CurrentNeighborhood Health Plan of Rhode IslandPolicy N/A

LTSS approval required for home care beyond preventive services

Governs requirement that members in the INTEGRITY (MMP) line of business must obtain EOHHS LTSS approval to receive home care hours beyond preventive levels; affects providers delivering home care and Neighborhood care management for these members.

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyLTSS approval required for home care beyond preventive services

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionObtain and document state EOHHS LTSS-HCBS waiver approval before providing home care beyond preventive hourly limits.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

6 hrs/wkPreventive homemaker/personal care allowed for a single member

10 hrs/wkPreventive homemaker/personal care allowed for household with 2+ members

1State agency required for LTSS approval (EOHHS)

Coverage Criteria for Long-Term Home Care

Long-Term Home Care Coverage

Covered beyond preventive limits only when ALL of the following are met

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyLTSS approval required for home care beyond preventive services

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionObtain and document state EOHHS LTSS-HCBS waiver approval before providing home care beyond preventive hourly limits.

SourceLink

On This Page

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Provider Responsibilities and Authorization Requirements

Prior Authorization

State LTSS approval required

Members enrolled in the INTEGRITY (MMP) line of business must have state EOHHS approval of LTSS (successful completion and approval of a LTSS‑HCBS waiver application) before providers deliver home care hours beyond the preventive service limits.

Preventive services limits: up to 6 hours/week for a single member or 10 hours/week for a household with two or more members.
State EOHHS LTSS‑HCBS waiver approval is required to exceed preventive levels.

Documentation Required

Document LTSS approval

Providers must document the member's approved LTSS‑HCBS waiver in the member's record prior to delivering home care beyond preventive levels. Ensure documentation includes evidence of EOHHS approval and the effective approval date.

Include LTSS approval copy or EOHHS confirmation in the chart.
Retain approval documentation for audit and payment support.

Denial Risk

LTSS approval required to avoid denial

Delivering home care hours beyond preventive levels for INTEGRITY (MMP) members without an approved LTSS‑HCBS waiver through EOHHS may result in denial of services or claims.

Verify LTSS approval before scheduling or providing extended home care services.
Contact Neighborhood Provider Services at 1-800-963-1001 or the member's Care Management team for assistance with LTSS application status.

Definitions and Service Limits

Preventive services

Single-member preventive limitUp to six (6) hours of homemaker and/or personal care services per week for a single member.

Household preventive limitUp to ten (10) hours per week for a household with two (2) or more members.

Service types includedHomemaker and/or personal care services counted toward preventive limits.

Application for additional servicesServices beyond these preventive limits require successful completion and approval of a LTSS-HCBS waiver application through EOHHS.

AssistanceNeighborhood's Care Management can assist members with LTSS-HCBS waiver applications.

LTSS-HCBS waiver approval

Approval requirementState EOHHS approval (LTSS-HCBS waiver approval) is required for members to receive more than preventive services on a long-term basis.

Who it applies toMembers enrolled in the INTEGRITY (MMP) line of business needing home care beyond preventive levels.

Where to applyMembers can complete a LTSS-HCBS waiver application on the EOHHS website.

Provider responsibilityProviders should ensure LTSS approval is obtained and documented before delivering home care beyond preventive limits to avoid noncoverage or denial.

Support contactNeighborhood Care Management can assist with applications and Provider Services can be contacted at 1-800-963-1001 for questions.

OpenPayer

LTSS approval required for home care beyond preventive services

Coverage Criteria for Long-Term Home Care

Provider Responsibilities and Authorization Requirements

Background

Definitions and Service Limits