of Excellence Programs |
