reglab/statecodes huggingface dataset:
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8 - Medical Assistance › Section 40-8-29. - Selective contracting.

§ 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 to ensure that all service expenditures under this chapter have the maximum benefit of competition, and afford Rhode Islanders the overall best value, optimal quality, and the most cost-effective care possible. Beneficiaries will be limited to using the services/products of only those providers determined in a competitive bidding process to meet the standards for best quality, performance, and price set by the department in accordance with applicable federal and state laws.
(b)
For purposes of this section, “selective contracting” shall mean the process for choosing providers to serve Medicaid beneficiaries based on their ability to deliver the best quality products or services, at the best value or price.
(c)
To ensure all services allowable for Medicare reimbursement for beneficiaries who are dually eligible, selective contractors must be willing and able to accept Medicare.
History of Section.
P.L. 2008, ch. 100, art. 17, § 7; P.L. 2009, ch. 68, art. 22, § 4; P.L. 2009, ch. 68, art. 23, § 2; P.L. 2009, ch. 69, § 4; P.L. 2010, ch. 23, art. 20, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8 - Medical Assistance › Section 40-8-30. - Suspension of participating providers.

§ 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 at the discretion of the department. Prior to suspension, a participating provider shall have the right to appeal such suspension to a state administrative hearing officer, in accordance with the rules of the department of human services.
History of Section.
P.L. 2009, ch. 68, art. 22, § 5; P.L. 2009, ch. 69, § 5.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8 - Medical Assistance › Section 40-8-31. - Payments to out-of-state facilities.

§ 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 to out-of-state providers that do not participate in the Rhode Island Medicaid program but that are determined to be acceptable due to extenuating circumstances by the secretary of the executive office of health and human services. Furthermore, the department of children, youth and families is required to submit a bi-weekly report to the chair of the house committee on finance, the chair of the senate committee on finance, the house fiscal advisor, the senate fiscal advisor, and the office of management and budget detailing payments for placements to out-of-state facilities. The report should also indicate the entity recommending or ordering the placement, the types of services required, and reason for using an out-of-state facility. This change may require the adoption of new or amended rules, regulations and procedures.
History of Section.
P.L. 2014, ch. 145, art. 18, § 2.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.1 - Personal Care Attendant Program › Section 40-8.1-1. - Authority to establish program — Administration.

§ 40-8.1-1. Authority to establish program — Administration.
The department of human services is hereby authorized to establish a participant-directed personal care attendant program for those with severe physical disabilities, to provide personal attendant care to those disabled individuals who meet certain eligibility criteria hereinafter stated. The department of human services shall be responsible for the administration of the program but may contract with other state agencies or nonprofit organizations in connection with the program.
History of Section.
P.L. 1979, ch. 122, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.1 - Personal Care Attendant Program › Section 40-8.1-2. - Services provided.

§ 40-8.1-2. Services provided.
Services that may be provided eligible persons if not available from other sources include:
(1)
Any appropriate vocational rehabilitation service, as well as other services that will enhance the ability of individuals with disabilities to live independently and function within the family and community;
(2)
Personal care attendant services;
(3)
Advocacy services;
(4)
Peer counseling;
(5)
Housing; and
(6)
Transportation.
History of Section.
P.L. 1979, ch. 122, § 1; P.L. 1999, ch. 83, § 98; P.L. 1999, ch. 130, § 98.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.1 - Personal Care Attendant Program › Section 40-8.1-3. - Eligibility for services.

§ 40-8.1-3. Eligibility for services.
Services available under this chapter may be provided to any person who meets the following criteria:
(1)
Has made application therefor to the director of the department of human services in a manner prescribed by the director;
(2)
Has a severe physical disability that caused the person to be unduly dependent, the disability to be certified by the division of vocational rehabilitation; and
(3)
Has not sufficient income or resources to meet the cost of home-care services, a determination of insufficiency to be made by the division of vocational rehabilitation.
History of Section.
P.L. 1979, ch. 122, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.1 - Personal Care Attendant Program › Section 40-8.1-4. - When services may be provided.

§ 40-8.1-4. When services may be provided.
Personal care attendant services may be provided when:
(1)
The requirements of § 40-8.1-3 are met; and
(2)
An attendant is available to provide the care needed.
History of Section.
P.L. 1979, ch. 122, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.1 - Personal Care Attendant Program › Section 40-8.1-5. - Appropriations.

