reglab/statecodes huggingface dataset:
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-6.6 - Quality Family Child Care Act › Section 40-6.6-7. - Economic aspects of contract subject to legislative appropriation.

§ 40-6.6-7. Economic aspects of contract subject to legislative appropriation.
Any aspects of a contract requiring appropriation by the federal government, the general assembly, or revisions to statutes and/or regulations shall be subject to passage of those state or federal appropriations or statutory and/or regulatory revisions.
History of Section.
P.L. 2013, ch. 456, § 1; P.L. 2013, ch. 465, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-6.6 - Quality Family Child Care Act › Section 40-6.6-8. - Duty to represent all CCAP family childcare providers fairly — Service charge and deductions.

§ 40-6.6-8. Duty to represent all CCAP family childcare providers fairly — Service charge and deductions.
(a)
A provider organization certified as the provider representative shall represent all CCAP family childcare providers in the state fairly and without discrimination, without regard to whether or not the CCAP family childcare providers are members of the provider organization.
(b)
Each CCAP family childcare provider may choose whether to be a member of the provider organization; provided, however, that after a first contract is ratified, the provider representative shall be authorized to collect from non-member CCAP family childcare providers a service charge as a contribution toward the negotiation and administration of the written contract. The service charge shall not exceed the regular dues paid by CCAP family childcare providers who are members of the provider representative. The state shall deduct the service charge, membership dues, and any voluntary deductions authorized by individual CCAP family childcare providers, from the payments to CCAP family childcare providers.
History of Section.
P.L. 2013, ch. 456, § 1; P.L. 2013, ch. 465, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-6.6 - Quality Family Child Care Act › Section 40-6.6-9. - Certification and decertification of provider organization.

§ 40-6.6-9. Certification and decertification of provider organization.
(a)
Petitions to certify a provider organization to serve as the provider representative of CCAP family childcare providers, petitions to intervene in the election, and any other petitions for investigation of controversies as to representation may be filed with, and acted upon by, the labor relations board in accordance with the provisions of chapter 7 of title 28 and the board’s rules and regulations; provided that any valid petition as to whether CCAP family childcare providers wish to certify or decertify a provider representative shall be resolved by a secret ballot election among CCAP family childcare providers, for which purpose the board may designate a neutral third party to conduct said secret ballot election.
(b)
The only appropriate unit shall consist of all CCAP family childcare providers in the state.
(c)
The cost of any certification election held under this section will be split equally among all the provider organizations that appear on the ballot.
History of Section.
P.L. 2013, ch. 456, § 1; P.L. 2013, ch. 465, § 1; P.L. 2020, ch. 79, art. 1, § 29.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-6.6 - Quality Family Child Care Act › Section 40-6.6-10. - Unfair practices.

§ 40-6.6-10. Unfair practices.
It shall be unlawful for the state to do any of the acts made unlawful under § 28-7-13. It shall be unlawful for the provider representative to do any of the acts made unlawful under § 28-7-13.1. Any alleged violation of this provision may be filed with the labor relations board as an unfair labor practice and considered and ruled upon in accordance with chapter 7 of title 28 and the board’s rules and regulations.
History of Section.
P.L. 2013, ch. 456, § 1; P.L. 2013, ch. 465, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-6.6 - Quality Family Child Care Act › Section 40-6.6-11. - CCAP family childcare providers not state employees.

§ 40-6.6-11. CCAP family childcare providers not state employees.
Nothing in this chapter shall be construed to make CCAP family childcare providers employees of the state for any purpose, including for the purposes of eligibility for the state employee pension program or state employee health benefits.
History of Section.
P.L. 2013, ch. 456, § 1; P.L. 2013, ch. 465, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-6.6 - Quality Family Child Care Act › Section 40-6.6-12. - Right of families to select, direct, and terminate CCAP family childcare providers.

§ 40-6.6-12. Right of families to select, direct, and terminate CCAP family childcare providers.
Nothing in this chapter shall be construed to alter the rights of families to select, direct, and terminate the services of CCAP family childcare providers.
History of Section.
P.L. 2013, ch. 456, § 1; P.L. 2013, ch. 465, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-6.6 - Quality Family Child Care Act › Section 40-6.6-13. - Strikes not authorized.

