Title 40, Title 40 Services

(a) A corporation, association, firm, partnership, or limited partnership is liable for the acts of its officers, directors, representatives, or agents acting within the scope of their authority. Proof of the acts of any officer, director, representative, or agent shall be receiv…

When the cost of the services provided to the patient is being paid under the Rhode Island Medicaid program, any person who knowingly and willfully: (1) Charges a patient, or anyone acting on behalf of a patient, money or other consideration at a rate in excess of the rates estab…

The legislature hereby finds and declares that preservation of the ability of the private acute-care hospital system of the state to continue to support an increasing uncompensated care burden is of critical importance to the public health and welfare of the citizens of Rhode Isl…

Effective July 1, 2021, and for each subsequent year, the executive office of health and human services is hereby authorized and directed to amend its regulations for reimbursement to hospitals for inpatient and outpatient services as follows: (a) Each hospital in the state of Rh…

As used in this chapter: (1) “Base year” means, for the purpose of calculating a disproportionate share payment for any fiscal year ending after September 30, 2024, the period from October 1, 2022, through September 30, 2023, and for any fiscal year ending after September 30, 202…

(a) For federal fiscal year 2024, commencing on October 1, 2023, and ending September 30, 2024, the executive office of health and human services shall submit to the Secretary of the United States Department of Health and Human Services a state plan amendment to the Rhode Island …

As a condition of receipt of a payment under this chapter, each participating hospital shall submit to the department data, reports and/or independent certified audits as may be required by the department to timely comply with the requirements of Section 1923 of the federal Socia…

Due to the high ratio of unqualified uncompensated-care expenses to qualified uncompensated-care expenses, the department of human services is hereby authorized and directed to pay by September 1, 2010, from revenues derived from taxes imposed in accordance with § 44-17-1: (1) Ac…

Effective July 1, 2008, the department of human services is hereby authorized and directed to amend its regulations and the Rhode Island State Plan for Medical Assistance pursuant to Title XIX of the Social Security Act for reimbursement to hospitals for outpatient service as fol…

Effective July 1, 2009, the department of human services is hereby authorized and directed to amend its regulations and the Rhode Island State Plan for Medical Assistance pursuant to Title XIX of the Social Security Act for reimbursement to hospitals for outpatient services as fo…

Effective July 1, 2010, the department of human services is hereby authorized and directed to amend its regulations for reimbursement to hospitals for outpatient services as follows: Hospitals — Outpatient adjustment payments. (a) Each hospital in the state of Rhode Island, as de…

Effective July 1, 2011, the executive office of health and human services is hereby authorized and directed to amend its regulations for reimbursement to hospitals for outpatient services as follows: Hospitals — Outpatient adjustment payments. (a) Each hospital in the state of Rh…

This chapter is hereby entitled “The Health Care for Families Act.”

(a) The department of human services is authorized to promulgate any regulations necessary to implement this chapter. (b) When promulgating any rule or regulation necessary to implement this chapter, or any rule or regulation related to RIte Care, the department shall send the no…

If any provision in any section of this chapter, or the application thereof, to any person or circumstances is held invalid, its invalidity does not affect other provisions or applications of this chapter that can be given effect without the invalid provision or application, and …

(a) Basic RIte Share health insurance premium assistance program. Under the terms of Section 1906 of Title XIX of the U.S. Social Security Act, 42 U.S.C. § 1396e, states are permitted to pay a Medicaid-eligible person’s share of the costs for enrolling in employer-sponsored healt…

To the extent permitted under Titles XIX and XXI of the Social Security Act, 42 U.S.C. § 1396 et seq. and 42 U.S.C. § 1397aa et seq., or by waiver from the Secretary of the United States Department of Health and Human Services, the department of human services shall adopt regulat…

(a) The legislature hereby finds and declares that: (1) Access to affordable, quality health and long-term care is of concern for all Rhode Islanders; (2) The complexities of the health-insurance and healthcare-delivery systems result in inefficiencies, confusion, and additional …

(a) There is hereby established an advisory commission to be known as the “advisory commission on health care” to advise the director of the department of human services on all matters relating to the RIte Care and RIte Share programs, and other matters concerning access for all …

The general assembly hereby finds and declares that: (1) Although Rhode Island has one of the highest rates of health insurance coverage in the nation, gaps in coverage remain and the rate of coverage dropped significantly during the past year; and (2) From 2001-2002, the state’s…

(a) To increase primary-care access for those state residents who do not have access to health insurance coverage, or who are unable to afford health insurance coverage, the director of the state department of human services, in collaboration with the director of the department o…

The department of human services shall annually prepare a public-health-access-beneficiary employer report. A “public-health-access-program beneficiary” means any person who receives medical benefits from RIte Care, RIte Share, or Medicaid. Any applicant for public health-benefit…

(a) Notwithstanding any other provision of state law, the delivery and financing of the healthcare services provided under this chapter shall be provided through a system of managed care. “Managed care” is defined as systems that: integrate an efficient financing mechanism with q…

It is the intent of the general assembly to continue to meet the goal established in 1993 pursuant to § 42-12.3-2 to ensure access to comprehensive health care by providing or creating access to health insurance to all Rhode Islanders who are uninsured. Over the course of several…

No later than July 1, 2019, the executive office of health and human services (EOHHS) shall apply for the appropriate federal approval to provide Medicaid beneficiaries up to three hundred sixty-five (365) days of prescription contraception dispensed as a single prescription.