§ 40-8.1-5. Appropriations.
There is hereby appropriated to the department of human services funds adequate to implement an independent-living program, including a participant-directed personal care attendant program, in the amount of ninety-five thousand dollars ($95,000) for fiscal year ending June 30, 1980. Additional funds shall be made available on a yearly basis to maintain the program.
History of Section.
P.L. 1979, ch. 122, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.2 - Medical Assistance Fraud › Section 40-8.2-1. - Short title.

§ 40-8.2-1. Short title.
This chapter shall be known as the “Rhode Island Medical Assistance Fraud Law.”
History of Section.
P.L. 1982, ch. 424, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.2 - Medical Assistance Fraud › Section 40-8.2-4. - Statute of limitations.

§ 40-8.2-4. Statute of limitations.
The statute of limitations for any violation of the provisions of this chapter shall be ten (10) years.
History of Section.
P.L. 1989, ch. 501, § 3.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.2 - Medical Assistance Fraud › Section 40-8.2-5. - Civil remedy.

§ 40-8.2-5. Civil remedy.
Any person, including the secretary of the executive office of health and human services or the office of program integrity acting on behalf of the secretary of the office, injured by any violation of the provisions of § 40-8.2-3 or § 40-8.2-4 may recover through a civil action from the persons inflicting the injury three (3) times the amount of the injury.
History of Section.
P.L. 1982, ch. 424, § 1; P.L. 2015, ch. 141, art. 5, § 12.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.2 - Medical Assistance Fraud › Section 40-8.2-7. - False statements made to gain certification.

§ 40-8.2-7. False statements made to gain certification.
Whoever knowingly and willfully makes, or causes to be made, or induces, or seeks to induce, the making of any false statement or representation of a material fact with respect to the conditions or operation of any institution or facility in order that the institution or facility may qualify (either upon initial certification or upon recertification) as a hospital, skilled nursing facility, intermediate-care facility, or home health agency, shall be guilty of a misdemeanor and, upon conviction thereof, shall be fined not more than five hundred dollars ($500) or imprisoned for not more than six (6) months, or both.
History of Section.
P.L. 1982, ch. 424, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.2 - Medical Assistance Fraud › Section 40-8.2-8. - Acts of officers, directors, representatives, or agents acting within the scope of their authority.

§ 40-8.2-8. Acts of officers, directors, representatives, or agents acting within the scope of their authority.
(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 received as prima facie proof of the acts of the corporation, association, firm, partnership, or limited partnership itself.
(b)
When a corporation, association, firm, partnership, or limited partnership violates this chapter, the violation shall be deemed to be that of the individual directors, members, officers, managers, employees, or agents of the corporation, association, firm, partnership, or limited partnership who knowingly authorized, ordered, aided, abetted, or advised in the acts or omissions constituting, in whole or in part, the violation, whether the individuals acted on their own behalf and for their own benefit, or for the corporation, association, firm, partnership, or limited partnership and in their representative capacity. The individuals, in their capacity as individuals, are subject to the provisions of this chapter and may be joined, if subject to personal jurisdiction, as additional parties defendant in the proceedings against the corporation, association, partnership, or limited partnership.
History of Section.
P.L. 1982, ch. 424, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.2 - Medical Assistance Fraud › Section 40-8.2-9. - Damages for overcharges.

§ 40-8.2-9. Damages for overcharges.
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 established by the state of Rhode Island; or
(2)
Charges, solicits, accepts, or receives, in addition to any amount otherwise required to be paid under the Rhode Island Medicaid program, any gift, money, or donation as a precondition of the admission of a patient to a hospital, skilled nursing facility, or intermediate-care facility, or of the continued stay in a facility, shall be liable in a civil action to the patient or person acting on his or her behalf for an amount equal to three (3) times the amount of the charge.
History of Section.
P.L. 1982, ch. 424, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.2 - Medical Assistance Fraud › Section 40-8.2-10. - Other civil remedies and criminal penalties.

§ 40-8.2-10. Other civil remedies and criminal penalties.
The penalties and remedies under this statute are not exclusive and shall not preclude the use of any other civil remedy or the application of any other criminal penalty deemed appropriate by the attorney general in accordance with federal law or regulations governing Title XIX or Title XXI or the general or public laws of this state.
History of Section.
P.L. 1982, ch. 424, § 1; P.L. 2015, ch. 141, art. 5, § 12.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.2 - Medical Assistance Fraud › Section 40-8.2-11. - Barring or suspending participation in program.

