The PsychU Guide To The Rhode Island Mental Health System
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MRC2.CORP.D.00146
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This resource is provided for informational purposes only and is not intended as reimbursement or legal advice. You should seek independent, qualified professional advice to ensure that your organization is in compliance with the complex legal and regulatory requirements governing health care services, and that treatment decisions are made consistent with the applicable standards of care. Except as otherwise indicated, the information provided is accurate to the best of Otsuka’s knowledge as of June 2016.
© Otsuka Pharmaceutical Development & Commercialization, Inc., Rockville, MD
MRC2.CORP.D.00146
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The PsychU Guide To Mental Health Payers In Rhode Island - Contents 1. 2.
3. 4. 5. 6. 7. 8. 9. 10. 11.
3
Health Care Coverage Map Of Rhode Island Population Distribution By Payer: National vs. State Largest Health Plans In Rhode Island By Enrollment Largest Health Plans in Rhode Island By SMI Enrollment Rhode Island Medicaid System Overview Rhode Island Medicaid Governance Rhode Island Medicaid System Benefits Rhode Island Medicaid Financing & Service Delivery Rhode Island Medicaid Fee-For-Service Rhode Island Medicaid Managed Care Rhode Island Medicaid Medical & Health Home Initiatives
12.
13. 14. 15. 16. 17.
Rhode Island State Mental Health & Addiction Treatment Department Governance Rhode Island State Psychiatric Institutions Rhode Island Accountable Care Organizations (ACOs) Rhode Island Health Care Reform Initiatives Rhode Island Health Insurance Marketplace Plans Rhode Island Essential Health Benefit Benchmark Plan
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1. Health Care Coverage Map Of Rhode Island
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2. Population Distribution By Payer: National vs. State National
Rhode Island
Medicaid 14% Medicare 14% Medicaid Expansion 5% Dual Eligibles 2% Commercial 53% Health Insurance Marketplace 3% Other Public 1% Uninsured 8%
Medicaid 15% Medicare 13% Dual Eligibles 3% Commercial 60% Health Insurance Marketplace 3% Other Public N/A Uninsured 5%
3% 5%
3% 1%
15%
8%
14%
13%
14% 5%
3% 60% 53%
2%
Total Population: 1,048,200
Total Population: 316,167,900
Based on 2014 data 5
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3. Largest Health Plans In Rhode Island By Enrollment Plan Name
Plan Type
Enrollment*
Blue CrossBasic and Blue Shield of Rhode Starter Island
Commercial Standard
Neighborhood Health Plan of Rhode Island
Medicaid
141,991
Medicare FFS
Medicare
118,022
UnitedHealthcare
Medicaid
84,074
UnitedHealthcare
Commercial Administrative Services Only (ASO)
75,880
Blue Cross and Blue Shield Of Rhode Island
Medicare
51,941
Medicaid FFS
Medicaid
46,773
Cigna
Commercial ASO
45,651
UnitedHealthcare Insurance Company
Commercial
42,793
Neighborhood UNITY
Medicaid dual eligibles
18,321
Premium
365,739
*Commercial enrollment is as of fourth quarter 2014. Medicare and Medicaid enrollment is as of first quarter 2016
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4. Largest Health Plans In Rhode Island By SMI Enrollment Plan Name Basic
Plan Type Starter
Standard
Enrollment Estimated SMI * Enrollment Premium
Medicare FFS
Medicare
118,022
10,268
Neighborhood Health Plan of RI
Medicaid
141,991
7,100
Neighborhood UNITY
Medicaid dual eligibles
18,321
5,112
Medicaid FFS
Medicaid
46,773
4,860
Blue Cross and Blue Shield Of Rhode Island
Medicare
51,941
4,519
UnitedHealthcare
Medicaid
84,074
4,204
Blue Cross and Blue Shield of Rhode Island
Commercial
365,739
2,560
UnitedHealthcare of New England, Inc.
Medicare
15,993
1,391
UnitedHealth
Commercial ASO
75,880
531
Cigna
Commercial ASO
45,651
320
*Commercial enrollment is as of fourth quarter 2014. Medicare and Medicaid enrollment is as of first quarter 2016.
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5. Rhode Island Medicaid System Overview Medicaid System Governance State Medicaid Director
Anya Rader Wallack
State Medicaid Director reports to
Elizabeth Roberts, Secretary, Executive Office of Health and Human Services
Medicaid Financial Delivery System State participating in Medicaid expansion?
Yes
Is managed care mandatory for populations with SMI?
Yes, except for individuals who are dual eligible or who receive LTSS
Is managed care mandatory for dual eligibles?
No
Total Medicaid population distribution
16% in FFS 84% in Managed Care
Medicaid beneficiaries with SMI: Primary service system
Because the SMI population must enroll in managed care unless they meet one of the FFS qualifications, the majority of the SMI population is served by managed care.
