Rhode Island TEFRA Program Agency Policy Manual

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The Rhode Island TEFRA Program Agency Policy Manual provides a comprehensive operational framework for agencies supporting children with disabilities who qualify for Medicaid benefits through the TEFRA eligibility pathway in Rhode Island. This manual aligns with the regulations established by the Rhode Island Executive Office of Health and Human Services (EOHHS), the Department of Human Services (DHS), and the Rhode Island Medicaid Program. It ensures compliance with federal guidelines under Section 134 of the Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982, which allows Medicaid eligibility for children with significant disabilities regardless of parental income, provided they meet institutional level-of-care criteria and can be safely cared for at home. The manual includes policies and procedures covering participant eligibility and application processes, level-of-care determinations, service planning and coordination, case management requirements, family cost-sharing responsibilities, provider qualifications and enrollment, rights and protections for children and families, documentation and billing, reporting and monitoring, and quality assurance. It emphasizes maintaining the health, safety, and well-being of children in the least restrictive environment by ensuring access to comprehensive home and community-based services. This manual serves as a foundational resource for TEFRA program agencies in Rhode Island, supporting the delivery of high-quality, compliant services that help families care for their children with complex needs at home while accessing vital supports through Medicaid.