2013 Rhode Island General Laws
Title 40 - Human services
Chapter 40-8.5 - Health Care for Elderly and Disabled Residents Act
Section 40-8.5-1.1 - Managed health care delivery systems.

§ 40-8.5-1.1 Managed health care delivery systems. – (a) To ensure that all medical assistance beneficiaries, including the elderly and all individuals with disabilities, have access to quality and affordable health care, the department of human services is authorized to implement mandatory managed care health systems.

(b) "Managed care" is defined as systems that: integrate an efficient financing mechanism with quality service delivery; provides a "medical home" to assure appropriate care and deter unnecessary services; and place emphasis on preventive and primary care. For purposes of Medical Assistance, managed care systems are also defined to include a primary care case management model in which ancillary services are provided under the direction of a physician in a practice that meets standards established by the department of human services. Managed care systems may also include services and supports that optimize the health and independence of recipients who are determined to need Medicaid funded long-term care under chapter 40-8.10 or to be at risk for such care under applicable rules and regulations promulgated by the department. Any medical assistance recipients who have third-party medical coverage or insurance may be provided such services through an entity certified by or in a contractual arrangement with the department or, as deemed appropriate, exempt from mandatory managed care in accordance with rules and regulations promulgated by the department of human services.

(c) In accordance with § 42-12.4-7, the department is authorized to obtain any approval through waiver(s), category II or III changes, and/or state plan amendments, from the secretary of the United States department of health and human services, that are necessary to implement mandatory managed health care delivery systems for all medical assistance recipients, including the primary case management model in which ancillary services are provided under the direction of a physician in a practice that meets standards established by the department of human services. The waiver(s), category II or III changes, and/or state plan amendments shall include the authorization to extend managed care to cover long-term care services and supports. Such authorization shall also include, as deemed appropriate, exempting certain beneficiaries with third-party medical coverage or insurance from mandatory managed care in accordance with rules and regulations promulgated by the department of human services.

(d) To ensure the delivery of timely and appropriate services to persons who become eligible for Medicaid by virtue of their eligibility for a U.S. social security administration program, the department of human services is authorized to seek any and all data sharing agreements or other agreements with the social security administration as may be necessary to receive timely and accurate diagnostic data and clinical assessments. Such information shall be used exclusively for the purpose of service planning, and shall be held and exchanged in accordance with all applicable state and federal medical record confidentiality laws and regulations.

History of Section.
(P.L. 2008, ch. 100, art. 17, § 6; P.L. 2009, ch. 68, art. 22, § 3; P.L. 2009, ch. 69, § 3; P.L. 2010, ch. 23, art. 20, § 3.)