Attention RI Medicaid Members: Update on Prescription Access Due to a cybersecurity issue, a contractor serving pharmacies and Medicaid programs across the US is unable to provide important online services at this time. In Rhode Island, this situation impacted pharmacies’ ability to fill prescriptions for members of the AIDS Drug Assistance Program (ADAP) and the Medicaid Program. In response, RI EOHHS has quickly brought online a new way for pharmacies to process claims. Rhode Island Medicaid has also told pharmacies that they can provide a 30-day supply of any prescriptions you are trying to fill, to help you get through this time. The pharmacy should not charge you for any prescription that is covered by Medicaid. Learn more.
Durable Medical Equipment Provider Representative: Fidelia Williams-Edward Tel. (401) 648-3759 email:fidelia.williams@gainwelltechnologies.com Provider Reference Manual Durable Medical Equipment Reference Manual Updates Prior Authorization for Durable Medical Equipment (DME) The Enteral Nutrition Guidelines can be found in the DME Reference Manual Useful Information Home Health Final Rule (2348-F) Effective July 1, 2017 Below are details of the Home Health Final Rule (2348-F) from CMS, including Medicaid face-to-face requirements for home health services, policy changes, and clarifications related to home health and Durable Medical Equipment. For more information click the following links: Medicaid Program: Face-to-Face Requirements for Home Health Services; Policy Changes and Clarifications Related to Home Health- A Rule by the Centers for Medicare and Medicaid Services on 02/02/2016 DME Items: Face to Face Requirement Effective 7/1/2017 Durable Medical Equipment Reimbursement Effective July 1, 2012 The Rhode Island Executive Office of Health and Human Services, in conjunction with the State Fiscal Year 2013 Budget, have been directed to implement a new reimbursement rate for durable medical equipment. The new rate is 85% of the Medicare Fee Schedule and will be effective retroactively to 7/1/2012. Adjustments will take place during each of the five financial cycles of May through June 2013. Should you have questions, please contact Customer Service at 401-784-8100 for local and long distance calls or 1-800-962-6411 for in-state toll calls and border communities. Financial Cycle Date Months To Be Adjusted May 10, 2013July and August 2012 May 17, 2013September and October 2012 May 31, 2013November and December 2012 June 14, 2013January and February 2013 June 28, 2013March and April 2013