§ 40-8.2-11. Barring or suspending participation in program.
Whenever a provider is sentenced or placed on probation for an offense under this chapter, the trial judge may, in his or her discretion, order that the provider be permanently barred from further participation in the program; that the provider’s participation in the program be suspended for a definite period of time not exceeding two (2) years; or that the provider conform to applicable federal regulations. For the purposes of this section, the office of program integrity may submit a recommendation to the trial judge as to whether the provider should be suspended or barred from the program. Nothing contained herein shall be construed to prevent the executive office of health and human services from imposing its own administrative sanctions.
History of Section.
P.L. 1982, ch. 424, § 1; P.L. 2015, ch. 141, art. 5, § 12.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.2 - Medical Assistance Fraud › Section 40-8.2-12. - Injunctive relief and civil penalties.

§ 40-8.2-12. Injunctive relief and civil penalties.
(a)
The superior court of this state shall have jurisdiction to prevent and restrain violations of this chapter. In addition to granting prohibitory injunctive and other restraints for a period of time and upon terms and conditions necessary to deter a provider from, and ensure against, the committing of future violations of this chapter, the court may grant injunctive relief reasonably necessary to dissipate the ill effects of the violation. The court may issue appropriate decrees upon consent and stipulation by the parties. The court may also issue restraining orders. Under no circumstances shall the state be required to post bond in any action hereunder.
(b) Attorney general
— Right to injunctive relief.
The attorney general may institute proceedings to prevent and restrain violations of this chapter as provided in subsection (a).
(c) Other persons
— Right to injunctive relief.
Any person, including the United States, may institute proceedings for injunctive relief, temporary or permanent, as provided in subsection (a) against threatened loss or damage to his or her property or business by a violation of this chapter. A preliminary injunction may be issued upon a showing that the danger of irreparable loss or damage is immediate and, within the court’s discretion, the execution of property bond against damages for an injunction improvidently granted. If the court issues a permanent injunction, the plaintiff shall be awarded reasonable attorney’s fees, filing fees, and reasonable costs of the suit. Reasonable costs for the suit may include, but shall not be limited to, the expenses of discovery and document reproduction.
(d) Civil penalty.
In addition to injunctive relief authorized pursuant to subsection (a), any person who violates this chapter may be liable for a civil penalty in a suit by the attorney general of this state of not more than one thousand dollars ($1,000) for each violation.
History of Section.
P.L. 1982, ch. 424, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.2 - Medical Assistance Fraud › Section 40-8.2-13. - Consent decrees.

§ 40-8.2-13. Consent decrees.
The attorney general may petition the court to enter a consent decree dismissing any criminal prosecution hereunder, but the court shall review the proceeding to determine whether entry thereof is in the public interest.
History of Section.
P.L. 1982, ch. 424, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.2 - Medical Assistance Fraud › Section 40-8.2-15. - Consistency with Confidentiality of Health Care Information Act.

§ 40-8.2-15. Consistency with Confidentiality of Health Care Information Act.
No investigative demand pursuant to this chapter shall solicit, extend to, or compel the production, inspection, copying, or release of any record or information otherwise protected as confidential healthcare information pursuant to chapter 37.3 of title 5.
History of Section.
P.L. 1982, ch. 424, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.2 - Medical Assistance Fraud › Section 40-8.2-16. - Rendering services to recipients after suspension or revocation of certification.

§ 40-8.2-16. Rendering services to recipients after suspension or revocation of certification.
No provider shall charge the Rhode Island Medicaid program for any services rendered to recipients subsequent to the revocation or suspension of the provider’s certification except as specified by a termination notice.
History of Section.
P.L. 1982, ch. 424, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.2 - Medical Assistance Fraud › Section 40-8.2-17. - Stays and review of revocation orders.

§ 40-8.2-17. Stays and review of revocation orders.
An order of the executive office of health and human services revoking a provider’s certification may, in the discretion of the program, go into immediate effect or may be stayed. Review of any order may be had in accordance with the Rhode Island administrative procedures act, §§ 42-35-1 — 42-35-18. If an administrative hearing is claimed, the program may, in its discretion, stay the effect of a revocation until a hearing is held and a decision is rendered, and for a period not to exceed ten (10) days after the administrative decision is rendered.
History of Section.
P.L. 1982, ch. 424, § 1; P.L. 2015, ch. 141, art. 5, § 12.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.2 - Medical Assistance Fraud › Section 40-8.2-18. - Filing and enforcement of administrative decision.