Medicaid Financing & Risk Arrangements: Behavioral Health
8
Traditional Behavioral Health Services
FFS population: FFS Managed care population: Included in the MCO’s capitation rate
Specialty Behavioral Health Services
FFS population: FFS Managed care population: Covered by the state with planned transition to managed care in 2016
Pharmaceuticals
FFS population: FFS Managed care population: Included in the MCO’s capitation rate
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6. Rhode Island Medicaid Governance
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6. Rhode Island Medicaid Governance
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Name
Position
Department
Elizabeth Roberts
Secretary
Executive Office of Health and Human Services
Anya Rader Wallack
Medicaid Director
Division of Health Care Quality and Financing
Deb Florio
Deputy Medicaid Director (acute care, long-term care, and behavioral health care)
Division of Health Care Quality and Financing
Darren McDonald
Deputy Medicaid Director (operations, administration, and finance)
Division of Health Care Quality and Financing
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7. Rhode Island Medicaid System Benefits Federally Mandated Services
Rhode Island’s Optional Services
1.
1. 2. 3. 4. 5. 6.
2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16.
11
Inpatient hospital services other than services in an institution for mental disease Outpatient hospital services Rural Health Clinic services Federally Qualified Health Center services Laboratory and X-ray services Nursing facilities for individuals 21 and over Early and Periodic Screening and Diagnosis and Treatment (EPSDT) Family planning services and supplies for individuals of child-bearing age Physician services Medical and surgical services of a dentist Home health services Nurse midwife services Nurse practitioner services Pregnancy services, including tobacco cessation programs Free standing birth centers Non-emergency transportation to medical care
7. 8. 9. 10. 11. 12. 13. 14.
Podiatrist, optometrist, and chiropractor services Other practitioners’ services Private duty nursing Dental services Physical and occupational therapy Services for persons with speech, hearing, and language disorders Prescribed drugs Prosthetic devices, dentures, and eyeglasses Diagnostic, screening, and preventive services Rehabilitative services Nursing and intermediate care facilities Inpatient psychiatric facility services Hospice care Case Management
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8. Rhode Island Medicaid Financing & Service Delivery Medicaid System Characteristics Characteristics
Medicaid Fee-For-Service (FFS)
Medicaid Managed Care (MC)
Enrollment
46,773
244,386
SMI Enrollment
Because the SMI population must enroll in managed care unless they meet one of the FFS qualifications, the majority of the SMI population is served by managed care.
Management
Executive Office of Health and Human Services
• •
• •
RIte Care: Two MCOs Rhody Health Partners: Two MCOs Rhody Health Options: One MCO Community Health Team-Rhode Island: PCCM
Payment Model
Fee-for-service
MCOs: Full-risk capitation PCCM: FFS for services and care management fee
Geographic Service Area
Statewide
All programs: Statewide
Total Medicaid 291,159 | Total Medicaid With SMI 21,275 12
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9. Rhode Island Medicaid Fee-For-Service 1. 2.
3.
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FFS enrollment as of October 2015 was 46,773. Rhode Island terminated two fee-for-service primary care case management (PCCM) programs on February 1, 2016: • The 664 beneficiaries of the Connect Care Choice PCCM program for the non-dual eligible aged, blind, and disabled population were mandatorily enrolled into managed care. • The 2,807 beneficiaries of the Connect Care Choice Community Partners PCCM program for dual eligible enrollees had the option to transition into managed care or to revert to FFS. The Community Health Team-Rhode Island PCCM program, which the state considers managed care, was launched on February 1, 2016 (see section B.7.).
Mandatory Enrollment In FFS (excluded from managed care)
Optional Enrollment In FFS
1. Persons with access to other health insurance who qualify for the RIte Share program 2. Recent enrollees with pending managed care enrollment 3. Persons eligible under flexible test of income 4. Persons with extended family planning benefits only
1. Dual eligibles 2. Medicaid-only beneficiaries who require long-term services and supports
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9. Rhode Island Medicaid FFS Program: Behavioral Health Overview FFS Behavioral Health Benefits: • Assessment and evaluation • Individual and group therapy • Medication treatment and review • Community psychiatric supportive treatment • Rehabilitation services • Crisis intervention services • Residential services • Substance abuse assessment services • Outpatient substance abuse counseling • Inpatient, residential, and outpatient detoxification services • Substance abuse residential treatment services • Day/evening treatment
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9. Rhode Island Medicaid FFS Program: SMI Population Individuals with SMI are not exempt from enrolling in managed care unless they also meet one of the fee-forservice criteria.
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10. Rhode Island Medicaid Managed Care •
Managed care enrollment as of September 2015 was 244,536.
•
Rhode Island operates a PCCM, two mandatory managed care programs, and one optional managed care program that provide health coverage statewide. The state’s managed care programs include: – RIte Care: Delivers Medicaid services to parents and families; pregnant women; children, including those with special health care needs; and young adults under age 19. Enrollment is mandatory for eligible populations. – Rhody Health Partners: Delivers Medicaid services to the Medicaid expansion population, and the non-dual eligible aged, blind, and disabled adult population. Enrollment is mandatory for eligible populations. – Rhody Health Options: Delivers Medicaid services to dual eligibles and Medicaid only individuals requiring LTSS. Enrollment is optional for all eligible populations. For more information see Section B.8.
•
The state’s PCCM is called The Community Health Team-Rhode Island. – The state considers the PCCM to be managed care. – The program launched February 1, 2016.
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10. Rhode Island Medicaid Managed Care: Rite Care & Rhody Health Partners
17
•
RIte Care and Rhody Health Partners are the state’s mandatory managed care programs.
•
RIte Care provides managed care to parents and families; pregnant women; children, including those with special health care needs; and young adults under age 19.
•
Rhody Health Partners provides managed care to the Medicaid expansion population, and the non-dual eligible aged, blind, and disabled adult population.
•
The state contracts with two MCOs that provide services for both programs. Individuals who do not choose an MCO are automatically assigned to an MCO. MCO
Mental Health Vendor
Neighborhood Health Plan of Rhode Island
Beacon Health Strategies
UnitedHealthcare
Optum Behavioral Health
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10. Rhode Island Medicaid Managed Care: Primary Case Management Community Health Team RI (CHT-RI) •
On February 1, 2016, Rhode Island launched the CHT-RI program for adults age 21 and older who live in the community and are not enrolled in a managed care plan. – The PCCM replaces the Connect Care Choice and Connect Care Choice Community Partners PCCMs. – The state considers the CHT-RI program to be managed care.
•
Rhode Island contracts with CareLink to provide PCCM services on per member per month basis. – Services include working with the primary care provider, member advocacy, health education, and health system navigation.
18
•
Eligible beneficiaries will be passively enrolled, but may opt-out.
•
To date 3,140 of approximately 3,300 eligible individuals have enrolled in the program.
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10. Rhode Island Medicaid Managed Care: Behavioral Health Overview • CHT-RI: All services, including behavioral health are covered FFS by the state. • RIte Care, Rhody Health Partners, and Rhody Health Options: Traditional mental health services and all substance abuse services are included in the MCO’s capitation rate. – Expanded mental health services for persons with SMI are excluded from the MCO’s capitation rate and provided FFS by the state.
• The state has submitted a state plan amendment request to include expanded mental health services in the MCO’s capitated rate. The requested effective date is January 1, 2016.
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10. Rhode Island Medicaid Managed Care: Behavioral Health Benefits Expanded Mental Health Services Covered By The State
Traditional Behavioral Health Benefits Included In The MCO’s Capitation Rate 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.
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Emergency and stabilization services Inpatient hospitalization Partial hospitalization Day/evening treatment Intensive outpatient treatment Individual, group, and family therapy Testing and evaluation Medication evaluation and management Substance abuse treatment Community and inpatient detoxification Residential treatment for youth Court-ordered mental health and substance abuse treatment
1. 2.
Health home program services Assertive community treatment (ACT)
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10. Rhode Island Medicaid Managed Care: SMI Population • Individuals with SMI are not exempt from enrolling in managed care unless they also meet one of the fee-for-service criteria. • Persons with SMI have access to an expanded benefit package, which includes ACT and health home services. These services are excluded from the MCO’s capitation rate and provided FFS by the state (see previous slide). • The Medicaid expansion population, if medically frail, must be offered the full array of State Plan benefits. Medically frail individuals include adults with serious mental illness and chronic substance abuse disorders.
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10. Rhode Island Medicaid Managed Care: SMI Population • The SMI population served by managed care receives behavioral health services through the BHOs. • Medicaid expansion population, if medically frail, must be offered the full array of State Plan benefits. Medically frail individuals include adults with serious mental illness and chronic substance abuse disorders.
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11. Rhode Island Medicaid Medical & Health Home Initiatives
23
1.
In 2014, the state implemented the Integrated Care Initiative, a new delivery system for the dual eligible population and persons requiring long-term services and supports.
2.
Rhode Island launched a Medicaid accountable care organization pilot program in 2016.
3.
Rhode Island Medicaid is a participant in the statewide multi-payer patient-centered medical home program.
4.
Rhode Island has three approved health home state plan amendments, one for children and young adults with chronic conditions; one for individuals with SMI; and one for individuals enrolled in opioid treatment programs.
5.
Rhode Island was awarded a State Innovation Model design grant in 2014. The information provided by PsychU is intended for your educational benefit only. It is not intended as, nor is it a substitute for medical care or advice or professional diagnosis. Users seeking medical advice should consult with their physician or other healthcare professional. © PsychU. All rights reserved.
