36-2945

36-2945. Provision of services without
contract; requirements

A. If there is an insufficient number of qualified bids in a county pursuant to
section 36-2944, or for those members not enrolled with program contractors, the director
on the approval of the legal advisor of the administration may:

1. Execute discount advance payment contracts for institutional and hospital
services.

2. Execute capped fee-for-service contracts for other services. Any capped
fee-for-service contract shall provide for reimbursement at a level which does not exceed
a capped fee-for-service schedule adopted by the director.

B. During any period in which services are needed and no contract exists, or for
those members not enrolled with program contractors, the director on the approval of the
legal advisor of the administration may do either of the following:

1. Pay noncontracting providers for services, other than hospital services, on a
capped fee-for-service basis for members. However, the director shall not pay any amount
for services which exceeds a maximum amount set forth in a capped fee-for-service
schedule adopted by the director.

2. Pay a hospital subject to the reimbursement level limitation prescribed in
section 36-2903.01.

C. If services are provided in the absence of a contract, the director shall
continue to attempt to procure by the bid process as provided in section 36-2944
contracts for such services as specified in this subsection.

D. The director may adopt rules or require contractual provisions that prescribe
requirements and time limits for submittal of and payment for claims submitted for
services to the administration.

E. Notwithstanding section 35-190, the director may pay claims arising during the
fiscal year for a period of six months after the close of the fiscal year.