§ 40-8.2-18. Filing and enforcement of administrative decision.
An administrative decision, not appealed, or which has been affirmed after judicial review under the Rhode Island administrative procedures act, §§ 42-35-1 — 42-35-18, determining any amounts due to the executive office of health and human services or to a provider, may be filed with the clerk of the superior court for Providence County and shall be enforceable as a judgment of that court.
History of Section.
P.L. 1982, ch. 424, § 1; P.L. 2015, ch. 141, art. 5, § 12.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.2 - Medical Assistance Fraud › Section 40-8.2-19. - Certification as a provider — Revocation or suspension of certification.

§ 40-8.2-19. Certification as a provider — Revocation or suspension of certification.
Before any provider of medical services receives payment from the Rhode Island Medicaid program, and as a condition of receipt of payment, the provider must have in effect a valid certification of eligibility from the Rhode Island executive office of health and human services. This certification of eligibility will take the form of either a separate provider agreement or language as required by federal regulations imprinted on the medical assistance billing form, which must be signed by the provider. This certification may be revoked or suspended, in accordance with administrative rules to be promulgated by the executive office, if a provider fails to meet professional licensure requirements; violates any administrative regulations of the executive office of health and human services; does not provide proper professional services; is the subject of a suspension of payments order; is convicted of Medicaid fraud; or otherwise violates any provision of this chapter.
History of Section.
P.L. 1982, ch. 424, § 1; P.L. 2015, ch. 141, art. 5, § 12.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.2 - Medical Assistance Fraud › Section 40-8.2-20. - Eligibility for certification.

§ 40-8.2-20. Eligibility for certification.
A certification will apply to any provider who agrees to provide services in accordance with the laws and regulations governing the Rhode Island Medicaid program and who has in effect a proper professional license when a license is a prerequisite to rendering services. Nothing contained herein shall be construed to mean that certification may not be revoked for failure to provide proper professional services, although a provider’s professional license has not been revoked or suspended.
History of Section.
P.L. 1982, ch. 242, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.2 - Medical Assistance Fraud › Section 40-8.2-21. - Suspension of payments to a provider.

§ 40-8.2-21. Suspension of payments to a provider.
(a)
The executive office of health and human services may issue a suspension of payments order if:
(1)
The provider does not meet certification requirements of the Rhode Island Medicaid program; or
(2)
The Rhode Island Medicaid program has been unable to collect (or make satisfactory arrangements for the collection of) amounts due on account of overpayments to any provider; or
(3)
The office of program integrity and/or the Medicaid fraud control unit of the attorney general’s office has been unable to obtain, from a provider, the data and information necessary to enable it to determine the existence or amount (if any) of the overpayments made to a provider; or
(4)
The office of program integrity or the Medicaid fraud control unit of the attorney general’s office has been denied reasonable access to information by a provider that pertains to a patient or resident of a long-term residential-care facility or to a former patient or resident of a long-term residential-care facility; or
(5)
The office of program integrity and/or the Medicaid fraud control unit of the attorney general’s office has been denied reasonable access to data and information by the provider for the purpose of conducting activities as described in § 1903(g) of the Social Security Act, 42 U.S.C. § 1396b(g); or
(6)
The office of program integrity has been presented with reliable evidence that the provider has engaged in fraud or willful misrepresentation under the Medicaid program.
(b)
Any such order of the executive office of health and human services may cease to be effective at such time as the office of program integrity is satisfied that the provider is participating in substantial negotiations that seek to remedy the conditions that gave rise to its order of suspension of payments, or that amounts are no longer due from the provider or that a satisfactory arrangement has been made for the payment of the provider or that a satisfactory arrangement has been made for the payment by the provider of any such amounts.
History of Section.
P.L. 1982, ch. 424, § 1; P.L. 1989, ch. 137, § 1; P.L. 2015, ch. 141, art. 5, § 12.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.2 - Medical Assistance Fraud › Section 40-8.2-22. - Interest on overcharges.

