Title 40, Title 40 Services

The director shall make and promulgate rules, regulations, and fee schedules not inconsistent with state law and fiscal procedures as he or she deems necessary for the proper administration of this chapter and to carry out the policy and purposes thereof, and to make the departme…

The department of human services and/or the secretary of the executive office of health and human services is hereby authorized and directed to amend its rules and regulations and amend the Rhode Island state plan for medical assistance (Medicaid) pursuant to Title XIX of the fed…

(a) The executive office of health and human services (“executive office”) shall implement a new methodology for payment for in-state and out-of-state hospital services in order to ensure access to, and the provision of, high-quality and cost-effective hospital care to its eligib…

The secretary of the executive office of health and human services is authorized to seek the federal authorities required to implement a hospital incentive program (HIP). The HIP shall provide the participating licensed hospitals the ability to obtain certain payments for achievi…

The general assembly shall annually appropriate a sum as it may deem necessary to carry out the purposes of this chapter, and the state controller is hereby authorized and directed to draw his or her orders upon the general treasurer for the payment of the sum or sums or so much …

(a)(1) Upon the death of a recipient of Medicaid under Title XIX of the federal Social Security Act (42 U.S.C. § 1396 et seq. and referred to hereinafter as the “Act”), the total sum for Medicaid benefits so paid on behalf of a beneficiary who was fifty-five (55) years of age or …

(a) The department of human services, before authorizing care in a nursing home or intermediate-care facility for a person who is eligible to receive benefits pursuant to Title XIX of the federal Social Security Act, 42 U.S.C. § 1396 et seq., and who is being discharged from a ho…

(a) Formation. The executive office of health and human services is directed and authorized to apply for and obtain any necessary waiver(s), waiver amendment(s), and/or state plan amendments from the Secretary of the United States Department of Health and Human Services, includin…

(a) It is the intent of this section to provide reimbursement for early and periodic screening, diagnosis, and treatment (EPSDT) services through local education agencies for children who are eligible for medical assistance. A local education agency’s participation as an EPSDT pr…

(a) Rate reform. (1) The rates to be paid by the state to nursing facilities licensed pursuant to chapter 17 of title 23, and certified to participate in Title XIX of the Social Security Act for services rendered to Medicaid-eligible residents, shall be reasonable and adequate to…

(a) On an annual basis, every licensed nursing facility participating in the medical assistance program shall file a financial statement or other financial information acceptable to the department with its annual cost report (BM-64) for the time period covered by the cost report …

The secretary of the executive office of health and human services is authorized to seek the federal authority required to implement a nursing facility incentive program (NFIP). The NFIP shall provide the participating licensed nursing facilities the ability to obtain certain pay…

As used in this chapter, unless the context shall otherwise require: (1) “Dental service” means and includes emergency care, X-rays for diagnoses, extractions, palliative treatment, and the refitting and relining of existing dentures and prosthesis. (2) “Department” means the dep…

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…

(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 forth herein. Every licens…

(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 …

(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 a…

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…

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 rela…

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 join…

(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 a…

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 …

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 health i…

(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 equipm…

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 …

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 consent or…

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 p…

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 I…

(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 patient of a…

(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 h…

(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, …

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, makin…

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 …

(a) Definitions. The following terms shall have the meanings indicated: “Applied income” — The amount of income a Medicaid beneficiary is required to contribute to the cost of his or her care. “Authorized representative” — An individual who signs an application for Medicaid benef…

Any applicant for or recipient of benefits aggrieved because of a decision, or delay in making a decision, shall be entitled to an appeal and shall be afforded reasonable notice and opportunity for a fair hearing conducted by the director.

Findings of fact by the director shall be final and his or her decision shall be subject to judicial review only by certiorari if the decision is arbitrary, capricious, or unreasonable or inconsistent with law.

Whoever knowingly makes a false statement or misrepresents a material fact with intent thereby to defraud the state of any benefit or wrongfully to obtain or increase any benefit either for himself or herself or for any other person shall, upon conviction, be punished by a fine o…

Whenever an individual who is receiving medical assistance under this chapter transfers an interest in real or personal property, the individual shall notify the executive office of health and human services within ten (10) days of the transfer. The notice shall be sent to the in…