Rhode Island

Current Updates (as of 4/30/2021)

Medicare-Medicaid Integration

On December 15, the Rhode Island Executive Office of Health and Human Services (EOHHS) released an RFP for procurement for Medicaid managed care organizations. The new RFP and contract requirements seek to enhance quality, oversight, and financial management of managed care services through measures including a reduction of unnecessary prior authorizations, executive level transparency, increased market competition among MCOs, increased accountability for the use of Pharmacy Benefit Managers, and others. The RFP will also include LTSS services and enhance coordination efforts for dually-eligible individuals.

This new program will replace Rhode Island’s dual eligible demonstration which is due to expire on December 31, 2025.

RFP responses are due February 23, 2024 and the new contracts are expected to begin on July 1, 2025.

(Source: State of Rhode Island; 12-15-2024)

Past Updates

Medicare-Medicaid Integration

On December 22, 2022, Rhode Island submitted a five-year extension request for its Medicaid section 1115(a) demonstration entitled the “Rhode Island Comprehensive Demonstration” (“the Demonstration”) to be effective January 1, 2024 through December 31, 2028. The Demonstration has been in place since 2009 and Rhode Island’s entire Medicaid program is operated under the Demonstration. The Demonstration offers a complete array of services, including medical, behavioral health, and Home and Community-Based Services (HCBS) to multiple eligibility groups. This Demonstration extension aims to continue to build upon the Demonstration’s foundational aims of equity and access while implementing new focused enhancements targeted at behavioral health, social determinants of health, and long-term services and supports. The state is requesting new expenditure authority to provide outreach and pre-release services to the justice-involved population, a restorative and recuperative care pilot, and authority for parents of disabled children to act as service providers. The federal comment period for this application was open from January 6, 2023 through February 5, 2023.

(Source: Medicaid.gov Bulletin; 1-06-2023)

On May 30, Rhode Island’s Executive Office of Health and Human Services released a Request for Information (RFI), soliciting informational responses from qualified potential vendors and other interested parties to inform procurement of its Medicaid Managed Care program. The RFI end date was June 27, 2023 and will inform a Request for Qualifications in the fall of 2023.

(Source: State of Rhode Island; 5-30-2023)

On January 6, 2020 the Rhode Island Executive Office of Health & Human Services (EOHHS) released a request for information (RFI) regarding payment and delivery system model for duals. The RFI is asking for information of a model that coordinates care for duals under a Medicare-Medicaid Plan (MMP) or Dual Eligible Special Needs Plan (D-SNP).

(Source: HMA Newsletter; 1-8-2020)

On November 9, 2020 GoLocalProv published an article announcing the Neighborhood Health Plan of Rhode Island signed a three-year extension with Rhode Island Executive Office of Health & Human Services (EOHHS) and CMS for the Medicare-Medicaid Duals Programs. Neighborhood’s INTEGRITY plan serves 13,000 duals and the extension will ensure continued service for beneficiaries.

(Source: GoLocalProv Neighborhood Health Plan of Rhode Island; 11-9-2020)

Rhode Island

Managed LTSS Program

On December 23, 2013, CMS approved the state’s Comprehensive §1115 Demonstration renewal request. In its March 28, 2014 Draft Comprehensive Quality Strategy for the §1115 Demonstration, Rhode Island described Rhody Health Options (RHO) as the LTSS aspect of its Integrated Care Initiative. RHO represents the integration of Medicaid LTSS services into a managed care delivery system. (Source: Rhode Island HHS websiteRhode Island Comprehensive Demonstration (Approved 12/23/2013)
Stakeholder Notice (3/28/2014)

On October 20, 2016, the Rhode Island Executive Office of Health & Human Services received approval of an amendment to Rhode Island’s section 1115(a) waiver, referred to as the Rhode Island Comprehensive Demonstration. The demonstration aims to advance delivery system reform through the implementation of Accountable Entities (AEs), which are integrated provider organizations that will be responsible for beneficiary experience, quality, and total cost of care for beneficiaries that are enrolled in MCOs. MCOs will enter fully capitated arrangements with certified AEs In addition to the changes in MCO contracts, the state will institute a Hospital and Nursing Home Incentive Program The program will last nine months, and aims to assist hospitals and nusrsing homes to participate in AEs, and further advance the state's MLTSS rebalancing efforts. (Source:  Approval Letter  10/20/2016)