§ 40-6.6-13. Strikes not authorized.
CCAP family childcare providers shall not engage in any strike or other collective cessation of the delivery of childcare services.
History of Section.
P.L. 2013, ch. 456, § 1; P.L. 2013, ch. 465, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-6.6 - Quality Family Child Care Act › Section 40-6.6-14. - State action exemption.

§ 40-6.6-14. State action exemption.
The state action exemption to the application of state and federal antitrust laws is applicable to the activities of CCAP family childcare providers and their provider representative authorized under this chapter.
History of Section.
P.L. 2013, ch. 456, § 1; P.L. 2013, ch. 465, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-7 - New England Welfare Compact › Section 40-7-2. - Compact administrator.

§ 40-7-2. Compact administrator.
The compact administrator provided in article V of the compact shall be the director of the department of human services.
History of Section.
P.L. 1965, ch. 105, § 1; G.L. 1956, § 40-9.1-2; Reorg. Plan No. 1, 1970.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-7 - New England Welfare Compact › Section 40-7-3. - Authority of governor to effectuate entry into compact.

§ 40-7-3. Authority of governor to effectuate entry into compact.
The governor on behalf of the state is authorized and directed to execute any formal documents necessary to effectuate the entry of this state into the New England Welfare Compact with any one or more of the states of Connecticut, Massachusetts, New Hampshire, and Vermont in substantially the form provided in this chapter.
History of Section.
P.L. 1965, ch. 105, § 3; G.L. 1956, § 40-9.1-3; Reorg. Plan No. 1, 1970.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-7 - New England Welfare Compact › Section 40-7-4. - Effect of existing reciprocal agreements.

§ 40-7-4. Effect of existing reciprocal agreements.
Entry by the state into the New England Welfare Compact with another state shall supersede existing reciprocal agreements with that state but shall in no way abrogate or replace compacts or agreements entered into with other states pursuant to § 40-6-18.
History of Section.
P.L. 1965, ch. 105, § 4; G.L. 1956, § 40-9.1-4; Reorg. Plan No. 1, 1970.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8 - Medical Assistance › Section 40-8-1. - Declaration of policy.

§ 40-8-1. Declaration of policy.
(a)
Whereas, in the state of Rhode Island there are many persons who do not have sufficient income and resources to meet the cost of medical care and who, except for income and resource requirements, would be eligible for aid or assistance under § 40-5.1-9 [repealed] or § 40-6-27; and
(b)
Whereas, it is in the best interest of all the citizens of this state to promote the welfare of persons with the characteristics of persons eligible to receive public assistance and ensure that they will receive adequate medical care and treatment in time of need;
(c)
Now, therefore, it is declared to be the policy of this state to provide medical assistance for those persons in this state who possess the characteristics of persons receiving public assistance under the provisions of § 40-5.1-9 [repealed] or § 40-6-27, and who do not have the income and resources to provide it for themselves or who can do so only at great financial sacrifice. Provided, further, that the medical assistance must qualify for federal financial participation pursuant to the provisions of Title XIX of the federal Social Security Act, 42 U.S.C. § 1396 et seq., as such provisions apply to medically needy only applicants and recipients.
(d)
Medical assistance shall be provided under this chapter without regard to the availability of federal financial participation: (1) To a person who does not meet the citizenship or alienage criteria under Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq., and who was lawfully residing in the United States before August 22, 1996, and who was a resident of this state prior to July 1, 1997; and provided, however, that the person meets all other eligibility requirements under this chapter or under Title XIX or Title XXI of the Social Security Act.
(e)
Medical assistance shall also be provided under this chapter to a non-citizen child who was lawfully admitted for permanent residence on or after August 22, 1996, or who first becomes otherwise entitled to reside in the United States on or after August 22, 1996; provided, however, that the person meets all other eligibility requirements under this chapter or under Title XIX or Title XXI of the Social Security Act.
History of Section.
P.L. 1966, ch. 266, § 2; G.L. 1956, § 40-10.1-1; Reorg. Plan No. 1, 1970; P.L. 1983, ch. 3, art. 3, § 1; P.L. 1983, ch. 167, art. 18, § 1; P.L. 1989, ch. 53, § 1; P.L. 1996, ch. 129, § 19; P.L. 1996, ch. 131, § 19; P.L. 1996, ch. 132, § 19; P.L. 1996, ch. 133, § 19; P.L. 1997, ch. 30, art. 34, § 5; P.L. 2006, ch. 246, art. 40, § 1; P.L. 2007, ch. 73, art. 18, § 7; P.L. 2008, ch. 9, art. 10, § 1; P.L. 2009, ch. 68, art. 23, § 3.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8 - Medical Assistance › Section 40-8-3.1. - Life estate in property — Retained powers.