11. Rhode Island Medicaid Initiatives: Integrated Care Initiative Integrated Care Initiative •
The Integrated Care Initiative (ICI) creates a new delivery system for the Medicaid-only population receiving LTSS and the Medicare-Medicaid dual eligible population.
•
ICI implementation is being carried out in two phases.
•
In 2014, Phase I of the ICI created two optional programs: – Rhody Health Options: A full-risk managed care model that includes physical health, behavioral health, and LTSS in the capitation rate. As of February 2016, one MCO, Neighborhood UNITY, provided services to the 21,417 enrollees. – The Connect Care Choice Community Partners: A PCCM program for dual eligible enrollees. The program was terminated on February 1, 2016.
•
In May 2016, the state implemented Phase II of the ICI, which consists of one optional program: – Dual eligibles have the option to enroll in the state’s dual eligible demonstration, which coordinates Medicare and Medicaid services under one health plan. See section C.4. for details.
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11. Rhode Island Medicaid Initiatives: Medicaid Accountable Care Organizations Accountable Care Organizations (ACO)
25
1.
ACOs are part of the initiative, Reinventing Medicaid, a cost-reduction program established through the legislative process in 2015. Rhode Island Medicaid calls its ACOs accountable entities (AEs).
2.
The state will certify two types of pilot AE with standards less rigorous than a planned eventual final certification process: • Type I: AE provides contracted MCO services to all MCO populations. • Type II: AE provides contracted MCO services to persons with SMI.
3.
To date, the state has certified five AEs, which are expected to serve up to 65,000 beneficiaries in FY 2017. • In April 2016, Integra Community Care Network ACO and the Medicaid MCO UnitedHealthcare, announced the formation of the first pilot AE. It is certified to serve both the general population and the population with SMI. • In May 2016, the Medicaid MCO Neighborhood Health Plan of Rhode Island announced that it is forming AEs with Providence Community Health Centers, Blackstone Valley Community Health Care, and the East Bay Community Action Program, which will be the second AE serving persons with SMI. • CharterCARE has also been certified by the state to participate in the program, but no partnering MCO has been announced.
4.
Although the state certifies the AEs, contracts are negotiated between the MCOs and AEs. The state will not be a party to the contracts. • The contracting MCOs and AEs will determine the savings and risk transfer arrangement. • AE structures permitted under the pilot are shared savings, shared risk, and full-risk models.
5.
The attribution process will be based primarily on where individuals receive their primary medical care, but a demonstrated relationship with a community mental health center can also be used for attribution.
6.
The state aims to have 25% of Medicaid beneficiaries enrolled in an AEs and 50% of Medicaid payments made through an alternative payment model by 2018. Evidence of contracts with pilot AEs will be taken into consideration during the reprocurement of MCO contracts.
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11. Rhode Island Medicaid Initiatives: Patient-Centered Medical Homes Care Transformation Collaborative 1.
Rhode Island‘s Office of the Health Insurance Commissioner launched the state’s multipayer patient-centered medical home (PCMH) program for adults in 2008. The program is administered by the non-profit Care Transformation Collaborative (CTC) of Rhode Island.
2.
Through its RIte Care, Rhody Health Partners, and Rhody Health Options MCOs, Rhode Island Medicaid is a participating payer in the PCMH program. •
26
There were approximately 300,000 persons served by the program in 2015. OPEN MINDS estimates that 84,000 of these individuals were attributed to Medicaid.
3.
To participate in the program a provider organization must have achieved NCQA level 3 certification or have participated in a formal PCMH transformation training program. Provider organizations must also have implemented cost management strategies and demonstrated performance improvements defined by the state.
4.
Provider organizations receive per member per month (PMPM) payments from each payer based on the number of that payer’s enrollees for whom the provider serves as the primary care provider.
5.
Regardless of payer, PMPM payments for 2016 include a $3.00 base payment, $2.50 for employment of a nurse care manager, and up to $3.25 in incentive payments for meeting certain quality thresholds, equaling a total possible payment of $8.75 PMPM. The information provided by PsychU is intended for your educational benefit only. It is not intended as, nor is it a substitute for medical care or advice or professional diagnosis. Users seeking medical advice should consult with their physician or other healthcare professional. © PsychU. All rights reserved.
11. Rhode Island Medicaid Initiatives: Health Homes CMS has approved three state plan amendments for Rhode Island health homes:
27
1.
CEDARR Family Centers health home SPA for children and young adults with chronic conditions was approved in 2011.
2.
The health home SPA for persons with SMI was approved in 2011.
3.
The health home SPA for persons receiving medication assisted treatment (MAT) for opioid addiction was approved in 2013.
