RI Medicaid Program: State Plan Amendments and Section 1115 Waiver Demonstration Category Changes

The RI Medicaid State Plan (MSP) and the State’s Medicaid Section 1115 waiver demonstration provide the legal authority required under federal law to operate the Medicaid program;

  • The MSP is a document that serves as a contract between the State and the federal government that delineates Medicaid eligibility standards, provider requirements, payment methods, and health benefit packages. A Medicaid State Plan is submitted by each state and is approved by the Centers for Medicare and Medicaid Services (CMS).
  •  The RI Section 1115 waiver constitutes the legal authority granted to the State by the Secretary of the U.S. Department of Health and Human Services. The Section 1115 waiver provides the State with the flexibility to pursue innovations that improve health care access, quality and outcomes and further the goals of the Medicaid and CHIP Programs.  The terms and conditions of the State’s Section 1115 waiver act as a contract that establishes the scope of the State’s flexibility under federal law relative to the MSP.   

Should the State make changes to the Medicaid program that affect eligibility, the amount, duration, or scope of services; payment methodologies; or delivery systems, alterations must be made to the MSP and/or the Section 1115 waiver in accordance with procedures established under federal law. State Plan Amendments alter the MSP while Category Changes update the Section 1115 waiver. The two change documents operate in similar manners.

Recent MSP and Section 1115 waiver amendments are available below:

Type of Amendment  Purpose Notice to Submit Effective Date
 SPA Nursing Home Rate Freeze and Direct Care Policy Adjustment Phase Out   10/27/17  
SPA   Recovery Audit Contractor Program  9/7/17  
 SPA Disproportionate Share Hospital Policy   7/30/17  
 SPA Out-patient Hospital Rates   7/30/17  
SPA  In-Patient Hospital Rates   7/30/17  
 SPA Revisions to Proposed Covered Outpatient Drug Payment Methodology   7/23/17  
SPA  Disproportionate Share Hospital Policy   6/29/17  
 SPA Home Health Face-to-Face Requirements   5/12/17  
 SPA Covered Outpatient Drug Payment Methodology   3/31/17
 SPA Medically Needy Income Limit   3/29/17
 SPA Standards for Optional State Supplemental Payments   3/29/17
 SPA Increase in Home Equity Limit for Long-Term Care   3/29/17
SPA Centers of Excellence   10/25/2016 11/1/16 

 Category 2

Institutional Level of Care Determination Policy

 7/29/2016  10/20/16


Opioid Treatment Programs Health Home

 7/29/2016 7/1/16 


Disproportionate Share Hospital Policy



Out-patient Hospital Rates

 7/29/2016 7/1/16 


In-patient Hospital Rates



R.I. Medicaid Health System Transformation Project

 4/27/2016  10/20/16


Cedar Health Centers

 2/4/2016 1/1/16 

Integrated Health Homes

 1/18/2016  1/1/16

Outpatient Hospital Rate Reduction


In-Patient Hospital Rate Reduction 


Cedar Family Center Redesign 

 Category 2

Adult Medical Day Care 

 Category 2

Peer Specialist 

 Category 2

Coordinated Care Program Pilot 

 Category 2

Home Stabilization Initiative 

 Category 2

Sobering Treatment Opportunity Program 

 Category 2

Level of Care Determination 

 10/26/2015 5/5/16 
 Category 2

Personal Choice Waiver 


Increase to GME Funding 


Reduce NICU Policy Adjustor 


Eliminate Nursing Home Rate Increase 


Disproportionate Share Hospital Policy 

 8/19/2015 7/21/15 
 Category 2

Cortical Integrative Therapy 


In-Patient Hospital Payment Methodology 

 SPA In-Patient Hospital Adjustment Payment   6/5/2015  
 SPA Graduate Medical Education   6/5/2015  
 SPA Rate Reduction for Incontinence Supplies   4/24/2015  
 SPA Elimination of Children's Health Insurance Program Premiums   1/21/2015  
 SPA  Standards for State Supplemental Payments  2/15/2015  
 SPA Increase in Home Equity Limit for Long-Term Care   2/15/2015  
SPA  Medically Needy Income Limit   2/15/2015  
 SPA Medically Needy Benefit Alignment   1/23/2015  
MSP   Disproportinate Hospital Share Policy  5/21/2014  
 Waiver Change Comprehensive Quality Strategy for 1115 Medicaid Demonstration   3/2014  
 MSP Presumptive Eligibility by Hospitals  2/25/2014  
 MSP Coverage of Barbiturates, Benzodiazepines, and Smoking Cessation Drugs  2/28/2014  
 MSP Transportation  3/3/2014  
 MSP  Standards for Optional State Supplementary Payments  3/12/2014  
 MSP  Medically Needy Income Limit  3/12/2014  
 MSP  Increase in Home Equity Limit for Long-Term Care
 MSP  Single State Agency  12/12/2013  1/1/2014
 MSP State Residency Requirements  12/12/2013  1/1/2014





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