KodaComplyHome care rules, state by state, in plain EnglishUpdated September 23, 2026

Rhode Island home care rules

Rhode Island's Department of Health licenses home care providers (personal care and homemaker services) and home nursing care providers, and every license is renewed each year.

More about Rhode Island

Medicaid long-term home care for adults without Medicare is paid fee-for-service by the Executive Office of Health and Human Services (EOHHS); people with Medicare and Medicaid can get it through Neighborhood Health Plan of Rhode Island's INTEGRITY for Duals plan. Electronic visit verification (EVV) claim checks restarted on July 7, 2026, and Medicaid is not approving new enrollments for two groups of home care/personal care providers (Types 65 and 72) or for home health and hospice providers until January 1, 2027.

68 official documents·collected September 22, 2026·checked against them September 23, 2026
License for non-medical home care?YesHome care provider license from RIDOH · 1 year, $650 · covers personal care and homemaker services. Certificate of need and accreditation within 2 years also required.
License for home health?YesHome nursing care provider license from RIDOH · 1 year, $650 · for nursing by RNs or LPNs, or therapy
EVVClaims checked since July 7Fee-for-service personal care, homemaker, combined and private duty nursing claims suspend without a matching EVV record, then deny after 30 days
Medicaid health plans3 plans · home care mostly fee-for-serviceNeighborhood, Tufts Health Public Plan, UnitedHealthcare. Neighborhood's INTEGRITY for Duals covers long-term services for its members with Medicare and Medicaid.

What changed, and what to do about it

Red means act now, amber means read it this month, grey is for the record.

Act nowRestarted July 7, 2026 · Provider Update 404, Sept. 2026

Claims without a matching EVV record now suspend, then deny

RI Medicaid restarted automated EVV checks on fee-for-service claims for T1000, S5125, S5130 and S5125 U1. A claim suspends if the Aggregator has no EVV record, if any of the six required data points is missing, or if the service code doesn't match. If the EVV data is still missing or wrong after 30 days, the claim denies.

What to do: Log in to your Aggregator account at least once a week, as EOHHS recommends, and clear any ESC 994, 995 or 996 claims within the 30 days.
Sources (2)
Read this monthJuly 1, 2026 to January 1, 2027 · Provider Updates 403 and 404

No new Medicaid enrollment for two personal care provider types, home health or hospice until January 1, 2027

Medicaid Provider Enrollment will not approve new Severely Disabled Nursing Homecare (Type 65), Personal Care Aid/Assistant (Type 72), home health or hospice providers during this six-month freeze. Existing providers, and applications sent before July 1, are not affected.

What to do: If you are opening a new agency, check which Medicaid provider type you would enroll as, and plan for enrollment to wait until the freeze ends if it is covered.
Sources (2)
Read this monthRIPIN program ended Feb. 28, 2026 · Provider Updates 399–402

Non-LTSS home care clients now come to you directly

EOHHS ended its care management program with RIPIN. Home care agencies no longer get RIPIN referrals. People who need non-LTSS home care refer themselves with an order from their practitioner, and agencies can start once the person is enrolled in the program in the Health Care Portal. Existing clients continue as authorized.

What to do: Before a new non-LTSS client starts, check the practitioner's order and the enrollment in the Health Care Portal.
Sources (2)
Read this monthFrom April 1, 2026 · Provider Update 402

At Home Cost Share authorizations are now weekly

OHA At Home Cost Share prior authorizations now come in one-week segments (Sunday through Saturday) instead of monthly. S5125 (personal care only) and S5130 (homemaking) can now be billed as well as S5125 U1.

What to do: Make sure each claim stays inside one authorization week.
For the recordFrom January 1, 2026 · Provider Update 396

Neighborhood's new plan for people with Medicare and Medicaid

Neighborhood INTEGRITY for Duals, a fully integrated dual-eligible special needs plan (FIDE-SNP), replaced the INTEGRITY Medicare-Medicaid Plan. Existing Medicare-Medicaid Plan members were set to move to it automatically. The plan covers long-term services and supports, and its contract requires personal care and home health providers to use EVV.

What to do: Check which of your clients are in the new plan, and confirm your contract and billing with Neighborhood.
Sources (2)

Deadlines coming up

Dates taken from the rules and notices as we read them.

8days
October 1, 2026

Federal Medicaid eligibility changes for some non-citizens begin

Some clients may lose coverage. EOHHS materials are at StayCovered.ri.gov.

83days
December 15, 2026

Written flu-shot refusals due before this date

Workers who refuse the yearly flu shot must give written notice before December 15 and wear a mask during patient contact when flu is declared widespread.

99days
December 31, 2026

Home care and home nursing care licenses expire

Renew for 2027. The annual fee is $650.

Sources (2)
100days
January 1, 2027

Enrollment freeze for some new home care/personal care, home health and hospice providers scheduled to end

Covers new Type 65 and Type 72 home care/personal care providers, and new home health and hospice providers. Existing providers are not affected.

311days
July 31, 2027

Yearly shift differential attestation due to EOHHS

EOHHS's July 2025 notice says employers attest each year, on or before July 31, that nursing assistants got the full $0.76-an-hour increase for off-shift hours. Watch for the 2027 notice.