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12. Rhode Island State Mental Health & Addiction Treatment Department Governance
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12. Rhode Island State Mental Health & Addiction Treatment Department Governance
29
Name
Position
Department
Maria Montanaro
Director
Department of Behavioral Health Care, Developmental Disabilities, and Hospitals
Elinore McCance-Katz, M.D.
Chief Medical Officer
Department of Behavioral Health Care, Developmental Disabilities, and Hospitals
Rebecca Boss
Supervisor
Office of Mental Health Services and Office of Substance Abuse Treatment Services
Steven Dean
Supervisor
Office of Finance and Contract Management
John Sutherland
Advising Chief Executive Officer
Eleanor Slater Hospital
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13. Rhode Island State Psychiatric Institutions Institution Name Basic
30
Location Starter
Standard
Beds
Average Daily Premium Census
Eleanor Slater Unified Hospital System, Zambarano Unit
Burrillville
189
120
Eleanor Slater Unified Hospital System, John O. Pastore Center
Cranston
306
240
Total
495
360
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14. Rhode Island Accountable Care Organizations (ACOs) Medicare Shared Savings Program 1. 2. 3. 4. 5.
Coastal Medical, Inc. Genesis Healthcare ACO, LLC Health Choice Care, LLC Integra Community Care Network, LLC Southcoast ACO, LLC
Commercial ACOs
31
ACO
Commercial Insurer
Coastal Medical, Inc.
UnitedHealthcare
Lifespan Corporation
Blue Cross and Blue Shield of Rhode Island
Lifespan Corporation
UnitedHealthcare
Rhode Island Primary Care Physicians
UnitedHealthcare
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15. Rhode Island Health Care Reform Initiatives Medicaid Expansion Choose to participate in expansion? Medicaid Eligibility Income Limit for Childless Adults
Specific Legislation Enacted
32
Yes
133% of FPL Note: The PPACA requires that 5% of income be disregarded with determining eligibility FY 2014 Budget
Health Insurance Marketplace
Type of Marketplace
State
Individual Enrollment Contact
http://healthsourcer i.com/ 1-855-840-4774
Small Business Enrollment Contact
http://healthsourcer i.com/employers/ 1-855-683-6757
32care or The information provided by PsychU is intended for your educational benefit only. It is not intended as, nor is it a substitute for medical advice or professional diagnosis. Users seeking medical advice should consult with their physician or other healthcare professional. © PsychU. All rights reserved.
16. Rhode Island Health Insurance Marketplace Plans Small Group Market
Individual Market • •
•
33
Blue Cross Blue Shield of Rhode Island Neighborhood Health Plan of Rhode Island UnitedHealthcare
• • • •
Blue Cross Blue Shield of Rhode Island Neighborhood Health Plan of Rhode Island Tufts Health Plan UnitedHealthcare
33care or The information provided by PsychU is intended for your educational benefit only. It is not intended as, nor is it a substitute for medical advice or professional diagnosis. Users seeking medical advice should consult with their physician or other healthcare professional. © PsychU. All rights reserved.
17. Rhode Island Essential Health Benefit Benchmark Plan Plan Type
Plan from largest small group product, Preferred Provider Organization
Issuer Name
Blue Cross and Blue Shield of Rhode Island
Plan Name
Vantage Blue BCBSRI
Supplemented Categories (Supplementary Plan Type)
• •
Habilitative Services Defined by State
Yes, habilitative services must be comprehensive and measured as per member per month cost of rehabilitation serviced covered under the plan.
Pediatric Oral (FEDVIP) Pediatric Vision (FEDVIP)
Issuer will be required to attach filing as an exhibit that identifies the habilitative services covered by the plan; includes an actuarial memorandum estimating the per member per month cost of the habilitative and rehabilitative services covered; and, includes in the actuarial memo the calculation and analysis used to develop the identified cost. All should happen no later than 90 days after the end of each calendar year. Issuer must also file with OHIC an actuarial memo, using the best available claims data and compare such claims and expense experience with the approved rate factor.
Biologically Based Mental Illness
34
Covered the same as any other medical benefit as described in the 2008 Mental Health Parity and Addiction Equity Act
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17. Rhode Island Essential Health Benefit Benchmark Plan: Behavioral Health Benefits
Non-Biologically Based Mental Illness
Benefit
35
Limit on Service
Exclusions
Mental/Behavioral Health Outpatient Services
None
Mental/Behavioral Health Inpatient Services
None
This plan does not cover recreation therapy, non-medical self-care, or self-help training, mental health residential treatment programs (including eating disorder residential treatment programs), telephone consultations, therapeutic reaction programs or wilderness programs, behavioral training assessment, education or exercise, including applied behavioral analysis.
Substance Abuse Disorder Outpatient Services
None
Substance Abuse Disorder Inpatient Services
None
This plan does not cover methadone clinics and treatments.