§ 40-8.2-22. Interest on overcharges.
Any provider of services or goods contracting with the executive office of health and human services, pursuant to Title XIX or Title XXI of the Social Security Act, who, without intent to defraud, obtains payments under this chapter in excess of the amount to which the provider is entitled, thereby becomes liable for payment of the amount of the excess with payment of interest allowable by law, under § 6-26-2, as was in effect on the date payment was made to the provider. The interest period will commence on the date upon which payment was made and will extend to the date upon which repayment is made to the state of Rhode Island.
History of Section.
P.L. 1982, ch. 424, § 1; P.L. 2015, ch. 141, art. 5, § 12.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.2 - Medical Assistance Fraud › Section 40-8.2-23. - Use of Medicaid funds for anti-union purposes prohibited.

§ 40-8.2-23. Use of Medicaid funds for anti-union purposes prohibited.
Medicaid reimbursement for costs incurred directly related to influencing employees regarding their right to organize, to form a union, or to join a union, shall not be considered to be allowable, whether performed directly by the provider or through contracts with consultants or attorneys.
History of Section.
P.L. 1985, ch. 358, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.3 - Uncompensated Care › Section 40-8.3-1. - Declaration of purpose.

§ 40-8.3-1. Declaration of purpose.
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 Island and that implementation of § 1923 of the Social Security Act, 42 U.S.C. § 1396r-4, which permits the federal government to share in the provision of payments to hospitals that provide a significant amount of uncompensated care, is an effective way for the state to assist the hospitals in continuing to provide uncompensated care.
History of Section.
P.L. 1996, ch. 100, art. 42, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.3 - Uncompensated Care › Section 40-8.3-4. - Reports and audits.

§ 40-8.3-4. Reports and audits.
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 Social Security Act, 42 U.S.C. § 1396r-4, as amended, and any implementing regulations or directives duly promulgated by the Secretary of the United States Department of Health and Human Services.
History of Section.
P.L. 2004, ch. 595, art. 9, § 2.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.3 - Uncompensated Care › Section 40-8.3-5. - Hospital payments.

§ 40-8.3-5. Hospital payments.
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) Acute-care hospitals in Washington County the amount of five hundred thousand dollars ($500,000) to South County Hospital, and seven hundred and fifty thousand dollars ($750,000) to The Westerly Hospital; (2) Any acute-care hospital in Kent County the amount of eight hundred thousand dollars ($800,000); and (3) Miriam Hospital the amount of one million six hundred thousand dollars ($1,600,000). The department of human services is authorized and directed to pay four million seven hundred fifty thousand dollars ($4,750,000) during state fiscal year 2011 to the following hospitals: one million seven hundred seventy-eight thousand eight hundred forty-three dollars ($1,778,843) to Kent Hospital; six hundred and forty-two thousand three hundred forty dollars ($642,340) to Saint Joseph’s Hospital; one million one hundred thirty-one thousand, nine hundred twenty-nine dollars ($1,131,929) to Miriam Hospital; four hundred thirty-eight thousand and four hundred eighty-two dollars ($438,482) to South County Hospital; two hundred ninety seven thousand eight hundred and six dollars ($297,806) to Westerly Hospital; one hundred thirty-three thousand and six hundred seventy-two dollars ($133,672) to Newport Hospital; one hundred seventy thousand nine hundred and sixty-four dollars ($170,964) to Butler Hospital; and one hundred fifty-five thousand and nine hundred sixty-three dollars ($155,963) to Bradley Hospital of Rhode Island. The department of human services is authorized to pay five hundred thousand dollars ($500,000) to South County Hospital and five hundred thousand dollars ($500,000) to Westerly Hospital in state fiscal year 2012.
History of Section.
P.L. 2009, ch. 68, art. 19, § 2; P.L. 2010, ch. 23, art. 20, § 2; P.L. 2011, ch. 151, art. 18, § 3.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.3 - Uncompensated Care › Section 40-8.3-6. - Outpatient adjustment payments for fiscal year 2009.

