40 R.I. Gen. Laws § 40-8-13.4. Rate methodology for payment for in state and out of state hospital services: Medical Assistance – Rhode Island

Status: Enacted
Year Enacted: 2009
Year Amended: 2017
File: Download

In order to improve efficiency and cost effectiveness, the executive office shall: With respect to inpatient services for persons in fee-for-service Medicaid, which is non-managed care, implement a new payment methodology for inpatient services utilizing the Diagnosis Related Groups (DRG) method of payment, which is, a patient-classification method that provides a means of relating payment to the hospitals to the type of patients cared for by the hospitals. It is understood that a payment method based on DRG may include cost outlier payments and other specific exceptions. The executive office will review the DRG-payment method and the DRG base price annually, making adjustments as appropriate in consideration of such elements as trends in hospital input costs; patterns in hospital coding; beneficiary access to care; and the Centers for Medicare and Medicaid Services national CMS Prospective Payment System (IPPS) Hospital Input Price index.

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