CurrentExecutive Office of Health and Human ServicesPolicy N/A

Neighborhood Health Plan of Rhode Island Amendment No. 8

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Amendment No. 8 modifies the Agreement between the Rhode Island Executive Office of Health and Human Services and Neighborhood Health Plan of Rhode Island governing Medicaid managed care services, including program standards, fee schedules, benefits (doula services), and contractor capitations for SFY2023; it affects the State (EOHHS) and the Contractor (NHPRI).

Policy Summary

PayerExecutive Office of Health and Human Services

PolicyNeighborhood Health Plan of Rhode Island Amendment No. 8

Policy CodePolicy N/A

Change TypeAmendment (operational updates to fee schedules, benefits, and rate attachments)

Effective DateJul 1, 2022

Next Review DateN/A

Key ActionDoula services are covered when medically necessary.

SourceLink

POLICY UPDATE CHANGES

Section 2.07.08 Level IV Alcohol and Drug Detoxification Program section is deleted in its entirety and subsequent sections renumbered.

Section 2.15.01.01 Fee Schedule updated with specified increases for hospital inpatient/outpatient (2.0% effective 7/1/2022) and nursing home rates (2.9% effective 10/1/2022), PCMH PMPM and CTC payment specifications.

Attachment A Schedule of In-Plan Benefits: Doula Services row replaced to state 'Covered when medically necessary.'

Attachment J (Contractor's Capitation Rates SFY 2023) replaced in its entirety with 'State Fiscal Year 2023 Risk Adjustment Medicaid Managed Care Program dated June 27, 2022.'

Attachment L: RATE-SETTING PROCESS is amended by deleting and replacing the attachment in its entirety with 'State Fiscal Year 2023 Risk Adjustment Medicaid Managed Care Program dated June 27, 2022'.

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CurrentExecutive Office of Health and Human ServicesPolicy N/A

Neighborhood Health Plan of Rhode Island Amendment No. 8

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Policy Summary

PayerExecutive Office of Health and Human Services

PolicyNeighborhood Health Plan of Rhode Island Amendment No. 8

Policy CodePolicy N/A

Change TypeAmendment (operational updates to fee schedules, benefits, and rate attachments)

Effective DateJul 1, 2022

Next Review DateN/A

Key ActionDoula services are covered when medically necessary.

SourceLink

POLICY UPDATE CHANGES

Section 2.07.08 Level IV Alcohol and Drug Detoxification Program section is deleted in its entirety and subsequent sections renumbered.

Attachment A Schedule of In-Plan Benefits: Doula Services row replaced to state 'Covered when medically necessary.'

Attachment J (Contractor's Capitation Rates SFY 2023) replaced in its entirety with 'State Fiscal Year 2023 Risk Adjustment Medicaid Managed Care Program dated June 27, 2022.'

Attachment L: RATE-SETTING PROCESS is amended by deleting and replacing the attachment in its entirety with 'State Fiscal Year 2023 Risk Adjustment Medicaid Managed Care Program dated June 27, 2022'.

Coverage Criteria

Doula services

Covered when ALL of the following are met:

Doula services are covered when medically necessary.

Provider Actions & Operational Notes

Note

Doula services: coverage trigger

Doula services are covered when medically necessary per the amended Attachment A Schedule of In‑Plan Benefits.

Billing Rule

Fee schedule and PMPM payment updates (effective dates and amounts)

Fee schedule and payment requirements were updated: hospital inpatient/outpatient rates increased 2.0% effective 7/1/2022; nursing home rates increased 2.9% effective 10/1/2022; PCMH payment of $3.00 PMPM (to providers meeting the OHIC PCMH definition) effective 7/1/2022; and CTC payment of $1.15 PMPM for administration of the program effective 7/1/2022.

Hospital inpatient/outpatient rates: 2.0% increase, effective 7/1/2022.
Nursing home rates: 2.9% increase, effective 10/1/2022 (1.0% attributable to staffing provisions).
PCMH PMPM: $3.00 PMPM to providers meeting OHIC PCMH definition, effective 7/1/2022.
CTC payment: $1.15 PMPM to the Care Transformation Collaborative for administration, effective 7/1/2022.

Documentation Required

Attachment L replaced for SFY2023 (Amendment No. 8)

Attachment L (RATE‑SETTING PROCESS) is deleted and replaced in its entirety with the 'State Fiscal Year 2023 Risk Adjustment Medicaid Managed Care Program dated June 27, 2022'; Amendment No. 8 was executed by the parties and dated in August 2022.

Attachment L replaced in full with the SFY 2023 Risk Adjustment Medicaid Managed Care Program (dated June 27, 2022).
Amendment No. 8 signatures and dates are included in the document (state and contractor execution).

Effective Dates & Coding/Payment Timing

Fee schedule effective dates

Hospital inpatient/outpatient effective date7/1/2022 (2.0% increase over prior year rates)

PCMH PMPM effective date7/1/2022 (PCMH PMPM set at $3.00 per member per month)

CTC payment effective date7/1/2022 ($1.15 PMPM to Care Transformation Collaborative)

Nursing home effective date10/1/2022 (2.9% increase over prior year rates)

Definitions & Payment Terms

Primary Care Medical Home (OHIC definition)

Payment amount$3.00 per member per month (PMPM)

EligibilityFor each member attributed to providers that meet the OHIC definition of Primary Care Medical Home (PCMH)

Effective date7/1/2022

Care Transformation Collaborative (CTC) payment

Payment amount$1.15 per member per month (PMPM)

RecipientPaid to the Care Transformation Collaborative for administration of the program

Eligibility