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210-RICR-30-05-2 TITLE 210 – EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES CHAPTER 30 – MEDICAID FOR CHILDREN, FAMILIES AND AFFORDABLE CARE ACT (ACA) ADULTS SUBCHAPTER 05 – SERVICE DELIVERY OPTIONS PART 2 – MEDICAID MANAGED CARE DELIVERY OPTIONS 2.1 RIte Care Overview A. RIte Care was initially established as a statewide managed care demonstration project in 1994 under a waiver granted pursuant to § 1115 of the Social Security Act, 42 U.S.C. § 1315. The project's goal was to use a managed care delivery system to increase access to primary and preventative care for certain individuals and families who otherwise might not be able to afford or obtain affordable coverage. Medicaid members participating in RIte Care are enrolled in a managed care organization (MCO). EOHHS contracts with MCOs to provide these health services to members at a capitated rate (fixed cost per enrollee per month). RIte Care managed care plans serve the following MACC coverage groups: children, parent caretakers, foster children (DCYF custody), and pregnant women. B. Individuals who have access to employer-sponsored health insurance plans are evaluated for participation in the RIte Share Premium Assistance Program in accordance with provisions contained in "RIte Share Premium Assistance Program" (Part 3 of this Subchapter). Adults in these families are required to enroll any Medicaid-eligible family members in a RIte Share approved plan as a condition of retaining Medicaid eligibility. Medicaid is provided on a fee-for- service basis for certain beneficiaries in the populations RIte Care plans serve. 2.2 Scope and Purpose A. The purpose of this Rule is to describe the RIte Care delivery system and the respective roles and responsibilities of EOHHS and the individuals and families that are receiving affordable coverage through a RIte Care MCO. 2.3 Legal Authority A. This Part is promulgated pursuant to Federal authorities as follows: 1. Federal Law: § 1115 of the Social Security Act, 42 U.S.C. § 1315; Title XIX of the Social Security Act, 42 U.S.C §§ 1396a-1396w-8; Title XXI of the Social Security Act, 42 U.S.C. §§ 1397aa-1397mm; 42 U.S.C. §