§ 40-8.3-6. Outpatient adjustment payments for fiscal year 2009.
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 follows:
Hospitals — Outpatient adjustment payments.
(a)
Each hospital in the state of Rhode Island, as defined in § 23-17-38.1, shall receive an adjustment payment during state fiscal year 2009 of an amount determined as follows:
(1)
Determine the percent of the state’s total Medicaid outpatient and emergency department services (exclusive of physician services) provided by each hospital during the hospital’s fiscal year ending during 2007;
(2)
Determine the sum of all Medicaid payments to hospitals made for outpatient and emergency department services (exclusive of physician services) provided during each hospital’s fiscal year ending during 2007;
(3)
Multiply the sum of all Medicaid payments as determined in subsection (a)(2) by fifty-six and five hundredths percent (56.05%) and then multiply that result by each hospital’s percentage of the state’s total Medicaid outpatient and emergency department services as determined in subsection (a)(1) to obtain the total outpatient adjustment for each hospital to be paid in SFY 2009;
(4)
Pay each hospital on its total outpatient adjustment as determined in subsection (a)(3).
(b)
The amounts determined in subsection (a) are in addition to Medicaid outpatient payments and emergency services payments (exclusive of physician services) paid to hospitals in accordance with current state regulation and the Rhode Island Plan for Medicaid assistance pursuant to Title XIX of the Social Security Act and are not subject to recoupment or settlement.
(c)
The payments are expressly conditioned upon approval by the Secretary of the United States Department of Health and Human Services, or his or her authorized representative, of any Medicaid state plan amendment necessary to secure for the state the benefit of federal financial participation in federal fiscal year 2009 for such payments, such amendment to be filed not later than July 9, 2008.
History of Section.
P.L. 2009, ch. 68, art. 19, § 2.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.3 - Uncompensated Care › Section 40-8.3-7. - Outpatient adjustment payments for fiscal year 2010.

§ 40-8.3-7. Outpatient adjustment payments for fiscal year 2010.
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 follows:
Hospitals — Outpatient adjustment payments.
(a)
Each hospital in the state of Rhode Island, as defined in § 23-17-38.1, shall receive a quarterly adjustment payment during state fiscal year 2010 of an amount determined as follows:
(1)
Determine the percent of the state’s total Medicaid outpatient and emergency department services (exclusive of physician services) provided by each hospital during the hospital’s fiscal year ending during 2008;
(2)
Determine the sum of all Medicaid payments to hospitals made for outpatient and emergency department services (exclusive of physician services) provided during each hospital’s fiscal year ending during 2008;
(3)
Multiply the sum of all Medicaid payments as determined in subsection (a)(2) by seventy-seven and forty-one hundredths percent (77.41%) and then multiply that result by each hospital’s percentage of the state’s total Medicaid outpatient and emergency department services as determined in subsection (a)(1) to obtain the total outpatient adjustment for each hospital to be paid in SFY 2010;
(4)
Pay each hospital on or about July 20, 2009, October 20, 2009, January 20, 2010, and April 20, 2010, one-quarter (.25) of its total outpatient adjustment as determined in subsection (a)(3).
(b)
The amounts determined in subsection (a) are in addition to Medicaid outpatient payments and emergency services payments (exclusive of physician services) paid to hospitals in accordance with current state regulation and the Rhode Island Plan for Medicaid Assistance pursuant to Title XIX of the Social Security Act and are not subject to recoupment or settlement.
History of Section.
P.L. 2009, ch. 68, art. 19, § 2.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.3 - Uncompensated Care › Section 40-8.3-8. - Outpatient adjustment payments for fiscal year 2011.

§ 40-8.3-8. Outpatient adjustment payments for fiscal year 2011.
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 defined in § 23-17-38.1, shall receive a quarterly adjustment payment during state fiscal year 2011 of an amount determined as follows:
(1)
Determine the percent of the state’s total Medicaid outpatient and emergency department services (exclusive of physician services) provided by each hospital during each hospital’s fiscal year ending during 2009;
(2)
Determine the sum of all Medicaid payments to hospitals made for outpatient and emergency department services (exclusive of physician services) provided during each hospital’s fiscal year ending during 2009;
(3)
Multiply the sum of all Medicaid payments as determined in subsection (a)(2) by 82.95 percent and then multiply that result by each hospital’s percentage of the state’s total Medicaid outpatient and emergency department services as determined in subsection (a)(1) to obtain the total outpatient adjustment for each hospital to be paid in SFY 2011;
(4)
Pay each hospital on or before July 20, 2010, October 20, 2010, January 20, 2011, and April 20, 2011, one-quarter of its total outpatient adjustment as determined in subsection (a)(3).
(b)
The amounts determined in subsection (a) are in addition to Medicaid outpatient payments and emergency services payments (exclusive of physician services) paid to hospitals in accordance with current state regulation and the Rhode Island Plan for Medicaid Assistance pursuant to Title XIX of the Social Security Act and are not subject to recoupment or settlement.
History of Section.
P.L. 2010, ch. 23, art. 15, § 2.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.3 - Uncompensated Care › Section 40-8.3-9. - Outpatient adjustment payments for fiscal year 2012.