The information provided by PsychU is intended for your educational benefit only. It is not intended as, nor is it a substitute for medical care or advice or professional diagnosis. Users seeking medical advice should consult with their physician or other healthcare professional. © PsychU. All rights reserved.
Sources 1. Rhode Island Health Care Coverage Map 1. Rhode Island Office of the Health Insurance Commissioner. (2015, August 19). OHIC Approved Commercial Health Insurance Rates for 2016. Retrieved May 17, 2016 from http://www.ohic.ri.gov/documents/Press-Rates-Final-2015.pdf 2. Rhode Island Executive Office of Health and Human Services. (2015, October 30). Accountable Entity Coordinated Care Pilot Program. Retrieved May 27, 2016 from http://www.eohhs.ri.gov/Portals/0/Uploads/Documents/AE%20Pilot%20Application.pdf 3. Health Plans USA. (2014). Subscription Database. Available from http://www.markfarrah.com/products/health-plans-usa.aspx
2. Rhode Island Population Distribution By Payer: National vs. State 1. Medicaid and CHIP Payment and Access Commission. (2015, December). MACStats Medicaid and CHIP Data Book. Retrieved January 6, 2016 from https://www.macpac.gov/wp-content/uploads/2015/11/MACStats-Medicaid-and-CHIP-Data-Book-December-2015.pdf 2. The Henry J. Kaiser Foundation. (2014). State Health Facts: Health Insurance Coverage of the Total Population. Retrieved March 24, 2016 from http://kff.org/other/state-indicator/total-population/ 3. United States Department of Health and Human Services. (March 11, 2016). Addendum to the Health Insurance Marketplaces 2016 Open Enrollment Period: Final Enrollment Report. Retrieved March 24, 2016 from https://aspe.hhs.gov/sites/default/files/pdf/188026/MarketPlaceAddendumFinal2016.pdf 4. The Kaiser Foundation definition for Medicaid includes dual eligible individuals. To avoid double counting, the number of dual eligibles was subtracted from the total number of Medicaid enrollees. 5. Other Public refers to military and Veteran’s Administration coverage. 3. Largest Health Plans In Rhode Island By Enrollment 1. Health Plans USA. (2014). Subscription Database. Available from http://www.markfarrah.com/products/health-plans-usa.aspx 2. Rhode Island Executive Office of Health and Human Services. (2015, October 30). Accountable Entity Coordinated Care Pilot Program. Retrieved May 27, 2016 from http://www.eohhs.ri.gov/Portals/0/Uploads/Documents/AE%20Pilot%20Application.pdf
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The information provided by PsychU is intended for your educational benefit only. It is not intended as, nor is it a substitute for medical care or advice or professional diagnosis. Users seeking medical advice should consult with their physician or other healthcare professional. © PsychU. All rights reserved.
Sources 4. Largest Health Plans in Rhode Island By SMI Enrollment 1. Health Plans USA. (2014). Subscription Database. Available from http://www.markfarrah.com/products/health-plans-usa.aspx 2. Rhode Island Executive Office of Health and Human Services. (2015, October 30). Accountable Entity Coordinated Care Pilot Program. Retrieved May 27, 2016 from http://www.eohhs.ri.gov/Portals/0/Uploads/Documents/AE%20Pilot%20Application.pdf 5. Rhode Island Medicaid System Overview • Compiled from information found throughout the profile. 6. Rhode Island Medicaid Governance 1. Rhode Island Executive Office of Health and Human Services. (2012, August 2). Medicaid State Plan Amendment RI 11-008. Retrieved May 17, 2016 from https://www.medicaid.gov/State-resource-center/Medicaid-State-Plan-Amendments/Downloads/RI/2011/RI-11-008.pdf 2. Rhode Island Executive Office of Health and Human Services. (2014, February 28). Medicaid State Plan Amendment RI 13-0017. Retrieved May 17, 2016 from https://www.medicaid.gov/State-resource-center/Medicaid-State-Plan-Amendments/Downloads/RI/RI-13-0017-MM.pdf 3. Rhode Island Executive Office of Health and Human Services. The EOHHS Departments. Retrieved May 17, 2016 from http://www.eohhs.ri.gov/Home/EOHHSDepartments.aspx 7. Rhode Island Medicaid System Benefits 1. Centers for Medicare and Medicaid Services. Medicaid Benefits. Retrieved July 1, 2014 from http://www.medicaid.gov/Medicaid-CHIPProgram-Information/By-Topics/Benefits/Medicaid-Benefits.html 2. Rhode Island Department of Human Services. Medicaid Program Regulations. Retrieved May 18, 2016 from http://www.dhs.ri.gov/Regulations/Medicaid%20Rules%20and%20Regulations.pdf 3. Rhode Island Secretary of State. Medical Assistance Program Regulations. Retrieved May 18, 2016 from http://sos.ri.gov/documents/archives/regdocs/released/pdf/DHS/6174.pdf 4. Rhode Island Executive Office of Health and Human Services. Medicaid Provider Manual. Retrieved May 18, 2016 from http://www.eohhs.ri.gov/ProvidersPartners/ProviderManualsGuidelines/MedicaidProviderManual.aspx
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The information provided by PsychU is intended for your educational benefit only. It is not intended as, nor is it a substitute for medical care or advice or professional diagnosis. Users seeking medical advice should consult with their physician or other healthcare professional. © PsychU. All rights reserved.