§ 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 consent or joinder by the holder(s) of the remainder interest, the principal place of residence shall not be regarded as an excluded resource for the purpose of Medicaid eligibility, unless the applicant or recipient individually, or through his or her guardian, conservator, or attorney in fact, conveys all outstanding remainder interest to him or herself.
An applicant or recipient who, by a deed created, executed and recorded on or before June 30, 2014, has reserved 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 joinder by the holder(s) of the remainder interest, shall not be ineligible for Medicaid on the basis of the deed, regardless of whether the transferee of the remainder interest is a person or persons, trust, or entity.
History of Section.
P.L. 2014, ch. 145, art. 19, § 3.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8 - Medical Assistance › Section 40-8-4. - Direct vendor payment plan.

§ 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 services in a hospital, institution, or facility for tuberculosis or mental diseases;
(2)
Nursing services for the period of time as the director shall authorize;
(3)
Visiting nurse service;
(4)
Drugs for consumption either by inpatients or by other persons for whom they are prescribed by a licensed physician;
(5)
Dental services; and
(6)
Hospice care up to a maximum of two hundred and ten (210) days as a lifetime benefit.
(b)
For purposes of this chapter, the payment of federal Medicare premiums or other health insurance premiums by the department on behalf of eligible beneficiaries in accordance with the provisions of Title XIX of the federal Social Security Act, 42 U.S.C. § 1396 et seq., shall be deemed to be a direct vendor payment.
(c)
[Deleted by P.L. 2021, ch. 162, art. 12, § 2.]
(d)
[Deleted by P.L. 2021, ch. 162, art. 12, § 2.]
(e)
No state agency shall pay a vendor for medical benefits provided to a recipient of assistance under this chapter until and unless the vendor has submitted a claim for payment to a commercial insurance plan, Medicare, and/or a Medicaid managed care plan, if applicable for that recipient, in that order. This includes payments for skilled nursing and therapy services specifically outlined in Chapters 7, 8, and 15 of the Medicare Benefit Policy Manual.
History of Section.
P.L. 1966, ch. 266, § 2; P.L. 1968, ch. 189, § 2; G.L. 1956, § 40-10.1-4; Reorg. Plan No. 1, 1970; P.L. 1977, ch. 269, § 1; P.L. 1988, ch. 356, § 1; P.L. 1989, ch. 53, § 1; P.L. 1991, ch. 6, art. 13, § 1; P.L. 1993, ch. 138, art. 21, § 2; P.L. 2007, ch. 73, art. 17, § 1; P.L. 2007, ch. 230, § 1; P.L. 2011, ch. 151, art. 23, § 2; P.L. 2015, ch. 141, art. 5, § 9; P.L. 2021, ch. 162, art. 12, § 2, effective July 1, 2021.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8 - Medical Assistance › Section 40-8-4.1. - Lowest price.

