HOME HEALTH CARE SERVICES PROVIDER IN RHODE ISLAND

Fatumata Kaba
Oct 9
4 min read

DELIVERING SKILLED NURSING, THERAPIES, AND SUPPORTIVE IN-HOME CARE TO IMPROVE HEALTH AND INDEPENDENCE ACROSS RHODE ISLAND COMMUNITIES

Home Health Care Services in Rhode Island are Medicaid-covered medical and supportive services provided in an individual’s home by licensed professionals. These services are essential for individuals recovering from illness, managing chronic conditions, or requiring long-term skilled care. Home health care is administered under Rhode Island Medicaid, the State Plan, and waiver programs, with oversight from the Rhode Island Department of Health (RIDOH) and the Executive Office of Health and Human Services (EOHHS).

1. GOVERNING AGENCIES

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

Role: Administers Medicaid and LTSS benefits, including home health authorizations.

Agency: Rhode Island Department of Health (RIDOH)

Role: Licenses and inspects Home Nursing Care Providers and Home Care Providers.

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

Role: Establishes federal compliance standards for Medicaid-funded home health agencies.

Agency: Community HealthChoices Managed Care Organizations (CHC MCOs)

Role: Authorize and reimburse home health services under integrated care models.

2. HOME HEALTH CARE SERVICES OVERVIEW

These services allow medically eligible individuals to receive necessary nursing and therapy in the comfort of their home, preventing institutionalization and promoting recovery.

Approved providers may deliver:

Skilled Nursing Services: Medication administration, wound care, disease management, and monitoring.
Home Health Aide Services: Basic care such as bathing, dressing, feeding, and mobility assistance.
Physical, Occupational, and Speech Therapy: Post-hospital rehab and long-term functional support.
Medical Social Work: Case management, counseling, and community resource navigation.
Telehealth (if authorized): Remote monitoring and virtual visits to supplement care.
Care Coordination & Documentation: Plan of care development, physician updates, and Medicaid billing compliance.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your agency with the Rhode Island Secretary of State.
Obtain an EIN and Type 2 NPI.
Apply for licensure as a Home Nursing Care Provider (for skilled services) or Home Care Provider (for aide services) through RIDOH.
Enroll in Rhode Island Medicaid and PROMISe™ as a home health provider.
Maintain professional liability and workers’ compensation insurance.
Develop a Home Health Care Services Policy & Procedure Manual following RIDOH and Medicaid guidelines.

4. RHODE ISLAND PROVIDER ENROLLMENT PROCESS

Step 1: Form your legal entity and obtain EIN, NPI, and required insurance policies.

Step 2: Submit a licensure application to RIDOH for either home nursing or home care services.

Step 3: Enroll in the Medicaid provider network via the RI provider portal.

Step 4: Contract with Medicaid MCOs and submit required staffing, policy, and readiness documentation.

Step 5: Once approved, receive service authorizations and begin accepting clients.

5. REQUIRED DOCUMENTATION

Articles of Incorporation and business registration
EIN and NPI verification
RIDOH license as Home Nursing or Home Care Provider
Insurance certificates (liability, malpractice, workers’ comp)
Home Health Care Policy & Procedure Manual including:
- Clinical care protocols and RN supervisory procedures
- HIPAA compliance and participant consent policies
- Emergency response, medication handling, and infection control
- Shift notes, electronic visit verification (EVV), and billing logs
- Admission assessment forms and discharge planning checklists

6. STAFFING REQUIREMENTS

Role: Registered Nurse (RN)

Requirements: RI nursing license; responsible for assessments, care plans, and staff supervision.

Role: Licensed Practical Nurse (LPN)

Requirements: Licensed by RIDOH; assists with clinical tasks under RN direction.

Role: Home Health Aide (HHA)

Requirements: Completion of certified training program; background checks; CPR/First Aid.

Role: Physical, Occupational, or Speech Therapist

Requirements: RI licensure in respective discipline; physician referral required.

Role: Program Administrator

Requirements: Manages operations, scheduling, compliance, and clinical staff coordination.

All staff must complete:

Orientation and skills competency validation
HIPAA and patient rights training
Infection control and emergency preparedness education
Documentation and billing compliance protocols

7. MEDICAID WAIVER PROGRAMS

Home Health Care Services are available under:

Rhode Island Medicaid State Plan: Covers physician-referred skilled care and aide support.
Global Consumer Choice Compact 1115 Waiver: Allows broader HCBS access including home nursing.
BHDDH DD Waivers: May authorize home health for individuals with developmental disabilities.
Katie Beckett Program: Supports skilled in-home care for medically complex children.

8. TIMELINE TO LAUNCH

Phase: Business Registration & Policy Manual Creation

Timeline: 1–2 months

Phase: RIDOH Licensure & Medicaid Enrollment

Timeline: 2–3 months

Phase: Staff Hiring, Credentialing & Compliance Training

Timeline: 30–60 days

Phase: Contracting & Service Launch

Timeline: Begins upon approval and authorization

9. CONTACT INFORMATION

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

Website: https://eohhs.ri.gov

Rhode Island Medicaid Provider Portal

Website: https://www.riproviderportal.org

Rhode Island Department of Health – Home Care Licensure

Website: https://health.ri.gov/licenses/detail.php?id=282

Centers for Medicare & Medicaid Services (CMS)

Website: https://www.cms.gov

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — RHODE ISLAND HOME HEALTH CARE PROVIDER

WCG helps new and expanding agencies launch fully licensed and compliant home health services tailored to Rhode Island’s Medicaid and managed care systems.

Scope of Work: