1. Program Definition and Services

The TEFRA/Katie Beckett pathway in Rhode Island provides Medicaid access to children under 19 with significant disabilities or complex medical needs. By evaluating only the child’s financial eligibility and bypassing parental income, the program funds home-based care to avert institutional placement. Services include:

• In-Home Personal Care: Shift-based and continuous daily living support (Personal Care Assistance [PCA], Home Health Aide [HHA] support, non-medical respite care, and pediatric case management)
• Residential Personal Care: Specialized clinical and therapeutic support delivered at home or in integrated settings (Skilled Nursing [RN/LPN], Physical, Occupational, and Speech-Language therapies, Applied Behavior Analysis [ABA], and Durable Medical Equipment coordination)

2. Regulations

The program is governed by the following regulations:

• 210-RICR-50-10-3 (Rhode Island EOHHS Katie Beckett Program Rules)
• Section 134 of the Federal Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982
• Rhode Island Medicaid 1115 Comprehensive Demonstration Waiver
• Federal HCBS Settings Final Rule (42 CFR 441.301)

3. Licensing or Certification

Providers delivering clinical, nursing, or therapy services under this pathway must hold an active agency license, such as a Home Nursing Care Provider, Home Care Provider, or Therapy Group credential from the Rhode Island Department of Health (RIDOH) and follow all Home and Community-Based Services (HCBS) guidelines.

4. Responsible State Agency

The Rhode Island Executive Office of Health and Human Services (EOHHS) directly manages the Katie Beckett Unit, establishes clinical eligibility, performs cost-effectiveness evaluations, and handles provider enrollment.

5. Application Process

The application process is managed through the electronic Rhode Island Medicaid Healthcare Portal. Agencies enroll under the specific specialty and provider type codes that match their RIDOH license to receive direct Medicaid service authorizations.

6. Required Documentation

While specific requirements vary by clinical track, providers typically need to submit:

• Active RIDOH Professional or Facility Licensure
• Pediatric-specific policies and procedures (including family engagement protocols and emergency workflows)
• Primary-source verification of staff credentials (RNs, LPNs, therapists, and BCBAs)
• Comprehensive general, professional, and medical malpractice liability insurance
• State-mandated Bureau of Criminal Identification (BCI) fingerprint clearances for all field staff

7. Timeline for Approval

The electronic enrollment track through the EOHHS portal typically takes 1 to 3 months, depending on state processing volumes, after which individual prior authorizations (PAs) can be issued.

8. Pre-Application Process

Prospective agencies must complete essential foundation tasks before applying. They must register their business entity with the Rhode Island Secretary of State, secure professional malpractice policies tailored to pediatric care, establish a compliant office space, and obtain their federal EIN and an Organizational Type 2 NPI.

9. Pre-Application Training

The state requires administrative and field personnel to fulfill specific educational modules. Agency directors and supervisors must complete online courses covering Medicaid Prior Authorization (PA) guidelines, Electronic Visit Verification (EVV) compliance rules, and mandated pediatric abuse reporting laws.

10. Additional Notes

• Providers must ensure that intensive care or therapy environments meet all state accessibility and environmental safety guidelines
• In-Home Personal Care and skilled interventions must be delivered directly by the certified agency's employed personnel, with Medicaid functioning as the payer of last resort behind private insurance
• All direct care staff must conduct mandatory background clearances and fingerprinting screenings through the RI Attorney General's Bureau of Criminal Identification (BCI)
• Providers must maintain detailed logs of face-to-face care for Medicaid billing, documenting severe functional limitations and syncing all home care shifts with state EVV infrastructure

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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.

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