40 Pa. Stat. and Pa. Cons. Stat. §§ 4501 through 4503, 4531 through 4535, 4551 through 4562: Pharmacy Audit Integrity and Transparency Act – Pennsylvania
Status: Enacted Year Enacted: 2016
Governs PBM cost transparency requirements.
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40 Pa. Stat. and Pa. Cons. Stat. Ann. §§ 1001-B through 1006-B: Fairness in Multiple Copayments – Pennsylvania
Status: Enacted Year Enacted: 2015
The general purpose of this article is to provide fairness for persons seeking medically necessary physical therapy, chiropractic and occupational therapy who are sharing the cost of the care pursuant to a health insurance policy …
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40 Pa. Stat. and Pa. Cons. Stat. Ann. §§ 991.2101 through 991.2194: Quality Health Care Accountability and Protection – Pennsylvania
Status: Enacted Year Enacted: 1998
Provisions governing managed care plans to ensure quality health care including prohibitions on financial incentives and gag clauses, standards regarding utilization review, prompt paymen of claims, and general responsibilities of managed care plans. Requires the …
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40 Pa.Stat. and Pa. Cons. Stat. Ann. §§ 981-1 through 981-11: Health Care Insurance Individual Accessibility – Pennsylvania
Status: Enacted Year Enacted: 1998
It is necessary to maintain the Commonwealth’s sovereignty over the regulation of health insurance in this Commonwealth by complying with the requirements of the Health Insurance Portability and Accountability Act of 1996. This article is …
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40 R.I. Gen. Laws § 40-8-13.3. Payment for services provided by in state and out of state hospitals: Medical Assistance – Rhode Island
Status: Enacted Year Enacted: 2009
The department of human services and/or the secretary of exectuive office of health and human services is authorized to amend its rules and regulations in order to provide for payment to hospitals for services provided …
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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
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 …
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40 R.I. Gen. Laws § 40-8-13.5. Hospital Incentive Program: Medical Assistance – Rhode Island
Status: Enacted Year Enacted: 2015
The secretary of the executive office of health and human services is authorized to seek the federal authorities required to implement a hospital incentive program (HIP). The HIP shall provide the participating licensed hospitals the …
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40 R.I. Gen. Laws § 40-8-17. Waiver request: Medical Assistance – Rhode Island
Status: Enacted Year Enacted: 1987
The executive office of health and human services, is directed and authorized to apply for and obtain any necessary waiver(s), waiver amendment(s) and/or state plan amendments from the secretary of the United States department of …
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40 R.I. Gen. Laws § 40-8-2. Definitions: Medical Assistance – Rhode Island
Status: Enacted Year Enacted: 1966
Definitions related to Medical Assistance
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40 R.I. Gen. Laws § 40-8-20.1. Prospective rate increments: Medical Assistance – Rhode Island
Status: Enacted Year Enacted: 2006
The department may consider the granting of a prospective rate that reflects demonstrated cost increases in excess of the rate that has been established by the application of the percentage increase
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40 R.I. Gen. Laws § 40-8-29. Selective contracting: Medical Assistance – Rhode Island
Status: Enacted Year Enacted: 2008
States that the department of health and human services may use selective contracting for purchasing services and equipment for Medicaid beneficiairies on the basis of cost and quality.
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40 R.I. Gen. Laws § 40-8-31. Payments to out-of-state facilities: Medical Assistance – Rhode Island
Status: Enacted Year Enacted: 2014
The office of health and human services shall require that any payment to an out-of-state provider from whom a Medicaid eligible individual receives services must be a facility that applies for and is approved to …
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40 R.I. Gen. Laws § 40-8-4. Direct vendor payment plan: Medical Assistance – Rhode Island
Status: Enacted Year Enacted: 1966
The department shall furnish medical care benefits to eligible beneficiaries through a direct vendor payment plan.
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40 R.I. Gen. Laws § 40-8-4.1. Lowest price: Medical Assistance – Rhode Island
Status: Enacted Year Enacted: 2009
States that no medical assistance provider shall bill or charge the department of human services more than the provider’s usual and customary charge.
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40 R.I. Gen. Laws § 40-8-6. Review of application for benefits: Medical Assistance – Rhode Island
Status: Enacted Year Enacted: 1966
The director or someone designated by him or her shall review each application for benefits filed in accordance with regulations, and shall make a determination of whether the application will be honored and the extent …
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40 R.I. Gen. Laws § 40-8.3-10. Hospital adjustment payments: Uncompensated Care – Rhode Island
Status: Enacted Year Enacted: 2012
Effective July 1, 2012 and for each subsequent year, the executive office of health and human services is hereby authorized and directed to amend its regulations for reimbursement to hospitals for inpatient and outpatient services
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