Rhode Island

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)

 

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, 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)

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; 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)

Disclaimer: This project was supported, in part by grant number 90BC0018, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.