Human services

Medical Assistance

SECTION 40-8-26

§ 40-8-26 Community health centers.

(a) For the purposes of this section the term community health centers refers to federally qualified health centers and rural health centers.

(b) To support the ability of community health centers to provide high quality medical care to patients, the department of human services shall adopt and implement a methodology for determining a Medicaid per visit reimbursement for community health centers which is compliant with the prospective payment system provided for in the Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2001. The following principles are to assure that the prospective payment rate determination methodology is part of the department of human services' overall value purchasing approach.

(c) The rate determination methodology will (i) fairly recognize the reasonable costs of providing services. Recognized reasonable costs will be those appropriate for the organization, management and direct provision of services and (ii) provide assurances to the department of human services that services are provided in an effective and efficient manner, consistent with industry standards. Except for demonstrated cause and at the discretion of the department of human services, the maximum reimbursement rate for a service (e.g. medical, dental) provided by an individual community health center shall not exceed one hundred twenty-five percent (125%) of the median rate for all community health centers within Rhode Island.

(d) Community health centers will cooperate fully and timely with reporting requirements established by the department.

(e) Reimbursement rates established through this methodology shall be incorporated into the PPS reconciliation for services provided to Medicaid eligible persons who are enrolled in a health plan on the date of service. Monthly payments by DHS related to PPS for persons enrolled in a health plan shall be made directly to the community health centers.

History of Section.
(P.L. 2006, ch. 246, art. 35, § 2.)