Office of Managed Care Regulation

Limited Enrollment Policy Change

The Office of Managed Care Regulation (OMCR) implemented the following policy change effective January 1, 2003 to adjust the threshold for a Limited Enrollment Health Plan Certification from 1,000 to 5,000 enrollees.

Health plans operated by an entity whose total Rhode Island enrollment is less than 5,000 members are required to be certified using the following documentation:

1. An original Application for Health Plan Certification/Re-Certification form completed, signed and notarized.
2. An original Application for Health Plan Certification/Re-certification Assurances form completed, signed and notarized.
3. Copies of agreements/contracts for health plans that delegate services to another organization.

Health plans with less than 5,000 Rhode Island entity enrollees ("Limited Enrollment Health Plans") are required to submit quarterly statistics at the entity level, on an annual basis, to OMCR using the form entitled Health Plan Data Reporting Form. This is a change from reporting on a quarterly basis to once per calendar year.