Rhode Island Code of Regulations
Title 210 - Executive Office of Health and Human Services
Chapter 40 - Medicaid for Elders and Adults with Disabilities
Subchapter 10 - Managed Care
Part 1 - Managed Care Service Delivery Arrangements
Section 210-RICR-40-10-1.6 - Rhody Health Options (RHO)
Current through June 23, 2025
A. In accordance with § 7 of Pub. Laws 18-047 enacted on June 22, 2018, Medicaid beneficiaries enrolled in RHO on and before October 1, 2018 will be placed in fee-for-service arrangements effective that date for all Medicaid covered long-term services and supports. The RHO program termination date is September 30, 2018.
B. Medicaid beneficiaries who were enrolled in RHO on and before October 1, 2018 will continue to receive all medically necessary services as contained in § 1.4(A) (4) of this Part. The standard of "medical necessity" is used as the basis for determining whether access to a Medicaid covered service is required and appropriate. Prior to the termination date of RHO for existing beneficiaries and after for all new beneficiaries, any member who is dually eligible for Medicaid and Medicare may be enrolled in a MMP while retaining the choice to opt out and receive LTSS on a fee-for service basis. For Medicaid beneficiaries who do not have Medicare, the transition is as follows:
The class of Medicaid beneficiaries who were enrolled in RHO on and before October 1, 2018 do not have the right to appeal the termination of their RHO coverage in accordance with 42 C.F.R. § 431.220(b) and §10 -05-2.2 .1(A)(7)(a) of this Title. The right to appeal agency actions unrelated to this change in law and policy that affect eligibility, or the scope, amount, and or duration of Medicaid benefits is preserved.