§ 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 any product or service at the time the product or service was provided. For the purpose of determining the lowest charge, fee, or rate:
(1)
If the provider offers discounts or rebates, the amount after applying discounts or rebates shall be utilized;
(2)
If the provider offers a sale for a limited period of time on any good or service, the sale price shall be utilized during the sale period;
(3)
If the provider regularly accepts less than its full charge from any customer, that amount accepted shall be utilized;
(4)
If any good or service is offered free of charge by the provider, no charge shall be made to the department for the provision of the product or service to the department or a client of the department who satisfies the terms of the offer;
(5)
If any good or service is covered under any warranty or guarantee offered by the provider, the amount charged to the department shall not exceed the amount that would otherwise be payable solely by the customer; and
(6)
If a provider structures or packages its goods or services in a manner that is exclusively or primarily used for Medicaid, Medicare, or other third-party payors, the charge for the most similar good or service offered to any other consumer shall be utilized.
(c)
The following items shall not be utilized in determining the “usual and customary” or lowest charge, fee, or rate:
(1)
Discounts offered solely to bona fide employees or family members of employees;
(2)
Discounts offered solely on the basis of age shall be utilized in determining the usual and customary charge only when the client of the department satisfies the age requirement;
(3)
Free goods or services or discounts provided to a limited number of persons on the basis of financial hardship;
(4)
Charges by an organization on a sliding-fee scale for a good or service where the organization’s charge is based on ability to pay;
(5)
Charges not collected as a result of bad debts incurred by the provider. A bad debt exists where sound business judgment indicates that there is no reasonable likelihood of recovery of the amount owed; and
(6)
Charges for educational-related services governed by 42 U.S.C. § 1396b(c).
(d)
The department may waive the application of this section if the department determines the action is necessary to ensure a continuum of care and service to persons served by community mental health centers, or to avert serious economic hardships to mental health centers.
History of Section.
P.L. 2009, ch. 68, art. 23, § 12.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8 - Medical Assistance › Section 40-8-5. - Agencies through which benefits paid.

§ 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 of the medical care benefits provided for in this chapter or for administration purposes. The regulations shall meet the federal requirements as may be set forth as conditions precedent to receiving the federal funds.
History of Section.
P.L. 1966, ch. 266, § 2; G.L., § 40-10.1-5; Reorg. Plan No. 1, 1970.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8 - Medical Assistance › Section 40-8-6. - Review of application for benefits.

§ 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 thirty (30) days after the filing, notify the applicant, in writing, of the determination. If the application is rejected, the notice to the applicant shall set forth therein the reason therefor. The director may at any time reconsider any determination.
History of Section.
P.L. 1966, ch. 266, § 2; G.L., § 40-10.1-6; Reorg. Plan No. 1, 1970.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8 - Medical Assistance › Section 40-8-7. - Appeals — Hearing.

§ 40-8-7. Appeals — Hearing.
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.
History of Section.
P.L. 1966, ch. 266, § 2; G.L., § 40-10.1-7; Reorg. Plan No. 1, 1970.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8 - Medical Assistance › Section 40-8-8. - Judicial review.

§ 40-8-8. Judicial review.
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.
History of Section.
P.L. 1966, ch. 266, § 2; G.L., § 40-10.1-8; Reorg. Plan No. 1, 1970.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8 - Medical Assistance › Section 40-8-9. - Fraudulent receipt of assistance as larceny — Penalty.

§ 40-8-9. Fraudulent receipt of assistance as larceny — Penalty.
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 of not less than twenty dollars ($20.00) nor more than fifty dollars ($50.00), or by imprisonment for not more than thirty (30) days, or by both a fine and imprisonment. Each false statement or representation shall constitute a separate and distinct offense.
History of Section.
P.L. 1966, ch. 266, § 2; G.L., § 40-10.1-9; Reorg. Plan No. 1, 1970.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8 - Medical Assistance › Section 40-8-9.1. - Notice.

§ 40-8-9.1. Notice.
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 individual’s local office and the legal office of the executive office of health and human services and include, at a minimum, the individual’s name, social security number or, if different, the executive office of health and human services identification number, the date of transfer, and the dollar value, if any, paid or received by the individual who received benefits under this chapter. In the event an individual fails to provide notice required by this section to the executive office of health and human services and in the event an individual has received medical assistance, any individual and/or entity, who knew or should have known that the individual failed to provide the notice and who receives any distribution of value as a result of the transfer, shall be liable to the executive office of health and human services to the extent of the value of the transfer. Moreover, any such individual shall be subject to the provisions of § 40-6-15 and any remedy provided by applicable state and federal laws and rules and regulations. Failure to comply with the notice requirements set forth in the section shall not affect the marketability of title to real estate transferred while the transferor is receiving medical assistance.
History of Section.
P.L. 2012, ch. 241, art. 11, § 6.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8 - Medical Assistance › Section 40-8-10. - Recovery of benefits paid in error.

