210 R.I. Code R. 210-RICR-20-00-1.4 - [Effective 9/13/2025] Medicaid Payment Policy
A. Medicaid is the
payor of last resort. Community, public, and private resources such as Federal
Medicare, Veteran's Administration benefits, accident settlements, or other
health insurance plans must be utilized fully before payment from the Medicaid
program can be authorized, including for prenatal services, labor, delivery,
and postpartum care services. However, the State makes payments without regard
to third (3rd) party liability for pediatric preventive services, unless the
State has made a determination related to cost-effectiveness and access to care
that warrants cost avoidance for ninety (90) days. The State may also make
payments without regard to potential third (3rd) party liability for up to one
hundred (100) days for claims related to child support enforcement
beneficiaries.
B. Payments to
physicians and other providers of medical services and supplies are made in
accordance with contractual arrangements with health plans or on a
fee-for-service basis in accordance with applicable Federal and State Rules and
Regulations, the Medicaid State Plan, and the State's Section 1115
demonstration waiver.
C. Payments
to Medicaid providers represent full and total payment. No supplementary
payments are allowed, except as specifically provided in the contract. Direct
reimbursement to recipients is prohibited except in specific circumstances to
correct a denial that is reversed on appeal.
Notes
Amended effective
Amended effective
Amended effective
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