Page 17

210-RICR-30-05-3 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 3 - RITE SHARE PREMIUM ASSISTANCE PROGRAM (210-RICR-30-05-3) Type of Filing: Amendment Agency Signature _________________________________________________________________ Agency Head Signature Agency Signing Date Department of State ____________________________ Regulation Effective Date _________________________________________________________________ Department of State Initials Department of State Date 08/17/2025 July 28, 2025 E-SIGNED by Richard Charest on 2025-07-28 10:39:57 EDT July 28, 2025 E-SIGNED by Department of State on 2025-07-28 10:44:47 EDT