§ 40-8-10. Recovery of benefits paid in error.
Any person, who through error or mistake of himself or herself or another, receives medical care benefits to which he or she is not entitled or with respect to which he or she was ineligible, shall be required to reimburse the state for the benefits paid through error or mistake.
History of Section.
P.L. 1966, ch. 266, § 2; G.L., § 40-10.1-10; Reorg. Plan No. 1, 1970; P.L. 1997, ch. 326, § 129.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8 - Medical Assistance › Section 40-8-11. - Civil action to recover benefits.

§ 40-8-11. Civil action to recover benefits.
Any sums required to be reimbursed to the state under the provisions of § 40-8-10 and any benefits obtained by false statement or misrepresentation may be collected by civil action. All civil actions shall be instituted in the name of the director, and he or she shall be exempt from giving any surety for costs. In any action, the director may be represented by any qualified attorney whom he or she has designated and employed for this purpose, or, at the director’s request, by the attorney general.
History of Section.
P.L. 1966, ch. 266, § 2; G.L., § 40-10.1-11; Reorg. Plan No. 1, 1970.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8 - Medical Assistance › Section 40-8-12. - Federal approval.

§ 40-8-12. Federal approval.
(a)
The department is empowered and authorized to submit its plan for medical assistance to the federal government, or any agency or department thereof having funds available for medical care benefits provided for in this chapter, for approval pursuant to the provisions of the federal Social Security Act, 42 U.S.C. § 1396 et seq. The department shall act for the state in any negotiations relative to the submission and approval of the plan and may make any arrangement or changes in its plan not inconsistent with this chapter that may be required by the Social Security Act, or the rules and regulations promulgated pursuant thereto, to obtain and retain the approval and to secure for this state the benefits of the provisions of the federal act relating to medical assistance for the needy.
(b)
The department shall make reports to the federal government, or any agency or department thereof, in the form and nature required by it, and shall, in all respects, comply with any request or direction of the federal government, or any agency or department thereof, that may be necessary to assure the correctness and verification of the reports.
History of Section.
P.L. 1966, ch. 266, § 2; G.L., § 40-10.1-12; Reorg. Plan No. 1, 1970; P.L. 2006, ch. 216, § 19.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8 - Medical Assistance › Section 40-8-13. - Rules, regulations, and fee schedules.

§ 40-8-13. Rules, regulations, and fee schedules.
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 department’s plan conform to the provisions of the federal Social Security Act, 42 U.S.C. § 1396 et seq., and any rules or regulations promulgated pursuant thereto.
History of Section.
P.L. 1966, ch. 266, § 2; G.L., § 40-10.1-13; Reorg. Plan No. 1, 1970.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8 - Medical Assistance › Section 40-8-13.1. - [Repealed.]

§ 40-8-13.1. [Repealed.]
History of Section.
P.L. 1995, ch. 370, art. 32, § 1; P.L. 2000, ch. 55, art. 12, § 1; P.L. 2006, ch. 216, § 19; P.L. 2009, ch. 5, art. 15, § 1; Repealed by its own terms pursuant to P.L. 2009, ch. 68, art. 23, § 6, effective March 30, 2010.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8 - Medical Assistance › Section 40-8-13.2. - [Repealed.]

§ 40-8-13.2. [Repealed.]
History of Section.
P.L. 2002, ch. 65, art. 33, § 1; P.L. 2007, ch. 73, art. 13, § 2; P.L. 2009, ch. 68, art. 23, § 6; Repealed by its own terms and pursuant to § 40-8-13.4(g), effective March 30, 2010.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8 - Medical Assistance › Section 40-8-13.3. - Payment for services provided by in-state and out-of-state hospitals.

§ 40-8-13.3. Payment for services provided by in-state and out-of-state hospitals.
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 federal Social Security Act, 42 U.S.C. § 1396 et seq., in order to provide for payment to hospitals for services provided to eligible recipients in accordance with this chapter. The amended rules and regulations will continue to recognize the importance, impact, and cost of the graduate medical education and training programs supported by the hospitals in Rhode Island. The provisions of this section shall be effective upon the promulgation of the amendments and new payment methodology pursuant to this section and § 40-8-13.4, on July 1, 2010, at which time the provisions of §§ 40-8-13.2, 27-19-14, 27-19-15 and 27-19-16 shall be repealed in their entirety.
History of Section.
P.L. 2009, ch. 68, art. 23, § 7; P.L. 2010, ch. 23, art. 20, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8 - Medical Assistance › Section 40-8-13.5. - Hospital Incentive Program (HIP).

