§ 40-8-13.4 Rate methodology for paymentfor in state and out of state hospital services. – (a) The department of human services shall implement a new methodology forpayment for in state and out of state hospital services in order to ensureaccess to and the provision of high quality and cost-effective hospital care toits eligible recipients.
(b) In order to improve efficiency and cost effectiveness,the department of human services shall:
(1) With respect to inpatient services: Implement a newpayment methodology for inpatient services utilizing the Diagnosis RelatedGroups (DRG) method of payment, which is, a patient classification method whichprovides a means of relating payment to the hospitals to the type of patientscared for by the hospitals. It is understood that a payment method based onDiagnosis Related Groups may include cost outlier payments and other specificexceptions.
(2) With respect to outpatient services. Notwithstanding anyprovisions of the law to the contrary, the department will reimburse hospitalsfor outpatient services using a rate methodology determined by the departmentand in accordance with federal regulations.
(c) It is intended that payment utilizing the DiagnosisRelated Groups method shall reward hospitals for providing the most efficientcare, and provide the department the opportunity to conduct value basedpurchasing of inpatient care.
(d) The director of the department of human services and/orthe secretary of executive office of health and human services is herebyauthorized to promulgate such rules and regulations consistent with thischapter, and to establish fiscal procedures he or she deems necessary for theproper implementation and administration of this chapter in order to providepayment to hospitals using the Diagnosis Related Group payment methodology.Furthermore, amendment of the Rhode Island state plan for medical assistance(Medicaid) pursuant to Title XIX of the federal Social Security Act is herebyauthorized to provide for payment to hospitals for services provided toeligible recipients in accordance with this chapter.
(e) The department shall comply with all public noticerequirements necessary to implement these rate changes.
(f) As a condition of participation in the DRG methodologyfor payment of hospital services, every hospital shall submit year-endsettlement reports to the department within one year from the close of ahospital's fiscal year. Should a participating hospital fail to timely submit ayear-end settlement report as required by this section, the department shallwithhold financial cycle payments due by any state agency with respect to thishospital by not more than ten percent (10%) until said report is submitted.
(g) The provisions of this section shall be effective uponimplementation of the amendments and new payment methodology pursuant to thissection and section 40-8-13.3, which shall in any event be no later than March30, 2010, at which time the provisions of §§ 40-8-13.2, 27-19-14,27-19-15 and 27-19-16 shall be repealed in their entirety.
§ 40-8-13.4 Rate methodology for paymentfor in state and out of state hospital services. – (a) The department of human services shall implement a new methodology forpayment for in state and out of state hospital services in order to ensureaccess to and the provision of high quality and cost-effective hospital care toits eligible recipients.
(b) In order to improve efficiency and cost effectiveness,the department of human services shall:
(1) With respect to inpatient services: Implement a newpayment methodology for inpatient services utilizing the Diagnosis RelatedGroups (DRG) method of payment, which is, a patient classification method whichprovides a means of relating payment to the hospitals to the type of patientscared for by the hospitals. It is understood that a payment method based onDiagnosis Related Groups may include cost outlier payments and other specificexceptions.
(2) With respect to outpatient services. Notwithstanding anyprovisions of the law to the contrary, the department will reimburse hospitalsfor outpatient services using a rate methodology determined by the departmentand in accordance with federal regulations.
(c) It is intended that payment utilizing the DiagnosisRelated Groups method shall reward hospitals for providing the most efficientcare, and provide the department the opportunity to conduct value basedpurchasing of inpatient care.
(d) The director of the department of human services and/orthe secretary of executive office of health and human services is herebyauthorized to promulgate such rules and regulations consistent with thischapter, and to establish fiscal procedures he or she deems necessary for theproper implementation and administration of this chapter in order to providepayment to hospitals using the Diagnosis Related Group payment methodology.Furthermore, amendment of the Rhode Island state plan for medical assistance(Medicaid) pursuant to Title XIX of the federal Social Security Act is herebyauthorized to provide for payment to hospitals for services provided toeligible recipients in accordance with this chapter.
(e) The department shall comply with all public noticerequirements necessary to implement these rate changes.
(f) As a condition of participation in the DRG methodologyfor payment of hospital services, every hospital shall submit year-endsettlement reports to the department within one year from the close of ahospital's fiscal year. Should a participating hospital fail to timely submit ayear-end settlement report as required by this section, the department shallwithhold financial cycle payments due by any state agency with respect to thishospital by not more than ten percent (10%) until said report is submitted.
(g) The provisions of this section shall be effective uponimplementation of the amendments and new payment methodology pursuant to thissection and section 40-8-13.3, which shall in any event be no later than March30, 2010, at which time the provisions of §§ 40-8-13.2, 27-19-14,27-19-15 and 27-19-16 shall be repealed in their entirety.
§ 40-8-13.4 Rate methodology for paymentfor in state and out of state hospital services. – (a) The department of human services shall implement a new methodology forpayment for in state and out of state hospital services in order to ensureaccess to and the provision of high quality and cost-effective hospital care toits eligible recipients.
(b) In order to improve efficiency and cost effectiveness,the department of human services shall:
(1) With respect to inpatient services: Implement a newpayment methodology for inpatient services utilizing the Diagnosis RelatedGroups (DRG) method of payment, which is, a patient classification method whichprovides a means of relating payment to the hospitals to the type of patientscared for by the hospitals. It is understood that a payment method based onDiagnosis Related Groups may include cost outlier payments and other specificexceptions.
(2) With respect to outpatient services. Notwithstanding anyprovisions of the law to the contrary, the department will reimburse hospitalsfor outpatient services using a rate methodology determined by the departmentand in accordance with federal regulations.
(c) It is intended that payment utilizing the DiagnosisRelated Groups method shall reward hospitals for providing the most efficientcare, and provide the department the opportunity to conduct value basedpurchasing of inpatient care.
(d) The director of the department of human services and/orthe secretary of executive office of health and human services is herebyauthorized to promulgate such rules and regulations consistent with thischapter, and to establish fiscal procedures he or she deems necessary for theproper implementation and administration of this chapter in order to providepayment to hospitals using the Diagnosis Related Group payment methodology.Furthermore, amendment of the Rhode Island state plan for medical assistance(Medicaid) pursuant to Title XIX of the federal Social Security Act is herebyauthorized to provide for payment to hospitals for services provided toeligible recipients in accordance with this chapter.
(e) The department shall comply with all public noticerequirements necessary to implement these rate changes.
(f) As a condition of participation in the DRG methodologyfor payment of hospital services, every hospital shall submit year-endsettlement reports to the department within one year from the close of ahospital's fiscal year. Should a participating hospital fail to timely submit ayear-end settlement report as required by this section, the department shallwithhold financial cycle payments due by any state agency with respect to thishospital by not more than ten percent (10%) until said report is submitted.
(g) The provisions of this section shall be effective uponimplementation of the amendments and new payment methodology pursuant to thissection and section 40-8-13.3, which shall in any event be no later than March30, 2010, at which time the provisions of §§ 40-8-13.2, 27-19-14,27-19-15 and 27-19-16 shall be repealed in their entirety.
