Rhode Island Code of Regulations Title 210 - Executive Office of Health and Human Services
Rhode Island Code of Regulations, Title 210, is the comprehensive set of regulations for the Executive Office of Health and Human Services (EOHHS) in Rhode Island. EOHHS is a cabinet-level agency established in 2006 to serve as the principal agency for managing and coordinating the state's various health and human services departments. Its mission is to ensure access to high-quality and cost-effective services that foster the health, safety, and independence of all Rhode Islanders.
Title 210 translates this mission into detailed rules and procedures that govern a vast array of services, primarily focusing on the administration of Medicaid and other state and federally funded health and human services programs.
Here's a breakdown of the key areas typically covered in Title 210:
1. EOHHS General Provisions (Chapter 10):
* Statutory Authority: This section details the legal basis for EOHHS's existence and authority, stemming from Rhode Island General Laws and federal statutes like Title XIX (Medicaid) and Title XXI (Children's Health Insurance Program - CHIP) of the Social Security Act. It designates EOHHS as the "single state agency" responsible for administering these programs.
* General Administrative Procedures: Rules for how EOHHS operates, including public records requests, appeals processes, and conduct of public hearings.
* Consumer Rights, Responsibilities, and Protections: Outlines the rights of individuals receiving services, their responsibilities, and protections related to confidentiality and fair treatment.
* Overview of Medicaid and CHIP Programs: Provides a general understanding of how these critical programs function in Rhode Island.
2. Medicaid Payments and Providers (Chapter 20):
* Provider Requirements and Certification: Sets forth the standards that healthcare providers must meet to be certified and participate in the Rhode Island Medicaid program. This includes compliance with federal and state laws, licensure, and often specific requirements to prevent fraud, waste, and abuse.
* Payment Methodologies: Details how EOHHS makes payments to certified providers for authorized services. These methodologies must align with federal requirements to qualify for federal matching funds.
* High-Risk Providers: Defines criteria for identifying providers that pose a high risk of fraud, waste, or abuse, and outlines additional scrutiny or conditions for their participation.
3. Medicaid for Children, Families, and Affordable Care Act (ACA) Adults (Chapter 30):
* This chapter focuses on Medicaid eligibility, coverage groups, and service delivery for specific populations.
* Affordable Coverage Groups: Defines the eligibility criteria for groups covered under the ACA expansion.
* Service Delivery Options: Details how services are delivered to these populations (e.g., managed care models).
* Premium Assistance: Rules related to premium assistance programs.
* Early Intervention: Regulations for early intervention services for infants and toddlers with developmental delays.
4. Medicaid for Elders and Adults with Disabilities (Chapter 40):
* This chapter addresses Medicaid eligibility and services tailored for older adults and individuals with disabilities.
* Integrated Coverage Groups: Rules for integrated health care coverage for these populations.
* Community Medicaid: Regulations for Medicaid services provided in community settings.
* Managed Care: How managed care is applied to this population.
* Disabled Working Adults: Specific provisions for adults with disabilities who are working.
5. Medicaid Long-Term Services and Supports (Chapter 50):
* This crucial chapter covers the regulations for long-term care services and supports provided through Medicaid.
* Institutional Long-Term Care: Rules for nursing facilities and other institutional settings.
* Home and Community-Based Long-Term Services and Supports (LTSS): A significant focus on providing services in home and community settings to allow individuals to remain in their homes rather than institutions. This often includes rules for self-directed care, personal care services, adult day health, and other supports.
* Personal Needs Funds: Regulations regarding personal funds for individuals in long-term care facilities.
Purpose and Impact of Title 210:
Title 210 is fundamental to the operation of Rhode Island's health and human services system. Its purposes include:
Implementing Federal and State Law: Translating broad legislative mandates (like the Social Security Act and Rhode Island General Laws) into actionable rules.
Ensuring Access to Services: Defining eligibility and covered services to ensure that eligible Rhode Islanders receive necessary healthcare and human services.
Protecting Vulnerable Populations: Establishing standards for care, consumer rights, and oversight to safeguard the well-being of children, families, elders, and individuals with disabilities.
Fiscal Responsibility and Program Integrity: Setting rules for provider payments, preventing fraud and abuse, and ensuring the efficient use of state and federal funds.
Provider Accountability: Establishing the requirements for providers to participate in state programs, including certification, compliance with standards, and mechanisms for oversight and enforcement.
Promoting Integrated Care: Many rules are designed to foster better coordination and integration of physical health, behavioral health, and long-term care services.
In essence, Rhode Island Code of Regulations Title 210 is the detailed operational guide for the state's Executive Office of Health and Human Services, ensuring the effective and equitable delivery of critical health and human services to the citizens of Rhode Island.
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