§ 40-8-13.5. Hospital Incentive Program (HIP).
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 achieving performance goals established by the secretary. HIP payments shall commence no earlier than July 1, 2016.
History of Section.
P.L. 2015, ch. 141, art. 5, § 10.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8 - Medical Assistance › Section 40-8-14. - Appropriations.

§ 40-8-14. Appropriations.
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 thereof as may be required from time to time, upon the receipt by him or her of properly authenticated vouchers.
History of Section.
P.L. 1966, ch. 266, § 2; G.L., § 40-10.1-14; Reorg. Plan No. 1, 1970.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8 - Medical Assistance › Section 40-8-16. - Notification of long-term care alternative.

§ 40-8-16. Notification of long-term care alternative.
(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 hospital to a nursing home, shall notify the person, in writing, of the provisions of the long-term-care alternative, a home- and a community-based program.
(b)
If a person, eligible to receive benefits pursuant to Title XIX of the federal Social Security Act, requires services in a nursing home and desires to remain in his or her own home or the home of a responsible relative or other adult, the person or his or her representative shall so inform the department.
(c)
The department shall not make payments pursuant to Title XIX of the federal Social Security Act for benefits until written notification documenting the person’s choice as to a nursing home or home- and community-based services has been filed with the department.
History of Section.
P.L. 1987, ch. 500, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8 - Medical Assistance › Section 40-8-17. - Waiver request.

§ 40-8-17. Waiver request.
(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, including, but not limited to, an extension of the section 1115(a) demonstration waiver amended, as appropriate, and renamed to reflect the state’s effort to coordinate all publicly financed health care. The secretary of the office shall ensure that the state’s health and human services departments and the people and communities they serve in the Medicaid program shall have the opportunity to contribute to and collaborate in the formulation of any request for a new waiver, waiver extension, and/or state plan amendment(s). Any actions shall: (1) Continue efforts to rebalance the system of long-term services and supports by assisting people in obtaining care in the most appropriate and least restrictive setting; (2) Pursue further utilization of care-management models that promote preventive care, offer a health home, and provide an integrated system of services; (3) Use smart payments and purchasing to finance and support Medicaid initiatives that fill gaps in the integrated system of care; and (4) Recognize and ensure access to non-medical services and supports, such as peer navigation and employment and housing stabilization services, that are essential for optimizing a person’s health, wellness, and safety and that reduce or delay the need for long-term services and supports.
(b)
Effective July 1, 2009, any provision presently in effect in the Rhode Island general laws where the executive office of health and human services is authorized to apply for and obtain any necessary waiver(s), waiver amendment(s), and/or state plan amendment(s) for the purpose of providing medical assistance to recipients, shall authorize the executive office of health and human services to proceed with appropriate category changes in accordance with the special terms and conditions of the Rhode Island Global Consumer Choice Compact section 1115(a) Demonstration Waiver or any extension thereof, as amended and/or renamed under the authority provided in this section.
History of Section.
P.L. 1987, ch. 500, § 2; P.L. 1988, ch. 84, § 26; P.L. 2008, ch. 100, art. 17, § 3; P.L. 2009, ch. 68, art. 23, § 11; P.L. 2013, ch. 144, art. 19, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8 - Medical Assistance › Section 40-8-19.2. - Nursing Facility Incentive Program (NFIP).

§ 40-8-19.2. Nursing Facility Incentive Program (NFIP).
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 payments for achieving performance goals established by the secretary. NFIP payments shall commence no earlier than July 1, 2016.
History of Section.
P.L. 2015, ch. 141, art. 5, § 11.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8 - Medical Assistance › Section 40-8-20. - [Repealed.]

§ 40-8-20. [Repealed.]
History of Section.
P.L. 1993, ch. 138, art. 20, § 1; Repealed by P.L. 2003, ch. 376, art. 41, § 2, effective October 1, 2005.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8 - Medical Assistance › Section 40-8-20.1. - Prospective rate increments.

