Medicaid Benefits: Online Database

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Acute Care Services

Institutional and Clinic Services

Practitioner Services

Prescription Drugs

Physical Therapy and Other Services

Products and Devices

Transportation Services

Other Services

Long-Term Care Services

Community Based Care

Institutional Care

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Benefits by State: Rhode Island (October 2008) Notes

Acute Care Services

Is the Benefit Covered?	Copayment Requirement	Prior Approval Requirement	Coverage Limitations	Reimbursement Methodology	Populations Covered

Institutional and Clinic Services
Clinic Services, by an organized facility or clinic not part of a hospital: Freestanding Ambulatory Surgery Center
No
Clinic Services, by an organized facility or clinic not part of a hospital: Public Health and Mental Health Clinics
No
Federally Qualified Health Center Services
Yes				Prospective cost based rate/visit	CN & MN - see state-specific FN
Inpatient Hospital Services, other than in an Institution for Mental Diseases
Yes		Admissions for state specified procedures		Negotiated prospective cost based payment with a ceiling on allowable cost increases	CN & MN - see state-specific FN
Outpatient Hospital Services
Yes	$3/non-emergency visit in ER	Physical and occupational therapy, speech pathology		Prospective payment with surgical procedures grouped using Medicare methodology	CN & MN - see state-specific FN
Rehabilitation Services: Mental Health and Substance Abuse
Yes			Specified services not covered	Negotiated rate	CN & MN - see state-specific FN
Rural Health Clinic Services
Yes				Prospective cost based rate/visit	CN & MN - see state-specific FN
Practitioner Services
Certified Registered Nurse Anesthetist Services
No
Chiropractor Services
No
Dental Services
Yes		All services except emergency care and palliative treatment	Orthodontia not covered	Fee for service	CN & MN - see state-specific FN
Medical and Remedial Care - Other Practitioners

Medical/Surgical Services of a Dentist
Yes		Specified services		Fee for service	CN & MN - see state-specific FN
Nurse Midwife Services
Yes				Fee for service	CN & MN - see state-specific FN
Nurse Practitioner Services
Yes				Fee for service	CN & MN - see state-specific FN
Optometrist Services
Yes			1 refractive exam/2 years	Fee for service	CN & MN - see state-specific FN
Physician Services
Yes		Specified surgical procedures, MN only - multiple visits for chronic and acute diagnoses, psych visits after evaluation	3 patients/home visit, 6 patients/group care facility, MN limited 37 inpatient hospital visits/year	Fee for service	CN & MN - see state-specific FN
Podiatrist Services
Yes		Specified services and appliances		Fee for service	CN - see state-specific FN
Psychologist Services
No
Prescription Drugs
Prescription Drugs
Yes		Specified drugs and injectables		WAC, plus $3.40 dispensing fee for traditional pharmacies and $2.85 dispensing fee for non-traditional pharmacies	CN & MN - see state-specific FN
Physical Therapy and Other Services
Occupational Therapy Services
No
Physical Therapy Services
No
Services for Speech, Hearing and Language Disorders
No
Products and Devices
Dentures
Yes		Yes		Fee for service	CN & MN - see state-specific FN
Eyeglasses
Yes			1 pair eyeglasses/2 years	Negotiated fee for eyeglass frames, industry provided price list for lenses	CN - see state-specific FN
Hearing Aids
Yes		New or replacement hearing aid		Reasonable charge	CN - see state-specific FN
Medical Equipment and Supplies
Yes		Yes	Coverage of molded shoes varies by group	Fee for service or reasonable charge with ceilings	CN & MN - see state-specific FN
Prosthetic and Orthotic Devices
Yes		Yes		Reasonable charge with ceilings	CN & MN - see state-specific FN
Transportation Services
Ambulance Services
Yes				Fee for service	CN & MN - see state-specific FN
Non-Emergency Medical Transportation Services
Yes		Yes		See service-specific FN	CN & MN - see state-specific FN
Other Services
Diagnostic, Screening and Preventive Services
Yes		Yes		Fee for service	CN & MN - see state-specific FN
Early and Periodic Screening, Diagnosis and Treatment
See service-specific FN.
Extended Services for Pregnant Women

Family Planning Services
See service-specific FN.
Laboratory and X-Ray Services, outside Hospital or Clinic
Yes		Specified services		Fee for service	CN & MN - see state-specific FN
Targeted Case Management
Yes				Fee for service	CN & MN - see state-specific FN

Long-Term Care Services


Community Based Care
Home and Community Based Services Waiver
Yes		Services for the following populations: 2, 4 & 8 - See service-specific FN	Dependent upon the services provided	CN & MN - see state-specific FN
Home Health Services, includes nursing services, home health aides, and medical supplies/equipment
Yes	Med equipment and supplies, therapies		Fee for service	CN & MN - see state-specific FN
Hospice Care
Yes		210 day maximum coverage	Prospective rates based on Medicare methodology	CN & MN - see state-specific FN
Personal Care Services
Yes		Limited to mentally ill in residential facilities with fewer than 17 beds	Fee for service using hourly rates	CN & MN - see state-specific FN
Private Duty Nursing Services
No
Program of All-Inclusive Care for the Elderly
Yes			Capitated payment	CN & MN - see state-specific FN
Institutional Care
Inpatient Hospital, Nursing Facility and Intermediate Care Facility Services In Institutions for Mental Diseases, age 65 and older
Yes		Leave days not covered	Prospective cost based per diem	CN & MN - see state-specific FN
Inpatient Psychiatric Services, under age 21
Yes	Admission		Percentage of charge	CN & MN - see state-specific FN
Intermediate Care Facility Services for the Mentally Retarded
Yes			Prospective cost based per diem	CN & MN - see state-specific FN
Nursing Facility Services, other than in an Institution for Mental Diseases
Yes		Leave days not covered	Prospective per diem based on cost, with efficiency incentives and occupancy adjustments	CN & MN - see state-specific FN
Religious Non-Medical Health Care Institution and Practitioner Services
No

Notes: This State has an approved Section 1115 Waiver from CMS under which it extended Medicaid eligibility to a number of previously uninsured individuals. This program, called Rhode Island RIte Care, has several components, for different groups at different income levels. The State has also added the optional Medicaid buy-in group of disabled adults permissible through the Balanced Budget Act of 1997 in a program called Working Adults with Disabilities and provides them the full scope of CN benefits including home health agency-based personal care services. Beneficiaries are required to pay income-based monthly premiums. Services are provided by managed care organizations. Only policies related to those services available to all populations or reimbursed directly by the State are reflected on the tables.