1. Program Definition and Services

Personal Care Services (PCS) in Rhode Island provide short-term and ongoing support to children, elders, and adults with intellectual/developmental disabilities, structural physical limits, and chronic conditions. The program aims to help maintain individuals with functional limitations in the community, averting the need for long-term institutional services and supports. Services include:

• In-Home Personal Care: Individual support in the individual/family home or community (Assistance with Activities of Daily Living [ADLs] such as bathing, dressing, grooming, toileting, eating, mobility, and essential non-clinical medication reminders)
• Residential Personal Care: Supervision and care in a licensed residential or community-based setting (Instrumental Activities of Daily Living [IADLs], including light housekeeping, meal preparation, grocery shopping, safety monitoring, and non-medical escort accompaniment to appointments)

2. Regulations

The program is governed by the following regulations:

• 216-RICR-40-10-17 (Rhode Island Department of Health Licensing for Home Care Providers)
• 210-RICR-20-05-1.6 (Rhode Island EOHHS Scope of Home Care and Home Health Services)
• Rhode Island Medicaid 1115 Comprehensive Demonstration Waiver
• Federal HCBS Settings Final Rule (42 CFR 441.301)

3. Licensing or Certification

Providers delivering personal care services must be formally licensed as a Home Care Provider by 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 Rhode Island Department of Health (RIDOH) are jointly responsible for reviewing applications, issuing facility licenses, and certifying personal care services providers.

5. Application Process

The application process is conducted through the electronic Rhode Island Medicaid Healthcare Portal. Providers must submit all state-mandated forms online to initiate the enrollment process after securing an active RIDOH home care license.

6. Required Documentation

While specific documentation requirements vary based on the target waiver or long-term support program, providers typically need to submit:

• Proof of an active RIDOH Home Care Provider License
• Agency clinical policies and procedures (detailing emergency backup coverage, abuse prevention, and patient grievance resolving mechanics)
• Staff qualifications, training records, and registered nurse supervisor credentials
• State-mandated criminal background fingerprint clearances (BCI checks)
• Proof of general liability, professional malpractice, and workers’ compensation insurance

7. Timeline for Approval

The exact timeline for approval fluctuates based on agency capacity and inspection backlogs. Providers should contact the RIDOH and EOHHS enrollment divisions for detailed information on current processing timeframes, which typically span 3 to 5 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 professional and commercial auto liability binders, lease or establish an operational office headquarters, and secure federal identification numbers (EIN and a Type 2 NPI).

9. Pre-Application Training

The state hosts mandatory administrative and compliance training sessions online. Prior to field assignment, all administrative leaders and direct care workers must complete state-approved modules addressing Electronic Visit Verification (EVV) compliance, HIPAA mandates, and elder abuse mandatory reporting protocols.

10. Additional Notes

• Providers must ensure that intensive care settings meet all state accessibility and environmental safety guidelines
• In-Home Personal Care must be provided directly by the certified agency's employed personnel; personal care services under RI Medicaid may only be billed when explicitly delivered by a licensed Nursing Assistant (NA)
• All direct care staff must conduct mandatory background clearances and fingerprinting screenings through the Rhode Island Attorney General's Bureau of Criminal Identification (BCI)
• Providers must maintain detailed records of face-to-face services for Medicaid documentation and billing, requiring real-time clock-in/clock-out tracking via an EOHHS-compliant EVV system

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.

To get started, click the link to request portal access