§ 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 made during the rate-determination process;
(2)
Significant increases in operating costs resulting from the implementation of new or additional programs, services, or staff specifically mandated by the Rhode Island department of health;
(3)
Significant increases in operating costs resulting from capital renovations, expansion, or replacement required for compliance with fire safety codes and/or certification requirements of the Rhode Island department of health, as well as increased energy costs that the facility can demonstrate are a result of the facility having expended funds for heating, lighting, hot water, and similar costs associated with the consumption of energy provided by public utilities;
(4)
Significant increases in workers’ compensation and/or health insurance premiums that cannot be accommodated within the nursing facility’s assigned aggregate per diem rate, if cost justified; provided, that the assigned per diem rate in the labor- and payroll-related-expenses cost center does not exceed two percent (2%) of the cost center ceiling; or
(5)
Extraordinary circumstances, including, but not limited to, acts of God, and inordinate increases in energy costs (e.g., federal BTU tax, regional or national energy crisis). Inordinate increases in energy costs will be immediately reflected in increased rates above the energy cost center ceiling maximum. Provided, however, that the increases will be rescinded immediately upon cessation of the extraordinary circumstance. All requests for rate increments shall be limited to one request per nursing facility for the factors set forth in subsections (2) and (3); provided, additional requests involving a per diem increase in excess of one percent of the nursing facility’s previously assigned aggregate per diem rate shall also be reviewed. Before a nursing facility shall be permitted to file for a rate increment, increases in operating costs set forth in subsections (2) and (3) must have been incurred for a period of not less than three (3) months in order to establish proof of the increase. Rate adjustments granted as a result of a request filed within one hundred twenty (120) days after the costs were first incurred shall be made effective retroactively to the date the costs were actually incurred; provided, further, any adjustments granted as a result of requests filed more than one hundred twenty (120) days after the costs were first incurred will be effective on the first day of the month following the filing of the request.
History of Section.
P.L. 2006, ch. 246, art. 15, § 2; P.L. 2007, ch. 73, art. 12, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8 - Medical Assistance › Section 40-8-20.2. - Best energy practices for licensed nursing facilities — Energy conservation retention credit.

§ 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 forth herein. Every licensed nursing facility participating in the Medicaid medical assistance program that: (1) Expends funds for energy conservation measures and the use of renewable fuels, energy sources, and so-called “green” sources of energy that result in a reduction of energy consumption; and (2) Which methods the facility can demonstrate, to the satisfaction of the department, result in the facility’s “pass through” per diem cost being reduced in the next base year in comparison to the immediately preceding base year, shall be permitted to retain the difference in the previous per diem and the new per diem for a period of up to twenty-four (24) months. Provided, that such retained funds shall be utilized by the nursing facility solely for either: (1) Costs directly associated with employing labor at the facility; or (2) To pay down any debt of the nursing facility incurred directly through the purchases of energy saving, conservation, and renewable energy or so-called “green” devices.
(b)
The department of human services shall convene a working group of interested parties, including, but not limited to, public utilities, provider trades associations, labor unions representing nursing home employees, and environmental advocates, to establish best energy practices for this industry.
History of Section.
P.L. 2007, ch. 73, art. 12, § 2.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8 - Medical Assistance › Section 40-8-21. - Appeals process.

§ 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) days from the date of notification of audit results or rate assignment, file a written request with the department for a review of the computation of the assigned rate. The foregoing right of appeal shall also apply to demonstrated errors made during the rate determination process.
(b)
A review conference will be conducted within fifteen (15) days from the date of receipt of the written request by a designee assigned by the director of the department of human services. As a result of the review conference, the designee may modify the audit adjustments and/or the rate of reimbursement. The designee shall provide the facility with a written decision within thirty (30) days from the date of the review conference.
(c)
Appeals beyond the review conference shall be in accordance with the provisions of chapter 35 of title 42. The facility shall file a written request for the hearing no later than fifteen (15) days after receipt of the review conference decision.
History of Section.
P.L. 1993, ch. 138, art. 20, § 1; P.L. 2003, ch. 376, art. 41, § 3.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8 - Medical Assistance › Section 40-8-22. - Protection of resources — Long-term care insurance partnership program.

