1. Program Definition and Services

Case Management Services in Rhode Island provide navigation and plan coordination to children and adults with disabilities, chronic illnesses, or aging-related needs. The program addresses health, behavioral, and social service networks to facilitate community integration and avert institutional care. Services include:

• In-Home Personal Care: Direct, person-centered support conducted in the individual/family home or community (Comprehensive Functional Assessments, Care Team Building, and Individualized Service Plan [ISP] Development)
• Residential Personal Care: High-level system oversight managed from an agency headquarters or community hubs (Referral Coordination for housing, medical, and employment networks; Care and Service Delivery Monitoring; and Medicaid Benefit Preservation)

2. Regulations

The program is governed by the following regulations:

• 210-RICR-50-10-1 (Rhode Island EOHHS Long-Term Services and Supports Rules)
• 212-RICR-10-05-1 (BHDDH Licensure and Certification Standards for Developmental Disability Organizations)
• Rhode Island Medicaid 1115 Comprehensive Demonstration Waiver
• Federal HCBS Settings Final Rule (42 CFR § 441.301(c)(1)(vi)) mandating Conflict-Free Case Management.

3. Licensing or Certification

Providers delivering long-term care case management must be formally certified as a Conflict-Free Case Management (CFCM) Entity by the Executive Office of Health and Human Services (EOHHS) and/or approved by the Department of Behavioral Healthcare, Developmental Disabilities & Hospitals (BHDDH). Certified agencies are legally prohibited from providing direct care services (such as home health or day habilitation) to the same client.

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) share joint structural oversight for evaluating applications, enforcing CFCM standards, and auditing case management agencies.

5. Application Process

The application process is handled through a multi-tier screening track. Agencies must first apply for and pass the specialized RI EOHHS CFCM Certification protocol. Once programmatic approval is granted, the agency submits its final enrollment documentation through the electronic Rhode Island Medicaid Healthcare Portal to activate billing credentials.

6. Required Documentation

While specific requirements vary by target population, providers must submit:

• Signed RI Medicaid Provider Agreement and active EOHHS/BHDDH CFCM Certification
• Case Management Policy & Procedure Manual (including ISP templates, referral workflows, and risk mitigation strategies)
• Primary-source education and license verifications for all employed case managers
• Proof of professional liability, general business liability, and workers’ compensation insurance policies
• Validated state Bureau of Criminal Identification (BCI) fingerprint clearances for all personnel

7. Timeline for Approval

The processing timeframe varies depending on the state's specific enrollment cycles or RFP open windows. The standard provider certification and enrollment track generally spans 2 to 4 months.

8. Pre-Application Process

Before applying to the state, prospective providers must register their legal entity with the Rhode Island Secretary of State, establish a physical office equipped for secure file retention, purchase professional malpractice insurance, and secure necessary federal identifying credentials (EIN and an Organizational Type 2 NPI).

9. Pre-Application Training

The state mandates specific administrative and compliance onboarding modules. Prior to managing cases, program coordinators and staff must complete online modules focused on Conflict-Free Case Management Rules, Person-Centered Plan (PCP) data generation formats, and state health information privacy protocols (HIPAA).

10. Additional Notes

• Providers must ensure that intensive care navigation settings and digital client systems meet all state accessibility and security guidelines
• In-Home Personal Care case assessments must be delivered exclusively by the certified agency's direct, qualified personnel
• All case management and coordination staff must undergo mandatory background checks and fingerprint screenings through the Rhode Island Attorney General's Bureau of Criminal Identification (BCI)
• Providers must maintain detailed logs of face-to-face contacts for Medicaid documentation, keeping all records fully synchronized with individual service timelines and federal Olmstead community-integration standards

Why Choose Waiver Consulting Group?

Starting or expanding your Medicaid waiver-funded agency can feel overwhelming, but it doesn't have to be. At Waiver Consulting Group, we simplify the process by guiding you through licensing, compliance, provider enrollment, policies & procedures, and regulatory approvals in any state.

With proven expertise, a structured process, and ongoing support, we take the guesswork out of launching your healthcare business. Whether you're a first-time entrepreneur or an established provider looking to expand, our team ensures you stay compliant, competitive, and fully operational.

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