On April 20, 2017, the Rhode Island Executive Office of Health & Human Services (EOHHS) announced that it has signed five-year contracts with three managed care organizations to coordinate care and provide comprehensive services for 250,000 individuals enrolled in Medicaid managed care. The MCOs selected are: Neighborhood Health Plan of Rhode Island, UnitedHealthcare Community Plan, and Tufts Health Plan. Neighborhood Health Plan and UnitedHealthcare were incumbents and have contracted with the state since 1994, while Tufts Health Plan is new to the Medicaid managed care market in Rhode Island, but has experience elsewhere.  The state intends to hold an open enrollment period during the summer for Medicaid enrollees. Currently, Neighborhood Health Plan holds approximately 66 percent of the market, and UnitedHealthcare holds 33 percent. (Source: Press Release 4/20/2017)

State Demonstration to Integrate Care for Dual Eligible Individuals

Rhode Island’s Integrated Care for Medicare and Medicaid Beneficiaries Demonstration proposes to enroll approximately 12,000 Medicaid-only enrollees and 23,000 Medicare-Medicaid enrollees into the Rhode Island Integrated Care Initiative (ICI) during two phases; the state plans to carve out individuals with I/DD and SMI. As of June 2014, the state’s Demonstration Proposal is pending with CMS. (Source: CMS and Truven Health Analytics, 7/2012; Duals Demonstration Presentation; 7/23/2012; Kaiser Duals Demonstration Proposal Status Map, 5/2014)
Demonstration Proposal

In November 2013, the state implemented Phase I of the ICI. April 2015 is the tentative start date for Phase II of the ICI, which will fully integrate Medicaid and Medicare services delivered by a health plan. (Source: State Integrated Care Initiative Update, 2/2014)
Integrated Care Initiative Phase II Draft Timeline (3/26/2014)

In May 2014, Rhode Island released an updated ICI financial alignment timeline. The effective contract date and opt-in enrollment effective date for Phase II of the ICI will be April 1, 2015. (Source: State HHS website; HMA Weekly Roundup, 5/28/2014)
Integrated Care Initiative Phase II Draft Procurement Timeline (5/30/2014)

On October 1, 2014, Rhode Island’s Executive Office of Health and Human Services (EOHHS) provided an enrollment update for its Integrated Care Initiative (ICI) dual eligible demonstration.  As of October 1, 2014:  22,435 individuals were enrolled in Phase One of the ICI.  This includes 17,162 individuals enrolled in Rhody Health Options (RHO); 4,964 individuals enrolled in Connect Care Choice (CCC) Community Partners; and 309 individuals enrolled in the PACE Program.  (Source:  HMA Weekly Roundup, 10/22/2014; ICI Phase I Presentation by Rhode Island EOHHS, 10/1/2014) 
EOHHS Rhody Health Options Fact Sheet (9/5/2014) 
EOHHS CCC Community Partners Fact Sheet (9/5/2014) 
EOHHS RHO, CCC Community Partners, PACE Comparison Chart (9/5/2014)

On July 30, 2015, the Centers for Medicare and Medicaid Services (CMS) and the State of Rhode Island announced an initiative to better coordinate care for the states’ dual eligible population. The program will expand upon the state’s Integrated Care Initiative, Rhody Health Options (RHO), that currently only coordinates care for Medicaid services, including LTSS. The initiative will allow qualified RHO plans to act as a Medicare-Medicaid Plan (MMP) that will cover Medicare in addition to Medicaid benefits. An estimated 30,000 Medicare-Medicaid beneficiaries are eligible to participate in the demonstration. (Source: CMS, link no longer available 7/30/2015; MOU)

