WARWICK – The R.I. Executive Office of Health and Human Services and Thrive Behavioral Health are again butting heads, with the EOHHS alleging that Thrive maintains the ability to bill Medicaid for its Hillsgrove House facility.
Thrive, which last week said that the "clubhouse" model rehabilitation center faces potential closure without a new funding source, maintains that it has lost the ability to bill Medicaid through the facility due to a state administrative issue. The mental health provider is now requesting $500,000 from the state to keep Hillsgrove House open.
Dawn Allen, CEO and president of Thrive, last week told Providence Business News that the nonprofit learned about the funding loss when EOHHS abruptly shut down the billing code on Jan. 11.
However, Stephanie Menders, a spokesperson for EOHHS, said that Thrive's designation as a Certified Community Behavioral Health Clinic allows the organization to continue billing Medicaid.
Menders also disputed Allen's statement that EOHHS did not give Thrive notice of the administrative change.
"R.I. Medicaid informed Thrive that the state did not currently have CMS authority to bill clubhouse as a standalone service," Menders said. "We are actively in the process of seeking that authority."
Chelsea DeCesare, a spokesperson for Thrive, said that "while Thrive is a CCBHC, that designation does not make all services or programs eligible for Medicaid reimbursement.
"Clubhouse services, including those at Hillsgrove Clubhouse, are not currently billable under the CCBHC model," she continued. "Specifically, Clubhouse is not tied to a Medicaid 'triggering code' that generates payment, was not included in Thrive’s CCBHC cost report, and cannot be billed through CCBHC if individuals receive services from another CCBHC provider."
Thrive has historically billed the clubhouse program outside of the CCBHC designation to avoid this conflict, DeCesare said.
"The state’s characterization does not reflect the practical limitations of how Medicaid billing works for this model," she added.
The internationally recognized clubhouse model serves as a non-residential, community-centered rehabilitation program for adults with serious mental health conditions. Participants are known as "members" and work alongside staff to run the facility.
Clubhouse services also emphasize opportunities for members to acclimate or reacclimate to the workforce.
Though the model is more common in neighboring states, Hillsgrove is the only clubhouse facility in Rhode Island, serving 170 members. Demand for the program is growing, Allen says.
Thrive became a CCBHC in 2024, meaning that the organization provided 24/7, comprehensive mental health and substance use care to all community members, regardless of ability to pay.
The Medicaid billing dispute isn't the first time that Thrive and EOHHS have clashed this year: In January, EOHHS alleged that an audit revealed that Thrive had improperly billed more than 9,000 claims to health insurance companies and Rhode Island’s Medicaid program, WPRI-TV CBS 12 reported, totaling $1.3 million in fraudulent billing.
Thrive denied those allegations, and
last month said in a letter to legislators that EOHHS has subjected Thrive to "a series of escalating regulatory actions that, taken together, reflect a pattern of inconsistent direction, shifting interpretations and enforcement positions that are not aligned with the underlying federal billing frameworks or with prior state guidance."
Allen spoke on Thrive's $500,000 funding ask last week at an R.I. House of Representatives Finance Committee Meeting. The proposal has yet to be scheduled for a vote.
Jacquelyn Voghel is a PBN staff writer. You may reach her at Voghel@PBN.com.