§ 40-8.3-9. Outpatient adjustment payments for fiscal year 2012.
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 Rhode Island, as defined in § 23-17-38.1, shall receive a quarterly adjustment payment during state fiscal year 2012 of an amount determined as follows:
(1)
Determine the percent of the state’s total Medicaid outpatient and emergency department services (exclusive of physician services) provided by each hospital during each hospital’s fiscal year ending during 2010;
(2)
Determine the sum of all Medicaid payments to hospitals made for outpatient and emergency department services (exclusive of physician services) provided during each hospital’s fiscal year ending during 2010;
(3)
Multiply the sum of all Medicaid payments as determined in subsection (a)(2) by 72.57 percent and then multiply that result by each hospital’s percentage of the state’s total Medicaid outpatient and emergency department services as determined in subsection (a)(1) to obtain the total outpatient adjustment for each hospital to be paid in SFY 2012;
(4)
Pay each hospital on or before July 20, 2011, October 20, 2011, January 20, 2012, and April 20, 2012, one-quarter of its total outpatient adjustment as determined in subsection (a)(3).
(b)
The amounts determined in subsection (a) are in addition to Medicaid outpatient payments and emergency services payments (exclusive of physician services) paid to hospitals in accordance with current state regulation and the Rhode Island Plan for Medicaid Assistance pursuant to Title XIX of the Social Security Act and are not subject to recoupment or settlement.
History of Section.
P.L. 2011, ch. 151, art. 18, § 2.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.4 - Health Care for Families › Section 40-8.4-1. - Title.

§ 40-8.4-1. Title.
This chapter is hereby entitled “The Health Care for Families Act.”
History of Section.
P.L. 1998, ch. 31, art. 33, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.4 - Health Care for Families › Section 40-8.4-2. - Purpose.

§ 40-8.4-2. Purpose.
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 years, health insurance through the RIte Care program has been extended to pregnant women and children living in families whose income is less than two hundred fifty percent (250%) of the federal poverty level. Many of the parents of these children are uninsured and without the means to purchase health insurance. Federal funds are available to help pay for health insurance for low-income families through the medical assistance program under § 1931 of Title XIX of the Social Security Act, 42 U.S.C. § 1396u-1, which de-links medical assistance from cash assistance and allows for expanded income and resource methodologies. It is the intent of the general assembly, therefore, to implement § 1931 of Title XIX of the Social Security Act and, in addition, to provide expanded access to health insurance for eligible families. Federal funds for some children and pregnant women may also be available under Title XXI of the Social Security Act, 42 U.S.C. § 1397aa et seq., and it is further the intent of the general assembly to access these funds as appropriate and as authorized in accordance with the legal authority provided by the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA), and Title XXI of the Social Security Act, 42 U.S.C. § 1397aa et seq.
History of Section.
P.L. 1998, ch. 31, art. 33, § 1; P.L. 2009, ch. 68, art. 23, § 4; P.L. 2020, ch. 79, art. 1, § 31.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.4 - Health Care for Families › Section 40-8.4-3. - Definitions.

§ 40-8.4-3. Definitions.
(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 the age of eighteen (18) or who is eighteen (18) and a full-time student in a secondary school or in the equivalent level of vocational or technical training.
History of Section.
P.L. 1998, ch. 31, art. 33, § 1; P.L. 2006, ch. 216, § 20.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.4 - Health Care for Families › Section 40-8.4-4. - Eligibility.