§ 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 Title XIX, 42 U.S.C. § 1396 et seq., of the Social Security Act (Medicaid), or waivers of state plan requirements, to allow protection of resources and income pursuant to this section. The protection shall be provided, to the extent approved by the federal Centers for Medicare and Medicaid Services, for any purchaser of a precertified, long-term-care policy delivered, issued for delivery, or renewed and shall last for the life of the purchaser. Notwithstanding any provision of the general laws, the resources of an individual, to the extent the resources are equal to the amount of qualifying long-term-care insurance benefits payments provided pursuant to a policy of long-term-care insurance precertified in accordance with department regulations and chapter 34.2 of title 27, shall not be considered by the department in a determination of: (1) His or her eligibility for Medicaid; (2) The amount of any Medicaid payment; or (3) In any subsequent recovery by the state of a payment for medical services. The precertified policies shall be known as “Medicaid qualifying long-term care partnership policies.”
(b)
The department shall count insurance benefit payments toward resource exclusion to the extent the payments: (1) Are for services covered under the state plan for medical assistance, including nursing home care, or formal services delivered to insureds in the community as part of a care plan; (2) Are for the lower of the actual charge or the amount paid by the insurance company; and (3) Are for services provided after the individual meets the coverage requirements for long-term-care benefits established by the department for this program. The department shall adopt rules and regulations to implement the provisions of this section and relating to determining eligibility of applicants for Medicaid and the coverage requirements for long-term-care benefits.
History of Section.
P.L. 1993, ch. 454, § 1; P.L. 2007, ch. 239, § 4.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8 - Medical Assistance › Section 40-8-23. - Contracting standards.

§ 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 the Accreditation of Healthcare Organizations and self-reporting activities by providers.
History of Section.
P.L. 1996, ch. 341, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8 - Medical Assistance › Section 40-8-24. - Less expensive alternative medications.

§ 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 a brand name is determined by the director to be less costly to the state than the equivalent generic. Calculation of comparative drug costs shall include consideration of the amount paid by the state to the pharmacy for a drug under the current retail pharmacy reimbursement formula, less any discounts or rebates, including those paid pursuant to federal Medicaid law during the previous calendar quarter, and inclusive of all dispensing fees.
History of Section.
P.L. 2002, ch. 65, art. 24, § 1; P.L. 2004, ch. 416, § 1; P.L. 2004, ch. 552, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8 - Medical Assistance › Section 40-8-25. - Nursing facility pharmaceutical waste reduction.

§ 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 health care oversight on or before March 1, 2005, regarding the methods employed and any resulting cost savings anticipated.
History of Section.
P.L. 2004, ch. 282, § 1; P.L. 2004, ch. 465, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8 - Medical Assistance › Section 40-8-27. - Cooperation by providers.

§ 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 program pursuant to § 40-8.4-12. Documents requested by the department may include, but are not limited to, certificates of coverage or a summary of benefits and employee obligations. Upon receiving notification that the department has determined that the employee is eligible for premium assistance under § 40-8.4-12, the provider shall accept the enrollment of the employee and his or her family in the employer-based health insurance plan without regard to any seasonal enrollment restrictions, including open-enrollment restrictions, and/or the impact on the employee’s wages. Additionally, the Medicaid provider employing such persons shall not offer “pay in lieu of benefits.” Providers who do not comply with the provisions set forth in this section shall be subject to suspension as a participating Medicaid provider.
History of Section.
P.L. 2008, ch. 100, art. 17, § 7.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8 - Medical Assistance › Section 40-8-28. - Vendors doing business in the state of Rhode Island.

§ 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 health insurance or health benefits offered by the vendor to the employee, including, but not limited to, a certificate of coverage or a summary of benefits and employee obligations for the purposes of, and only to the extent necessary to carry out the provisions of this section of the general laws. The employer shall accept the enrollment of the individual and/or the family in the employer-based health insurance plan without regard to any seasonal enrollment restrictions, including open-enrollment restrictions, without regard to the impact on the member’s wages. This is known as “pay in lieu of benefits.”
History of Section.
P.L. 2008, ch. 100, art. 17, § 7.