Border community provider status for Rhode Island Medicaid
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Defines which named border communities are treated as in-state providers for the Rhode Island Medicaid Program and are therefore exempt from out-of-state service restrictions and prior authorization requirements.
No material clinical or coverage changes in this revision.
In-State Treatment for Border Community Providers
In‑state treatment of border community providers
Covered when the provider is located in one of the named border communities listed below; such providers are treated as in‑state for Rhode Island Medicaid and are not subject to out‑of‑state service restrictions or prior authorization requirements.
Named border communities (examples from source)
- Connecticut: Danielson, Groton, Moosup, Mystic, New London, North Stonington, Pawcatuck, Putnam, Stonington, Thompson, Waterford
- Massachusetts: Attleboro, Bellingham, Bellingham?, Blackstone, Dartmouth, Fall River, Foxboro, Milford, New Bedford, North Attleboro, North Dartmouth, Rehoboth, Seekonk, Somerset, South Attleboro, Swansea, Taunton, Uxbridge, Webster, Westport, Whitinsville
Coding and Summary Metrics
| No codes listed |
| Danielson | Connecticut — treated as in-state provider for Rhode Island Medicaid |
| Groton | Connecticut — treated as in-state provider for Rhode Island Medicaid |
| Moosup | Connecticut — treated as in-state provider for Rhode Island Medicaid |
| Mystic | Connecticut — treated as in-state provider for Rhode Island Medicaid |
| New London | Connecticut — treated as in-state provider for Rhode Island Medicaid |
| North Stonington | Connecticut — treated as in-state provider for Rhode Island Medicaid |
| Pawcatuck | Connecticut — treated as in-state provider for Rhode Island Medicaid |
| Putnam | Connecticut — treated as in-state provider for Rhode Island Medicaid |
| Stonington | Connecticut — treated as in-state provider for Rhode Island Medicaid |
| Thompson | Connecticut — treated as in-state provider for Rhode Island Medicaid |
Authorization and Billing Implications for Providers
Border community authorization exception — no out-of-state restrictions or prior authorization
Providers located in the listed border communities are considered in-state for the Rhode Island Medicaid Program and are not subject to out-of-state service restrictions or prior authorization requirements.
- Listed communities span towns in Connecticut and Massachusetts that border Rhode Island (approximately 28 communities).
Defined Terms
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