§9-5-26. Supplemental Medicare and Medicaid Reimbursement
(a) A ground emergency medical transportation services provider, owned, operated by, or providing services under contract to, the state, or a city, a county, or city and county, that provides services to Medicare and Medicaid beneficiaries is eligible for supplemental reimbursement. (b) An eligible provider’s supplemental reimbursement shall be calculated and paid as follows: (1) […]
§9-5-27. Transitioning Foster Care Into Managed Care
(a) “Eligible services” means acute care, including medical, pharmacy, dental, and behavioral health services. (b) The secretary shall transition to a capitated Medicaid program for a child classified as a foster child and a child placed in foster care under Title IV-E of the Social Security Act who is living in the state by January […]
§9-5-28. Requirement for Telehealth Rates
The Medicaid plan, which issues, renews, amends, or adjusts a plan, policy, contract, or agreement on or after July 1, 2021, shall provide reimbursement for a telehealth service at a rate negotiated between the provider and the insurance company for virtual telehealth encounters. The Medicaid plan, which issues, renews, amends, or adjusts a plan, policy, […]
§9-5-29. Payments to Substance Use Disorder Residential Treatment Facilities Based Upon Performance-Based Outcomes
(a) For purposes of this section: (1) “Department” means the Department of Health and Human Resources.
§9-5-15. Medicaid Program; Preferred Drug List and Drug Utilization Review
The Legislature finds that it is a public necessity that trade secrets, rebate amounts, percentage of rebate, manufacturer's pricing and supplemental rebates that are contained in records, as well as any meetings at which this information is negotiated or discussed need confidentiality to insure the most significant rebates available for the state. Information pertaining to […]
§9-5-16. Medicaid Program; Legislative Purpose; Health Care Provider Reimbursement Study by Department; Hearings; Report
(a) It is the purpose of the Legislature in enacting this section to encourage the long-term well planned development of fair and equitable reimbursement methodologies and systems for all health care providers reimbursed under the Medicaid program in its entirety, and to ensure that reimbursement for services of all such health care providers is determined […]
§9-5-16a. Medicaid-Certified Nursing Homes; Screening of Applicants and Residents for Mental Illness; Reimbursement of Hospitals
(a) The department of human services and department of health shall cause individuals applying for admission to or residing in a Medicaid-certified nursing home to be screened as required by the Omnibus Budget Reconciliation Act of 1987. (b) Effective April 1, one thousand nine hundred eighty-nine, hospitals shall receive administrative day payment at a rate […]
§9-5-17. Nonprofit Agency or Facility, in Receipt of Medicaid Moneys, Shall Provide Annual Accounting of Gross Receipts and Disbursements Including Salaries
Any nonprofit health care agency or facility which receives Medicaid moneys shall, as a condition of the receipt of same, provide an annual accounting of that facility's or provider's receipts and disbursements, including the total salaries of all employees and administrators, with one copy of same to be submitted to the Joint Committee on Government […]
§9-5-19. Summary Review for Certain Behavioral Health Facilities and Services
(a) A certificate of need as provided in article two-d, chapter sixteen of this code is not required by an entity proposing additional behavioral health care services, but only to the extent necessary to gain federal approval of the Medicaid MR/DD waiver program, if a summary review is performed in accordance with the provisions of […]
§9-5-20. Medicaid Program; Chronic Kidney Disease; Evaluation and Classification
(a) Any enrollee in Medicaid who is eligible for services and who has a diagnosis of diabetes or hypertension or, who has a family history of kidney disease, shall receive coverage for an evaluation for chronic kidney disease through routine clinical laboratory assessments of kidney function. (b) Any enrollee in Medicaid who is eligible for […]