Rhode Island

State of Hepatitis C
Medicaid Access:

A-

Rhode Island

Liver damage restrictions

Fee-For-Service (FFS) does not impose liver damage restrictions. One Managed Care Organization (MCO), Neighborhood Health Plan, requires severe liver damage (F3 or greater). One MCO, UnitedHealthcare Community Plan, does not impose liver damage restrictions. One MCO, Tufts Health Plan, does not have publicly available treatment criteria.

Sobriety restrictions

FFS does not impose sobriety restrictions. Two MCOs, UnitedHealthcare Community Plan and Neighborhood Health Plan, do not impose sobriety restrictions. One MCO, Tufts Health Plan, does not have publicly available treatment criteria.

Prescriber restrictions

FFS requires that for patients with severe liver damage (F3 or F4), the provider must be on the Rhode Island Medicaid Hepatitis C Preferred Provider List, or such provider must be consulted and co-manage the patients with a primary care provider. All other patients can be treated by a primary care physician, advance practice nurse, or physician assistant. Two MCOs, UnitedHealthcare Community Plan and Neighborhood Health Plan, require the prescriber to be approved by the state. One MCO, Tufts Health Plan, does not have publicly available treatment criteria.

Recommendations

  • Remove liver damage, sobriety and prescriber requirements.
  • Ensure hepatitis C coverage parity across FFS and MCO programs and transparency regarding hepatitis C coverage guidelines.

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