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210-RICR-10-00-7 TITLE 210 – EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES CHAPTER 10 – EOHHS GENERAL PROVISIONS SUBCHAPTER 00 – GENERAL PROVISIONS PART 7 – MEDICAID PROGRAM INSTITUTIONS FOR MENTAL DISEASES 7.1 Legal Authority

The State of Rhode Island Executive Office of Health and Human Services (EOHHS), as the single state agency responsible for the State of Rhode Island Medicaid Program, reviews compliance with federal requirements to determine whether a Medicaid provider remains eligible for Medicaid reimbursement. R.I. Gen. Laws § 42-7.2-2 (a)(6); Title XIX of the U.S. Social Security Act, 42 U.S.C. § 1396a et seq. This includes ensuring compliance with federal regulations regarding whether a facility is excluded from the Medicaid program as an Institution for Mental Disease (IMD). 42 C.F.R. § 435.1010; CMS State Medicaid Manual, § 4390. This IMD compliance review is critical to the proper administration of the Medicaid Program in compliance with all applicable federal laws and regulations. 7.2 Purpose and Scope

This regulation applies to any hospital, nursing facility, or other institution of more than sixteen (16) beds, that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases, including medical attention, nursing care, and related services shall be considered an IMD and be excluded from Medicaid reimbursement. Whether a facility is an IMD is determined by its overall character as that of a facility established and maintained primarily for the care and treatment of mental disease whether or not the facility is licensed as such. 7.3 Definitions A. For purposes of this section, the following definitions apply: 1. “At-risk facility” means a facility that is considered at risk of becoming an IMD if one (1) of the following applies: a. The facility was identified as an At-Risk Facility during a prior IMD review by EOHHS; b. Forty-five percent (45%) or more of the facility’s residents or patients carry a primary diagnosis of a mental disorder or disease