Rhode Island has officially finalized plans and begun the enrollment process for Phase 2 of the state’s Integrated Care Initiative, a fully capitated dual eligible demonstration. Phase 2 is a collaboration between CMS, the State of Rhode Island, and Neighborhood Health Plan of Rhode Island. Opt-in enrollment commenced on June 1, 2016, and will be followed by two additional enrollment waves beginning July 1 and August 1. All three enrollment waves include all populations, for example, beneficiaries in institutional facilities, duals with LTSS, and duals without LTSS.  (Source: EOHHS 6/2/2016; MOU; HMA Weekly Roundup 5/11/2016)

On January 19, 2018, Rhode Island’s governor released the state’s budget for fiscal year 2018. The FY18 budget request for Medicaid recommends $2.354 billion, which includes $1.430 billion from federal sources, and $911.7 million from state general revenue. The proposed FY18 budget recommends that the state transfer long-term stay nursing home residents from the Neighborhood Health Plan back to FFS, and to utilize the anticipated savings from decreased administrative payments to the health plan to provide enhanced home and community-based services (HCBS). This change is a part of the states’ emphasis on rebalancing its LTSS system towards more community-based care. The FY18 budget also recommends changes to improve the patient share collection for members eligible for LTSS; proposes freezing rates for managed care administration, hospital payments, and nursing homes; and suggests that the state eliminate the managed care provider incentive program. (Source: FY18 HHS Executive Summary 1/19/2018)

CMS released a summary of quality withhold analyses of Rhode Island’s Medicare-Medicaid Plan (MMP) for the first demonstration year (CY 2016-2017) of the Financial Alignment Initiative (FAI), called the Rhode Island Integrated Care Initiative.  A percentage of both state Medicaid and federal Medicare capitation rates are withheld from the MMPs to ensure quality for dually eligible individuals. MMPs can earn the withheld funds back if Federal, CMS Core, and state-specific quality withhold performance measures were met. In CY 2016, Rhode Island’s MMP met 88 percent of the overall withhold quality measures, 100 percent of the CMS core measures, and 83 percent of the state’s specific measures. In CY 2017, Rhode Island’s MMP met 56 percent of the overall withhold quality measures, 67 percent of the CMS core measures, and 50 percent of the state’s specific measures.

(Source: Rhode Island Medicare-Medicaid Plan Quality Withhold Analysis Results, 8-14-2019)

Balancing Incentive Program

Rhode Island is planning to participate in the Balancing Incentive Program in FY 2014. However, the state has not yet submitted a BIP Application to CMS. (Source: Kaiser BIP website, 6/2014)

Health Homes

Rhode Island has two approved Health Homes State Plan Amendments implemented statewide, effective October 1, 2011. Rhode Island Community Mental Health Organization Health Homes State Plan Amendment (approved 11/23/2011) targets individuals with a serious and persistent illness (SPMI). Rhode Island CEDARR Family Center Health Homes State Plan Amendment (approved 11/23/2011) is for children and youth under age 21 with diagnosis of severe mental illness or serious emotional disturbance, or with two of the following chronic conditions, or have one and at risk of developing another: mental health condition, asthma, diabetes, DD, Down syndrome, mental retardation, or seizure disorder. (Source: Integrated Care Resource Center, State-by-State Health Homes State Plan Amendment Matrix: Summary Overview, Updated June 2012, link no longer available; Kaiser Commission on Medicaid and the Uninsured, Medicaid Health Homes for Beneficiaries with Chronic Conditions, August 2012)
Approved CEDARR Health Home State Plan Amendment (Effective 10/1/2011)
Approved Community Mental Health Organization Health Home State Plan Amendment (Effective 10/1/2011)

The state submitted to CMS a draft Health Homes State Plan Amendment for a third health home. (Source: CMS Health Home Proposal Status website, 4/2013)

On November 6, 2013, CMS approved the state’s third Health Home State Plan Amendment, with an effective date of July 1, 2013. The Health Home targets opioid-dependent Medicaid recipients who currently receive or meet the criteria for Medication Assisted Treatment. (Source: CMS Health Home SPA Matrix, 3/2014; CMS Health Home Proposal Status website, 2/2014; Medicaid.gov website)
Approved Opioid Treatment Health Home State Plan Amendment (Effective 7/1/2013)