A managed long-term-care arrangement must require that all participating managed care organizations use only the EOHHS level-of-care tool in determining coverage of long-term-care supports and services for beneficiaries. EOHHS may amend the level-of-care tool provided that any changes are established in consultation with beneficiaries and providers of Medicaid-covered long-term-care supports and services, and are based upon reasonable medical evidence or consensus, in consideration of the specific needs of Rhode Island beneficiaries. Notwithstanding any other provisions herein, however, in the case of a duals demonstration project, a managed care organization may use a different level-of-care tool for determining coverage of services that would otherwise be covered by Medicare, since the criteria established by EOHHS are directed towards Medicaid-covered services; provided, that the level-of-care tool is based on reasonable medical evidence or consensus in consideration of the specific needs of Rhode Island beneficiaries. History of Section.P.L. 2014, ch. 145, art. 18, § 6.
Rhode Island Legal Code