§ 40-8.4-4. Eligibility.
(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 the aid to families with dependent children program on July 16, 1996, or such increased standards as the department may determine. The executive office of health and human services is directed to amend the medical assistance Title XIX state plan and to submit to the United States Department of Health and Human Services an amendment to the RIte Care waiver project to provide for medical assistance coverage to families under this chapter in the same amount, scope, and duration as coverage provided to comparable groups under the waiver. The department is further authorized and directed to submit amendments and/or requests for waivers to the Title XXI state plan as may be necessary to maximize federal contribution for provision of medical assistance coverage provided pursuant to this chapter, including providing medical coverage as a “qualified state” in accordance with Title XXI of the Social Security Act, 42 U.S.C. § 1397aa et seq. Implementation of expanded coverage under this chapter shall not be delayed pending federal review of any Title XXI amendment or waiver.
(b) Income.
The secretary of the executive office of health and human services is authorized and directed to amend the medical assistance Title XIX state plan or RIte Care waiver to provide medical assistance coverage through expanded income disregards or other methodology for parents or relative caretakers whose income levels are below one hundred thirty-three percent (133%) of the federal poverty level.
History of Section.
P.L. 1998, ch. 31, art. 33, § 1; P.L. 2000, ch. 200, § 3; P.L. 2000, ch. 229, § 3; P.L. 2002, ch. 65, art. 32, § 1; P.L. 2005, ch. 117, art. 12, § 2; P.L. 2006, ch. 246, art. 25, § 1; P.L. 2008, ch. 100, art. 10, § 1; P.L. 2009, ch. 68, art. 23, §§ 4, 13; P.L. 2013, ch. 144, art. 19, § 4.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.4 - Health Care for Families › Section 40-8.4-5. - Managed care.

§ 40-8.4-5. Managed care.
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 care and deter unnecessary and inappropriate care; and places emphasis on preventive and primary health care.
History of Section.
P.L. 1998, ch. 31, art. 33, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.4 - Health Care for Families › Section 40-8.4-6. - Administration.

§ 40-8.4-6. Administration.
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 health and/or other state agencies to achieve the purposes of this section. Children and families applying for cash assistance through the family independence program, § 40-5.1-1 et seq. [repealed], shall not be required to complete a separate application for medical assistance under this chapter.
By December 1, 2006, the department shall provide to the chair of the senate health and human services committee, the chair of the house health, education and welfare committee, and to the chairs of the house and senate finance committees a report describing a process for renewing eligibility for the RIte care program by using an “ex-parte” process whereby the department uses information provided to the department from the recipients’ cash assistance, food stamp, and/or childcare assistance records and from other reliable sources that are readily available to the department. The report shall include at a minimum: how the ex-parte renewal process will work; the date by which the process could be implemented; the number and types of cases to which the ex-parte renewal process is anticipated to be applied; the costs and anticipated savings of implementing the process; and how the department will assure the accuracy of the eligibility determination when the ex-parte process is used. The department shall consult with, and as appropriate include, members of the RIte care consumer advisory council in preparing this report.
History of Section.
P.L. 1998, ch. 31, art. 33, § 1; P.L. 2006, ch. 603, § 1; P.L. 2006, ch. 615, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.4 - Health Care for Families › Section 40-8.4-7. - Buy-In.

§ 40-8.4-7. Buy-In.
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-insurance among Rhode Islanders, and shall provide a report on these efforts to the permanent joint committee on health care oversight established pursuant to § 40-8.4-14 on or before February 15 of each year.
History of Section.
P.L. 1998, ch. 31, art. 33, § 1; P.L. 1999, ch. 413, § 2; P.L. 2000, ch. 200, § 3; P.L. 2000, ch. 229, § 3.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.4 - Health Care for Families › Section 40-8.4-8. - Appropriations — Authorization to pay for health care.

§ 40-8.4-8. Appropriations — Authorization to pay for health care.
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 department of human services, 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; provided, however, that the department of human services may enter into cooperative agreements for the transfer of funds to effectuate the purposes set forth in this chapter.
History of Section.
P.L. 1998, ch. 31, art. 33, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.4 - Health Care for Families › Section 40-8.4-9. - Assignment of medical support rights.

§ 40-8.4-9. Assignment of medical support rights.
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 such person.
History of Section.
P.L. 1998, ch. 31, art. 33, § 1.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.4 - Health Care for Families › Section 40-8.4-10. - Regulations.

§ 40-8.4-10. Regulations.
(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 notice referred to in § 42-35-3 and a true copy of the rule referred to in § 42-35-4 of the Rhode Island administrative procedures act to each of the co-chairpersons of the permanent joint committee on health care oversight established by § 40-8.4-14.
History of Section.
P.L. 1998, ch. 31, art. 33, § 1; P.L. 2000, ch. 200, § 3; P.L. 2000, ch. 229, § 3.
2023 Rhode Island General Laws › Title 40 - Human Services › Chapter 40-8.4 - Health Care for Families › Section 40-8.4-11. - Severability.

§ 40-8.4-11. Severability.
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 to this end the provisions of this chapter are severable.
History of Section.
P.L. 1998, ch. 31, art. 33, § 1.