Sources 8. Rhode Island Medicaid Financing & Service Delivery 1. Rhode Island Department of Human Services. Medicaid Rules and Regulations. Retrieved May 23, 2016 from http://www.dhs.ri.gov/Regulations/Medicaid%20Rules%20and%20Regulations.pdf 9. Rhode Island Medicaid Fee-For-Service 1. Rhode Island Executive Office of Health and Human Services. (2016, January 5). Important Information on Connect Care Choice and Connect Care Choice Community Partners. Retrieved May 23, 2016 from http://www.eohhs.ri.gov/Portals/0/Uploads/Documents/PressReleases/FactSheet_4CP_CCC_1_5_16.pdf 2. Rhode Island Department of Human Services. Medicaid Rules and Regulations. Retrieved May 23, 2016 from http://www.dhs.ri.gov/Regulations/Medicaid%20Rules%20and%20Regulations.pdf 9. Rhode Island Medicaid FFS Program: Behavioral Health Overview 1. Rhode Island Executive Office of Health and Human Services. (2016, January). Medicaid Fee Schedule. Retrieved May 24, 2016 from http://www.eohhs.ri.gov/Portals/0/Uploads/Documents/Fee%20Schedules/Medicaid%20Fee%20Schedule.pdf 2. Rhode Island Department of Human Services. Medicaid State Plan. Emailed to OPEN MINDS June 13, 2016. 9. Rhode Island Medicaid FFS Program: SMI Population 1. Rhode Island Department of Human Services. Medicaid Rules and Regulations. Retrieved May 23, 2016 from http://www.dhs.ri.gov/Regulations/Medicaid%20Rules%20and%20Regulations.pdf 10. Rhode Island Medicaid Managed Care 1. Rhode Island Executive Office of Health and Human Services. (2015, October). Monitoring Quality and Access In RIte Care and Rhody Health Partners. Retrieved May 24, 2016 from http://www.eohhs.ri.gov/Portals/0/Uploads/Documents/MonitoringQualityandAccess2015.pdf 2. Rhode Island Department of Human Services. Medicaid Rules and Regulations. Retrieved May 23, 2016 from http://www.dhs.ri.gov/Regulations/Medicaid%20Rules%20and%20Regulations.pdf
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The information provided by PsychU is intended for your educational benefit only. It is not intended as, nor is it a substitute for medical care or advice or professional diagnosis. Users seeking medical advice should consult with their physician or other healthcare professional. © PsychU. All rights reserved.
Sources 10. Rhode Island Medicaid Managed Care Program: Behavioral Health Overview 1. Rhode Island Department of Human Services. Medicaid Rules and Regulations. Retrieved May 23, 2016 from http://www.dhs.ri.gov/Regulations/Medicaid%20Rules%20and%20Regulations.pdf 2. Rhode Island Department of Human Services. (2016, June 30). Email to OPEN MINDS. 3. Rhode Island Department of Human Services. (2016, January 1). Neighborhood Health Plan of Rhode Managed Care Contract Amendment 10. CD-ROM 10. Medicaid Managed Care Program: SMI Populations 1. United State Government. (2014, June 23). Federal Register Federal Register §440.315 Exempt individuals. Retrieved July 1, 2014 from http://www.ecfr.gov/cgi-bin/text-idx?SID=bf8c9a15d9868d4dd8eea9e9198a6a7d&node=42:4.0.1.1.9&rgn=div5 2. Rhode Island Department of Human Services. Medicaid Rules and Regulations. Retrieved May 23, 2016 from http://www.dhs.ri.gov/Regulations/Medicaid%20Rules%20and%20Regulations.pdf 3. Rhode Island Department of Human Services. (2016, January 1). Neighborhood Health Plan of Rhode Managed Care Contract Amendment 10. CD-ROM 4. Rhode Island Department of Human Services. (2016, June 30). Email to OPEN MINDS. 11. Rhode Island Medicaid Medical & Health Home Initiatives 1. Care Transformation Collaborative of Rhode Island. Annual Report 2013. Retrieved May 25, 2016 from https://www.ctcri.org/files/uploads/CSI-RI%202013%20Annual%20Report_FINAL.pdf 2. Care Transformation Collaborative of Rhode Island. 2015 Common Contract. Retrieved May 25, 2016 from https://www.ctcri.org/content/ctc-deliverables 3. Care Transformation Collaborative of Rhode Island. 2016 Per Member Per Month Payments. Retrieved May 25, 2016 from https://www.ctcri.org/files/uploads/Per-Member-Per-Month%20Payments.pdf 4. Rhode Island Office of the Health Insurance Commissioner. (2016, February 10). Rhode Island 2016-2017 Care Transformation Plan. Retrieved May 25, 2016 from http://www.ohic.ri.gov/documents/2016-2017-Care-Transformation-Plan-Signed.pdf 5. Rhode Island Executive Office of Health and Human Services. (2015, July 8). Report of the Working Group to Reinvent Medicaid. Retrieved May 25, 2016 from http://www.eohhs.ri.gov/Portals/0/Uploads/Documents/ReinventMedicaid/Final_report_ReinventMedicaid.pdf 6. The number of Medicaid beneficiaries served by the PCMH program was estimated by multiplying the 2013 UnitedHealthcare and Neighborhood Health Plan PCMH beneficiary shares by the 2015 enrollment. Because UnitedHealthcare has non-Medicaid enrollees, OPEN MINDS database information was used to refine the estimate.
