§ 40-8.13-1. Definitions.
For purposes of this section the following terms shall have the meanings indicated:
(1) "Beneficiary� means an individual who is eligible for medical assistance under the
Rhode Island Medicaid state plan established in accordance with 42 U.S.C. § 1396, and includes individuals who are additionally eligible for benefits under the Medicare
program (42 U.S.C. § 1395 et seq.) or other health plan.
(2) "Duals demonstration project� means a demonstration project established pursuant to
the financial alignment demonstration established under section 2602 of the Patient
Protection and Affordable Care Act (Pub. L. No. 111-148) [42 U.S.C. § 1315b], involving a three-way contract between Rhode Island, the federal Centers for Medicare
and Medicaid Services ("CMS�), and qualified health plans, and covering healthcare
services provided to beneficiaries.
(3) "EOHHS� means the Rhode Island executive office of health and human services.
(4) "EOHHS level-of-care tool� refers to a set of criteria established by EOHHS and used
in January, 2014 to determine the long-term-care needs of a beneficiary as well as
the appropriate setting for delivery of that care.
(5) "Long-term-care services and supports� means a spectrum of services covered by the
Rhode Island Medicaid program and/or the Medicare program, that are required by individuals
with functional impairments and/or chronic illness, and includes skilled or custodial
nursing facility care, as well as various home- and community-based services.
(6) "Managed care organization� means any health plan, health-maintenance organization,
managed care plan, or other person or entity that enters into a contract with the
state under which it is granted the authority to arrange for the provision of, and/or
payment for, long-term-care supports and services to eligible beneficiaries under
a managed long-term-care arrangement.
(7) "Managed long-term-care arrangement� means any arrangement under which a managed care
organization is granted some or all of the responsibility for providing and/or paying
for long-term-care services and supports that would otherwise be provided or paid
under the Rhode Island Medicaid program. The term includes, but is not limited to,
a duals demonstration project, and/or phase I and phase II of the integrated care
initiative established by the executive office of health and human services.
(8) "Plan of care� means a care plan established by a nursing facility in accordance with
state and federal regulations and that identifies specific care and services provided
to a beneficiary.