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community-based setting as defined in Part 50-10-1 of this Title will receive all essential primary care benefits through a Rhody Health Partners managed care plan. Medicaid LTSS will be provided out-of-plan and paid for on a fee-for-service basis after the first 30 days. 2. Medicaid-only LTSS in a health institution --Persons seeking or receiving Medicaid in an institutional setting such as a nursing facility or hospital in accordance with Part 50-05-1 of this Title will be receive all Medicaid- covered services (primary care, subacute care, long-term services and supports) on a fee-for-service basis. 1.6.1 RHO Appeals

The class of Medicaid beneficiaries who were enrolled in RHO on and before October 1, 2018 do not have the right to appeal the termination of their RHO coverage in accordance with 42 C.F.R. § 431.220 (b) and § 10-05-2.2.1(A)(7)(a) of this Title. The right to appeal agency actions unrelated to this change in law and policy that affect eligibility, or the scope, amount, and or duration of Medicaid benefits is preserved. 1.7 Medicare-Medicaid Plan (MMP) 1.7.1 Overview

Under the authority of a special Federal Financial Alignment Demonstration, the MMP is designed to manage and coordinate the full spectrum of both Medicaid and Medicare services for Medicare and Medicaid (MME) adults. Enrollment is voluntary for eligible beneficiaries. A three (3) way agreement between EOHHS, the MCO operating the MMP, and the Federal Centers for Medicare and Medicaid Services (CMS) governs the organization, financing, and delivery of Medicaid and Medicare services to MME beneficiaries who choose to participate. 1.7.2 MMP Participation Criteria A. MME beneficiaries are eligible for participation in the MMP if they are age twenty- one (21) and older as follows: 1. MME Enrollees – Medicare-Medicaid beneficiaries who are receiving Medicaid health coverage, enrolled in Medicare Part A, enrolled in Medicare Part B, and eligible to enroll in Medicare Part D. This cohort includes MME and other Community Medicaid IHCC group beneficiaries as well as those who need LTSS. Eligible MME beneficiaries include: a. Members of the IHCC groups receiving Community Medicaid, including persons with serious and persistent mental illness, who do not need LTSS; b. MAGI-eligible adults in the MACC group for parents/caretakers;