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The information provided by PsychU is intended for your educational benefit only. It is not intended as, nor is it a substitute for medical care or advice or professional diagnosis. Users seeking medical advice should consult with their physician or other healthcare professional. © PsychU. All rights reserved.
Sources 12. Rhode Island State Mental Health & Addiction Treatment Department Organization Chart 1. Rhode Island Department of Behavioral Health Care, Developmental Disabilities, and Hospitals. Contact Us. Retrieved May 16, 2016 from http://www.bhddh.ri.gov/about/contact/contact.php 2. State of Rhode Island. Telephone Directory. Retrieved May 17, 2016 from http://www.ripay.ri.gov/ri-directory.pdf 12. Rhode Island State Mental Health & Addiction Treatment Department Governance 1. Rhode Island Department of Behavioral Health Care, Developmental Disabilities, and Hospitals. Contact Us. Retrieved May 16, 2016 from http://www.bhddh.ri.gov/about/contact/contact.php 2. Rhode Island Department of Behavioral Health Care, Developmental Disabilities, and Hospitals. Behavioral Health Contact Information. Retrieved May 16, 2016 from http://www.bhddh.ri.gov/bhservices/contact.php 13. Rhode Island State Psychiatric Institutions 1. Rhode Island Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals. Eleanor Slater Hospital. Retrieved May 17, 2016 from http://www.bhddh.ri.gov/esh/zam.php 2. Rhode Island Legislature. (2015, April 28). 2015-2016 Governor’s Budget Analysis. Retrieved May 16, 2016 from www.rilegislature.gov/sfiscal/Budget Analyses/FY2016 SFO Governor's Budget.pdf 14. Rhode Island Accountable Care Organizations (ACOs) • OPEN MINDS Database 15. Rhode Island Health Care Reform Initiatives 1. Rhode Island Legislature. (2013, August, 26). Senate Fiscal Office Report FY 2014 Budget As Enacted. Retrieved May 18, 2016 from http://www.rilin.state.ri.us/sfiscal/Budget%20Analyses/FY2014%20SFO%20Budget%20as%20Enacted.pdf 2. State of Rhode Island. HealthSource RI. Retrieved May 18, 2016 from http://healthsourceri.com/
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The information provided by PsychU is intended for your educational benefit only. It is not intended as, nor is it a substitute for medical care or advice or professional diagnosis. Users seeking medical advice should consult with their physician or other healthcare professional. © PsychU. All rights reserved.
Sources 16. Rhode Island Health Insurance Marketplace Plans 1. Rhode Island Office of the Health Insurance Commissioner. (2015, August 19). OHIC Approved Commercial Health Insurance Rates for 2016. Retrieved May 17, 2016 from http://www.ohic.ri.gov/documents/Press-Rates-Final-2015.pdf 17. Rhode Island Essential Health Benefit Benchmark Plan 1. State of Rhode Island. (2014). Rhode Island EHB Benchmark Plan. Retrieved May 17, 2016 from https://www.cms.gov/CCIIO/Resources/Data-Resources/Downloads/Updated-Rhode-Island-Benchmark-Summary.pdf
17. Rhode Island Essential Health Benefit Benchmark Plan: Behavioral Health Benefits 1. State of Rhode Island. (2014). Rhode Island EHB Benchmark Plan. Retrieved May 17, 2016 from https://www.cms.gov/CCIIO/Resources/Data-Resources/Downloads/Updated-Rhode-Island-Benchmark-Summary.pdf
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The information provided by PsychU is intended for your educational benefit only. It is not intended as, nor is it a substitute for medical care or advice or professional diagnosis. Users seeking medical advice should consult with their physician or other healthcare professional. © PsychU. All rights reserved.
