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Rhode Island - Adult Health Transportation — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

Rhode Island manages Medicaid non-emergency medical transportation (NEMT) exclusively through a statewide broker model administered by Medical Transportation Management, Inc. (MTM) under the Executive Office of Health and Human Services (EOHHS). Providers seeking to deliver adult health transportation to covered appointments and waiver services under the Rhode Island Comprehensive Demonstration (1115 waiver) do not enroll as independent fee-for-service billers, but instead must apply to join the MTM credentialed provider network.

Approval requires passing MTM's vehicle and driver credentialing standards, securing commercial auto liability insurance, and executing a network provider agreement with the broker. Once contracted, transportation providers receive trip assignments and reimbursement directly from MTM rather than submitting claims through the state's Medicaid Management Information System (MMIS).

1. Service Definition and Scope

NEMT in Rhode Island covers transportation for eligible Medicaid beneficiaries to and from covered medical appointments and authorized home and community-based waiver services. The service is strictly non-emergency and is authorized only when the beneficiary has no other means of transportation.

Because Rhode Island utilizes a broker model, the scope of service delivery is dictated by the broker's network requirements and the state's NEMT manual.

2. Regulatory and Oversight Agencies

The Rhode Island Executive Office of Health and Human Services (EOHHS) holds the ultimate authority over the Medicaid program and the 1115 Comprehensive Demonstration waiver. However, day-to-day oversight, credentialing, and routing of NEMT providers are delegated to the state's contracted broker, MTM.

Providers must comply with both EOHHS Medicaid regulations and MTM's specific network provider standards.

3. Gatekeeping Prerequisites: Who Can Even Apply

Rhode Island does not permit open fee-for-service enrollment for NEMT providers. The structural precondition blocking direct application to the state is the mandatory broker subcontracting requirement; all NEMT providers must be approved by and contract with MTM.

Providers cannot bypass the broker to bill EOHHS directly for standard NEMT trips.

4. Licensure and Certification Requirements

Rhode Island does not issue a distinct NEMT license through the Department of Health. Instead, providers must meet the vehicle and business certification standards enforced by MTM and the Rhode Island Division of Public Utilities and Carriers (DPUC) if operating as a commercial carrier.

All vehicles must pass rigorous safety and compliance inspections before being authorized to transport Medicaid members.

5. Medicaid Provider Enrollment

Because of the broker model, traditional Medicaid provider enrollment through the EOHHS MMIS is bypassed for standard NEMT. Providers submit their credentialing applications directly to MTM's network management team.

MTM acts as the credentialing entity, ensuring all federal and state Medicaid exclusion checks are completed.

6. Staffing, Training and Background Checks

Drivers must meet strict credentialing standards before transporting Medicaid beneficiaries. MTM requires comprehensive background checks, driving record reviews, and specific safety training.

Providers are responsible for maintaining up-to-date driver files that are subject to MTM audits.

7. Documentation, Policies and Records

Providers must maintain detailed trip records to substantiate claims and pass MTM quality assurance audits. Documentation must prove the beneficiary was picked up and dropped off at the authorized locations.

Failure to maintain accurate records can result in claim denials or removal from the MTM network.

8. Billing, Rates and Claims

Billing is conducted entirely through MTM's proprietary portal, not the state MMIS. Rates are negotiated between the provider and MTM, typically structured as a base rate plus mileage.

Providers must adhere to MTM's timely filing limits and prior authorization requirements to ensure payment.

9. Approval Sequence and Timeline

The process begins with an inquiry to MTM, followed by application submission, vehicle inspections, and driver credentialing. The timeline depends on the provider's readiness and MTM's network adequacy needs.

Providers cannot accept trips until the network agreement is fully executed.

10. Common Denials and Survey Findings

Applications are most frequently delayed or denied due to incomplete driver files or vehicles failing safety inspections. Post-enrollment, providers face corrective action for late pickups or missing trip documentation.

MTM actively monitors on-time performance and member complaints.

11. Key Contacts and Resources

Providers should direct all enrollment and operational inquiries to MTM, while referencing EOHHS for overarching Medicaid policies.

The state's NEMT manual provides the foundational rules for the program.

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