Effective January 1, 2026, Neighborhood Health Plan of Rhode Island (Neighborhood) is introducing two new Dual Eligible Special Needs Plans (D-SNPs): Neighborhood INTEGRITY for Duals (HMO D-SNP) and Neighborhood Dual CONNECT (HMO D-SNP).
These new products replace the current Neighborhood INTEGRITY (Medicare-Medicaid Plan), which will end on December 31, 2025, as the MMP sunsets and transitions to Fully Integrated Dual-Eligible Special Needs Plan (FIDE-SNP.)
Neighborhood INTEGRITY for Duals is a FIDE-SNP designed for individuals who qualify for both Medicare and full Medicaid benefits. This plan will continue to support members’ medical, behavioral health, and long-term services and supports (LTSS) needs in partnership with the Rhode Island Executive Office of Health and Human Services (EOHHS).
Neighborhood Dual CONNECT is a Coordination-Only D-SNP (CO D-SNP) created for members with partial Medicaid benefits. Eligibility is limited to those who are considered Qualified Medicare Beneficiaries (QMB) only. These beneficiaries are protected from Medicare cost-sharing through the state’s Medicare Premium Payment Program.
The FAQs below provide answers to common provider questions about this transition, including contracting, billing, authorizations, eligibility verification, and member enrollment.
D-SNP FAQs
Neighborhood’s current Medicare-Medicaid Plan (MMP), Neighborhood INTEGRITY, will end December 31, 2025. Beginning January 1, 2026, Neighborhood will offer two new Dual Eligible Special Needs Plans (DSNPs): The INTEGRITY (MMP) is transitioning to a Dual-Eligible Special Needs Plan (D-SNP) because the MMP was a temporary demonstration program that is ending on December 31, 2025. The federal government is requiring states to move MMP members to integrated D-SNPs, such as INTEGRITY for Duals, to continue offering a unified Medicare and Medicaid plan. This change is planned to ensure a seamless transition and maintain the benefits of integrated care, such as one identification card and care coordination. Members currently enrolled in Neighborhood INTEGRITY (MMP) will automatically move to Neighborhood INTEGRITY for Duals (HMO D-SNP) on January 1, 2026, unless they choose another plan. Members will receive new ID cards and a welcome packet explaining the change.
Neighborhood INTEGRITY for Duals is a Fully Integrated Dual-Eligible Special Needs Plan (FIDE-SNP) designed for individuals who qualify for both Medicare and full Medicaid benefits. This plan will continue to support members’ medical, behavioral health, and long-term services and supports (LTSS) needs in partnership with the Rhode Island Executive Office of Health and Human Services (EOHHS). INTEGRITY (MMP) members will automatically transition to INTEGRITY for Duals unless they pick another plan. Neighborhood Dual CONNECT is a Coordination-Only D-SNP (CO D-SNP) created for members with partial Medicaid benefits. Beneficiaries who are eligible for CONNECT are those who are considered only Qualified Medicare Beneficiaries (QMB-only). These beneficiaries receive no additional state Medicaid benefits, but whose Medicare premiums, deductibles and cost shares are paid by Medicaid. They are protected from Medicare cost-sharing through the state’s Medicare Premium Payment Program. Use NaviNet to confirm a member’s plan and benefits. Each member will have a new ID number and plan name effective January 1, 2026. All D-SNP members (both Neighborhood Dual CONNECT and Neighborhood INTEGRITY for Duals) will be issued new member ID cards in December with ID numbers that: “Deeming” refers to a temporary period in which members continue to receive Medicare Advantage benefits after losing Medicaid eligibility. The period is: Medicaid benefits, cost-sharing and premium coverage may be paused during this time. Members may be responsible for out-of-pocket costs or increased cost-sharing for Medicare covered services. Providers should verify member eligibility at each visit in NaviNet.
No. All providers currently contracted with Neighborhood remain in-network for the new D-SNP products. The transition is automatic. No. Providers’ credentialing status carries over to the D-SNP plans. No additional paperwork or re-credentialing is required.
For members enrolled in Neighborhood INTEGRITY for Duals, providers must bill directly to Neighborhood for reimbursement. For members enrolled in Neighborhood Dual CONNECT, providers must submit Medicare covered benefits to Neighborhood and any remaining copays/coinsurance amounts and Medicaid only benefits (if available) to EOHHS for reimbursement.
All current MMP members will be automatically enrolled in Neighborhood INTEGRITY for Duals effective January 1, 2026. Members may opt out of this enrollment and choose a different plan with another carrier if they prefer. Eligible individuals (QMB-Only) may enroll during the Medicare Annual Enrollment Period (October 15 – December 7, 2025). Eligible individuals will be required to complete an application in order to enroll. Direct members to the INTEGRITY for Duals and Dual CONNECT enrollment pages, which provides plan details, eligibility information, and contact links for assistance.
Yes. Annual training is required for all participating providers. For details on how to complete the training, please visit our Provider Training webpage. Yes, the D-SNP Model of Care training is integrated within the annual training. Yes. The training has been updated to apply across all lines of business. Completion of this training fulfills your contractual requirement through Fall 2026. Yes. If you completed and attested to the training prior to October 15, 2025, you are required to complete and attest again to meet the updated training requirements. Yes, a draft version of the updated Provider Manual has been posted to the website. This version outlines the new policies and procedures associated with the upcoming plans and will take effect on January 1, 2026. All contracted providers are expected to review the manual prior to this effective date to ensure compliance. Providers can email ProviderComms@nhpri.org to ask any further questions or request clarification regarding the new D-SNP products.
Provider Resources
- Provider Training
- Provider Manual (Effective 1/1/26)