ADULT HEALTH SERVICES PROVIDER IN RHODE ISLAND

Fatumata Kaba
Oct 9
4 min read

DELIVERING COMPREHENSIVE HEALTH, PERSONAL SUPPORT, AND WELLNESS SERVICES TO ADULTS WITH DISABILITIES, CHRONIC CONDITIONS, OR AGE-RELATED NEEDS

Adult Health Services in Rhode Island encompass a broad array of Medicaid-funded supports for adults who require ongoing assistance with personal care, medical monitoring, and wellness activities. These services are primarily delivered in home-based or community settings and are authorized through the Rhode Island Medicaid State Plan, 1115 Global Waiver, and various Home and Community-Based Services (HCBS) Waivers. Adult health supports are designed to prevent institutionalization, promote independence, and maintain overall health and well-being.

1. GOVERNING AGENCIES

Agency: Rhode Island Executive Office of Health and Human Services (EOHHS)

Role: Administers Medicaid programs and waiver services, processes provider enrollment and service authorizations.

Agency: Rhode Island Department of Health (RIDOH)**

Role: Licenses healthcare and home care agencies, regulates nursing and personal care standards.

Agency: Department of Behavioral Healthcare, Developmental Disabilities & Hospitals (BHDDH)**

Role: Authorizes adult health services for individuals with intellectual/developmental disabilities under HCBS waivers.

Agency: Centers for Medicare & Medicaid Services (CMS)**

Role: Sets federal guidelines for Medicaid services, including home-based care and adult wellness supports.

2. ADULT HEALTH SERVICES OVERVIEW

Adult Health Services are non-institutional supports aimed at helping adults maintain or improve their functional status, manage chronic conditions, and live independently.

Approved providers may deliver:

Skilled Nursing Care: Medication administration, wound care, chronic condition management.
Personal Care Services: Assistance with bathing, grooming, dressing, mobility, and toileting.
Health Monitoring: Vital signs, symptom tracking, and medication adherence.
Nutritional Support: Meal planning, preparation, feeding assistance, and dietary monitoring.
Home Health Aide Services: Supervised in-home assistance with ADLs and IADLs.
Adult Day Health (optional): Structured care during the day with meals, nursing oversight, and activities.
Respite & Companion Services: Temporary relief for caregivers and social support for isolated adults.
Therapy Coordination: Referrals for PT/OT/ST and behavioral support as needed.
Documentation: Care plans, shift notes, incident reports, and Medicaid billing logs.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Rhode Island Secretary of State.
Obtain an EIN and Type 2 NPI.
Apply for licensure through RIDOH if delivering skilled or in-home care services.
Enroll as a Medicaid provider through EOHHS or the RI provider portal.
Submit an Adult Health Services Policy & Procedure Manual for approval (if required).
Maintain insurance (liability, workers’ comp, malpractice for skilled care).

4. RHODE ISLAND PROVIDER ENROLLMENT PROCESS

Step 1: Register your business and secure RIDOH licensure (if applicable).

Step 2: Apply to become a Medicaid provider under appropriate service codes.

Step 3: Submit service descriptions, staff qualifications, and care protocols.

Step 4: Pass readiness checks or site inspections (for in-home and adult day health providers).

Step 5: Begin service delivery upon authorization.

5. REQUIRED DOCUMENTATION

Articles of Incorporation and EIN/NPI confirmations
RIDOH licensure certificate (for applicable services)
Insurance certificates (general, workers’ comp, malpractice)
Adult Health Services Policy & Procedure Manual including:
- Care planning and service delivery protocols
- Documentation and billing standards
- Medication safety and emergency procedures
- Staff supervision and training guidelines
- Participant rights, HIPAA compliance, and incident reporting
- Quality assurance and participant feedback tools

6. STAFFING REQUIREMENTS

Role: Registered Nurse (RN)

Requirements: RI licensure, CPR certification, care coordination experience.

Role: Certified Nursing Assistant (CNA) / Home Health Aide (HHA)

Requirements: RIDOH certification, CPR/First Aid, background check.

Role: Adult Day Program Coordinator (if applicable)

Requirements: Program oversight, staff management, and compliance knowledge.

Optional: Licensed Therapists (PT/OT/ST)

Requirements: Licensed in RI; required only if therapy is provided directly.

All staff must complete:

HIPAA and confidentiality training
Abuse prevention and mandatory reporting
Participant engagement and dignity-in-care training
Emergency preparedness and infection control
Annual performance reviews and skills assessments

7. MEDICAID WAIVER PROGRAMS

Adult Health Services are offered through:

Medicaid State Plan (PCA, HHA, RN/LPN Services)
1115 Global Waiver (HCBS): Covers adult health services in home and day settings
BHDDH IDD Waivers: Authorizes care for adults with disabilities living in the community
Katie Beckett/TEFRA (for transition-aged youth)
Self-Directed Waiver Supports: Participants can choose their own providers of adult health services

8. TIMELINE TO LAUNCH

Phase: Business Formation & Policy Manual Development

Timeline: 1–2 months

Phase: RIDOH Licensing & Medicaid Enrollment

Timeline: 2–3 months

Phase: Staff Hiring & Service Setup

Timeline: 30–60 days

Phase: Readiness Review & Participant Referrals

Timeline: Begins once enrollment and authorization are approved

9. CONTACT INFORMATION

Rhode Island Executive Office of Health and Human Services (EOHHS)

Website: https://eohhs.ri.gov

Rhode Island Department of Health (RIDOH)

Website: https://health.ri.gov

Rhode Island Medicaid Provider Portal

Website: https://www.riproviderportal.org

Department of Behavioral Healthcare, Developmental Disabilities & Hospitals (BHDDH)

Website: https://bhddh.ri.gov

Centers for Medicare & Medicaid Services (CMS)Website: https://www.cms.gov

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — RHODE ISLAND ADULT HEALTH SERVICES PROVIDER

WCG supports adult health service providers in Rhode Island with compliance, documentation, and Medicaid startup to deliver high-quality care in homes and communities.

Scope of Work: