§ 40-8-26 - Community health centers.
SECTION 40-8-26
§ 40-8-26 Community health centers. –(a) For the purposes of this section the term community health centers refersto federally qualified health centers and rural health centers.
(b) To support the ability of community health centers toprovide high quality medical care to patients, the department of human servicesshall adopt and implement a methodology for determining a Medicaid per visitreimbursement for community health centers which is compliant with theprospective payment system provided for in the Medicare, Medicaid and SCHIPBenefits Improvement and Protection Act of 2001. The following principles areto assure that the prospective payment rate determination methodology is partof the department of human services' overall value purchasing approach.
(c) The rate determination methodology will (i) fairlyrecognize the reasonable costs of providing services. Recognized reasonablecosts will be those appropriate for the organization, management and directprovision of services and (ii) provide assurances to the department of humanservices that services are provided in an effective and efficient manner,consistent with industry standards. Except for demonstrated cause and at thediscretion of the department of human services, the maximum reimbursement ratefor a service (e.g. medical, dental) provided by an individual community healthcenter shall not exceed one hundred twenty-five percent (125%) of the medianrate for all community health centers within Rhode Island.
(d) Community health centers will cooperate fully and timelywith reporting requirements established by the department.
(e) Reimbursement rates established through this methodologyshall be incorporated into the PPS reconciliation for services provided toMedicaid eligible persons who are enrolled in a health plan on the date ofservice. Monthly payments by DHS related to PPS for persons enrolled in ahealth plan shall be made directly to the community health centers.