§ 40-8-20.1. Prospective rate increments. The department may consider the granting of a prospective rate that reflects demonstrated cost increases in excess of the rate that has been established by the application of the percentage increase. In order to qualify for the rate increment, demonstrated increased costs must be the result of: (1) Demonstrated errors […]
§ 40-8-20.2. Best energy practices for licensed nursing facilities — Energy conservation retention credit. (a) In order to reduce overall energy consumption and to slow the rate of the growth in state Medicaid expenditures, the state of Rhode Island shall adopt an energy conservation retention credit for licensed nursing facilities that meet the criteria set […]
§ 40-8-21. Appeals process. (a) Any provider that is not in agreement, after being provided an exit-audit conference or rate-appeal conference, with a final rate of reimbursement assigned as a result of an audit for its base year, or with the application of the principles of reimbursement for an applicable year, may within fifteen (15) […]
§ 40-8-22. Protection of resources — Long-term care insurance partnership program. (a) The department of human services shall coordinate a program entitled the Rhode Island Partnership for Long-Term Care whereby private insurance and funds may be utilized to finance long-term care. The department shall seek appropriate amendments to its state plan for medical assistance under […]
§ 40-8-23. Contracting standards. The director shall establish and maintain contracting standards for home health aide, homemaker, and nursing services. These standards shall apply to all such services purchased by the state from licensed providers. The contracting standards shall take into consideration industry guidelines published by national accreditation organizations such as the Joint Commission for […]
§ 40-8-24. Less expensive alternative medications. For pharmaceutical purchases eligible for reimbursement under the Medicaid state plan, the department shall encourage the substitution of generic drugs which are therapeutically equivalent and interchangeable with specific brand name drugs in accordance with § 21-31-16.1 and related regulations of the department of health, except in the event that […]
§ 40-8-25. Nursing facility pharmaceutical waste reduction. The department shall implement one or more methods to reduce the disposal of unused pharmaceuticals paid for by the medical assistance program for residents of nursing facilities licensed pursuant to chapter 17 of title 23. The department shall make a report to the permanent joint legislative committee on […]
§ 40-8-26. Community health centers. (a) For the purposes of this section, the term community health centers refers to federally qualified health centers and rural health centers. (b) To support the ability of community health centers to provide high-quality medical care to patients, the executive office of health and human services (“executive office”) may adopt […]
§ 40-8-27. Cooperation by providers. Medicaid providers who employ individuals applying for benefits under any chapter of this title shall comply in a timely manner with requests made by the department for any documents describing employer-sponsored health insurance coverage or benefits the provider offers that are necessary to determine eligibility for the state’s premium assistance […]
§ 40-8-28. Vendors doing business in the state of Rhode Island. All vendors who do business with the state of Rhode Island in accordance with title 37 and who are also employers of Rhode Island medical assistance recipients shall make available in a timely manner to the department at the department’s request, documents describing the […]
§ 40-8-29. Selective contracting. (a) Notwithstanding any other provision of state law, the department of human services is authorized to utilize selective contracting with prior general assembly approval for the purpose of purchasing for Medicaid recipients shared-living provider services, durable medical equipment and supplies, non-emergency transportation, and any other Medicaid services, when appropriate, in order […]
§ 40-8-3. Eligibility requirements. Medical care benefits shall be provided under this chapter to at least any person: (1) Who has attained the age of sixty-five (65) years; or (2) Who has no vision or whose vision is so defective as to prevent performance of ordinary activities for which eyesight is essential; or (3) Who […]
§ 40-8-3.1. Life estate in property — Retained powers. When an applicant or recipient of Medicaid owns a life estate in property that is his or her principal place of residence with the reserved power and authority, during his or her lifetime, to sell, convey, mortgage, or otherwise dispose of the real property without the […]
§ 40-8-30. Suspension of participating providers. Any approved medical assistance provider who declines to participate in contracting for benefits in any one of the department’s medical assistance programs, including, but not limited to, any and all managed care programs, may be suspended as a participating provider and denied participation in all state-operated medical assistance programs […]
§ 40-8-31. Payments to out-of-state facilities. Effective September 1, 2014, the executive office of health and human services shall require that any payment to an out-of-state provider from whom a Medicaid-eligible individual receives services must be a facility that applies for, and is approved to participate in, the Rhode Island Medicaid program. This excludes payments […]
§ 40-8-32. Support for certain patients of nursing facilities. (a) Definitions. For purposes of this section: (1) “Applied income” shall mean the amount of income a Medicaid beneficiary is required to contribute to the cost of his or her care. (2) “Authorized individual” shall mean a person who has authority over the income of a […]
§ 40-8-4. Direct vendor payment plan. (a) The department shall furnish medical care benefits to eligible beneficiaries through a direct vendor payment plan. The plan shall include, but need not be limited to, any or all of the following benefits, which benefits shall be contracted for by the director: (1) Inpatient hospital services, other than […]
§ 40-8-4.1. Lowest price. (a) Notwithstanding any provision of law to the contrary, no medical assistance provider shall bill or charge the department of human services more than the provider’s usual and customary charge, as defined within. (b) The term “usual and customary” means the lowest charge, fee, or rate charged by a provider for […]
§ 40-8-5. Agencies through which benefits paid. Benefits shall be applied for, and paid in accordance with, prescribed regulations through the state offices or state or private agencies or organizations as the director may designate, and as shall be approved by the federal government, or any department or agency thereof, making funds available in support […]
§ 40-8-6. Review of application for benefits. The director, or someone designated by him or her, shall review each application for benefits filed in accordance with regulations, and shall make a determination of whether the application will be honored and the extent of the benefits to be made available to the applicant, and shall, within […]
