1. Program Definition and Services

Nursing Facility Transition (NFT) Services in Rhode Island provide short-term and ongoing support to children and adults with intellectual/developmental disabilities, structural physical limits, and chronic conditions. The program aims to help maintain individuals in the community, averting the need for long-term services and supports by safely relocating individuals from institutional nursing homes back into independent living. Services include:

• In-Home Personal Care: Individual support in the individual/family home or community (Individualized Transition Planning, Housing Searches, Benefit Application Assistance, and Post-Discharge Coordination)
• Residential Personal Care: Supervision and care in a licensed residential or community-based setting (Community Support Setup, Housing Stabilization including security deposits/utility coordination, Life Skills Coaching, and Follow-Up Post-Transition Monitoring)

2. Regulations

The program is governed by the following regulations:

• 210-RICR-50-00-1 (Rhode Island EOHHS Medicaid Long-Term Services and Supports Rules)
• 216-RICR-40-10-17 (Rhode Island Department of Health Licensing for Home Care Providers, where applicable)
• Rhode Island Medicaid 1115 Comprehensive Demonstration Waiver
• Federal HCBS Settings Final Rule (42 CFR 441.301)

3. Licensing or Certification

Providers delivering core transition coordination must be approved as an HCBS provider by the Rhode Island Executive Office of Health and Human Services (EOHHS). If the transition plan involves delivering hands-on personal care or nursing elements during relocation, the provider must also hold an active Home Care Provider License from the Rhode Island Department of Health (RIDOH) and strictly follow all Home and Community-Based Services (HCBS) requirements.

4. Responsible State Agency

The Rhode Island Executive Office of Health and Human Services (EOHHS) and the Department of Behavioral Healthcare, Developmental Disabilities & Hospitals (BHDDH) are responsible for reviewing applications, overseeing LTSS data tracking, and certifying nursing facility transition services providers.

5. Application Process

The application process is conducted through the electronic Rhode Island Medicaid Healthcare Portal. Providers must submit all foundational enrollment applications online to activate their transition specialty codes. If delivering personal care components, an active RIDOH home care license must be cross-verified during this cycle.

6. Required Documentation

While specific documentation requirements vary based on the target waiver, providers typically need to submit:

• Proof of compliance with state safety and operational rules (including RIDOH licensure, if applicable)
• Agency policies and procedures (detailing discharge planning workflows, housing coordination frameworks, and risk mitigation strategies)
• Staff qualifications and professional transition case manager profiles
• Certified Rhode Island Attorney General Bureau of Criminal Identification (BCI) fingerprint clearances for all field personnel
• Proof of general liability, professional malpractice, and workers’ compensation insurance

7. Timeline for Approval

The exact timeline for approval fluctuates based on state agency capacity and contract review queues. Providers should expect the complete profile validation and enrollment track across state agencies and Managed Care Organizations (MCOs) to take 2 to 4 months.

8. Pre-Application Process

Prospective providers must complete specific foundation tasks before applying. They must establish their business entity with the Rhode Island Secretary of State, purchase necessary operational general liability insurance, establish an office location meeting state compliance guidelines, and obtain required federal identification numbers (EIN and an Organizational Type 2 NPI).

9. Pre-Application Training

The state hosts mandatory administrative and compliance training sessions online. Prior to managing participant discharges, transition case managers and coordinators must complete explicit modules covering Medicaid LTSS benefit structures, community housing navigation pathways, and mandated Electronic Visit Verification (EVV) compliance rules for subsequent home visits.

10. Additional Notes

• Providers must ensure that intensive care or transitional community settings meet all state accessibility, local zoning, and environmental safety guidelines.
• In-Home Personal Care transition assists must be provided directly by the certified agency's employed and verified personnel.
• All direct care and coordination staff must conduct mandatory background clearances and fingerprinting screenings through the RI Attorney General's Bureau of Criminal Identification (BCI).
• Providers must maintain detailed records of face-to-face services for Medicaid documentation and billing, keeping encounter tracking fully aligned with state-approved individual discharge timelines.

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