Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 00 - General Provisions › Part 5 - Interception of Insurance Payments (210-RICR-10-00-5) › Section 210-RICR-10-00-5.3 - Process for Recovery

Current through June 14, 2024
A. Every domestic
				  insurer or insurance company authorized to issue policies of liability
				  insurance and any worker's compensation insurer or self-insured employer, shall
				  review information provided by the EOHHS, pursuant to R.I. Gen. Laws Chapter
				  27-57.1, indicating whether or not the claimant has received Medicaid funded
				  services as a result of an accident or loss which is the basis of the claim.
				  Said review shall occur within thirty (30) days prior to making any payment
				  equal to or in excess of five hundred dollars ($500.00) to any claimant who is
				  a resident of this state, for personal injury or Workers' Compensation benefits
				  under a contract of insurance. For Workers' Compensation insurers, or
				  self-insured employers, said review shall occur within thirty (30) days prior
				  to making any lump sum settlement (R.I. Gen. Laws §
										28-33-25),
				  denial and dismissal settlement (R.I. Gen. Laws §
										28-33-25.1)
				  or specific compensation (R.I. Gen. Laws §
										28-33-19)
				  payment equal to or in excess of five-hundred dollars ($500) to any claimant
				  who is a resident of this state.
B.
				  The EOHHS shall electronically furnish these insurers and insurance companies
				  with a database data match option report of names of individuals with last
				  known addresses, as of the date of the report, who have received Medicaid in
				  excess of five hundred dollars ($500).
C. To facilitate the efficient and prompt
				  reporting of those Medicaid beneficiaries in one centralized location, the duty
				  and responsibility of the insurance companies doing business is as follows:
1. Utilize one centralized database, to which
				  the EOHHS shall report and administer.
2. Any insurer receiving information
				  identifying a Medicaid beneficiary shall maintain the confidentiality of that
				  information to the full extent required under federal and state law. Minimal
				  data elements, including, but not limited to, the date of injury and other
				  necessary identifying information, shall be shared with an agency contracted by
				  the EOHHS which maintains a centralized database of insurance claims.
3. The contracted centralized database is
				  required to keep confidential: any personal and personnel information; records
				  sufficient to identify a person applying for or receiving Medicaid; preliminary
				  drafts, notes, impressions, memoranda, working papers, and work products; as
				  well as any other records, reports, opinions, information, and statements
				  deemed confidential pursuant to state or federal law or regulation, or rule of
				  court. Any such confidential data shall not be disclosed to the insurer except
				  that in the case of Workers' Compensation where the agency shall share that
				  information necessary for the Workers' Compensation insurer or self-insured
				  employer to comply with its obligations pursuant to R.I. Gen. Laws §§
											28-33-5 to
				   28-33-8.
4. Matched results indicating that
				  a beneficiary is a claimant of an insurer are returned to the EOHHS through its
				  contracted agency. Proper quality assurance shall be performed by the
				  contracted agency to insure the claim is open. The contracted agency may also
				  collect additional information from the insurer, including but not limited to
				  contact information.