RI Medicaid: Community Health Workers

Authors: Rhode Island Executive Office of Health and Human Services Medicaid Program
Year: 2022
State: RI
Website link: https://nachw.org/wp-content/uploads/2023/03/RI-CHW-Manual-7-19-2022.pdf
Publicly Available: Yes
Certification: CHW role scope of practice, Competencies, Legislative language bills etc.
Policy: Legislative language, Lessons learned from other states
Sustainable Financing: How to engage and work with Medicaid, Billing/CPT codes, Reimbursement TA for FQHCs Medicaid etc., Documentation of how CHWs can work within care teams

The Rhode Island Executive Office of Health and Human Services (EOHHS) partners with Gainwell Technologies as its Fiscal Agent to process the state’s Medicaid Program claims, to enroll and train providers, and perform other duties to fulfill State and Federal requirements. EOHHS has the sole responsibility for formatting program policy and procedures. The purpose of this policy is to establish the rules of payment for services provided to individuals determined to be eligible for RI Medicaid. The General Rules for RI Medicaid along with this policy are to be used together to determine eligibility for services. The Rhode Island Medicaid Program will only reimburse providers for medically necessary services. The RI Medicaid conducts both pre-payment and post-payment reviews of services rendered to recipients. Determinations of medical necessity are made by the staff of the RI Medicaid Program, trained medical consultants, and independent State and private agencies under contract with the RI Medicaid.

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