A Guide to Rhode Island’s Integrated Care Initiative for Individuals and Families
Nursing Home Residents
(updatedApril 2014)
Rhode Island has launched a new Integrated Care Initiative to better manage the care of individuals receiving long term care services under Medicaid. This includes nursing home residents, assisted living residents, and people receiving services in the community such as adult day and home care services. This Integrated Care Initiative is a dramatic change for individuals and families, and LeadingAge RI has created this brief document to supplement the information that is being provided by the State.
- How is the Rhode Island Medicaid program changing its long term care services?
The RI Medicaid program is moving most individuals with Medicaid and Medicare that receive long term care services into one of two new programs – Rhody Health Options, which is administered by Neighborhood Health Plan of Rhode Island; or Connect Care Choice Community Partners (4CP), which is administered by CareLink. In addition, consumers will still be able to access the PACE program (which has separate eligibility criteria) or remain with the traditional Medicaid program they are currently in.
- What is Rhody Health Options?
Rhody Health Options is a managed care program operated by Neighborhood Health Plan of RI (NHPRI). NHPRI is a managed care organization and is responsible for the payment and delivery of your Medicaid services. It will have contracts with a network of providers for your services, just like managed care companies usually do for doctors, etc. Please note that there will be no change to your Medicare services. So if you have Medicare Advantage, that does not change, nor will any other Medicare-related service like physician care, hospital care, etc. NHPRI is only responsible for Medicaid, which helps pay for your long term care services.
- What is Connect Care Choice Community Partners (4CP)?
This program is a care coordination model, in which CareLink care managers will work with your existing providers to ensure you are receiving the care that is necessary. It is not a managed care organization and is not responsible for contracting or paying for your services.
- How is Rhode Island notifying consumers about these new long term care programs?
The state is sending out letters to individuals on Medicaid and Medicare assigning them to Rhody Health Options or 4CP. It transitioned existing individuals between November 2013 and April 2014, and is now enrolling newly eligible people into one of these two programs.
- What do I do if I do not want to be in one of these programs?
It is very important that you understand all of your options. While the state is automatically assigning you to one of the new programs, you can “opt-out” of this decision and remain in the current Medicaid program. So when you receive your letter, if you do not want to be in one of these programs, you need to call the state at 1-855-444-3604 and request to stay with “Medicaid fee-for-service.” Similarly, if you wish to change programs from Rhody Health Options to 4CP or vice versa, you also need to call the state and request a change.
- Do I need to select a program?
The state is using an “opt-out” approach, in which it is automatically assigning consumers to one of the new programs. So there is nothing for consumers to do until they receive their letter.
- What do I do when I receive a letter assigning me to a program?
When you receive the letter, you need to understand which program you have been assigned to (Rhody Health Options / NHPRI or 4CP / CareLink) and what your options are. If you are comfortable with the plan selected for you, you do not need to do anything, and you will hear from either NHPRI or CareLink when your enrollment becomes effective. You will also want to alert your nursing home that you have received the letter and the program in which you were enrolled. And again, if you do not want to be in the program that the letter assigns you to, you can call the number on the letter and request a change.
- What do I do if I change my mind about these options?
If you change your mind about your program, you can switch programs each month or opt out. You can do so by calling the state at 1-855-444-3604 and requesting the change.
- Will this affect my eligibility for services or the services that I receive?
No. The current process for eligibility, involving your financial eligibility and your Level of Care, does not change at all. There shouldalso be no immediate change in your services. Whether you are in the 4CP / CareLink program or the Rhody Health Options / NHPRI program, you cannot be forced out of your nursing home. You may receive periodic visits by another nurse or care manager from either NHPRI or CareLink to help coordinate any additional assistance you need. Again, there will be no changes to your Medicare services (physicians, etc.)
- Will I have to pay more for services?
No. Regardless of which program you are enrolled in, there will be no change to any cost sharing payments under Medicaid that you may be responsible for. NHPRI and CareLink cannot charge you separately for any services you are already receiving under Medicaid. And again, this does not affect Medicare in any way.
- Why is the state doing this?
The Rhode Island Medicaid program, like several other states, is pursuing new ways to provide the long term care and services people receive in the hopes that it will improve care and be more cost-effective.
- What is the benefit to me?
The goal of the two programs is to better coordinate your health care and long term care services to make sure your needs are effectively met. NHPRI and CareLink are intended to be partners in your care, working with you.
- What if I have a problem or a complaint?
This is a new initiative, so it is important that you voice any problems or concerns that you have. If you do, you can contact either NHPRI at 401-459-6601 or CareLink at 1-855-654-4067. There is not currently a complaint hotline operated by the state, but NHPRI and CareLink have to report any grievances to the state.