(a) “Family” means a minor child or children and the parent(s) or relative as defined in § 40-5.1-3 [repealed], with whom they reside, including two-parent families in which one parent is working more than one hundred (100) hours per month. (b) “Minor child” means a child under t…

(a) Medical assistance for families. There is hereby established a category of medical assistance eligibility pursuant to § 1931 of Title XIX of the Social Security Act, 42 U.S.C. § 1396u-1, for families whose income and resources are no greater than the standards in effect in th…

The delivery and financing of the healthcare services provided under this chapter shall be provided through a system of managed care. A managed care system integrates an efficient financing mechanism with quality service delivery; provides a “medical home” to ensure appropriate c…

The department of human services shall ensure that eligibility and enrollment are determined and provided in a timely, efficient, and user-friendly manner, including mail-in applications. The department may enter into any necessary cooperative agreements with the department of he…

The department of human services shall investigate and develop opportunities for individuals and/or employers to buy into, at the individual’s and/or employer’s expense, one or more programs the department may establish under this chapter or chapter 12.3 of title 42 to address un…

The general assembly shall annually appropriate to the department of human services the sums as it may deem necessary to carry out the purposes of this chapter. Authorization to pay for healthcare services specified in this chapter shall be made by representatives of the departme…

Any person who is determined eligible for healthcare assistance under this chapter is hereby deemed to have made an assignment of rights to medical support in accordance with § 40-6-9(b), and the provisions of § 40-6-9(b) and (d) are incorporated by reference and shall apply to s…

The department of human services is hereby authorized and directed to amend its Title XIX state plan to provide for categorically needy medical assistance coverage as permitted pursuant to Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq., as amended, to individuals …

(a) To ensure that all medical assistance beneficiaries, including the elderly and all individuals with disabilities, have access to quality and affordable health care, the executive office of health and human services (“executive office”) is authorized to implement mandatory man…

(a) As used in this section the terms: (1) “Adult victim with severe impairments” means: (i) A person over the age of eighteen (18) who has a disability attributable to a mental or physical impairment, or combination of mental and physical impairments, and results in substantial …

(a) Purpose. Contingent on appropriation, there is hereby established a special pilot program to be administered by the department of human services to provide payment for nursing facility services and the following ancillary services: pharmacy, physician, laboratory, dental, and…

The department may establish rules and regulations regarding which nursing facility or facilities may provide services as part of this pilot program, waiting list procedures, and any other administrative functions that are necessary for the conduct of this program.

The department shall issue an annual report to the long-term care coordinating council, the general assembly, the senate fiscal advisor, and the house fiscal advisor on the status of this program on or before April 15 of each year. The report shall include at least the number of …

This chapter shall be known and may be cited as “The Sherlock Act” or “The Ticket to Work Program.”

The executive office of health and human services is hereby authorized and directed to maintain a Medicaid buy-in program pursuant to the “Balanced Budget Act of 1997,” 42 U.S.C. § 1396a(a)(10)(A)(ii)(XIII), and the federal Ticket to Work and Work Incentives Improvement Act of 19…

The purpose of the Medicaid buy-in program is to: (1) Enable individuals with disabilities to enter and reenter the work force as soon as possible; (2) Provide health care and employment support services to individuals with disabilities that will enable those individuals to reduc…

As used in this chapter, the term: (1) “Employed” means the individual with disabilities is engaged in a work effort that meets substantial and reasonable threshold criteria for hours of work, wages, or other measures, as defined by the department of human services and as permitt…

(a) The department of human services is hereby authorized and directed to amend its Title XIX state plan to initiate a Medicaid buy-in program for employed individuals with disabilities. (b) The department of human services is hereby authorized and directed to amend its Title XIX…

(a) To be eligible for benefits under the Medicaid buy-in program: (1) The person shall be an individual with disabilities as defined in § 40-8.7-4, but without regard to the person’s ability to engage in substantial gainful activity, as specified in the Social Security Act, 42 U…

(a) The department of human services is authorized and directed to promulgate such rules to establish the monthly premium payments for employed individuals with disabilities who opt to participate directly in the Medicaid buy-in program. To participate in the Medicaid buy-in prog…

(a) Medicaid buy-in participants shall continue on the Medicaid buy-in program for up to four (4) months after loss of employment due to a medical condition. If the loss of employment is not due to a medical condition, the individual may continue to be eligible for up to four (4)…